nep-hea New Economics Papers
on Health Economics
Issue of 2012‒04‒23
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Relationship Between Low Birthweight and Socioeconomic Status in Ireland By David Madden
  2. Working Paper 148 - Role of Fiscal Policy in Tackling the HIV/AIDS Epidemic in Southern Africa By AfDB
  3. The Social Value of Mortality Risk Reduction: VSL vs. the Social Welfare Function Approach By Adler, Matthew; Hammitt, James; Treich, Nicolas
  4. Immigration, Obesity and Labor Market Outcomes in the UK By Averett, Susan; Argys, Laura; Kohn, Jennifer L.
  5. Education, Health and Mortality: Evidence from a Social Experiment By Meghir, Costas; Palme, Mårten; Simeonova, Emilia
  6. Mental Health and Education Decisions By Cornaglia, Francesca; Crivellaro, Elena; McNally, Sandra
  7. Link between Pay for Performance Incentives and Physician Payment Mechanisms: Evidence from the Diabetes Management Incentive in Ontario By Kantarevic, Jasmin; Kralj, Boris
  8. Health goes Facebook: Social Media in der Gesundheitswirtschaft By Kluska, Denise; Merkel, Sebastian; Romanowski, Sascha
  9. Perceptions of health risk and smoking decisions of young people (Online First). By Gerking, S.D.; Khaddaria, R.
  10. Primate Evidence on the Late Health Effects of Early Life Adversity By Gabriella Conti; Christopher Hansman; James J. Heckman; Matthew F. X. Novak; Angela Ruggiero; Stephen J. Suomi
  11. "The Effects of Hypertension and Obesity on Total Health Care Expenditures of Diabetes Patients in the United States" By Simon Condliffe; Charles Link; Micheal F. Pollack; Shreekant Parasuraman
  12. Time and chance happen to them all? Duration modelling versus lifetime incidence of cancer By Howdon, D.;
  13. Empirical evidence for decreasing returns to scale in a health capital model By Galama, T.;; Hullegie, P.;; Meijer, E.;; Outcault, S.;
  14. Education, HIV Status, and Risky Sexual Behavior: How Much Does the Stage of the HIV Epidemic Matter? By Danielia Iorio; Raul Santaeulalia-Llopis
  15. "Channels of Stabilization in a System of Local Public Health Insurance: The Case of the National Health Insurance in Japan" By Masayoshi Hayashi
  16. "An Econometric Analysis of Insurance Markets with Separate Identification for Moral Hazard and Selection" By Shunya Sugawara; Yasuhiro Omori
  17. The impact of health worker migration on development dynamics: evidence of wealth-effects from Africa By Simplice A, Asongu
  18. Estimating the eect of retirement on mental health via panel discontinuity designs By Fe, Eduardo; Hollingsworth, Bruce
  19. Medicare Reimbursements and Shortages of Sterile Injectable Pharmaceuticals By Ali Yurukoglu
  20. Saving Babies: The Contribution of Sheppard-Towner to the Decline in Infant Mortality in the 1920s By Carolyn M. Moehling; Melissa A. Thomasson
  21. Compulsory Schooling Reforms, Education and Mortality in Twentieth Century Europe By Gathmann, Christina; Jürges, Hendrik; Reinhold, Steffen

  1. By: David Madden (University College Dublin)
    Abstract: There is now fairly substantial evidence of a socioeconomic gradient in low birthweight for developed countries. The standard summary statistic for this gradient is the concentration index. Using data from the recently published Growing Up in Ireland survey, this paper calculates this index for low birthweight arising from preterm and intra-uterine-growth-retardation. It also carries out a decomposition of this index for the different sources of low birthweight and finds that income inequality appears to be less important for the case of preterm births, while fathers education and local environmental conditions appear to be more relevant for IUGR. The application of the standard Blinder-Oaxaca decomposition also indicates that the socioeconomic gradient for all sources of birthweight appear to arise owing to different characteristics of rich and poor, and not because the return to characteristics differ between rich and poor.
    Keywords: Low birthweight, Concentration Index, decomposition
    Date: 2012–04–18
  2. By: AfDB
    Date: 2012–04–16
  3. By: Adler, Matthew; Hammitt, James; Treich, Nicolas
    Abstract: We examine how different welfarist frameworks evaluate the social value of mortality riskreduction. These frameworks include classical, distributively unweighted cost-benefit analysis—i.e., the “value per statistical life” (VSL) approach—and three benchmark social welfare functions (SWF): a utilitarian SWF, an ex ante prioritarian SWF, and an ex post prioritarian SWF. We examine the conditions on individual utility and on the SWF under which these frameworks display the following five properties: i) wealth sensitivity, ii) sensitivity to baseline risk, iii) equal value of risk reduction, iv) preference for risk equity, and v) catastrophe aversion. We show that the particular manner in which VSL ranks risk-reduction measures is not necessarily shared by other welfarist frameworks, and we identify when the use of an ex ante or an ex post approach has different implications for risk policymaking.
    Keywords: Value of statistical life, social welfare functions, cost-benefit analysis, equity
    JEL: D61 D63 D81 Q51
    Date: 2012–03
  4. By: Averett, Susan (Lafayette College); Argys, Laura (University of Colorado Denver); Kohn, Jennifer L. (Drew University)
    Abstract: We estimate the dual effects of immigration and obesity on labor market outcomes in the UK. There is only one other paper that has estimated these dual effects on a sample of immigrants to the US. We use the British Household Panel Survey, which contains information on height and weight for 2004 and 2006, along with immigration status and labor market outcomes. This was a period of increased immigration to the UK resulting in large part from the accession of new EU member states, though our sample includes both recent arrivals and those who have been in the UK for decades. We first analyze an immigrant-only sample and then expand the sample to compare the experience of these immigrants to natives with similar weight and other observable characteristics. We find support for the "healthy immigrant hypothesis" that suggests that immigrants are less likely to be obese than natives, and also evidence of an assimilation effect in which immigrants' weight increases with their time in the UK. The results indicate a wage premium and higher proportions of white collar work for immigrant men, but a wage penalty and lower proportions of white collar work for overweight and obese immigrant men. We find weaker but still negative associations between weight and labor market outcomes for immigrant women. Data limitations preclude efforts to address endogeneity, so these findings should be viewed as associations that support the need for better data for additional analysis of the dual effects of immigration and obesity on labor market outcomes.
    Keywords: immigrant, obesity, labor market outcomes
    JEL: I10 J15 J31
    Date: 2012–03
  5. By: Meghir, Costas (Yale University); Palme, Mårten (Stockholm University); Simeonova, Emilia (Tufts University)
    Abstract: We study the effect of a compulsory education reform in Sweden on adult health and mortality. The reform was implemented by municipalities between 1949 and 1962 as a social experiment and implied an extension of compulsory schooling from 7 or 8 years depending on municipality to 9 years nationally. We use detailed individual data on education, hospitalizations, labor force participation and mortality for Swedes born between 1946 and 1957. Individual level data allow us to study the effect of the education reform on three main groups of outcomes: (i) mortality until age 60 for different causes of death; (ii) hospitalization by cause and (iii) exit from the labor force primarily through the disability insurance program. The results show reduced male mortality up to age fifty for those assigned to the reform, but these gains were erased by increased mortality later on. We find similar patterns in the probability of being hospitalized and the average costs of inpatient care. Men who acquired more education due to the reform are less likely to retire early.
    Keywords: causal effects of education, compulsory schooling laws, comprehensive school reforms, education reform, returns to schooling
    JEL: I12 I18 I21
    Date: 2012–04
  6. By: Cornaglia, Francesca (Queen Mary, University of London); Crivellaro, Elena (University of Padova); McNally, Sandra (London School of Economics)
    Abstract: Mental health problems – and depression in particular – have been rising internationally. The link between poor mental health and poor educational outcomes is particularly interesting in the case of the UK which has a low international ranking both on measures of child wellbeing and the probability of early drop-out from the labour market and education. We study this issue using a large longitudinal study of a recent cohort of teenagers in England. We use the General Health Questionnaire to derive measures of poor mental health. We find a large negative association between mental health problems and educational outcomes – where we consider examination results before leaving compulsory education and the probability of being "not in education, employment or training" at a young age. The association is large even after including a very rich set of controls. Results are stronger for girls and also vary according to the different components of the mental health measure. We also explore the potential role of intermediary mechanisms (truancy and risky behaviors).
    Keywords: mental health, educational attainment, drop-out
    JEL: I1 I2
    Date: 2012–03
  7. By: Kantarevic, Jasmin (Ontario Medical Assocation); Kralj, Boris (Ontario Medical Assocation)
    Abstract: Pay for performance (P4P) incentives for physicians are generally designed as additional payments that can be paired with any existing payment mechanism such as salary, fee-for-service, and capitation. However, the link between the physician response to performance incentives and the existing payment mechanisms is still not well understood. In this paper, we study this link using the recent primary care reform in Ontario as a natural experiment and the Diabetes Management Incentive (DMI) as a case study. Using a comprehensive administrative data and a difference-indifferences matching strategy, we find that physicians in a blended capitation model are more responsive to the DMI than physicians in an enhanced fee-for-service model. We show that for a given payment mechanism this result implies that the optimal size of P4P incentives varies negatively with the degree of supply-side cost sharing. These results have important implications for the design of P4P programs and the cost of their implementation.
    Keywords: pay for performance, physician remuneration, diabetes management
    JEL: I10 I12 I18
    Date: 2012–04
  8. By: Kluska, Denise; Merkel, Sebastian; Romanowski, Sascha
    Abstract: Das Internet ist für gesundheitsinteressierte Bürgerinnen und Bürger heute eine der wichtigsten Informationsquellen. Ergänzend zu den Gesundheitsportalen läuft ein großer Teil der Gesundheitskommunikation inzwischen über Social Media. Soziale Online-Netze wie Facebook bieten viele Möglichkeiten verstreute Informationen zu bündeln und zielgruppenorientiert aufzubereiten. Derzeit spielen Gesundheitsinformationen über Social Media noch eine untergeordnete Rolle, ihre Bedeutung wird in den nächsten Jahren jedoch deutlich steigen. Auch Krankenhäuser nutzen zunehmend Facebook. Insgesamt existieren derzeit 195 Facebook-Pages von Kliniken. Genutzt werden sie u.a. für Personalwerbung, Kundenansprache und -bindung oder auch für das Beschwerdemanagement. --
    Date: 2011
  9. By: Gerking, S.D. (Tilburg University); Khaddaria, R.
    Date: 2012
  10. By: Gabriella Conti (University of Chicago, Harris School of Public Policy Studies); Christopher Hansman (Columbia University); James J. Heckman (University of Chicago); Matthew F. X. Novak (Central Oregon Community College); Angela Ruggiero (NICHD); Stephen J. Suomi (NICHD)
    Abstract: This paper exploits a unique ongoing experiment to analyze the effects of early rearing conditions on physical and mental health in a sample of rhesus monkeys (Macaca mulatta). We analyze the health records of 231 monkeys which were randomly allocated at birth across three rearing conditions: Mother Rearing, Peer Rearing, and Surrogate Peer Rearing. We show that the lack of a secure attachment relationship in the early years engendered by adverse rearing conditions has detrimental long-term effects on health which are not compensated by a normal social environment later in life.
    Keywords: rhesus monkeys, health, maternal behavior, social deprivation
    JEL: I12 J13
    Date: 2012–04
  11. By: Simon Condliffe (Department of Economics and Finance, West Chester University); Charles Link (Department of Economics, University of Delaware); Micheal F. Pollack (HealthCore, Inc.); Shreekant Parasuraman (AstraZeneca LP. Health Economics and Outcomes Research)
    Abstract: We identify a representative sample of U.S. diabetes patients with comorbid hypertension and evaluate health care expenditures in this population across BMI strata. The underlying hypothesis is that the presence of comorbid obesity and hypertension poses an additional burden on patients with diabetes, thus impacting their overall resource utilization. That is, hypertension and obesity in combination have a greater adverse impact on health care expenditures than individually. More than one-third of diabetes patients suffer from comorbid obesity and hypertension, which outnumbers diabetes patients with neither or only one of these comorbidities. The results of multivariate regression clearly show the significant impact these comorbidities can have on the health care expenditures of the diabetes population.
    Keywords: diabetes, health care expenditures, hypertension, obesity
    JEL: I10 I12 I19
    Date: 2012
  12. By: Howdon, D.;
    Abstract: While current work on socioeconomic inequality in cancer looks at lifetime incidence of cancer, it is more informative to consider survival times: healthy time lived without cancer. This paper uses the rst wave of, and latest longitudinal follow-up to, the Health and Lifestyle Survey (HALS) to investigate the social gradient in cancer, considering both lifetime incidence and duration models of time-to-cancer. Contrary to previous work on the relationship between circumstances and the development of cancer, notably Deaton (2002), a social gradient in time to cancer is observed, with those in the lowest two social classes developing cancer signi cantly (at the 5% level of signi cance) sooner than individuals in the highest social class. This relationship holds after excluding smokers from the sample. No gradient is observed when only lifetime incidence of cancer is considered.
    Date: 2012–04
  13. By: Galama, T.;; Hullegie, P.;; Meijer, E.;; Outcault, S.;
    Abstract: We estimate a health investment equation, derived from a health capital model that is an extension of the well-known Grossman model. Of particular interest is whether the health production function has constant returns to scale, as in the standard Grossman model, or decreasing returns to scale, as in the Ehrlich-Chuma model and extensions thereof. The model with decreasing returns to scale has a number of theoretically and empirically desirable characteristics that the constant returns model does not have. Although our empirical equation does not point-identify the decreasing returns to scale curvature parameter, it does allow us to test for constant versus decreasing returns to scale. The results are suggestive of decreasing returns and in line with prior estimates from the literature. But when we attempt to control for the endogeneity of health by using instrumental variables, the results become inconclusive. This brings into question the robustness of prior estimates in this literature.
    Keywords: health investment; lifecycle model; Grossman model; optimal control
    JEL: I12 J24 D91
    Date: 2012–03
  14. By: Danielia Iorio; Raul Santaeulalia-Llopis
    Abstract: We study the relationship between education and individual HIV status using nationally representative data (Demographic and Health Surveys, DHS) for 18 countries in Sub- Saharan Africa (SSA). Because the diffusion of knowledge on HIV prevention.hence, actual change in sexual behavior.may differ across education groups, we explicitly explore the possibility of a dynamic relationship between education and the probability of being infected with HIV over aggregate stages of the HIV epidemic. Our contribution is twofold. First, we construct an innovative algorithm that positions, for any set of countries, the country-specific evolution of the HIV epidemic in a unified framework.a normalized epidemiological define stages of the HIV epidemic in a comparable manner across SSA countries. Second, using this framework, we exploit epidemiological stage variation across DHS country observations and find that the relationship between education and individual HIV status is dynamic and significantly evolves with the course of the epidemic. Specifically, we show that the education gradient of HIV displays a large U-shaped (positive-zero-positive) pattern over the aggregate stages of the HIV epidemic.
    Keywords: HIV, demographics
    JEL: I15
    Date: 2011–11
  15. By: Masayoshi Hayashi (Faculty of Economics, University of Tokyo)
    Abstract: There are more than 1,700 municipalities serving as insurers in Japan's system of National Health Insurance (NHI). The NHI has several institutional routes to buffer local premiums from abrupt changes in regional health demands that destabilize the NHI benefit expenditures. After briefly introducing the system of public health care in Japan, this study elaborates on the methods for quantifying the degree of stabilization of local public health care expenditures by critically evaluating the methods that have been utilized in the related literature and proposes a modified method appropriate for this study. It then quantifies the channels and degrees of stabilization using municipal NHI data in the 2000s. </table>
    Date: 2012–04
  16. By: Shunya Sugawara (Graduate School of Economics, University of Tokyo); Yasuhiro Omori (Faculty of Economics, University of Tokyo)
    Abstract: This paper proposes a simple econometric framework that can identify moral hazard and selection problems separately in insurance markets. Although our methodology requires behavioral assumptions on the consumer's optimization, we show that these assumptions are necessary for the separate identification of the two sources of information asymmetry. Our method is applied to the dental insurance market in the United States. In addition to standard moral hazard, we find advantageous selection, which is not detected by a conventional methodology.
    Date: 2012–04
  17. By: Simplice A, Asongu
    Abstract: This paper examines three relevant hypotheses on the incidence of health worker migration on human development and economic prosperity (at macro and micro levels) in Africa. Owing to lack of relevant data on Health Human Resource(HHR) migration for the continent, the subject matter has remained empirically void over the last decades despite the acute concern of health professional emigration. Using quantile regression, the following findings have been established. (1) The effect of HHR emigration is positive (negative) at low (high) levels of economic growth. (2) HHR emigration improves (mitigates) human development (GDP per capita growth) in low (high) quantiles of the distribution. (3)Specific differences in effects are found in top quantiles of human development and low quantiles of GDP per capita growth where the physician (nurse) emigration elasticities of development are positive (negative) and negative (positive) respectively. As a policy implication blanked health-worker emigration control policies are unlikely to succeed across countries with different levels of human development and economic prosperity. Hence the policies should be contingent on the prevailing levels of development and tailored differently across the most and least developed African countries.
    Keywords: Welfare; Health; Human Capital; Migration
    JEL: F22 O15 J24 D60 I10
    Date: 2012–04–18
  18. By: Fe, Eduardo; Hollingsworth, Bruce
    Abstract: This article explores the potential effects of retirement on mental health and health care utilisation isolating sources of potential heterogeneity in treatment effect. To estimate the effects of retirement, we devise a new identifying strategy that combines kink and regression discontinuity designs with panel data methods. Our method is then applied to the British Household Panel Survey, a rich representative longitudinal survey. It is found that retirement has a small impact on primary care use, but overall has little effect on mental health.
    Keywords: Discontinuity design; weak identification; retirement; health; kink regression; regression discontinuity
    JEL: I18 C90 C30 J26 C21
    Date: 2012–03–02
  19. By: Ali Yurukoglu
    Abstract: This paper investigates the rise in shortages of sterile injectable pharmaceutical drugs in the United States. I focus on a policy change that occured in 2005 that reduced Medicare reimbursements for sterile injectable drugs. The policy change affected different drugs by different amounts. I empirically look at the change in shortages for drugs after the policy change conditional on the amount that the policy change affected each drug. I find that drugs that were more affected by the policy change, ie with greater "treatment," either because they serve older patient populations or have low fixed costs, have had a greater increase in shortages and a greater decrease in number of manufacturers post-regulation. I interpret these results using a model of capacity choice with supply uncertainty. Total installed capacity is higher and the probability of a shortage is lower when margins are higher. I conclude that Medicare's generous payments before the policy change provided manufacturers with incentives to take actions to avoid shortages either by investing in additional maintenance or capacity, or by inducing more entry into production of the drug. The effect on total welfare of removing those payments is theoretically ambiguous, and would require more detailed data to credibly estimate.
    JEL: I11 I18 L51
    Date: 2012–04
  20. By: Carolyn M. Moehling; Melissa A. Thomasson
    Abstract: From 1922 to 1929, the Sheppard-Towner Act provided matching grants to states to fund maternal and infant care education initiatives. We examine the effects of this public health program on infant mortality. States engaged in different types of activities, allowing us to examine whether different interventions had differential effects on mortality. Interventions that provided one-on-one contact and opportunities for follow-up care, such as home visits by public health nurses, reduced infant deaths more than classes and conferences. Overall, we estimate that Sheppard-Towner activities can account for 9 to 21 percent of the decline in infant mortality over the period.
    JEL: H51 I18 N32
    Date: 2012–04
  21. By: Gathmann, Christina; Jürges, Hendrik; Reinhold, Steffen
    Abstract: Education yields substantial non-monetary benefits, but the size of these gains is still debated. Previous studies, for example, report contradictory effects of education and compulsory schooling on mortality – ranging from zero to large mortality reductions. Using data from 19 compulsory schooling reforms implemented in Europe during the twentieth century, we quantify the mean mortality effect and explore its dispersion across gender, time and countries. We find that men benefit from compulsory education both in the shorter and longer run. In contrast, compulsory schooling reforms have little or no effect on mortality for women.
    Keywords: Compulsory schooling , education , mortality , Europe
    JEL: I12 I21 I28
    Date: 2012

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