nep-hea New Economics Papers
on Health Economics
Issue of 2012‒05‒15
eighteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. On the reliability of self-reported health: Evidence from Albanian data By Nicolas Gérard Vaillant; François-Charles Wolff
  2. The role of family incomes in cigarette smoking: Evidence from French students By Christian Ben Lakhdar; Grégoire Cauchie; Nicolas Gérard Vaillant; François-Charles Wolff
  3. Is Recipiency of Disability Pension Hereditary? By Bratberg, Espen; Nilsen, Øivind Anti; Vaage, Kjell
  4. Sick Leave Before, During and After Pregnancy By Rieck, Karsten Marshall E.; Telle, Kjetil
  5. Early interventions and disability insurance: experience from a field experiment By Engström, Per; Hägglund, Pathric; Johansson, Per
  6. Health Expenditure Growth: Looking beyond the Average through Decomposition of the Full Distribution By Claudine de Meijer; Marc Koopmanschap; Owen O'Donnell; Eddy van Doorslaer
  7. The Impact of State Children’s Health Insurance Program (SCHIP) Expansion on Health Insurance Coverage in Hawaii By Gerard Russo; Jaclyn R.K. Lindo; Sang-Hyop Lee; Rui Wang; Thamana Lekprichakul; Abdul Jabbar
  8. Pharmaceutical patents and prices : a preliminary empirical assessment using data from India By Duggan, Mark; Goyal, Aparajita
  9. What has driven the decline of infant mortality in Kenya ? By Demombynes, Gabriel; Trommlerova, Sofia Karina
  10. Women in cabinet and public health spending: Evidence across countries By Astghik Mavisakalyan
  11. Comparing the treatment provided by migrant and nonmigrant health professionals: dentists in Scotland By Chalkley, Martin; Wang, Shaolin; Tilley, Colin
  12. Heterogeneity, Demand for Insurance and Adverse Selection By Johannes Spinnewijn
  13. Health Perceptions in Latin America By Eduardo Lora
  14. Saving Lives: Evidence from a Micronutrient Intervention in Ecuador By Stephan Litschig; Marian Meller
  15. Multidimensional Screening in a Monopolistic Insurance Market By Pau Olivella; Fred Schroyen
  16. Seeds of hope: Assessing the effect of development aid on the reduction of child mortality By Roberto Burguet; Marcelo Soto
  17. Measuring the Child Mortality Impact of Official Aid for Fighting Infectious Diseases, 2000-2010 By Roberto Burguet; Marcelo Soto
  18. Remedies for Sick Insurance By Daniel McFadden; Carlos Noton; Pau Olivella

  1. By: Nicolas Gérard Vaillant (LEM - Lille - Economie et Management - CNRS : UMR8179 - Université Lille 1 - Sciences et Technologies - Fédération Universitaire et Polytechnique de Lille, Université Catholique de Lille - Université Catholique de Lille); François-Charles Wolff (LEMNA - Laboratoire d'économie et de management de Nantes Atlantique - Université de Nantes : EA4272, INED - Institut National d'Etudes Démographiques Paris - INED)
    Abstract: This paper investigates the reliability of self-assessed measures of health using panel data collected in Albania by the World Bank in 2002, 2003 and 2004 through the Living Standard Measurement Study project. As the survey includes questions on a self-assessed measure of health and on more objective health problems, both types of information are combined with a view to understanding how respondents change their answers to the self-reported measures over time. Estimates from random effects ordered Probit models show that differences in self-reported subjective health between individuals are much more marked than those over time, suggesting a strong state dependence in subjective health status. The empirical analysis also reveals respondent consistency, from both a subjective and an objective viewpoint. Self-reported health is much more influenced by permanent shocks than by more transitory illness or injury.
    Keywords: self-reported health ; random effects ordered Probit ; Albania
    Date: 2012–05–04
  2. By: Christian Ben Lakhdar (LEM - Lille - Economie et Management - CNRS : UMR8179 - Université Lille 1 - Sciences et Technologies - Fédération Universitaire et Polytechnique de Lille, Université Catholique de Lille - Université Catholique de Lille); Grégoire Cauchie (LEM - Lille - Economie et Management - CNRS : UMR8179 - Université Lille 1 - Sciences et Technologies - Fédération Universitaire et Polytechnique de Lille, Université Catholique de Lille - Université Catholique de Lille); Nicolas Gérard Vaillant (LEM - Lille - Economie et Management - CNRS : UMR8179 - Université Lille 1 - Sciences et Technologies - Fédération Universitaire et Polytechnique de Lille, Université Catholique de Lille - Université Catholique de Lille); François-Charles Wolff (LEMNA - Laboratoire d'économie et de management de Nantes Atlantique - Université de Nantes : EA4272, INED - Institut National d'Etudes Démographiques Paris - INED)
    Abstract: In this paper, we study the smoking behavior of students aged from 18 to 25 using four cross-section data sets collected in France from 1997 to 2006. We focus on the role played by student income and parental resources. We find that both the probability of smoking and the number of cigarettes smoked are positively correlated to family resources. Among students, only wages earned and transfers received from parents increase smoking participation. However, sensitivity to income remains weak since a rise of 1% in income of either the students or their parents leads to an increase in smoking prevalence of about 0.15-0.20%.
    Keywords: cigarette smoking ; students ; income effects
    Date: 2012–05–04
  3. By: Bratberg, Espen (Universitetet i Bergen,); Nilsen, Øivind Anti (Norwegian School of Economics,); Vaage, Kjell (University of Bergen)
    Abstract: This paper addresses whether children’s exposure to parents receiving disability benefits induces a higher probability of receiving such benefits themselves. Most OECD countries experience an increasing proportion of the working-age population receiving permanent disability benefits. Using data from Norway, a country where around 10% of the working-age population rely on disability benefits, we find that the amount of time that children are exposed to their fathers receiving disability benefits affects their own likelihood of receiving benefits positively. This finding is robust to a range of different specifications, including family fixed effects.
    Keywords: Disability; intergenerational correlations; siblings fixed effects
    JEL: H55 J62
    Date: 2012–05–09
  4. By: Rieck, Karsten Marshall E. (University of Bergen, Norway); Telle, Kjetil (Statistics Norway)
    Abstract: Using registry data on every employed Norwegian woman giving birth to her first child during the period 1995–2008, we describe patterns of certified and paid sick leave before, during and after pregnancy. By following the same women over time, we can explore how observed sick leave patterns are – or are not – related to the women’s exiting (or reentering) employment. The results show that sick leave increases abruptly in the month of conception, and continues to grow throughout the term of pregnancy. Sick leave during pregnancy has been rising substantially compared with pre-pregnancy levels over the period 1995–2008, but this increase seems unrelated to women’s growing age at first birth. In line with hypotheses of women’s “double burden”, observed sick leave rates increase in the years after birth. However, when we handle some obvious selection issues – like sick leave during a succeeding pregnancy – the increase in women’s sick leave in the years after birth dissolves. Overall, we find little, if any, sign of the relevance of “double burden” hypotheses in explaining the excessive sick leave of women compared with men.
    Keywords: Sick leave; pregnancy; female employment; double burden.
    JEL: C23 H55 I18 J13 J22
    Date: 2012–05–08
  5. By: Engström, Per (Department of Economics, Uppsala University); Hägglund, Pathric (The Swedish Social Insurance Inspectorate (ISF)); Johansson, Per (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: This paper estimates the effects of early interventions in the Swedish sickness insurance system. The aim of the interventions is to screen and, further to, rehabilitate sick listed individuals. We find that the early interventions – in contrast to what is expected – increase the inflow into disability benefits by around 20 percent. In order to explain the results, we develop a simple theoretical model based on asymmetric information of the health status. The model predicts that the treatment effect is larger for individuals with low incentives to return to work. In order to test this prediction we estimate effects for sick listed employed and unemployed separately. Consistent with the model’s prediction, we find that the effect is larger for the unemployed than for the employed.
    Keywords: Monitoring; screening; vocation rehabilitation; disbility insurance; sickness insurances; unemployment insurance; randomized experiment
    JEL: C93 H51 H55 I18 J22
    Date: 2012–04–24
  6. By: Claudine de Meijer (Erasmus University Rotterdam); Marc Koopmanschap (Erasmus University Rotterdam); Owen O'Donnell (Erasmus University Rotterdam); Eddy van Doorslaer (Erasmus University Rotterdam)
    Abstract: Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth in expenditures on hospital care is strongest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects.
    Keywords: Health care expenditure; decomposition; aging; pharmaceuticals; the Netherlands
    JEL: I10
    Date: 2012–05–08
  7. By: Gerard Russo (Department of Economics, University of Hawaii at Manoa); Jaclyn R.K. Lindo (Department of Economics, University of Hawaii at Manoa); Sang-Hyop Lee (Department of Economics, University of Hawaii at Manoa); Rui Wang; Thamana Lekprichakul; Abdul Jabbar
    Abstract: This study investigates the impact of the State Children’s Health Insurance Program (SCHIP) expansion in Hawaii on health insurance coverage among low-income children ages 0 to 18 using the Current Population Survey. We employ a difference-in-differences approach by construction of a control group for which SCHIP eligibility remained constant, and a treatment group for which SCHIP eligibility changed over the observation period. We find that the initial SCHIP implementation of July 1, 2000 resulted in a 20 percent increase in SCHIP beneficiaries, with 87 percent of these children drawn from the ranks of the privately insured. The presence of substantial crowd-out is likely the result of important factors unique to Hawaii’s health insurance environment and implies that the cost to state and federal taxpayers per newly insured child is much higher than the usual per-capita expense. Subsequent expansions to higher federal poverty line that occurred since initial SCHIP implementation also likely generated substantial crowd-out.
    Keywords: SCHIP; Medicaid; Crowd-out; Health Insurance
    JEL: I18 I19
    Date: 2012–05–09
  8. By: Duggan, Mark; Goyal, Aparajita
    Abstract: The enforcement of stringent intellectual property rights in the pharmaceutical sector of developing countries generates considerable controversy, due to both the extensive research investment and the public policy importance of this sector. This paper explores the likely effects of enforcing product patents on prices and utilization of drugs in the Central Nervous System market in India. The Central Nervous System segment is the second largest therapeutic category in terms of retail sales in the world and is one of the fastest growing segments in India. Using information on product patents granted by the government and panel data on pharmaceutical prices and utilization from 2003-2008, the paper finds limited evidence of overall price increase following the introduction of product patents. However, there appear to be heterogeneous effects on prices by the type of product patent granted on drugs, implying the need for a careful examination of the product patent portfolio.
    Keywords: Markets and Market Access,Pharmaceuticals&Pharmacoeconomics,Real&Intellectual Property Law,E-Business,Access to Markets
    Date: 2012–05–01
  9. By: Demombynes, Gabriel; Trommlerova, Sofia Karina
    Abstract: Substantial declines in infant and under-5 mortality have taken place in recent years in many countries in Sub-Saharan Africa. Kenya's infant mortality rate has fallen by 7.6 percent per year, the fastest rate of decline among the 20 countries in the region for which recent Demographic and Health Survey data is available. Kenya's rate of postneonatal deaths per 1,000 live births fell by more than half over a five-year period, dropping from 47 to 22, as measured using data from the 2003 and 2008-09 Demographic and Health Surveys. Among the possible causes of the decline are various targeted new public health initiatives and improved access to water and sanitation. A Oaxaca-Blinder decomposition using Demographic and Health Survey data shows that the increased ownership of insecticide-treated bednets in endemic malaria zones explains 39 percent of the decline in postneonatal mortality and 58 percent of the decline in infant mortality. Changes in other observable candidate factors do not explain substantial portions of the decline. The portion of the decline not explained may be associated with generalized trends such as the overall improvement in living standards that has taken place with economic growth. The widespread ownership of insecticide-treated bednets in areas of Kenya where malaria is rare suggests that better targeting of insecticide-treated bednet provision programs could improve the cost-effectiveness of such programs.
    Keywords: Population Policies,Health Monitoring&Evaluation,Early Child and Children's Health,Adolescent Health,Disease Control&Prevention
    Date: 2012–05–01
  10. By: Astghik Mavisakalyan
    Abstract: This article studies the effect of women’s cabinet representation on public health policy outcomes. Based on a large sample of countries in the year 2000, the analysis shows that an increase in the share of women in cabinet is associated with an increase in public health spending. There is also an indication of a decrease in the gender gap in life expectancies in places with higher cabinet representation of women. The endogeneity of women’s cabinet representation is accounted for by using the share of daughters that a national leader parents as an instrument.
    JEL: H11 H51 J16
    Date: 2012–05
  11. By: Chalkley, Martin; Wang, Shaolin; Tilley, Colin
    Abstract: Many OECD countries are increasingly relying on migrants to address shortages of trained health professionals. One key concern is whether migrant health professionals provide equivalent health care. We compare the treatment provided by migrant and non-migrant health professionals using administrative data from the Scottish dental system. A difference-in-differences model is estimated to examine whether migrant dentists respond differently to case mix and individual circumstances as compared with their non-migrant counterparts, and assess the extent to which any differences diminish over time. After controlling for both observed and unobserved differences between individual dentists and the cohort of patients that they treat, we find that migrant dentists have marginally different practice styles, and the variation diminishes over time within two years of practice.
    Keywords: Migrant health professionals, Treatment difference, Assimilation, British NHS, Administrative data,
    Date: 2011
  12. By: Johannes Spinnewijn
    Abstract: Recent empirical work finds that surprisingly little variation in the demand for insurance is explained by heterogeneity in risks. I distinguish between heterogeneity in risk preferences and risk perceptions underlying the unexplained variation. Heterogeneous risk perceptions induce a systematic difference between the revealed and actual value of insurance as a function of the insurance price. Using a sufficient statistics approach that accounts for this alternative source of heterogeneity, I find that the welfare conclusions regarding adversely selected markets are substantially different. The source of heterogeneity is also essential for the evaluation of different interventions intended to correct inefficiencies due to adverse selection like insurance subsidies and mandates, risk-adjusted pricing and information policies.
    Keywords: Heterogeneity, adverse selection, risk perceptions, welfare and policy
    JEL: D60 D82 D83 G28
    Date: 2012–05
  13. By: Eduardo Lora
    Abstract: This is the first study that uniformly analyzes health perceptions in all of Latin America and tests in a systematic way their relation to economic conditions at the country, income group and individual levels. The study uses three types of health self-assessment questions: i) health satisfaction; ii) health status on a scale of 0- 10; and iii) the EuroQol 5D instrument (EQ-5D), which asks about mobility, self- care, usual activities, pain/discomfort, and anxiety/depression. The empirical analysis finds support for the hypothesis that cultural differences between countries prevent cross-national comparisons of health perceptions, but it does not find support for the widely held view that the same applies within countries, presumably because the poor are more tolerant of their health problems.
    JEL: I10 J10
    Date: 2011–12
  14. By: Stephan Litschig; Marian Meller
    Abstract: Many governments in developing countries implement programs that aim to address nutrional failures in early childhood, yet credible evidence on the effectiveness of these interventions is scant. In this paper, we evaluate the impact of a large-scale, government-run, food fortification program-the Programa de Alimentación y Nutrición Nacional (PANN) 2000-on child mortality in Ecuador. The program was implemented by regular administrative staff at local public health posts and consisted of offering free micronutrient-fortified powder, Mi Papilla, for children aged 6 to 24 months in exchange for health check-ups for the children. Our regression discontinuity design exploits the fact that at its inception, the PANN 2000 was running for about eight months only in the poorest communities (parroquias) of the country. Our main result is that the presence of the program reduced child mortality in the exposed cohort from a level of about 2.5 percent by 1 to 1.5 percentage points. Consistent with this effect, we also find evidence that the number of check-ups at health posts increased in treatment parroquias, even if only in the Sierra region, where check-ups were lower to start with.
    Keywords: early childhood nutrition, mortality, nutritional interventions, regression discontinuity, Ecuador
    JEL: I15 I18
    Date: 2012–02
  15. By: Pau Olivella; Fred Schroyen
    Abstract: In this paper, we consider a population of individuals who differ in two dimensions: their risk type (expected loss) and their risk aversion. We solve for the profit maximizing menu of contracts that a monopolistic insurer puts out on the market. First, we find that it is never optimal to fully separate all the types. Second, if heterogeneity in risk aversion is sufficiently high, then some high-risk individuals (the risk-tolerant ones) will obtain lower coverage than some low-risk individuals (the risk-averse ones). Third, we show that when the average man and woman differ only in risk aversion, gender discrimination may lead to a Pareto improvement.
    Keywords: insurance markets, asymmetric information, screening, gender discrimination, positive correlation test
    JEL: D82 G22
    Date: 2012–02
  16. By: Roberto Burguet; Marcelo Soto
    Abstract: The Millennium Declaration (2000) set as one of its targets a substantial reduction in child mortality. This paper studies whether the massive increase in development aid can account for part of the reduction in child mortality observed in developing countries since the year 2000. To do so, we analyze a panel of more than 130 developing countries over the 2000-2008 period. We use the time trend evolution of aid to identify an exogenous source of variation. Total aid has had no statistically significant effect on child mortality. However, a disaggregate analysis identifies certain sectors of aid that have had a significant impact. The effects have been larger in high mortality countries, including Sub-Saharan Africa. Projections based on our estimates strongly support the concern that most countries in that region will miss the Millennium Goals target on child mortality.
    Keywords: ODA, child mortality, aid effectiveness
    JEL: O11 O15 I15
    Date: 2011–11
  17. By: Roberto Burguet; Marcelo Soto
    Abstract: Aid for fighting infectious and parasitic diseases has had a statistically significant role in the under-five mortality reduction in the last decade. Point estimates indicate a country average reduction of 1.4 deaths per thousand under fives live-born attributable to aid at its average level in 2000-2010. The effect would be an average drop of 3.3 in the under-five mortality rate at the aid levels of 2010. By components, a dollar per capita spent in fighting malaria has caused the largest average impact, statistically higher than a dollar per capita spent in STD/HIV control. We do not find statistically significant effects of other infectious disease aid, including aid for the control of tuberculosis.
    Keywords: ODA, child mortality, infectious diseases
    JEL: F35 J13 O15
    Date: 2012–03
  18. By: Daniel McFadden; Carlos Noton; Pau Olivella
    Abstract: This expository paper describes the factors that contribute to failure of health insurance markets, and the regulatory mechanisms that have been and can be used to combat these failures. Standardized contracts and creditable coverage mandates are discussed, along with premium support, enrollment mandates, guaranteed issue, and risk adjustment, as remedies for selection-related market damage. An overall conclusion of the paper is that the design and management of creditable coverage mandates are likely to be key determinants of the performance of the health insurance exchanges that are a core provision of the PPACA of 2010. Enrollment mandates, premium subsidies, and risk adjustment can improve the stability and relative efficiency of the exchanges, but with carefully designed creditable coverage mandates are not necessarily critical for their operation.
    Keywords: health insurance; adverse selection; health care reform; creditable coverage
    JEL: D4 D62 I18
    Date: 2012–03

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