nep-hea New Economics Papers
on Health Economics
Issue of 2011‒11‒07
fifteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Effect of Health and Employment Risks on Precautionary Savings By Johannes Geyer
  2. Evaluating Hospital Efficiency Adjusting for Quality Indicators: an Application to Portuguese NHS Hospitals By : Álvaro Almeida; José Pedro Fique
  3. “How are you feeling?” Assessing reporting bias in a subjective measure of health by quantile regression By Lunde, Lene; Løken, Katrine Vellesen
  4. A Markov Chain Model for Analysing the Progression of Patient’s Health States By Jonsson, Robert
  5. Genetic testing with primary prevention and moral hazard By David Bardey; Philippe De Donder
  6. Prenatal Smoking Cessation and Infant Health: Evidence from Sibling Births By Ji Yan
  7. Health Effects on Children's Willingness to Compete By Björn Bartling; Ernst Fehr; Daniel Schunk
  8. Disease and Development: The Role of Human Capital By Rodolfo Manuelli
  9. Matching with a Handicap: The Case of Smoking in the Marriage Market By Pierre-André Chiappori; Sonia Oreffice; Climent Quintana-Domeque
  10. Estimating the Effects of Friendship Networks on Health Behaviors of Adolescents By Jason M. Fletcher; Stephen L. Ross
  11. The Time of the Infant, Parent-Infant Desynchronization and Attachment Disorganization, or How Long Does it Take for a Preventive Action to be Effective? By Antoine Guedeney; Nicole Guedeney; Susana Tereno; Romain Dugravier; Tim Greacen; Bertrand Welniarz; Thomas Saias; CAPEDEP Study Group
  12. Will You Still Want Me Tomorrow? The Dynamics of Families' Long-Term Care Arrangements By Michelle Goeree; Bridget Hiedemann; Steven Stern
  13. Some notes on how to catch a red herring Ageing, time-to-death & care costs for older people in Sweden By Karlsson, Martin; Klohn, Florian
  14. Food insecurity and therelationship between household income and child health in Brazil By Mauricio Cortez Reis

  1. By: Johannes Geyer
    Abstract: This paper extends the idea of using ex-ante risk measures in a model of precautionary savings by explicitly simulating future net-income risks. The uncertainty measure takes into account the interdependency of labour market status and health. The model is estimated for prime age males using the German Socio-Economic Panel Study for years 2001-2007. The empirical analysis is conducted using a measure for saving stocks and saving flows. The latter model allows to control for individual specific effects. I find evidence for precautionary savings in response to the uncertainty measures. The results are robust and stable across specifications. There is evidence for a share of precautionary wealth of about 14 to 17 percent.
    Keywords: Precautionary savings, health, employment, risks
    JEL: D91 E21
    Date: 2011
  2. By: : Álvaro Almeida (CEF.UP, Faculdade de Economia, Universidade do Porto); José Pedro Fique (Faculdade de Economia, Universidade do Porto)
    Abstract: The objective of this paper is to develop a methodology to incorporate measures of hospital quality in efficiency analysis, applied to Portuguese NHS hospitals, in order to assess whether there is a trade-off between efficiency and quality in Portuguese hospitals. We develop and compare two methodologies to compute DEA technical efficiency scores adjusted for output quality, for a sample of Portuguese NHS hospitals in 2009. When DEA efficiency scores are adjusted for output quality, the decision making units that lie on the technical efficiency frontier remain largely unaltered, even if a great weight is given to quality indicators over quantity indicators of output. Nevertheless, we find that outside of the frontier adjusting for quality does have an impact in efficiency scores.We conclude that the empirical evidence is not sufficient to identify a clear trade-off between efficiency and quality in the hospitals under review, implying the possibility that efficiency gains may achieved without a significant sacrifice of service quality. Nevertheless, there is enough evidence to conclude that analyzing hospital efficiency without consideration of differences in quality of service will generate biased results. When perceived quality is brought to the analysis, the gap between efficient and inefficient units tends to widen.
    Keywords: Hospital efficiency, Hospital quality, Data Envelopment Analysis
    JEL: I1 I18
    Date: 2011–11
  3. By: Lunde, Lene (University of Bergen); Løken, Katrine Vellesen (University of Bergen)
    Abstract: In this paper we investigate reporting heterogeneity in the Visual Analogue Scale (VAS) when it is used to measure current health status in cardiovascular patients. We provide a new framework to identify reporting heterogeneity using quantile regressions. EQ-5D responses are used as a proxy to control for objective health. The objectiveness of this generic measure is supported by other measures of actual health. The data comes from a Norwegian, health-related quality of life study. We find substantial evidence of reporting bias in VAS related to gender and education. For some quantiles we observe reporting heterogeneity related to age and weight.
    Keywords: Reporting bias; quantile regression; health measurement
    JEL: C21 I10 I12
    Date: 2011–05–01
  4. By: Jonsson, Robert (Statistical Research Unit, Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: Markov chains (MCs) have been used to study how the health states of patients are progressing in time. With few exceptions the studies have been based on the questionable assumptions that the MC has order m=1 and is homogeneous in time. In this paper a three-state non-homogeneous MC model is introduced that allows m to vary. It is demonstrated how wrong assumptions about homogeneity and about the value of m can invalidate predictions of future health states. This can in turn seriously bias a cost-benefit analysis when costs are attached to the predicted outcomes. The present paper only considers problems connected with model construction and estimation. Problems of testing for a proper value of m and of homogeneity is treated in a subsequent paper. Data of work resumption among sick-listed women and men are used to illustrate the theory. A nonhomogeneous MC with m = 2 was well fitted to data for both sexes. The essential difference between the rehabilitation processes for the two sexes was that men had a higher chance to move from the intermediate health state to the state ‘healthy’, while women tended to remain in the intermediate state for a longer time.
    Keywords: Rehabilitation; transition probability; prediction; Maximum Likelihood
    JEL: C10
    Date: 2011–10–31
  5. By: David Bardey; Philippe De Donder
    Abstract: Abstract: We develop a model where a free genetic test reveals whether the individual tested has a low or high probability of developing a disease. A costly prevention effort allows high-risk agents to decrease the probability of developing the disease. Agents are not obliged to take the test, but must disclose its results to insurers. Insurers offer separating contracts which take into account the individual risk, so that taking the test is associated to a discrimination risk. We study the individual decisions to take the test and to undertake the prevention effort as a function of the effort cost and of its efficiency. We obtain that, if effort is observable by insurers, agents undertake the test only if the effort cost is neither too large nor too low. If the effort cost is not observable by insurers, they face a moral hazard problem which induces them to under-provide insurance. We obtain the counter intuitive result that moral hazard increases the value of the test if the effort cost is low enough. Also, agents may perform the test for lower levels of prevention efficiency when effort is not observable.
    Date: 2011–10–31
  6. By: Ji Yan
    Abstract: This paper uses a unique large panel data of sibling births to provide new evidence on when prenatal smokers must quit smoking to deliver the healthy newborn. In a series of the mother fixed effect estimation, I find robust results that early cessation in the first trimester nullifies the adverse smoking impact, but late cessation in the second trimester still leaves a remarkably irreversible damage on infant health. About two third of the adverse smoking impact on infant health occurs in the second trimester, mainly through fetal growth retardation. Therefore the first trimester is the critical period for prenatal smoking cessation. In particular, failing to stop smoking promptly in this period is crucial to explain why low socioeconomic status prenatal smokers transmit their poor health and economic status to the offspring. The policy implication is that reallocating resources on prenatal smoking cessation towards the first trimester can lead to a significant effciency gain. This paper also uncovers a new source of downward bias in estimating the causal relation between a group measure "prenatal smokers" and infant health, if the timing information of smoking cessation is misused. Key Words: Prenatal Smoking, Timing of Smoking Cessation, Birth Weight, Low Birth Weight
    Date: 2011
  7. By: Björn Bartling (University of Zurich, Department of Economics); Ernst Fehr (University of Zurich, Department of Economics); Daniel Schunk (University of Zurich and University of Mainz, Department of Economics)
    Abstract: The formation of human capital is important for a society's welfare and economic success. Recent literature shows that child health can provide an important explanation for disparities in children's human capital development across different socio-economic groups. While this literature focuses on cognitive skills as determinants of human capital, it neglects non-cognitive skills. We analyze data from economic experiments with preschoolers and their mothers to investigate whether child health can explain developmental gaps in children’s non-cognitive skills. Our measure for children's noncognitive skills is their willingness to compete with others. Our findings suggest that health problems are negatively related to children's willingness to compete and that the effect of health on competitiveness differs with socio-economic background. Health has a strongly negative effect in our sub-sample with low socioeconomic background, whereas there is no effect in our sub-sample with high socio-economic background.
    Keywords: willingness to compete, non-cognitive skills, human capital, health, household survey studies
    JEL: C90 I10 J24
    Date: 2011–05
  8. By: Rodolfo Manuelli (Department of Economics, Washington University in St. Louis and Federal Reserve Bank of St. Louis)
    Abstract: This paper presents a model of human capital accumulation that allows for feedback effects between the consequences and the likelihood of suffering from particular diseases and the decisions to invest in knowledge, both in the form of schooling and on-the-job training. I use a calibrated version of the model to estimate the long run impact of eradicating HIV/AIDS and malaria for a number of Sub- Saharan African countries. I find that the effect on output per worker can be substantial.
    Date: 2011–06
  9. By: Pierre-André Chiappori (Columbia University); Sonia Oreffice (Universitat d'Alacant and IZA); Climent Quintana-Domeque (Universitat d'Alacant)
    Abstract: We develop a matching model on the marriage market, where individuals have preferences over the smoking status of potential mates, and over their socioeconomic quality. Spousal smoking is bad for non-smokers, but it is neutral for smokers, while individuals always prefer high socioeconomic quality. Furthermore, there is a gender difference in smoking prevalence, there being more smoking men than smoking women for all education levels, so that smoking women and non-smoking men are in short supply. The model generates clear cut conditions regarding matching patterns. Using CPS data and its Tobacco Use Supplements for the years 1996 to 2007, and proxying socioeconomic status by educational attainment, we find that these conditions are satisfied. There are fewer "mixed" couples where the wife smokes than vice-versa, and matching is assortative on education within smoking types of couples. Among non-smoking wives those with smoking husbands have on average 0.14 fewer years of completed education than those with non-smoking husbands. Finally, and somewhat counterintuitively, we find that, as theory predicts, among smoking husbands, those who marry smoking wives have on average 0.16 more years of completed education than those with non-smoking wives.
    Keywords: Smoking, education, matching, marriage market.; Smoking, education, matching, marriage market
    JEL: D1 J1
    Date: 2011–04
  10. By: Jason M. Fletcher (Yale University); Stephen L. Ross (University of Connecticut)
    Abstract: Researchers typically examine peer effects by defining the peer group broadly (all classmates, schoolmates, neighbors) because of the lack of friendship information in many data sources as well as to enable the use of plausibly exogenous variation in peer group composition across cohorts in the same school. This paper estimates the effects of friend's health behaviors on own health behaviors for adolescents. A causal effect of friend's health behaviors is identified by comparing similar individuals who have the same friendship opportunities because they attend the same school and make the same friendship choices, under the assumption that the friendship choice reveals information about an individual's unobservables. We combine this identification strategy with a cross-cohort, within school design so that the model is identified based on across grade differences in the clustering of health behaviors within specific friendship options. This strategy allows us to separate the effect of friends behavior on own behavior from the effect of friends observables attributes on behavior, a key aspect of the reflection problem. We use a partial equilibrium model of friendship formation in order to derive the conditions under which our identification strategy will provide consistent estimates, and the key assumption required for our strategy to be feasible is supported by the empirical patterns of across cohort variation that we observe in our data. Our results suggest that friendship network effects are important in determining adolescent tobacco and alcohol use, but are over-estimated in specifications that do not fully take into account the endogeneity of friendship selection by 15-25%.
    Date: 2011–03
  11. By: Antoine Guedeney (Hospital Bichat-Claude Bernard APHP, Universite Paris); Nicole Guedeney (Intitut Mutualiste Monsouris); Susana Tereno (Intitut Mutualiste Monsouris); Romain Dugravier (Hospital Bichat-Claude Bernard APHP, Universite Paris); Tim Greacen (Hospital Maison Blanche); Bertrand Welniarz (Hospital Perray-Vaucluse); Thomas Saias (Hospital Maison Blanche); CAPEDEP Study Group
    Abstract: The classical version of early development by psychoanalysis has been largely challenged by developmental psychology, and particularly by attachment theory. Psychopathology appears to be much more linked with a sequence of events involving interpersonal relationship disorders rather than with intra psychic conflicts, as hypothesised by drive theory. Establishing synchrony between parent and infant is probably one of the major tasks of the first year of life. Attachment theory appears to be the modern paradigm to understand how the several types of answers from caregivers to stressing situations in the infant give way to different emotional and cognitive regulatory strategies, with impact on the effectiveness of the stress buffer systems. This paper presents what we can figure out about what is time to the infant, the importance of synchronization within infant and caregiver, the key concept of attachment disorganization, the concept of sustained social withdrawal as a defence mechanism and an alarm signal when synchronisation fails, and finally the key issue of conditions for effectiveness of early parent- infant preventive intervention.
    Keywords: Parent- infant synchrony, Attachment Disorganization, Parenting, infant social withdrawal behaviour, early prevention and intervention
    Date: 2011
  12. By: Michelle Goeree (University of Zurich); Bridget Hiedemann (Seattle University); Steven Stern (University of Virginia)
    Abstract: We estimate dynamic models of elder-care arrangements using data from the Assets and Health Dynamics Among the Oldest Old Survey. We model the use of institutional care, formal home health care, care provided by a child, and care provided by a spouse in the selection of each care arrangement, the primary arrangement, and hours in each arrangement. Our results indicate that both observed heterogeneity and true state dependence play roles in the persistence of care arrangements. We find that positive state dependence (i.e., inertia) dominates caregiver burnout, and that formal care decisions depend on the cost and quality of care.
    Keywords: Dynamic Models, Long-Term Care, Home Health Care, Informal Care
    JEL: C51 C61 J14
    Date: 2011–07
  13. By: Karlsson, Martin; Klohn, Florian
    Abstract: In this paper we test the 'red herring' hypothesis for expenditures on long-term care. The main contribution of this paper is that we assess the 'red herring' hypothesis using an aggregated measure that allows us to control for entering the final period of life on the individual level. In addition we implement a model that allows for age specific time-to-death (TTD) effects on Long Term Care. We also account for the problem that mortality, and therefore TTD, are themselves influenced by care expenditure. For our analysis we use administrative data from the Swedish statistical office. In contrast to many previous empirical studies, we are able to use the entire population for estimation instead of a sample. Our identification strategy is based on fixed effects estimation and the instrumental variable approach to achieve exogenous variation in TTD. Our results indicate that although time-to-death is a relevant indicator for long term care, age itself seems to be much more important for the projection of long-term care expenditure.
    Date: 2011–10
  14. By: Mauricio Cortez Reis
    Date: 2011
    Date: 2011

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