nep-hea New Economics Papers
on Health Economics
Issue of 2012‒04‒17
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Regional Disparity in Health and Health Care in China By Hong Wang; Licheng Zhang; Heng-fu Zou
  2. Influence of Parentsf Unemployment on the Health of Newborn Babies By Miki Kohara; Fumio Ohtake
  3. Income Inequality and Mental Health By Grace Lordan; Prasada Rao; Lucy Bechtel
  4. Does Women's Empowerment Reduce Prevalence of Stunted and Underweight Children in Rural India? By Katsushi S. Imai; Samuel Kobina Annim; Raghav Gaiha; Veena S. Kulkarni
  5. Mental health and economic conditions: how do economic fluctuations influence mental problems? By Mariya Melnychuk
  6. Financial consequences of falling ill: Changes in the German health insurance system since the 1980s By Wörz, Markus
  7. The impact of health events on individual labor market histories : the message from difference in differences with exact matching By Emmanuelle Duguet; Christine Le Clainche
  8. Well-being, Health and Work By Alex Bryson; Francis Green; Bridges, S.; Craig, R.
  9. Mortality in the British Panel Household Survey: a Test of a Standard Treatment for Non-Response By Martin Weale; Silvia Lui; James Mitchell
  10. Education and its Effects on the Income, Health and Survival of those aged Sixty-five and Over By Martin Weale; Silvia Lui
  11. Identifying the Effect of WIC on Infant Health When Participation is Endogenous and Misreported By Manan Roy
  12. Does Delay Cause Decay? The Effect of Administrative Decision Time on the Labor Force Participation and Earnings of Disability Applicants By David Autor; Nicole Maestas; Kathleen Mullen; Alexander Strand
  13. Estimating income equity in social health insurance system By Galina Besstremyannaya
  14. Would you rather be ill now, or later? By Attema, AE; Versteegh, MM
  15. A methodology of estimation on air pollution and its health effects in large Japanese cities. By Hirota, Keiko; Shibuya, Satoshi; Sakamoto, Shogo; Kashima, Shigeru
  16. An Experimental Investigation of Mixed Systems of Public and Private Health Care Finance By Neil J. Buckley; Katherine Cuff; Jeremiah Hurley; Logan McLeod; Stuart Mestelman; David Cameron

  1. By: Hong Wang (Yale University); Licheng Zhang (Beijing University); Heng-fu Zou (The World Bank)
    Abstract: One major critique of the Chinese economic reform focuses on disparities in development. This study examines the recent trends in the disparities in health and health care resources across the provinces. This study also examines the relationship between health status, health care resources, and socioeconomic status. A panel data from "All China Data" and China Health Statistic Yearbooks is used in this study. These data include health status, health care resources, and socioeconomic status variables at the provincial level from 1980 to 2003. Index of disparity was used as the indicator for measuring regional disparity in health and health care resources. A fixed effect model was used to estimate the relationships between health status and health care resources and their potential determinants. The results of this study show that the disparities in maternal mortality, number of beds, and number of doctors increased and then declined in most recent years. However, the values of their indexes of disparity in 2002 are still higher than their values in 1985. Therefore the disparities in health status and health care resources across the provinces increased after the economic reform. The results of this study also suggest that socioeconomic status has significant association with health status and health care resources. The association between socioeconomic indicators and health status and health care resources varies in different economic zones.
    Date: 2012
  2. By: Miki Kohara (Osaka School of International Public Policy, Osaka University); Fumio Ohtake (Institute of Social and Economic Research, Osaka University)
    Abstract: Recent research has shown that low-income households have a higher probability of babies being born underweight, which is an indicator of poor health. The causes and effects of the weights of newborn babies need to be analyzed in Japan, where the proportion of low-weight babies is extremely high relative to the other OECD countries. In this paper, we use panel data by prefecture to analyze the influence of market labor conditions on the weights of newborn babies in Japan. Controlling for heterogeneity among prefectures and years as random effects, we first show that high unemployment rates among parents do reduce the weights of newborn babies. However, our analysis does not confirm the influence of poverty and low income on the weights of newborn babies. Unemployment of parents may hamper the health of a baby for reasons other than financial difficulties.
    Keywords: unemployment, low birth]weight, panel data, Japan
    JEL: I1 J1 J2
    Date: 2012–03
  3. By: Grace Lordan (School of Economics, The University of Queensland); Prasada Rao (School of Economics, The University of Queensland); Lucy Bechtel
    Abstract: The causal association between absolute income and health is well established, however the relationship between income inequality and health is not. The conclusions from the received studies vary across the region or country studied and/or the methodology employed. Using the Household, Income and Labour Dynamics in Australia panel survey, this paper investigates the relationship between mental health and inequality in Australia. A variety of income inequality indices are calculated to test both the Income Inequality and Relative Deprivation Hypothesis. We find that mental health is only adversely affected by the presence of relative deprivation to a very small degree. In addition we do not find support for the Income Inequality Hypothesis. Importantly our results are robust to a number of sensitivity analyses.
    Date: 2012
  4. By: Katsushi S. Imai (Economics, School of Social Sciences, University of Manchester, UK & Research Institute for Economics & Business Administration (RIEB), Kobe University, Japan); Samuel Kobina Annim (Economics, School of Social Sciences, University of Manchester, UK & Department of Economics, University of Cape Coast, Ghana); Raghav Gaiha (Faculty of Management Studies, University of Delhi, India); Veena S. Kulkarni (Arkansas State University, USA)
    Abstract: This study investigates whether mother's empowerment or relative bargaining power affects children's nutritional status using NFHS and NCAER data in 1992-2006. First, the relative bargaining index defined as the share of mother's schooling years over father's schooling years positively and significantly influences z scores of 'weight-for-age' and 'weight-for-height' -short-term measures of nutritional status of children. The results of quantile regression suggest, however, that the bargaining power will improve a chronic measure of nutritional status, or 'height for age' at the low end of conditional distribution of z score or those stunted. We also find that access to health scheme or health insurance and health-related facility, infrastructure and environment are important factors in reducing child malnutrition.
    Keywords: Child Nutrition, Malnutrition, Empowerment, Bargaining, NFHS, NCAER, Quantile Regressions, Pseudo Panel, India
    JEL: C21 C23 C26 I14
    Date: 2012–03
  5. By: Mariya Melnychuk (Dpto. Fundamentos del Análisis Económico)
    Date: 2012–03
  6. By: Wörz, Markus
    Abstract: The incidence of a health risk may result in two different types of financial consequences: the creation of new needs and the loss of savings and/or income to meet those needs. Illness often requires the purchase of medical help. Although in Germany virtually the entire population is covered by statutory or private health insurance, over time these insurance schemes have become less generous as private out-of-pocket payments continue to rise and, in extreme cases, lead to financial hardship and even poverty. This paper describes the institutional regulations that cover the financial risks of becoming ill and the changes in these regulations since the 1980s. It begins with a structural overview of the German health insurance system, the benefits provided (both in-kind and in-cash) and the evolution of benefits since the 1980s. It then considers the related risk of permanent work-disability and the main institutional means of covering this risk. Here the discussion focuses solely on provisions dealing with loss of income and the changes therein since the 1980s. Aggregate data on short- and long-term illness are then presented to illustrate several effects resulting from changes in institutional rules. The paper concludes with a brief summary of major legislative changes, followed by conclusions and hypotheses about the consequences of occurring risks. --
    Date: 2011
  7. By: Emmanuelle Duguet; Christine Le Clainche
    Abstract: We studied the effect of health events (accidents and chronic diseases) on the occupation probabilities at the individual level, while accounting for both correlated individual and time effects. Using difference-in-differences with exact matching estimators, we found that health events have a strong impact on individual labor market histories. The workers affected by a health event have a stronger probability of entering inactivity and a lower probability of keeping their jobs. We also found that the less qualified workers, women, and workers with short term jobs are the most negatively affected by health events.
    Date: 2012–03
  8. By: Alex Bryson; Francis Green; Bridges, S.; Craig, R.
    Abstract: This paper presents measures of subjective well-being in England using a specially designed module of the 2010 Health Survey for England. It also looks at the relationship between well-being and labour market status, and, among those who are working, considers how well-being is associated with aspects of job quality.
    Date: 2012–02
  9. By: Martin Weale; Silvia Lui; James Mitchell
    Abstract: Mortality rates computed from data reported in the British Household PanelSurvey are lower than those computed from registration of deaths; the main source of this error is likely to be a failure to distinguish non-response due to unreported death from other forms of non-response. Here we model the interaction between state of health, mortality and non-response of men aged 65 and over in a trivariate probit model so as to correct for non-response. We then explore whether the restrictions on the model coefficients required to produce the observed aggregate mortality rates can be accepted statistically. We find that the required restrictions are rejected suggesting that the standard treatment of non-response does not fully address the problem. A possible explanation is that the original sample is not fully representative of the population.
    Date: 2011–11
  10. By: Martin Weale; Silvia Lui
    Abstract: We explore the effects of income and, additionally education on the income, self-reported health and survival of people aged sixty-five and over in order to identify benefits resulting from education which are omitted in the conventional analysis with its focus on labour income excluding employer contributions. We find that well educated people enjoy substantially higher incomes and longer healthy lives. However our estimates of the magnitudes of these are sharply reduced if we imposed on our model, estimated from British Household Panel Survey Data, the restrictions that the mortality rates it generates should be consistent with aggregate official data.
    Date: 2011–11
  11. By: Manan Roy (Southern Methodist University)
    Abstract: The existing evaluations of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agree on a beneficial association with birth weight but not necessarily gestation age. Regardless, considerable doubt exists over whether these associations represent a causal relationship. Endogenous selection into WIC, lack of valid exclusion restrictions, and rampant under-reporting of participation are to blame. Here, I utilize the nonparametric bounds method in Kreider et al. (2011) to address both identification problems simultaneously to assess the causal effect of prenatal WIC participation on birth outcomes. In addition, I complement the partial identification approach by reporting instrumental variable estimates following Lewbel (2010) to circumvent the need for a traditional instrument. Using data from the ECLS-B, I show that ignoring misreporting and only accounting for self-selection, WIC improves birth weight and, sometimes, gestation age. However, if only one percent of eligible women misreport their participation, well below the expected level of misreporting, the effect of WIC on birth outcomes cannot be signed.
    Keywords: Special Supplemental Nutrition Program for Women, Infants, and Children, WIC, Chil- dren, Treatment Effects, Health Outcomes, Instrumental Variables, Partial Identification, Nonparametric Bounds, Classification Error.
    JEL: C14 C21 I12 I18
    Date: 2012–02
  12. By: David Autor (MIT and NBER); Nicole Maestas (RAND); Kathleen Mullen (RAND); Alexander Strand (Social Security Administration)
    Abstract: An influential body of research studies the labor supply and earnings of denied Social Security Disability Insurance (SSDI) applicants to estimate the potential employment and earnings of those awarded benefits. This research design implicitly treats employability as a stable applicant attribute that is not directly impacted by the process of applying for SSDI benefits. If, plausibly, applicants’ employment potential deteriorates while they are out of the labor force, then the labor force participation of denied applicants -- who spend an average of 10 months seeking benefits -- may understate their employment potential at the time of application. This paper tests whether the duration of SSDI applications causally affects applicants’ subsequent employment. We use a unique Social Security Administration workload database to identify exogenous variation in applicants’ initial decision times induced by differences in processing speed among the disability examiners to which they are randomly assigned. This variation significantly affects applicants’ total processing time but, importantly, is uncorrelated with their initial award and denial outcomes. We find that longer processing times reduce the employment and earnings of SSDI applicants in the years after their initial decision. A one standard deviation (2.4 month) increase in initial processing time reduces annual employment rates by 1 percentage point (3.2%) in years two, three and four post-decision. Extrapolating these effects to total applicant processing times, we estimate that the SSDI determination process directly reduces the post-application employment of denied applicants by approximately 3.6 percentage points (7%) and allowed applicants by approximately 5.2 percentage points (33%).
    Date: 2011–09
  13. By: Galina Besstremyannaya (Center for Economic and Financial Research at New Economic School)
    Abstract: The paper measures horizontal equity in health care access and utilization in Japan by estimating the coefficients for income groups in a multi-part model which distinguishes between non-users of health care, the users of inpatient and outpatient care. To account for consumer unobservable characteristics, we apply a latent class approach. We address a retransformation problem of logged health care expenditure, using generalized linear models. Our sample is the 2009 data for 4,022 adult consumers (Japan Household Panel Survey). The coefficients for income groups are insignificant both in the binary choice models for inpatient/outpatient health care use, and in the models for health care expenditure. Consumers separate into two latent classes in the generalized linear model for outpatient health care expenditure. Although the results reveal horizontal equity in health care access and utilization in Japan, horizontal inequity remains in health insurance premiums and the prevalence of catastrophic coverage.
    Keywords: health care demand, equity, income elasticity, generalized linear models, latent class, two-part model, four-part model, social health insurance
    JEL: I10 I18 G22 R22
    Date: 2012–04
  14. By: Attema, AE; Versteegh, MM
    Abstract: The Time Tradeoff (TTO) method is used to calculate the quality adjustment of the Quality Adjusted Life Year, and is therefore an important element in the calculation of the benefits of medical interventions. New specifications of TTO, known as ‘lead time’ TTO and ‘lag time’ TTO, have been developed to overcome methodological issues of the ‘classic’ TTO. In the lead time TTO, ill-health is explicitly placed in the future, after a period of good health, while in lag time TTO a health state starts immediately and is followed by a ‘lag time’ of good health. In this study, we take advantage of these timing properties of lead and lag time TTO. In particular, we use data from a previous study that employed lead and lag time TTO to estimate their implied discounting parameters. We show that individuals prefer being ill later, rather than now, with larger per-period discount rates for longer durations of the health states.
    Keywords: TTO; Time preference; discounting; lead time TTO; lag time TTO
    JEL: D90 I10
    Date: 2012–04–05
  15. By: Hirota, Keiko; Shibuya, Satoshi; Sakamoto, Shogo; Kashima, Shigeru
    Abstract: The correlation between air pollution and health effects in large Japanese cities presents a great challenge owing to the limited availability of data on the exposure to pollution, health effects and the uncertainty of mixed causes. A methodology for quantitative relationships (between the emission volume and air quality, and the air quality and health effects) is analysed with a statistical method in this article; the correlation of air pollution reduction policy in Japan from 1974 to 2007. This chapter discusses a step-by-step methodology of determining the direct correlation between emission volumes, air quality, and health effects. The relationship between total emissions (NOx, PM) (from both stationary and mobile sources) and air quality (NO2, TSP) was found to be significant. The correlation analysis of emission volume, and air quality suggests that NOx and PM levels worsen according to increases in NO2. When the correlation between the air pollutant and the type of health effect (certified, mortality, recovery, and newly registered) was examined according to the certified area, an inverse relationship was observed. The relationship between air quality (NO2) and health effect was found to be significant. When NO2 worsens, certified patients, mortality rates and newly certified patients increase, according to the data from 1989 to 2007 with dummy variable analysis.
    Keywords: Air pollution; Health Effect; Japan; The Pollution-Related Health Damage Prevention System; Certified patients
    JEL: C10 I18 Q51 P28 C80
    Date: 2011–10–01
  16. By: Neil J. Buckley; Katherine Cuff; Jeremiah Hurley; Logan McLeod; Stuart Mestelman; David Cameron
    Abstract: This paper presents the results of a revealed-choice experiment testing the theoretical predictions of a model of a mixed system of public and private finance. In the context of a mixed system of health care finance, we investigate behavioural responses to changing the public sector allocation rule (needs-based vs. random), the supply of health care resources, and the size of the public health care budget on the following outcomes: the equilibrium market price for health care resources, the number of individuals who purchase private insurance, the probability of health treatment in the public system for those without private insurance, the health status of individuals left untreated, and the incomes of individuals who receive treatment. Our findings are generally consistent with the predictions of the theoretical model, although individuals consistently exhibit greater willingnesses-to-pay for private insurance than predicted resulting in a larger than predicted amount of private insurance being purchased. A commonly used risk-aversion measure only partially explains this observed deviation. We also find that, relative to a system of public financing only, a mixed system of health care finance results in higher health care prices and sicker, poorer people being left untreated.
    Keywords: experiment, health care finance, public health care, rationing, needs-based allocation.
    JEL: C92
    Date: 2012–04

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