nep-hea New Economics Papers
on Health Economics
Issue of 2013‒01‒19
sixteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Health and Economic Growth By Robert J. Barro
  2. Does the Effect of Pollution on Infant Mortality Differ between Developing and Developed Countries? Evidence from Mexico City By Arceo, Eva; Hanna, Rema; Oliva, Paulina
  3. Fiscal Federalism and European Health System Decentralization: A Perspective By Joan Costa-i-Font
  4. Pharmaceuticals: Getting Better Value for Money By Gorecki, Paul K.; Nolan, Anne; Brick, Aoife; Lyons, Seán
  5. Towards an index of health coverage By Moreno-Serra, R; Smith, PC
  6. The Changing of the Guards: Can Physicians Contain Social Insurance Costs? By Markussen, Simen; Røed, Knut; Røgeberg, Ole J.
  7. Getting Disabled Workers Back to Work: How Important Are Economic Incentives? By Fevang, Elisabeth; Hardoy, Inés; Røed, Knut
  8. The Availability and Usability of Behavioral Health Organization Encounter Data in MAX 2009. Washington, DC: Mathematica Policy Research By Jessica Nysenbaum; Ellen Bouchery; Rosalie Malsberger
  9. Assessing the Usability of Encounter Data for Enrollees in Comprehensive Managed Care Across MAX 2007-2009. Washington, DC: Mathematica Policy Research By Vivian L.H. Byrd; Allison Hedley Dodd
  10. The Effects of Childhood ADHD on Adult Labor Market Outcomes By Jason Fletcher
  11. Health, Education, and the Post-Retirement Evolution of Household Assets By James M. Poterba; Steven F. Venti; David A. Wise
  12. Equilibrium Labor Market Search and Health Insurance Reform By Naoki Aizawa; Hanming Fang
  13. Do Housing Prices Reflect Environmental Health Risks? Evidence from More than 1600 Toxic Plant Openings and Closings By Janet Currie; Lucas Davis; Michael Greenstone; Reed Walker
  14. Valuation of Human Health: An Integrated Model of Willingness to Pay for Mortality and Morbidity Risk Reductions By Shelby Gerking; Mark Dickie; Marcella Veronesi
  15. Survival prediction based on compound covariate under cox proportional hazard models By Emura, Takeshi; Chen, Yi-Hau; Chen, Hsuan-Yu
  16. Economic Growth and Public Healthcare Expenditure in Kenya (1982 - 2012) By Nyamwange, Mathew

  1. By: Robert J. Barro (Harvard University)
    Date: 2013
  2. By: Arceo, Eva (CIDE, Mexico City); Hanna, Rema (Harvard University); Oliva, Paulina (University of CA, Santa Barbara)
    Abstract: Much of what we know about the marginal effect of pollution on infant mortality is derived from developed country data. However, given the lower levels of air pollution in developed countries, these estimates may not be externally valid to the developing country context if there is a nonlinear dose relationship between pollution and mortality or if the costs of avoidance behavior differs considerably between the two contexts. In this paper, we estimate the relationship between pollution and infant mortality using data from Mexico. We find that an increase of 1 parts per billion in carbon monoxide (CO) over the last week results in 0.0032 deaths per 100,000 births, while a 1 (mu)g/m[superscript 3] increase in particulate matter (PM[subscript 10]) results in 0.24 infant deaths per 100,000 births. Our estimates for PM[subscript 10] tend to be similar (or even smaller) than the U.S. estimates, while our findings on CO tend to be larger than those derived from the U.S. context. We provide suggestive evidence that a non-linearity in the relationship between CO and health explains this difference.
    Date: 2012–11
  3. By: Joan Costa-i-Font
    Abstract: How does fiscal decentralisation affect the development of a health system?Evidence from health care decentralisation in Europe can offer some insights to the question above. This paper addresses the effects of health care decentralisation in Europe, and reviews some of the key questions on the design of a health system. We argue that contrary to old mobility argument, the effects of health care decentralisation result from tighter political agency, which generally stands as an alternative to health care privatisation. However, whether efficiency improves after a process of decentralisation depends heavily on the incentives fiscal design exerts on cost –containment, inter-jurisdictional competition, policy innovation and diffusion. Experiences of health care decentralisation highlight important concerns associated with vertical imbalances and limited horizontal imbalances. Finally, health care decentralisation can give rise to a new regional political cycle where citizens can reward or penalise the performance of health policy.
    Keywords: health systems decentralisation, fiscal federalism, health care, political agency
    JEL: H51 I18
    Date: 2012–12
  4. By: Gorecki, Paul K.; Nolan, Anne; Brick, Aoife; Lyons, Seán
    Date: 2012–06
  5. By: Moreno-Serra, R; Smith, PC
    Date: 2013–01–08
  6. By: Markussen, Simen (Ragnar Frisch Centre for Economic Research); Røed, Knut (Ragnar Frisch Centre for Economic Research); Røgeberg, Ole J. (Ragnar Frisch Centre for Economic Research)
    Abstract: Based on administrative data from Norway, we examine the extent to which family doctors influence their clients' propensity to claim sick pay and disability benefits. The analysis is based on exogenous shifts of family doctors occurring when physicians quit, retire, or for other reasons sell their patient lists to other doctors. Our key finding is that family doctors have significant influence on their clients' benefit claims. We conclude that it is possible for family doctors to contain social insurance costs to some extent, and that there is a significant variation across doctors in the way they do so.
    Keywords: sick pay, disability insurance, absence certification, gatekeepers
    JEL: H55
    Date: 2013–01
  7. By: Fevang, Elisabeth (Ragnar Frisch Centre for Economic Research); Hardoy, Inés (Institute for Social Research, Oslo); Røed, Knut (Ragnar Frisch Centre for Economic Research)
    Abstract: We investigate the impacts of economic incentives on the duration and outcome of temporary disability insurance (TDI) spells. The analysis is based on a large quasi-experiment in Norway, with a complete overhaul of the TDI benefit system. Our findings show that the labor supply of TDI claimants responds to both the benefit-level and to the level of local labor demand. The estimated elasticity of the employment hazard with respect to the benefit-level is – 0.3. We also find that the level of TDI benefits significantly affects the transition rate to alternative social insurance programs such as permanent disability and unemployment.
    Keywords: temporary disability, rehabilitation, hazard rate models, labor supply
    JEL: H55 I38 J22
    Date: 2013–01
  8. By: Jessica Nysenbaum; Ellen Bouchery; Rosalie Malsberger
    Keywords: Medicaid; behavioral health services; managed care arrangements, encounter data managed care organizations, Medicaid managed care enrollees, behavioral health organization encounter data; BHO
    JEL: I
    Date: 2012–12–30
  9. By: Vivian L.H. Byrd; Allison Hedley Dodd
    Keywords: MAX, Medicaid, Comprehensive Managed Care, Health
    JEL: I
    Date: 2012–12–30
  10. By: Jason Fletcher
    Abstract: While several types of mental illness, including substance abuse disorders, have been linked with poor labor market outcomes, no current research has been able to examine the effects of childhood ADHD. As ADHD has become one of the most prevalent childhood mental conditions, it is useful to understand the full set of consequences of the illness. This paper uses a longitudinal national sample, including sibling pairs, to show important labor market outcome consequences of ADHD. The employment reduction is between 10-14 percentage points, the earnings reduction is approximately 33%, and the increase in social assistance is 15 points, which are larger than many estimates of the black-white earnings gap and the gender earnings gap. A small share of the link is explained by education attainments and co-morbid health conditions and behaviors. The results also show important differences in labor market consequences by family background and age of onset. These findings, along with similar research showing that ADHD is linked with poor education outcomes and adult crime, suggest that treating childhood ADHD can substantially increase the acquisition of human capital.
    JEL: I1 I12 I18 J22 J24 J3 J31
    Date: 2013–01
  11. By: James M. Poterba; Steven F. Venti; David A. Wise
    Abstract: This paper explores the relationship between education and the evolution of wealth after retirement. Asset growth following retirement depends in part on health capital and financial capital accumulated prior to retirement, which in turn are strongly related to educational attainment. These “initial conditions” for retirement can have a lingering effect on subsequent asset evolution. Our aim is to disentangle the effects of education on post-retirement asset evolution that operate through health and financial capital accumulated prior to retirement from the effects of education that impinge directly on asset evolution after retirement. We consider the indirect effect of education through financial resources—in particular Social Security benefits and defined benefit pension benefits—and through health capital that was accumulated before retirement. We also consider the direct effect of education on asset growth following retirement, emphasizing the correlation between education and the returns households earn on their post-retirement investments. Households with different levels of education invest, on average, in different assets, and they may consequently earn different rates of return. Finally, we consider the additional effects of education that are not captured through these pathways. Our empirical findings suggest a substantial association between education and the evolution of assets. For example, for two person households the growth of assets between 1998 and 2008 is on average much greater for college graduates than for those with less than a high school degree. This difference ranges from about $82,000 in the lowest asset quintile to over $600,000 in the highest.
    JEL: E21 I14 I24
    Date: 2013–01
  12. By: Naoki Aizawa; Hanming Fang
    Abstract: We present and empirically implement an equilibrium labor market search model where risk averse workers facing medical expenditure shocks are matched with firms making health insurance coverage decisions. Our model delivers a rich set of predictions that can account for a wide variety of phenomenon observed in the data including the correlations among firm sizes, wages, health insurance offering rates, turnover rates and workers' health compositions. We estimate our model by Generalized Method of Moments using a combination of micro data sources including Survey of Income and Program Participation (SIPP), Medical Expenditure Panel Survey (MEPS) and Robert Wood Johnson Foundation Employer Health Insurance Survey. We use our estimated model to evaluate the equilibrium impact of the 2010 Affordable Care Act (ACA) and find that it would reduce the uninsured rate among the workers in our estimation sample from 20.12% to 7.27%. We also examine a variety of alternative policies to understand the roles of different components of the ACA in contributing to these equilibrium changes. Interestingly, we find that the uninsured rate will be even lower (at 6.44%) if the employer mandate in the ACA is eliminated.
    JEL: G22 I11 J32
    Date: 2013–01
  13. By: Janet Currie; Lucas Davis; Michael Greenstone; Reed Walker
    Abstract: A ubiquitous and largely unquestioned assumption in studies of housing markets is that there is perfect information about local amenities. This paper measures the housing market and health impacts of 1,600 openings and closings of industrial plants that emit toxic pollutants. We find that housing values within one mile decrease by 1.5 percent when plants open, and increase by 1.5 percent when plants close. This implies an aggregate loss in housing values per plant of about $1.5 million. While the housing value impacts are concentrated within 1/2 mile, we find statistically significant infant health impacts up to one mile away.
    JEL: D62 I18 Q51 Q53
    Date: 2013–01
  14. By: Shelby Gerking; Mark Dickie; Marcella Veronesi
    Abstract: This paper develops and applies an integrated model of human mortality and morbidity valuation that is consistent with principles of welfare economics. The standard expected utility model of one person facing two health states (alive and dead) is extended to a setting in which two family members (a parent and a child) face three health states (healthy, sick, and dead). A key finding is that total health benefits of public programs equate to the sum of willingness to pay for reduced mortality risk plus a fraction of the willingness to pay for reduced morbidity risk. Implications of the integrated model are tested using two field data sets from the U.S. on skin cancer and leukemia risk reductions. Results obtained show how the integrated model can be used to increase the accuracy of health benefit estimation for benefit-cost analyses as well as for the design of public hazard reduction programs.
    Keywords: willingness to pay, children, environmental hazards, health, integrated analysis, morbidity, mortality, value of statistical life, cancer, stated preference
    JEL: Q51
    Date: 2012–10
  15. By: Emura, Takeshi; Chen, Yi-Hau; Chen, Hsuan-Yu
    Abstract: Survival prediction from a large number of covariates is a current focus of statistical and medical research. In this paper, we study a methodology known as the compound covariate prediction performed under univariate Cox proportional hazard models. We demonstrate via simulations and real data analysis that the compound covariate method generally competes well with ridge regression and Lasso methods, both already well-studied methods for predicting survival outcomes with a large number of covariates. Furthermore, we develop a refinement of the compound covariate method by incorporating likelihood information from multivariate Cox models. The new proposal is an adaptive method that borrows information contained in both the univariate and multivariate Cox regression estimators. We show that the new proposal has a theoretical justification from a statistical large sample theory and is naturally interpreted as a shrinkage-type estimator, a popular class of estimators in statistical literature. Two datasets, the primary biliary cirrhosis of the liver data and the non-small-cell lung cancer data, are used for illustration. The proposed method is implemented in R package “compound.Cox” available in CRAN at
    Keywords: Cox proportional hazard model; Prediction; Survival analysis
    JEL: C13 C14 C34 C24 C4
    Date: 2012
  16. By: Nyamwange, Mathew
    Abstract: This study advices on a suitable strategy for financing healthcare in Kenya as the sector faces challenges of underfunding with an increased demand of quality and availability of health care services that are equitable and affordable for a growing population.The study examines the effect of per capita gross domestic product (GDP per capita) on public healthcare expenditure (PHCE) in Kenya, and uses estimates of public recurrent & development expenditures, (1982 - 2012), as well as the economic survey and statistical abstracts for the same years. The analysis is a time series estimation of the effect of per capita gross domestic product on public healthcare expenditure, so as to explain the minimum amount of funding that the government should direct to public healthcare expense given future predictions of GDP per capita by institutions like World Bank. The study employs OLS regression and checks for co-integration on the long-run relationship between PHCE and GDP per capita, as well as other tests of granger causality, unit root presence and stationarity and study attempts to determine the properties of healthcare in Kenya. Results reveal that healthcare in Kenya is a necessary good and has an elasticity of 0.024% to GDP per capita. This is to mean that for every 1% increase in GDP per capita, PHCE should increase by 0.024%.
    Keywords: Public Healthcare Expenditure; Economic Growth; Kenya Healthcare Financing;
    JEL: E0 H0 A1 C0 D9 B4 H5 E6 H6 C2 I1
    Date: 2012–11–06

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