nep-hea New Economics Papers
on Health Economics
Issue of 2012‒12‒06
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. A New Approach for Assessing Sleep Duration and Postures from Ambulatory Accelerometry By Cornelia Wrzus; Andreas M. Brandmaier; Timo von Oertzen; Viktor Müller; Gert G. Wagner; Michaela Riediger
  2. Aid Effectiveness in the Health Sector By Acharya, Arnab; Alvarez, Melisa Mart.nez
  3. Mutual health insurance and its contribution to improving child health in Rwanda By Binagwaho, Agnes; Hartwig, Renate; Ingeri, Denyse; Makaka, Andrew
  4. Consistency in preferences for road safety: An analysis of precautionary and stated behavior By Andersson, Henrik
  5. Privatization and Quality: Evidence from Elderly Care in Sweden By Spagnolo, Giancarlo; Bergman, Mats A.; Lundberg, Sofia
  6. Competition, Gatekeeping, and Health Care Access By Godager, Geir; Iversen, Tor; Albert Ma, Ching-to
  7. Direct and indirect costs of the Norwegian Breast Cancer Screening Program By Moger, Tron Anders; Kristiansen, Ivar Sønbø
  8. The Consequences of Measurement Error when Estimating the Impact of BMI on Labour Market Outcomes By Donal O'Neill; Olive sweetman
  9. Mortality Convergence Across High-Income Countries : An Econometric Approach. By Hippolyte d'Albis; Loesse Jacques Esso; Héctor Pifarré i Arolas
  10. Weather and Infant Mortality in Africa By Kudamatsu, Masayuki; Persson, Torsten; Strömberg, David
  11. Care and the Capability of Living a Healthy Life in a Gender Perspective By Tindara Addabbo; Marco Fuscaldo; Anna Maccagnan
  12. Holding Out or Opting Out? Deciding Between Retirement and Disability Applications in Recessions By Matthew S. Rutledge
  13. New Estimates of the Value of a Statistical Life Using Air Bag Regulations as a Quasi-Experiment By Rohlfs, Chris; Sullivan, Ryan; Kniesner, Thomas J.
  14. Long Run Impacts of Childhood Access to the Safety Net By Hilary W. Hoynes; Diane Whitmore Schanzenbach; Douglas Almond
  15. The Effect of Pharmaceutical Innovation on Longevity: Patient-Level Evidence from the 1996-2002 Medical Expenditure Panel Survey and Linked Mortality Public-Use Files By Frank R. Lichtenberg
  16. Tax Compliance and Psychic Costs: Behavioral Experimental Evidence Using a Physiological Marker By Uwe Dulleck; Jonas Fooken; Cameron Newton; Andrea Ristl; Markus Schaffner; Benno Torgler

  1. By: Cornelia Wrzus; Andreas M. Brandmaier; Timo von Oertzen; Viktor Müller; Gert G. Wagner; Michaela Riediger
    Abstract: Interest in the effects of sleeping behavior on health and performance is continuously increasing–both in research and with the general public. Ecologically valid investigations of this research topic necessitate the measurement of sleep within people’s natural living contexts. We present evidence that a new approach for ambulatory accelerometry data offers a convenient, reliable, and valid measurement of both people’s sleeping duration and quality in their natural environment. Ninety-two participants (14–83 years) wore acceleration sensors on the sternum and right thigh while spending the night in their natural environment and following their normal routine. Physical activity, body posture, and change in body posture during the night were classified using a newly developed classification algorithm based on angular changes of body axes. The duration of supine posture and objective indicators of sleep quality showed convergent validity with self-reports of sleep duration and quality as well as external validity regarding expected age differences. The algorithms for classifying sleep postures and posture changes very reliably distinguished postures with 99.7% accuracy. We conclude that the new algorithm based on body posture classification using ambulatory accelerometry data offers a feasible and ecologically valid approach to monitor sleeping behavior in sizable and heterogeneous samples at home.
    Date: 2012
  2. By: Acharya, Arnab; Alvarez, Melisa Mart.nez
    Abstract: This paper explores the current evidence underlying the debate on aid effectiveness, with a specific focus on the health sector. It summarizes the history of aid and outlines the methodological challenges encountered when assessing its effectiveness. The
    Keywords: aid effectiveness, health, fungibility, harmonization
    Date: 2012
  3. By: Binagwaho, Agnes; Hartwig, Renate; Ingeri, Denyse; Makaka, Andrew
    Abstract: Rwanda is among the few countries in Sub-Saharan Africa and the developing approaching universal health insurance coverage. To date, over 90 per cent of the population are enrolled in the Mutuelles de Santé - a system that started off from a number of stand-alone community based health insurance schemes and gradually evolved into a unified social health insurance plan. The country has also made remarkable progress in ameliorating child health, particularly since 2005, which coincides with the year when the Mutuelles de Santé was standardised and raises the question to what extent the insurance scheme did contribute to the observed improvements. In order to address this issue we conduct a quantitative impact evaluation using nationally representative micro-data from the 2005 and 2010 Rwandan Demographic and Health Surveys (RDHSs) and also consider potential channels from which improvements could originate. Our results suggest the following: The Mutuelles de Santé improves access to preventative and curative health services. Insured households are more sensitive to health issues, in the sense that they are more inclined to use bed nets and ensure safe drinking water. Despite a weak effect on health outcomes overall, the insurance scheme seems to have contributed to improvements in stunting and mortality, at the critical ages (before the age of two). --
    Keywords: Health Insurance,Child Health,Mutuelles de Santé,Rwanda
    JEL: I11 I38 J13
    Date: 2012
  4. By: Andersson, Henrik
    Abstract: This study analyzes stated willingness to pay (WTP) for trafic safety, the use of trafic safety equipments, and the consistency between the two. Using data from a Swedish contingent valuation study we find that the estimated value of a statistical life (VSL) based on the respondents' rear- seatbelt usage is similar to the estimate found using the respondents' stated WTP. However, when estimating VSL based on the respondents' use of bicycle helmets we find a significantly higher VSL; the VSL from bicycle-helmet usage is 7 times higher than the estimate based on seatbelt usage. Moreover, we do not find any strong relationship between risk perception and usage, or individual stated WTP and usage. Hence, the main conclusion, based on our analysis, is that stated and observed WTP are not consistent.
    Keywords: Revealed preferences; Road safety; Stated preferences; Value of a statistical life; Willingness to pay
    Date: 2012–11
  5. By: Spagnolo, Giancarlo (Stockholm Institute of Transition Economics); Bergman, Mats A. (Södertörn University); Lundberg, Sofia (Umeå University)
    Abstract: Many quality dimensions are hard to contract upon and are at risk of degradation when services are procured rather than produced in-house. However, procurement may foster performance-improving innovation. We assemble a large data set on elderly care services in Sweden between 1990 and 2009, including survival rates - our measure of non-contractible quality - and subjectively perceived quality of service. We estimate how procurement from private providers affects these measures using a difference-in-difference approach. The results indicate that procurement significantly increases non-contractible quality as measured by survival rate, reduces the cost per resident but does not affect subjectively perceived quality.
    Keywords: elderly care; incomplete contracts; limited enforcement; mortality; non-contractible quality; outsourcing; nursing homes; performance measurement; perceived quality; privatization; procurement.
    JEL: H57 I18 L33
    Date: 2012–11–09
  6. By: Godager, Geir (Department of Health Management and Health Economics); Iversen, Tor (Department of Health Management and Health Economics); Albert Ma, Ching-to (Department of Economics, Boston University and University of Oslo)
    Abstract: We study the impact of competition on primary care physicians’specialty referrals. Our data come from a Norwegian survey in 2008-9 and Statistics Norway. From the data we construct three measures of competition the number of open primary physician practices with and without population adjustment, and the Her…ndahl-Hirschman Index. We build a theoretical model, and derive two opposing e¤ects of competition on gatekeeping physicians’ specialty referrals. The empirical results suggest that competition has negligible or small positive e¤ects on referrals. Our results do not support the policy claim that increasing the number of primary care physicians reduces secondary care.
    Keywords: primary; care; physicians
    JEL: H51
    Date: 2012–08–01
  7. By: Moger, Tron Anders (Department of Health Management and Health Economics); Kristiansen, Ivar Sønbø (Department of Health Management and Health Economics)
    Abstract: Norway has had a nationwide, biennial public screening program for breast cancer since 2005. The program includes all women aged 50-69 years. The aim of this study was to estimate the total societal costs of one screening round. The cost analysis was based on the number women in the relevant age group, the proportions attending screening, estimated travel time to nearest mammography facility, and the proportion of women having repeat examination. Unit costs were taken from the DRG price list and other sources. The cost of mobile mammography units were based on cost accounts. The total costs of one screening round were estimated to be NOK 521 million (NOK 1,262 per woman attending screening), of which 64% were health care costs, and 36% were travel costs and productivity losses. The total costs of repeat examinations in one screening round for women with suspicious findings or inadequate quality on the screening mammograms were NOK 52.8 million (NOK 3,655 per woman reexamined). NOK 44.4 million of these costs may be due to false positive findings in the screening mammograms.
    Keywords: screening; mammograms; breast cancer
    JEL: H51
    Date: 2012–11–21
  8. By: Donal O'Neill (Department of Economics Finance and Accounting, National University of Ireland, Maynooth); Olive sweetman (Department of Economics Finance and Accounting, National University of Ireland, Maynooth)
    Abstract: This paper uses data on both self-reported and true measures of individual Body Mass Index (BMI) to examine the nature of measurement error in self-reported BMI and to look at the consequences of using self-reported measures when estimating the effect of BMI on economic outcomes. In keeping with previous studies we find that self-reported BMI is subject to significant measurement error and this error is negatively correlated with the true measure of BMI. In our analysis this non-classical measurement error causes the traditional approach to overestimate the relationship between BMI and both income and education. Furthermore we show that popular alternatives estimators that have been adopted to address problems of measurement error in BMI, such as the conditional expectation approach and the instrumental variables approach, also exhibit significant biases.
    Keywords: Obesity, Non-Classical Measurement Error, Auxiliary Data, Instrumental Variables
    JEL: C13 C26 I14
    Date: 2012
  9. By: Hippolyte d'Albis (Centre d'Economie de la Sorbonne - Paris School of Economics); Loesse Jacques Esso (ENSEA - Abidjan); Héctor Pifarré i Arolas (Toulouse School of Economics - LERNA)
    Abstract: This work is devoted to the study of the variations of mortality patterns across a sample of high-income countries since 1960. We study changes in age-at-death distributions through two indicators, life expectancy and Gini coefficient, by applying econometric tools commonly used in the economic growth literature to assess the existence of convergence across the countries in our sample. We contribute to the ongoing debate over the existence of convergence amongst high-income countries in adult mortality by offering two main empirical regularities. First, our results show that the convergence hypothesis is rejected when we consider the entire sample of industrialized countries. Second, we provide evidence of convergence in both the life expectancy and Gini coefficient among a subset of countries and for some subperiods. This constitutes preliminary evidence against the convergence to a common age-at-death stationary distribution but of the existence of convergence clubs.
    Keywords: Age-at-death distributions, convergence.
    Date: 2012–10
  10. By: Kudamatsu, Masayuki; Persson, Torsten; Strömberg, David
    Abstract: We estimate how random weather fluctuations affected infant mortality across 28 African countries in the past, combining high-resolution data from retrospective fertility surveys (DHS) and climate-model reanalysis (ERA-40). We find that infants were much more likely to die when exposed in utero to much longer malaria spells than normal in epidemic malaria regions, and to droughts in arid areas, especially when born in the hungry season. Based on these estimates, we predict aggregate infant deaths in Africa, due to extreme weather events and to maternal malaria in epidemic areas for 1981-2000 and 2081-2100.
    Keywords: climate change; maternal malaria; maternal malnutrition; natural experiments
    JEL: I15 O13 O15 O55 Q54
    Date: 2012–11
  11. By: Tindara Addabbo; Marco Fuscaldo; Anna Maccagnan
    Abstract: This paper deals with the definition of the capability of living a healthy life with special reference to the Italian context. The increasing ageing of Italian population and the higher likelihood for elderly to experience poorer health conditions (Addabbo, Picchio; 2010; Addabbo, Chiarolanza, Fuscaldo, Pirotti, 2010) lead us to focus especially on elderly population and gender differences in the measurement of the development of this capability. Institutional as well family and individual conversion factors are analysed in their interaction with the observed development of the capability of living a healthy life taking a gender perspective. To measure the latter we use both self assessed health status and objective gerontological measures of health conditions available in the Italian sample of the Survey of Health, Ageing, Retirement in Europe (SHARE). The self-completion questionaire, that is submitted only to a part of the whole SHARE sample, allows to gain important information on the household characteristics and in particular on the sharing of different responsibilities within the household (doing the cleaning, caring for children and elderlies, earning money etc.). Part of this information is also retrospective. This allows us to extend our analysis on the measurement of individual current achievement in the capability taking into account how conversion factors can interact with the development of the capability since it allows a long term analysis of their effect.
    Keywords: health
    JEL: I14 J14
    Date: 2012–11
  12. By: Matthew S. Rutledge
    Abstract: Workers over age 55 with chronic health conditions must choose between applying for Social Security Disability Insurance (SSDI) benefits or continuing to work until their Social Security retirement benefits become available. Previous research has investigated the influence of macroeconomic conditions on disability application and, separately, on retirement claiming. This project uses data from the Survey of Income and Program Participation Gold Standard File to determine whether there is a relationship between national and state unemployment rates and disability applications, taking into account the current or future receipt of Social Security retirement benefits. First, reduced-form estimates indicate that retirement beneficiaries are more likely to apply for SSDI as unemployment increases – and, conversely, eligible individuals who have not yet claimed benefits are less likely to apply when unemployment rises. But after accounting for unobserved characteristics associated with both the decision to apply for disability insurance and Social Security benefits, individuals are no more likely to apply for disability benefits when unemployment is high. Second, we find that the probability of SSDI application among individuals age 55-61 is unrelated to macroeconomic conditions and unrelated to proximity to one’s 62nd birthday. These results suggest that, unlike prime-age adults, the decision among older individuals to apply for disability is based primarily on health, and not financial incentives.
    Date: 2012–11
  13. By: Rohlfs, Chris (Syracuse University); Sullivan, Ryan (Naval Postgraduate School); Kniesner, Thomas J. (Syracuse University)
    Abstract: Due to Federal regulations, automobile air bag availability was a model-specific discontinuous function of model year for used vehicles in the 1990s and early 2000s. We use these discontinuities and the gradual increase in the supply of air bags to trace out the demand curve for air bags and the implied distribution of the Value of a Statistical Life (VSL) across consumers. While imprecise, our preferred point estimates indicate that the median VSL is between $7 million and $13 million, but that a sizable portion of consumers placed negative values on air bags, probably due to distrust of the technology.
    Keywords: value of statistical life, VSL, airbags, regression discontinuity design, quasi-experiment
    JEL: J17 R41 I18 K32 L62 D12 D61 H40
    Date: 2012–11
  14. By: Hilary W. Hoynes; Diane Whitmore Schanzenbach; Douglas Almond
    Abstract: A growing economics literature establishes a causal link between in utero shocks and health and human capital in adulthood. Most studies rely on extreme negative shocks such as famine and pandemics. We are the first to examine the impact of a positive and policy-driven change in economic resources available in utero and during childhood. In particular, we focus on the introduction of a key element of the U.S. safety net, the Food Stamp Program, which was rolled out across counties in the U.S. between 1961 and 1975. We use the Panel Study of Income Dynamics to assemble unique data linking family background and county of residence in early childhood to adult health and economic outcomes. The identification comes from variation across counties and over birth cohorts in exposure to the food stamp program. Our findings indicate that the food stamp program has effects decades after initial exposure. Specifically, access to food stamps in childhood leads to a significant reduction in the incidence of “metabolic syndrome” (obesity, high blood pressure, and diabetes) and, for women, an increase in economic self-sufficiency. Overall, our results suggest substantial internal and external benefits of the safety net that have not previously been quantified.
    JEL: H53 I14
    Date: 2012–11
  15. By: Frank R. Lichtenberg
    Abstract: We investigate the effect of the vintage (year of FDA approval) of the prescription drugs used by an individual on his or her survival and medical expenditure. When we only control for age, sex, and interview year, we estimate that a one-year increase in drug vintage increases life expectancy by 0.52%. Controlling for other variables including activity limitations, race, education, family income as a percent of the poverty line, insurance coverage, Census region, BMI, smoking and over 100 medical conditions has virtually no effect on the estimate of the effect of drug vintage on life expectancy. Between 1996 and 2003, the mean vintage of prescription drugs increased by 6.6 years. This is estimated to have increased life expectancy of elderly Americans by 0.41-0.47 years. This suggests that not less than two-thirds of the 0.6-year increase in the life expectancy of elderly Americans during 1996-2003 was due to the increase in drug vintage. The 1996-2003 increase in drug vintage is also estimated to have increased annual drug expenditure per elderly American by $207, and annual total medical expenditure per elderly American by $218. This implies that the incremental cost-effectiveness ratio (cost per life-year gained) of pharmaceutical innovation was about $12,900.
    JEL: I12 J11 O33
    Date: 2012–11
  16. By: Uwe Dulleck (QUT); Jonas Fooken (QUT); Cameron Newton (QUT); Andrea Ristl; Markus Schaffner (QUT); Benno Torgler (QUT)
    Abstract: Although paying taxes is a key element in a well-functioning civilized society, the understanding of why people pay taxes is still limited. What current evidence shows is that, given relatively low audit probabilities and penalties in case of tax evasion, compliance levels are higher than would be predicted by traditional economics-of-crime models. Models emphasizing that taxpayers make strategic, financially motivated compliance decisions, seemingly assume an overly restrictive view of human nature. Law abidance may be more accurately explained by social norms, a concept that has gained growing importance as a facet in better understanding the tax compliance puzzle. This study analyzes the relation between psychic cost arising from breaking social norms and tax compliance using a heart rate variability (HRV) measure that captures the psychobiological or neural equivalents of psychic costs (e.g., feelings of guilt or shame) that may arise from the contemplation of real or imagined actions and produce immediate consequential physiologic discomfort. Specifically, this nonintrusive HRV measurement method obtains information on activity in two branches of the autonomous nervous system (ANS), the excitatory sympathetic nervous system and the inhibitory parasympathetic system. Using time-frequency analysis of the (interpolated) heart rate signal, it identifies the level of activity (power) at different velocities of change (frequencies), whose LF (low frequency) to HF (high frequency band) ratio can be used as an index of sympathovagal balance or psychic stress. Our results, based on a large set of observations in a laboratory setting, provide empirical evidence of a positive correlation between psychic stress and tax compliance and thus underscore the importance of moral sentiment in the tax compliance context.
    Keywords: tax compliance, psychic costs, stress, tax morale, cooperation, heart rate variability, biomarkers, experiment
    JEL: H26 H41 K42 D31 D63 C91
    Date: 2012–11–07

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