nep-hea New Economics Papers
on Health Economics
Issue of 2012‒12‒22
twenty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Causes of mortality and development: Evidence from large health shocks in 20th century America By Casper Worm Hansen
  2. GINI DP 39: Socioeconomic Gradient in Health: How Important is Material Deprivation? By Maite Blázquez Cuesta; Elena Cottini; Herrarte, A. (Ainhoa)
  3. Does the Leader’s Ethnicity Matter? Ethnic Favoritism, Education and Health in Sub-Saharan Africa By Raphaёl Franck; Ilia Rainer
  4. Prices Matter: Comparing Two Tests of Adverse Selection in Health Insurance By Polimeni, Rachel; Levine, David I.
  5. Migraine Headache and Labor Market Outcomes By Rees, Daniel I.; Sabia, Joseph J.
  6. Per Se Drugged Driving Laws and Traffic Fatalities By Anderson, D. Mark; Rees, Daniel I.
  7. The Developmental Approach to Child and Adult Health By Conti, Gabriella; Heckman, James J.
  8. The Economic Consequences of Death in South Africa By Cally Ardington; Till Bärnighausen; Anne Case; Alicia Menendez
  9. The Social Value of Mortality Risk Reduction: VSL vs. the Social Welfare Function Approach By Adler, Matthew; Hammitt, James; Treich, Nicolas
  10. Expert Elicitation of the Value per Statistical Life in an Air Pollution Context By Hammitt, James; Roman, Henry; Stieb, David; Walsh, Tyra
  11. Assessment of a spatial panel model for the efficiency analysis of the heterogonous healthcare systems in the world By Vahidin Jeleskovic; Benjamin Schwanebeck
  12. National Data to Inform Childhood Obesity Prevention Strategies: Beverage, Dietary, and Activity Practices at Home and School. New Haven, CT: Rudd Center for Food Policy, Yale University By Ronette Briefel
  13. Perceptions of Electronic Health Records and Their Effect on the Quality of Care: Results from a Survey of Patients in Four States. Princeton, NJ: Mathematica Policy Research By Jelena Zurovac; Stacy Dale; Martha Kovac
  14. Medicare Advantage 2013 Spotlight: Plan Availablity and Premiums. Menlo Park, CA: The Henry J. Kaiser Family Foundation By Marsha Gold; Gretchen Jacobson; Anthony Damico; Tricia Neuman
  15. Physician Service Use and Participation in Medicaid, 2009. Washington, DC: Mathematica Policy Research By David Baugh; Shinu Verghese
  16. Essays on pensions, health expectancy and credit insurance. By Zheng, J.
  17. Does Famine Matter For Aggregate Adolescent Human Capital Acquisition In Sub-Saharan Africa? By Julius A. Agbor and Gregory N. Price
  18. The declines in infant mortality and fertility: Evidence from British cities in demographic transition By Andrew Newell; Ian Gazeley
  19. The value of private information in the physician-patient relationship: a game-theoretic account By Kris De Jaegher
  20. Assessing Impact of Health Oriented Aid on Infant Mortality Rates By Yousuf, Ahmed Sadek

  1. By: Casper Worm Hansen (Aarhus University)
    Abstract: Exploiting pre-intervention variation in flu/pneumonia, tuberculosis and maternal mortality, together with time variation arising from medical breakthroughs starting in the late 1930s, this paper studies the aggregate impact of large health shocks across US states. The analysis demonstrates that the shocks influenced income per capita in different ways. While the shock to flu/pneumonia mortality has been conductive for development, the large reduction in the incidence of tuberculosis deaths has been a negative force in the development of US states over the second-half of 20th century. In addition, the decline in maternal mortality has a fragile, but positive relationship with income per capita. Because these specific health shocks affected mortality across the life cycle differently, the evidence here underscores the general tenet of regarding health as multifaceted.
    Keywords: Economic development; Mortality; Population growth; Large health shocks; Medical innovations; US states
    JEL: I15 J24 O11 O51
    Date: 2012–12–07
  2. By: Maite Blázquez Cuesta (Dpto de Análisis Económico: Teoría Económica e Historia Económica , Universidad Autónoma de Madrid); Elena Cottini (Departments and Institutes of Economics, Institute for Industrial and Labour Economics); Herrarte, A. (Ainhoa)
    Abstract: In this paper we use the Spanish Living Conditions Survey (2005-2008) to investigate whether there is a socioeconomic gradient in health when alternative measures of socioeconomic status, apart from income, are considered. In particular we construct a material deprivation index that reflects some minimum standards of quality of life, and we analyze its impact on self-reported health. To address this issue, we use a deprivation index that incorporates comparison effects with societal peers and we estimate health equations using a random effects model. Furthermore, the model is extended to include a Mundlak term that corrects for the potential correlation between the error term and the regressors. Our results reveal that the relationship between health and income operates through comparison information with respect to societal peers. In contrast, material deprivation in terms of financial difficulties, basic necessities and housing conditions exerts a direct effect on individual health.
    Keywords: Self-assessed health, random effects model, material deprivation, social exclusion, Mundlak correction JEL-Codes: C23, D63, I10
    Date: 2012–03
  3. By: Raphaёl Franck (Bar-Ilan University); Ilia Rainer
    Abstract: In this paper we reassess the role of ethnic favoritism in Sub-Saharan Africa. Using data from 18 African countries, we study how primary education and infant mortality of ethnic groups were affected by changes in the ethnicity of the countries’ leaders during the last fifty years. Our results indicate that the effects of ethnic favoritism are large and widespread, thus providing support for ethnicity-based explanations of Africa’s underdevelopment. We also conduct a crosscountry analysis of ethnic favoritism in Africa. We find that ethnic favoritism is less prevalent in countries with one dominant religion. In addition, our evidence suggests that stronger fiscal capacity may have enabled African leaders to provide more ethnic favors in education but not in infant mortality. Finally, political factors, linguistic differences and patterns of ethnic segregation are found to be poor predictors of ethnic favoritism.
    Date: 2012–03
  4. By: Polimeni, Rachel; Levine, David I.
    Abstract: A standard test for adverse selection in health insurance examines whether people with characteristics predicting high health care utilization are more likely to buy insurance (or buy more generous nsurance). George Akerlof’s theory of adverse selection suggests a test based on prices: those who purchase insurance at the regular price will have higher expected utilization than those buying insurance when offered a deeply discounted price. Both tests provide (different) lower bounds on self-selection. We use a randomly allocated coupon for deeply discounted health insurance in rural Cambodia coupled with a longitudinal survey to test for adverse selection. While the standard test can show only a small amount of self-selection, the Prices test shows vastly more self-selection – providing a much more informative lower bound.
    Keywords: Business, Management, Marketing, and Related Support Services, Human Resources Management and Services, D82, I13, Asymmetric and Private Information, Health Insurance
    Date: 2012–12–12
  5. By: Rees, Daniel I. (University of Colorado Denver); Sabia, Joseph J. (San Diego State University, California)
    Abstract: While migraine headache can be physically debilitating, no study has attempted to estimate its effects on labor market outcomes. Using data drawn from the National Longitudinal Study of Adolescent Health, we estimate the effect of migraine headache on labor force participation, hours worked, and wages. We find that migraine headache is associated with a decrease in wages. However, there is little evidence that migraine headache leads to reductions in labor force participation or hours worked. We conclude that estimates of the cost of migraine headache to society should include its impact on wages.
    Keywords: migraine headache, wages, labor force participation, productivity
    JEL: I10 J30
    Date: 2012–11
  6. By: Anderson, D. Mark (Montana State University); Rees, Daniel I. (University of Colorado Denver)
    Abstract: The Office of National Drug Control Policy (ONDCP) recently announced a goal of reducing drugged driving by 10 percent within three years. In an effort to achieve this goal, ONDCP is encouraging all states to adopt per se drugged driving laws, which make it illegal to operate a motor vehicle with a controlled substance in the system. To date, 16 states have passed per se drugged driving laws, yet little is known about their effectiveness. The current study examines the relationship between these laws and traffic fatalities, the leading cause of death among Americans ages 5 through 34. Our results provide no evidence that per se drugged driving laws reduce traffic fatalities.
    Keywords: drugged driving, per se laws, traffic fatalities, marijuana
    JEL: I10 I18
    Date: 2012–11
  7. By: Conti, Gabriella (University of Chicago); Heckman, James J. (University of Chicago)
    Abstract: Pediatricians should consider the costs and benefits of preventing rather than treating childhood diseases. We present an integrated developmental approach to child and adult health that considers the costs and benefits of interventions over the life cycle. We suggest policies to promote child health which are currently outside the boundaries of conventional pediatrics. We discuss current challenges to the field and suggest avenues for future research.
    Keywords: health, prevention, remediation, capabilities, technology of capability formation
    JEL: I12 I18
    Date: 2012–12
  8. By: Cally Ardington (SALDRU, School of Economics, University of Cape Town); Till Bärnighausen (Africa Centre for Health and Population Studies and Harvard School of Public Health); Anne Case (Princeton University); Alicia Menendez (University of Chicago)
    Abstract: Using a large longitudinal dataset, we quantify the impact of adult deaths on household economic wellbeing. The timing of lower socioeconomic status observed for households in which members die of AIDS suggests that the socioeconomic gradient in AIDS mortality is being driven primarily by poor households being at higher risk for AIDS. Following a death, households that experienced an AIDS death are observed being poorer still. However, the additional socioeconomic loss following death is very similar to the loss observed from deaths from other causes. Funeral expenses can explain some of the impoverishing effects of death in the household.
    Date: 2012
  9. 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
  10. By: Hammitt, James; Roman, Henry; Stieb, David; Walsh, Tyra
    Abstract: The monetized value of avoided premature mortality typically dominates the calculated benefits of air pollution regulations; therefore, characterization of the uncertainty surrounding these estimates is key to good policymaking. Formal expert judgment elicitation methods are one means of characterizing this uncertainty. They have been applied to characterize uncertainty in the mortality concentration-response function, but have yet to be used to characterize uncertainty in the economic values placed on avoided mortality. We report the findings of a pilot expert judgment study for Health Canada designed to elicit quantitative probabilistic judgments of uncertainties in Value-per-Statistical-Life (VSL) estimates for use in an air pollution context. The two-stage elicitation addressed uncertainties in both a base case VSL for a reduction in mortality risk from traumatic accidents and in benefits transferrelated adjustments to the base case for an air quality application (e.g., adjustments for age, income, and health status). Results for each expert were integrated to develop example quantitative probabilistic uncertainty distributions for VSL that could be incorporated into air quality models.
    Date: 2012–01
  11. By: Vahidin Jeleskovic (University of Kassel); Benjamin Schwanebeck (University of Kassel)
    Abstract: Various panel models were presented to resolve the ranking of global health care systems according to efficiency. However, in terms of the spatial distribution of statistical units, spatial dependence as a result of various forms of spatial interactions caused biased estimators in classical regression. To our knowledge, this is the first paper which analyzes the healthcare systems of WHO members with regard to spatial dependencies while distinguishing between heterogeneity and inefficiency. It was possible to determine a significant spatial autocorrelation. Therefore one have to consider these spatial spillovers when assessing the performance of healthcare systems. The most meaningful way of implementing these effects appears to be by regressing the health output on various explanatory variables through a combination of the fixed effects spatial lag and the fixed effects cross regressive model. This allows spatial spillovers due to level of education, healthcare expenditure, and the quality of the healthcare system itself, to be diagnosed. Modeling these spatial effects allows previous results to be given more precision with regard to the quality of the healthcare systems of WHO members.
    Keywords: panel data, fixed effects, production of health, efficiency measurement, heterogeneity, spatial effects, spatial autocorrelation
    JEL: C12 C21 I12
    Date: 2012
  12. By: Ronette Briefel
    Keywords: Childhood Obesity, Beverage, Dietary, Activity, home, school
    JEL: I0 I1
    Date: 2012–11–07
  13. By: Jelena Zurovac; Stacy Dale; Martha Kovac
    Keywords: EHRs, Electronic Health Records, Quality of Care, Survey of Patients
    JEL: I
    Date: 2012–11–30
  14. By: Marsha Gold; Gretchen Jacobson; Anthony Damico; Tricia Neuman
    Keywords: Medicare Advantage, Plan Availability, Premiums, Medicare Policy
    JEL: I
    Date: 2012–12–30
  15. By: David Baugh; Shinu Verghese
    Keywords: Physician Service Use, Participation, Medicaid, Health
    JEL: I
    Date: 2012–10–30
  16. By: Zheng, J. (Tilburg University)
    Abstract: The choice of payment terms has increasingly become more important in determining the success of exporting transactions. While exporters often use Open Account (OA) terms to secure international contracts and to expand export levels, these terms in turn make them face more non-payment risks. In Export Credit Insurance and Trade Promotion, we present a theoretical model showing the competitiveness of OA terms in international trade, and the risk-reducing as well as export-enhancing role played by export credit insurance programs. Our theoretical analysis shows that, when exporters are risk averse, these programs are always effective without breaking the legal and financial obligations. Using Chinese export and insurance data, both static and dynamic models show a positive and statistically significant export-promoting effect of export credit insurance in China. The insurance effect across income groups also suggests the success of export credit insurance in diversifying export destinations.
    Date: 2012
  17. By: Julius A. Agbor and Gregory N. Price
    Abstract: To the extent that in utero and childhood malnutrition negatively affects later stage mental and physical health, it can possibly constrain later stage human capital acquisition, which is an important driver of economic growth. This paper considers the impact of famine on aggregate adolescent human capital formation in Sub-Saharan Africa. We parameterize a joint adolescent human capital and food nutrition production function to estimate the effects of famine on primary school completion rates of individuals age 15 - 19. Mixed fixed and random coefficient parameter estimates for 32 Sub-Saharan African countries between 1980 - 2010 reveal that primary school completion rates of adolescents are proportional to the quantity of food and nutrition produced during childhood and in utero. This suggests that declines in food production and nutrition associated with famine in Sub-Saharan Africa have large negative effects on the acquisition of human capital by adolescents and on long-run material living standards. Our findings also suggest that policy makers in Sub-Saharan Africa should prioritize food security policies that prevent food shortages and famines, which would increase long-run economic growth and material living standards.
    Keywords: Human Capital, Famine, Nutrition, Sub-Saharan Africa
    JEL: C33 I15 I25 O10 O15 O55 Q18
    Date: 2012
  18. By: Andrew Newell (Department of Economics, University of Sussex, UK; IZA, Bonn, Germany); Ian Gazeley (Department of History, University of Sussex, UK)
    Abstract: At the beginning of the twentieth century Britain was roughly halfway through a 60-year demographic transition with declining infant mortality and birth rates. Cities exhibited great and strongly correlated diversity in these rates. We demonstrate cross–section correlations with, for instance, women’s employment, population density, literacy and improved water supply and sanitation, that have been linked to the transition. When we analyse data from the late 1850s and the early 1900s, the changes in the two rates are not correlated across cities, but we find a robust and large impact from sanitation improvement to long-period infant mortality reduction. We also find the extension of basic literacy is related to increases in female labour market participation, which is in turn related to fertility reduction. Lastly we find that more rapid urban growth accelerates fertility decline, but, in late 19th century Britain it slowed the reduction of infant mortality.
    Keywords: Fertility, infant mortality, education and sanitary reform, 19th century and early 20th century Britain.
    JEL: N33 J13 I15
    Date: 2012–12
  19. By: Kris De Jaegher
    Abstract: This paper presents a game-theoretical model of the physician-patient relationship. There is a conflict of interest between physician and patient, in that the physician prefers the patient to always obtain a particular treatment, even if the patient would not consider this treatment in his interest. The patient obtains imperfect cues of whether or not he needs the treatment. The effect is studied of an increase in the quality of the patient's information improves in this sense, he may either become better off or worse off. The precise circumstances under which either result is obtained, are derived.
    Keywords: physician-patient relationship, value of private information.
    JEL: I11 D82 C72
    Date: 2012–12
  20. By: Yousuf, Ahmed Sadek
    Abstract: This paper examines the relationship between health aid and infant mortality, using data from in total 135 countries (for the purposes of this study, developing countries), between 1975 and 2010. Utilizing both conventional Instrumental Variable and System GMM approaches, a tentative conclusion can be drawn that aid comes to have a statistically significant and positive effect on infant mortality rate, as doubling of aid leads to an approximately 1.3% reduction in infant mortality rates. Thus for an average aid recipient country, doubling per capita aid leads to a reduction of about 790 deaths per million live births in a particular year. This effect, in comparison to the set goals of the Millennium Development Goals, is small and may not be enough to ensure that the MDG targets are met by 2015. --
    Keywords: Health Oriented Aid,Infant Mortality Rates,Panel Instrumental Variable,System GMM,MDG
    JEL: F35 C23 C33 I10
    Date: 2012

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