|
on Health Economics |
| By: | Jan Marcus |
| Abstract: | Studies on health effects of unemployment usually neglect spillover effects on spouses. This study specifically investigates the effect of an individual’s unemployment on the mental health of their spouse. In order to allow for causal interpretation of the estimates, it focuses on an exogenous entry into unemployment (i.e. plant closure), and combines difference-in-difference and matching based on entropy balancing to provide robustness against observable and time-invariant unobservable heterogeneity. Using German Socio-Economic Panel Study data the paper reveals that unemployment decreases the mental health of spouses almost as much as for the directly affected individuals. The findings highlight that previous studies underestimate the public health costs of unemployment as they do not account for the potential consequences for spouses. |
| Keywords: | Unemployment, mental health, plant closure, entropy balancing, matching, job loss |
| JEL: | I12 J65 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwsop:diw_sp488&r=hea |
| By: | AfDB |
| Date: | 2012–05–14 |
| URL: | http://d.repec.org/n?u=RePEc:adb:adbw12:380&r=hea |
| By: | Daysal, N. Meltem (Tilburg University); Trandafir, Mircea (University of Sherbrooke); van Ewijk, Reyn (University of Mainz) |
| Abstract: | Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogeneity in location of birth, we exploit the exogenous variation in distance from a mother's residence to the closest hospital. We find that giving birth in a hospital leads to substantial reductions in newborn mortality. We provide suggestive evidence that proximity to medical technologies may be an important channel contributing to these health gains. |
| Keywords: | medical technology, birth, home birth, mortality |
| JEL: | I11 I12 I18 J13 |
| Date: | 2012–09 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp6879&r=hea |
| By: | Maura Francese (Structural Economic Analysis Department – Economics, Research and International Relations Area, Bank of Italy, Italy); Massimiliano Piacenza (Department of Economics and Statistics (Dipartimento di Scienze Economico-Sociali e Matematico-Statistiche), University of Torino, Italy); Marzia Romanelli (Structural Economic Analysis Department – Economics, Research and International Relations Area, Bank of Italy, Italy); Gilberto Turati (Department of Economics and Statistics (Dipartimento di Scienze Economico-Sociali e Matematico-Statistiche), University of Torino, Italy) |
| Abstract: | The upward trend in the incidence of caesarean deliveries is a widespread stylised fact in many countries. Several studies have argued that it does not reflect, at least in part, patients’ needs but that it is also influenced by other factors, such as providers/physicians incentives. Not surprisingly, the incidence of caesarean sections is often used as an indicator of the degree of (in)appropriateness in health care, which has also been found to be strongly correlated with excessive expenditure levels. In this paper, we exploit the significant regional variation in the share of caesarean sections recorded in Italy to explore the impact on inappropriateness of three groups of variables: 1) structural supply indicators (e.g., the incidence of private providers); 2) pricing policies (role of DRG tariffs); 3) political economy indicators (to capture different approaches to the governance of the health care sector). The analysis controls for demand side factors, such as the demographic structure of the population and education levels. The results suggest that DRG tariffs might be an effective policy tool to control inappropriateness, once the composition of the regional health care system – in terms of private vs. public providers – is taken into account. Also some characteristics of regional governments and the funding sources of regional health spending do matter. |
| Keywords: | health care, inappropriateness, regional disparities, pricing policy, political economy |
| JEL: | D78 H75 I18 L33 |
| Date: | 2012–02 |
| URL: | http://d.repec.org/n?u=RePEc:tur:wpapnw:001&r=hea |
| By: | Harry Clarke (Department of Economics, La Trobe University); David Prentice (Department of Economics, La Trobe University) |
| Abstract: | The Australian Parliament has passed legislation compelling tobacco products to be sold in ?plain packaging?. This paper reviews this legislation and its likely effects on prices, market structure in the tobacco industry and on smoking behaviour. Industry changes following two previous sets of restrictions on advertising are examined for relevant empirical evidence. Without offsetting tax increases the legislation will plausibly reduce prices but significant entry into the industry and greater consumption of counterfeit/illegal cigarettes are unlikely. Provided that tax increases offset any induced fall in prices that might result, plain packaging will reduce cigarette consumption. |
| Keywords: | Cigarettes, Plain Packaging, Competition, Concentration, Advertising, Entry, Exit |
| JEL: | I18 K2 K32 L11 L13 L66 M37 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:trb:wpaper:2012.03&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | On 11 September 2012, the Subcommittee on Healthcare and Technology of the United States House Committee on Small Business led by Chairwoman Renee Ellmers (R-NC) and Ranking Member Cedric Richmond (D-LA) held a hearing on Medicare’s Durable Medical Equipment Competitive Bidding Program, which is in its pilot stage, but soon is to expand to over one-half of the country. The program is administered by the Centers for Medicare and Medicaid Services (CMS). Under the 2003 Medicare Modernization Act, Congress mandated CMS to identify providers and price home medical equipment through competitive bid. The hearing helped illuminate the serious problems with the current program. As an auction expert and someone quite knowledgeable with both CMS’ current program and the stakeholders’ Market Pricing Program, which replaces the current program with a modern efficient auction, I provide comments on CMS’ testimony. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:12cmafc&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | On November 2, nearly one year after bids were taken for the Centers for Medicare and Medicaid Services (CMS) auction for durable medical equipment, CMS announced the winning bidders. This paper examines the change in market structure in each of the nine service areas for the three largest product categories—CPAP, Diabetes, and Oxygen. The change in market structure is dramatic. The vast majority of existing suppliers both by volume and number will be excluded from supplying Medicare beneficiaries. This radical transformation of the industry is the result of a fatally flawed auction design and not the outcome of an efficient competitive process. The result will be immediate harm to Medicare beneficiaries and the vast majority of Medicare providers in the nine service areas covered by the auction. Beneficiaries will face poor service, selective fulfillment of orders, fraud, and other abuses. Existing suppliers will have to lay off employees and in many cases cease operation. The disruption in terms of job loss and involuntary supplier substitution will be large. Fortunately, the troubled program is still in the pilot stage, so the harm will be limited to the millions of Medicare beneficiaries and thousands of Medicare suppliers in the nine service areas covered in the pilot. Nonetheless, Congress and CMS should immediately stop the implementation of the Round 1 Rebid and move quickly to address the design flaws before the program is scaled up to the entire nation. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:11cmaf&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | We examine the theoretical properties of the auction for Medicare Durable Medical Equipment. Two unusual features of the Medicare auction are 1) bids are non-binding and 2) winners are paid the median winning bid. These two features lead to complete market failure. Lowball bids result in a price that is below each bidder’s cost, so no quantity is supplied. In sharp contrast, the standard clearing-price auction has each bidder bid true costs as a dominant strategy, resulting in competitive equilibrium prices and full efficiency. Recent Caltech experiments (Merlob, Plott, and Zhang 2012) confirm these theoretical findings. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:12cekdtf&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | An auction design for Medicare Durable Medical Equipment is presented. The design addresses the flaws in the current program. Bids are binding commitments. Each bid binds the bidder to particular performance obligations depending on the auction outcome. The bids are made credible through a rigorous qualification one month before the auction. Each bidder provides a financial guarantee in the form of a bid bond or a deposit in proportion to the bidder’s capacity. Capacity is objectively estimated based on the bidder’s supply in recent years, with the most recent year given the most weight. Each winner provides a performance guarantee in proportion to the winner’s estimated volume won. The auction establishes a market clearing price for each product in each service area. The price paid to all suppliers is the clearing price that balances supply and demand. These prices are found in a simultaneous descending clock auction, a simple price discovery process that allows both substitution across items and complementarities. Competition in the auction comes from new entry or the expansion of existing suppliers into new product categories and service areas. After the auction, the winners compete for Medicare beneficiaries by offering quality products and services. Thus, beneficiary choice is used to further strengthen incentives to provide high quality products and services. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:11cadm&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | In the fall of 2010, 167 auction experts from top universities around the country sent a letter to Congress expressing concern regarding the Centers for Medicare and Medicaid Services (CMS) planned implementation of the durable medical equipment (DME) competitive bidding program which was scheduled to be begin in nine cities beginning January 2011. In June of 2011, 244 economists, computer scientists, and engineers from top universities across the country, including four Nobel laureates, wrote the White House warning that continued implementation of the current CMS competitive bidding program would lead to market failure and thereby deny seniors access to this critical health care benefit while increasing health care costs. Pursuant to a Freedom of Information Request (FOIA), CMS has now released startling new data which demonstrates how destructive the current competitive bidding program was in its first year of implementation. The following is an analysis of this recently released data and recommendations of how Congress can address these problems before the program is expanded to 91 cities across the country. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:12chcfma&r=hea |
| By: | Ian Ayres; Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | Economists and other auction experts agree that using administrative prices from 25 years ago to set Medicare prices is a bad idea, and that a much better approach is to price Medicare supplies in competitive auctions. That is not surprising. What is surprising is the degree of consensus that Medicare’s shift to auctions is fatally flawed and must be fixed for the Medicare auctions to succeed in lowering costs while maintaining quality for medical equipment and supplies. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:10acfm&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | One sensible way to reduce healthcare costs is to harness market forces, where practical, to nurture competition and innovation. Lower prices and improved services should follow. However, the switch to market pricing is not an easy one. Medicare’s experience with medical supplies illustrates the challenges and offers some important lessons. The key lesson is that government programs can benefit from introducing market methods, but doing so requires good market design—something that may not come naturally to the implementing agency, especially in light of political forces and organizational inertia. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:10ckrhc&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | Our Economists’ Voice column of October 2010 summarized the severe problems with the current and proposed Medicare auctions. The column was based on a careful reading and analysis of the auction rules. Since that time we and other auction experts have studied the Medicare auctions with theory, experiment, and the limited amount of field data that the Centers for Medicare and Medicaid Services (CMS) has made available. This substantial body of evidence is available at www.cramton.umd.edu/papers/health-care. The evidence strongly supports our preliminary analysis that the auction program is fatally flawed and must be fixed. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:11ckev&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | Chairwoman Ellmers, Ranking Member Richmond, and members of the House Committee on Small Business, I am honored to appear before you today and have this opportunity to speak to such a critical committee on a matter of great significance to our future: Medicare auction reform. Without the effective use of market methods to control costs and encourage efficient supply and demand, Medicare is unsustainable. This is why it is essential for Congress to step in and insist that the Centers for Medicare and Medicaid Services (CMS) replace its fatally-flawed competitive bidding program for Durable Medical Equipment with a modern auction based on best-practice and science (see Market Pricing Program Summary 2012). CMS has had ten years to adopt a sensible auction, but has refused to do so. Congress must give CMS more specific instructions. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:12cmaft&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland); Ulrich Gall; Pacharasut Sujarittanonta |
| Abstract: | On 1 April 2011, 110 stakeholders in the Medicare Durable Medical Equipment (DME) industry came to the University of Maryland to discuss how the CMS’ current competitive bidding program could be improved. The participants included Medicare providers, government leaders, and auction experts. A major part of the event was the conduct of a mock auction based on the auction design proposed in Cramton (2011a). This design addresses the fatal flaws in the CMS design (Letter from experts 2010, 2011). The proposed design has been shown to be highly effective in theory (Cramton et al. 2011), in the experimental lab (Merlob et al. 2010), and in practice (Ausubel and Cramton 2004, 2006). This paper presents the mock auction results. The mock auction demonstrated the feasibility of the proposal as well as its excellent performance. Despite the complex bidding environment, the mock auction achieved high levels of economic efficiency: 97% of the potential gains from trade were realized. Moreover, the participants were able to understand the auction format and auction platform, and successfully execute bidding strategies for 6 products in 9 regions, all in a matter of hours. The conference also demonstrated the advantages of advancing the Medicare auctions through collaboration among industry, government, and auction experts. To avoid program failure, the Medicare auctions must be reformed to take advantage of modern auction methods. The mock auction demonstrates the high efficiency of the proposed approach. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:10cgsma&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | The Medicare Auction Conference, sponsored by the National Science Foundation and the University of Maryland, was an opportunity for collaboration among the stakeholders of the Medicare DME Competitive Bidding program: DME providers, Medicare beneficiaries, government agencies, Congressional staff, and auction experts. The Medicare auction program is currently in a pilot stage, but will soon be expanding nationwide (with Round 2). The conference provided an opportunity to debate the basic issues as well as learn about the latest auction methods that could simplify and improve the effectiveness and sustainability of the auction program. In addition, the conference provided a forum to debate whether auctions are feasible in the Medicare setting and how they can best be structured. On 1 April 2011, 110 stakeholders in the Medicare Durable Medical Equipment (DME) industry came to the University of Maryland to discuss how the CMS’ current competitive bidding program could be improved. The participants included Medicare providers, government leaders, and auction experts. A major part of the event was the conduct of a mock auction based on the auction design proposed in Cramton (2011a). This design addresses the fatal flaws in the CMS design (Letter from experts 2010, 2011). The proposed design has been shown to be highly effective in theory (Cramton et al. 2012), in the experimental lab (Merlob et al. 2012), and in practice (Ausubel and Cramton 2004, 2006). This paper presents the mock auction results. The mock auction demonstrated the feasibility of the proposal as well as its excellent performance. Despite the complex bidding environment, the mock auction achieved high levels of economic efficiency: 97% of the potential gains from trade were realized. Moreover, the participants were able to understand the auction format and auction platform, and successfully execute bidding strategies for 6 products in 9 regions, all in a matter of hours. The conference also demonstrated the advantages of advancing the Medicare auctions through collaboration among industry, government, and auction experts. To avoid program failure, the Medicare auctions must be reformed to take advantage of modern auction methods. The mock auction demonstrates the high efficiency of the proposed approach. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:10cmac&r=hea |
| By: | Peter Cramton (Economics Department, University of Maryland) |
| Abstract: | We are economists, computer scientists and engineers with expertise in the theory and practice of auctions. In September 2010, many of us signed a letter to Congressional leaders pointing out the numerous fatal flaws in the current Medicare competitive bidding program for durable medical equipment (DME). We also emphasized that the flaws could easily be fixed by adopting modern auction methods that have been developed over the last fifteen years and are now well-understood. The flaws in the auctions administered by the Centers for Medicare and Medicaid Services (CMS) are numerous. The use of non-binding bids together with setting the price equal to the median of the winning bids provides a strong incentive for low-ball bids—submitting bids dramatically below actual cost. This leads to complete market failure in theory and partial market failure in the lab. Another problem is the lack of transparency. For example, bidder quantities are chosen arbitrarily by CMS, enabling a wide range of prices to emerge that have no relation to competitive market prices. We write today, nine months later, to report that—much to our dismay—there are to date no signs that CMS has responded to the professional opinions of auction experts or taken any serious steps to fix the obvious flaws to the competitive bidding program. Rather CMS continues to recite the mantra that all is well and that CMS does not plan to make any changes to the program as it expands from nine pilots to the entire United States. |
| Keywords: | Medicare auctions, health care auctions, procurement auctions |
| JEL: | D44 I18 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pcc:pccumd:11lto&r=hea |
| By: | Boris Augurzky; Thomas K. Bauer; Arndt R. Reichert; Christoph M. Schmidt; Harald Tauchmann |
| Abstract: | We test whether financial incentives have an effect on weight reduction in a randomized controlled trial involving 700 obese persons assigned to three experimental groups. While two treatment groups obtain Euro150 and Euro300, respectively, for achieving an individually assigned target weight within four months, a control group receives no such premium. The results indicate that the weight losses for the treatment groups are 2.6 and 2.9 percentage points higher than that achieved by the control group, raising the average total weight loss for the incentivized groups to 5 percent of the initial weight. This percentage is typically regarded as a threshold to improve the health status of the obese. Further evidence indeed indicates some health improvements. The higher reward causes only the group of obese women to lose more weight. Overall, the results suggest that financial incentives can motivate people to lose weight significantly. |
| Keywords: | Randomized experiment; financial incentives for weight loss; obesity; nonrandom sample attrition; effect heterogeneity |
| JEL: | I10 I18 H23 C93 |
| Date: | 2012–09 |
| URL: | http://d.repec.org/n?u=RePEc:rwi:repape:0368&r=hea |
| By: | Timothy Guinnane; Jochen Streb |
| Abstract: | The German government introduced compulsory accident insurance for industrial firms in 1884. This insurance scheme was one of the main pillars of Bismarck’s famous social insurance system. The accident-insurance system achieved only one of its intended goals: it successfully compensated workers and their survivors for losses due to accidents. The accident-insurance system was less successful in limiting the growth of work-related accidents, although that goal had been a reason for the system’s creation. We trace the failure to stem the growth of accidents to faulty incentives built into the 1884 legislation. The law created mutual insurance groups that used an experiencerating system that stressed group rather than firm experience, leaving firms with little hope of saving on insurance contributions by improving the safety of their own plants. The government regulator increasingly stressed the imposition of safety rules that would force all firms to adopt certain safety practices. Econometric analysis shows that even the flawed tools available to the insurance groups were powerful, and that more consistent use would have reduced industrial accidents earlier and more extensively. |
| Keywords: | Social insurance; accident insurance; workman‘s compensation; regulation |
| JEL: | N33 G22 H55 |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:rwi:repape:0364&r=hea |
| By: | Carlo Alcaraz; Daniel Chiquiar; María José Orraca; Alejandrina Salcedo |
| Abstract: | In this paper we study the causal effect of a large expansion of publicly provided health insurance on children's academic performance using the case of Mexico. In general, access to free health insurance could improve education outcomes directly by making household members healthier or indirectly by raising the amount of resources available for education expenses. Using a panel of municipalities from 2007 to 2009, we find that the expansion of the Mexican public health insurance program, Seguro Popular, had a positive, statistically significant effect on standardized test scores of primary school children. |
| Keywords: | Health insurance, Public health, Seguro Popular, Mexico, Education, Test scores. |
| JEL: | I15 I25 I38 |
| Date: | 2012–09 |
| URL: | http://d.repec.org/n?u=RePEc:bdm:wpaper:2012-10&r=hea |
| By: | Rabassa, Mariano; Skoufias, Emmanuel; Jacoby, Hanan G. |
| Abstract: | The effect of weather shocks on children's anthropometrics is investigated using the two most recent rounds of the Nigeria Demographic and Health Survey. For this purpose, climate data for each survey cluster are interpolated using daily weather-station records from the national network. The findings reveal that rainfall shocks have a statistically significant and robust impact on child health in the short run for both weight-for-height and height-for-age, and the incidence of diarrhea. The impacts of weather shocks on health are of considerable magnitude; however, children seem to catch up with their cohort rapidly after experiencing a shock. The paper does not find any evidence of nonlinear impacts of weather variability on children's health, suggesting that a moderate increase in future rainfall variability is not likely to bring additional health costs. Finally, it appears that the impact of these shocks is the same for young boys and girls, which suggests that there is no gender-based discrimination in the allocation of resources within households. |
| Keywords: | Health Monitoring&Evaluation,Science of Climate Change,Environmental Economics&Policies,Disease Control&Prevention,Climate Change Mitigation and Green House Gases |
| Date: | 2012–10–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:6214&r=hea |
| By: | Witter, Sophie; Somanathan, Aparnaa |
| Abstract: | Demand-side financing approaches have been introduced in a number of low and middle-income countries, with a particular emphasis on sexual and reproductive health. This paper aims to bring together the global evidence on demand-side financing mechanisms, their impact on the delivery of sexual and reproductive health services, and the conditions under which they have been effective. The paper begins with a discussion of modalities for demand-side financing. It then examines 13 existing schemes, including cash incentives, vouchers, and longer term social protection policies. Based on the available literature, it collates evidence of their impact on utilization of services, access for the poor, financial protection, quality of care, and health outcomes. Evidence on costs and cost-effectiveness are examined, along with analysis of funding and sustainability of policies. Finally, the paper discusses the preconditions for effectiveness of demand-side financing schemes and the strengths and weaknesses of different approaches. It also highlights the extent to which results for sexual and reproductive health services are likely to be generalizable to other types of health care. It is clear that some of these policies can produce impressive results, if the preconditions for effectiveness outlined are met. However, relatively few demand-side financing schemes have benefited from robust evaluation. Investigation of the impact on financial protection, equity, and health outcomes has been limited. Most importantly, cost effectiveness and the relative cost effectiveness of demand-side financing in relation to other strategies for achieving similar goals have not been assessed. |
| Keywords: | Health Monitoring&Evaluation,Population Policies,Health Systems Development&Reform,Adolescent Health,Housing&Human Habitats |
| Date: | 2012–10–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:6213&r=hea |
| By: | Jing Liu; Brigitte Waldorf (Department of Agricultural Economics, College of Agriculture, Purdue University, W. Lafayette, IN) |
| Abstract: | The paper focuses on body weight gain among immigrants in the US. The emphasis is on disentangling different time lines that are relevant in the context of immigration and acculturation, namely length of exposure to the high obesity culture, age at immigration, year of immigration and aging. Using data from the National Latino and Asian American Study (NLAAS), we find that (1) acculturation is associated with higher BMIs for the 1st generation, but not the 1.5 generation; (2) immigration at an early age (before 12) facilitates acculturation progress and drives BMI convergence to natives; (3) the effect of sojourn length in the host country is unstable across model specifications; (4) BMI differences between Asian and Latino immigrants are partly due to effect size differences in the acculturation variables. |
| Keywords: | immigration, obesity, acculturation |
| JEL: | I10 J15 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:pae:wpaper:12-1&r=hea |
| By: | Jocelyn E. Finlay (Harvard Center for Population and Development Studies); David Canning (Harvard Center for Population and Development Studies); June Y. T. Po (Harvard Center for Population and Development Studies) |
| Abstract: | We develop an index of reproductive health laws around the world. Laws regarding abortion, contraceptive pill, condom, intrauterine device, and sterilization are detailed for 186 countries from 1960 through to 2009. Using qualitative information dating from the 1960s, we code information on reproductive health laws around the world into panel data. In this paper we summarize the indexation of the laws, detailing the sources and methodologies we used to create the index. We show changes in the laws over time, and compare laws across countries. In addition, we demonstrate the potential use of the panel data by exploring the differential liberalization of reproductive health laws across country-level socioeconomic factors. We show that countries with more liberal abortion laws associated with higher income per capita, higher levels of female education, and lower fertility rates. |
| Keywords: | Fertility, Reproductive Health Laws, Abortion, Contraception |
| Date: | 2012–10 |
| URL: | http://d.repec.org/n?u=RePEc:gdm:wpaper:9612&r=hea |
| By: | Mary C. Daly; Daniel J. Wilson; Norman J. Johnson |
| Abstract: | We assess the importance of interpersonal income comparisons using data on suicide deaths. We examine whether suicide risk is related to others’ income, holding own income and other individual and environmental factors fixed. We estimate models of the suicide hazard using two independent data sets: (1) the National Longitudinal Mortality Study and (2) the National Center for Health Statistics’ Multiple Cause of Death Files combined with the 5 percent Public Use Micro Sample of the 1990 decennial census. Results from both data sources show that, controlling for own income and individual characteristics, individual suicide risk rises with others’ income. |
| Keywords: | Income distribution ; Suicide ; Happiness |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedfwp:2012-16&r=hea |
| By: | Michelle Sovinsky (University of Zurich); Steven Stern (University of Virginia) |
| Abstract: | This paper describes and analyzes research on the dynamics of long-term care and suggests directions for the literature to make progress. We discuss sources and causes of dynamics including inertia/state dependence (confounded by unobserved heterogeneity); match-speciÂ…c effects; and costs of changing caregivers. We comment on causes of dynamics including learning/human capital accumulation; burnout; and game playing. We suggest how to deal with endogenous geography; dynamics in discrete and continuous choices; and equilibrium issues (multiple equilibria, dynamic equilibria). Next, we evaluate the advantages of different potential data sources (NLTCS, PSID, AHEAD/HRS, SHARE, ELSA) and identify fiÂ…rst order data problems including noisy measures of wealth and family structure. We suggest some methods to handle econometric problems such as endogeneity (work, geography) and measurement error. Finally, we discuss potential policy implications of dynamics including the effect of dynamics on parameter estimates and direct policy implications of inertia (implications for family welfare, parent welfare, child welfare, and cost of government programs). |
| Keywords: | Long-Term Care, Dynamic Models |
| JEL: | C51 C61 J14 |
| Date: | 2012–06 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2012-019&r=hea |
| By: | Holger Strulik; Katharina Werner |
| Abstract: | We set up a simple overlapping generation model that allows us to distinguish between life expectancy and active life expectancy. We show that individuals optimally adjust to a longer active life by educating more and, if the labor supply elasticity is high enough, by supplying less labor. When calibrated to US data the model explains the historical evolution of increasing education and declining labor supply (of cohorts born 1850-1950) as an optimal response to increasing active life expectancy. We integrate the theory into a unified growth model and reestablish increasing life expectancy as an engine of long-run economic development. |
| Keywords: | longevity, active life expectancy, education, hours worked, economic growth |
| JEL: | E20 I25 J22 O10 O40 |
| Date: | 2012–09–18 |
| URL: | http://d.repec.org/n?u=RePEc:got:cegedp:141&r=hea |
| By: | Isaac Ehrlich; Yong Yin |
| Abstract: | The problem of the uninsured – those eschewing the purchase of health insurance policies – cannot be fully understood without considering informal alternatives to market insurance called “self-insurance” and “self-protection”, including the publicly and charitably-financed safety-net health care system. This paper tackles the problem of the uninsured by formulating a “full-insurance” paradigm that includes all 4 measures of insurance as interacting components, and analyzing their interdependencies. We apply both a baseline and extended versions of the model through calibrated simulations to estimate the degree to which these non-market alternatives can account for the fraction of the non-elderly adults who are uninsured, and estimate their behavioral and policy ramifications. Our results indicate that policy analyses that do not consider the role of self-efforts to avoid health losses can grossly distort the success of the ACA mandate to insure the uninsured and to improve the health and welfare outcomes of the previously uninsured. |
| JEL: | G22 H42 I28 |
| Date: | 2012–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18444&r=hea |
| By: | FUJII Mayu; OSHIO Takashi; SHIMIZUTANI Satoshi |
| Abstract: | Using panel data from two surveys in Japan and Europe, we examine the comparability of the self-rated health (SRH) of the middle-aged and elderly across Japan and the European countries and the survey periods. We find that a person's own health is evaluated on different standards (thresholds) across the different countries and survey waves. When evaluated on common thresholds, the Japanese elderly are found to be healthier than their counterparts in the European countries. At the individual level, reporting biases leading to discrepancies between the changes in individuals' SRH and their actual health over the survey waves are associated with age, education, and country of residence. |
| Date: | 2012–10 |
| URL: | http://d.repec.org/n?u=RePEc:eti:dpaper:12061&r=hea |
| By: | Michael P. Cameron (University of Waikato); Peter A. Newman (University of Toronto); Surachet Roungprakhon (Rajamangala University of Technology Phra Nakhon); Riccardo Scarpa (University of Waikato) |
| Abstract: | This paper estimates the marginal willingness-to-pay for attributes of a hypothetical HIV vaccine using discrete choice modeling. We use primary data from 326 respondents from Bangkok and Chiang Mai, Thailand, in 2008-2009, selected using purposive, venue-based sampling across two strata. Participants completed a structured questionnaire and full rank discrete choice modelling task administered using computer-assisted personal interviewing. The choice experiment was used to rank eight hypothetical HIV vaccine scenarios, with each scenario comprising seven attributes (including cost) each of which had two levels. The data were analyzed in two alternative specifications: (1) best-worst; and (2) full-rank, using logit likelihood functions estimated with custom routines in Gauss matrix programming language. Knowledge of the relative importance of determinants of HIV vaccine acceptability is important to ensure the success of future vaccination programs. Future acceptability studies of hypothetical HIV vaccines should use more finely-grained biomedical attributes, and could also improve the external validity of results by including more levels of the cost attribute. |
| Keywords: | HIV vaccine; willingness-to-pay; conjoint analysis; discrete choice; Thailand |
| JEL: | I19 |
| Date: | 2012–09–30 |
| URL: | http://d.repec.org/n?u=RePEc:wai:econwp:12/11&r=hea |