nep-hea New Economics Papers
on Health Economics
Issue of 2013‒06‒04
29 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Observational Study of Cell Phone and Texting Use Among California Drivers 2012 and Comparison to 2011 Data By Cooper, Jill F; Ragland, David R; Ewald, Katrin; Wasserman, Lisa; Murphy, Christopher J
  2. The quality of life of female informal caregivers: from Scandinavia to the Mediterranean Sea By Cinzia Di Novi; Rowena Jacobs; Matteo Migheli
  3. Harsh occupations, health status and social security By PESTIEAU, Pierre; RACIONERO, Maria
  4. Behavioral biases and long term care insurance: A political economy approach By DE DONDER, Philippe; LEROUX, Marie-Louise
  5. Love and Death : A Freund Model with Frailty By Christian Gouriéroux; Yang Lu
  6. Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand By Supon Limwattananon; Sven Neelsen; Owen O'Donnell; Phusit Prakongsai; Viroj Tangcharoensathien; Eddy van Doorslaer
  7. Unemployment and Smoking: Causation, Selection, or Common Cause? Evidence from Longitudinal Data By Reinhard Schunck; Benedikt G. Rogge
  8. The Course of Subjective Sleep Quality in Middle and Old Adulthood and Its Relation to Physical Health By Sakari Lemola; David Richter
  9. Screening stringency in the disability insurance program By Johansson, Per; Laun, Lisa; Laun, Tobias
  10. A life-cycle model of unemployment and disability insurance By Sagiri Kitao
  11. Analyzing Regional Variation in Health Care Utilization Using (Rich) Household Microdata By Eibich, Peter; Ziebarth, Nicolas R.
  12. The Economic Case for Devoting Public Resources to Health By Bloom, David E.; Fink, Günther
  13. Global Health Governance and Tropical Diseases By Bärnighausen, Till; Bloom, David E.; Humair, Salal
  14. Disparities in Consumption of Sugar-Sweetened and Other Beverages by Race/Ethnicity and Obesity Status Among United States Schoolchildren. By Allison Hedley Dodd; Ronette Briefel; Charlotte Cabili; er Wilson; Mary Kay Crepinsek
  15. Analysis of the Variation in Efficiency of Medicare Advantage Plans. By Marsha Gold; Maria Cupples Hudson
  16. Identifying Medicare Beneficiaries with Disabilities: Improving on Claims-Based Algorithms. By Yonatan Ben-Shalom; David Stapleton
  17. Lessons from Three Pilots to Integrate Physical and Behavioral Health Care for Medicaid Beneficiaries in Pennsylvania. By Jung Y. Kim; Angela M. Gerolamo; Jonathan Brown
  18. Impacts of Waiting Periods for Home and Community Based Servicws on Consumers and Medicaid Costs in Iowa. By Greg Peterson; Randy Brown; Allison Barrett
  19. Relationship Between NCQA Medical Home Recognition and Health Care Utilizaiton Among Children in Medicaid with Disabilities or Special Health Care Needs. By Kate Stewart; Henry Ireys; Dana Petersen; Joe Zickafoose; Lisa Schottenfeld
  20. Outreach to Low-Income Families During the First Year of HeA PA. By Maggie Colby
  21. Effectiveness of Alternative Ways of Implementing Care Coordination Components in Medicare D-SNPs. By Jelena Zurovac; Randy Brown; Bob Schmitz
  22. New Medicare-Medicaid Enrollees: The Transition to Medicaid Coverage Among Medicare Beneficiaries. By Carol V. Irvin; Rosemary Borck; Wilfredo Lim
  23. Making Sense of the Change in How Medicare Advantage Plans are Paid. By Marsha Gold
  24. The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization By Katherine Baicker; Michael Chernew; Jacob Robbins
  25. The Determinants of Rising Inequality in Health Insurance and Wages: An Equilibrium Model of Workers' Compensation and Health Care Policies By Rong Hai
  26. Survival or performance? Healthcare viewed through organization, information management, and personnel By Kauhanen, Antti; Kulvik, Martti; Maijanen, Sirpa; Martikainen, Olli; Ranta, Paula; Kulvik, Silja
  27. Resource allocation in health care processes: A case study By Kauhanen, Antti; Kulvik, Martti; Kulvik, Silja; Maijanen, Sirpa; Martikainen, Olli; Ranta, Paula
  28. The Evolution Of Education And Health Poverty During Economic Development:The Case Of Indonesia, 1991–2007 By Andy Sumner
  29. Analyzing the effects of insuring health risks: On the trade-off between short run insurance benefits vs. long run incentive costs By Cole, Harold L.; Kim, Soojin; Krueger, Dirk

  1. By: Cooper, Jill F; Ragland, David R; Ewald, Katrin; Wasserman, Lisa; Murphy, Christopher J
    Abstract: This methodological report describes survey research and data collection methods employed for the second Observational Survey of Cell Phone and Texting Use among California Drivers study conducted in 2012. This study was conducted by Ewald & Wasserman Research Consultants (E&W) on behalf of the California Office of Traffic Safety and the Safe Transportation Research and Education Center at University of California at Berkeley. The survey’s goal was to obtain a statewide statistically representative observational sample of California’s cell phone use behaviors, focusing on mobile device use and compare it to 2011 survey data. Vehicle drivers were observed at controlled intersections, such as traffic lights and stop signs, using a protocol similar to the National Occupancy Protection Use Study methodology published by the National Highway Traffic Safety Administration. The sample frame included a total of 5,664 vehicle observations from 129 sites. The total percentage of distracted driving by electronic devices (holding a phone to the ear, manipulating a hand-held electronic device while driving, or talking on a hand-held device) observed increased to 6.2% in 2012 from 4.2% in 2011. California’s baseline level of cell phone use and driving will be a critical metric over the years as traffic safety stakeholders mobilize to conduct high visibility enforcement campaigns, explore newpolicies, expand educational programs, and engineer countermeasures to increase safety on the roads. 
    Keywords: Public Health, Transportation and Highway Engineering
    Date: 2013–05–01
  2. By: Cinzia Di Novi (Dipartimento di Economia, Università Ca' Foscari, Venezia, Italy); Rowena Jacobs (Centre for Health Economics, University of York, UK); Matteo Migheli (Dipartimento di Economia "S. Cognetti De Martiis", Università di Torino, Italy)
    Abstract: We analyse the impact of the provision of care on the health and quality of life (QoL) of mature female informal caregivers using a representative sample drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE). We match each informal caregiver with a non-carer using Propensity Score matching and test whether matched individuals differ on self-assessed health and a functional indicator of QoL and whether this relationship differs across European regions. We find a North-South gradient both for self-assessed health and QoL and our results show that the provision of caregiving to close relatives in Europe impacts on the caregivers’ quality of life and health in a way that depends on their geographical location, the degree of formal care and specific cultural and social factors of the area. We find that informal caregiving is a complex phenomenon which may bring both psychological rewards and distress to providers of care and this complexity, along with the geographical gradient highlight the importance of ensuring that policies match the needs of individual carers in their own geographical areas and cultural contexts.
    Keywords: informal caregiving; quality of life; self-assessed health; Europe
    JEL: I10 I12 D10
    Date: 2013–05
  3. By: PESTIEAU, Pierre (CREPP, Université de Liège, Belgium; Université catholique de Louvain, CORE, Belgium); RACIONERO, Maria (Research School of Economics, Australian National University)
    Abstract: We study the optimal design of a social security system when individuals differ in health status and occupation. Health status is private information but is imperfectly correlated with occupation: individuals in harsh occupations are more likely to be in poor health. We explore the desirability of letting the social security policy differ by occupation and compare the results with those obtained when disability tests are used instead. We show that tagging by occupation is preferable to testing when the audit technology is relatively expensive and/or the proportion of disabled workers differs markedly across occupations. We also study the implications of imposing horizontal equity among disabled workers and show that those in the harsh occupation may be induced to retire later.
    Keywords: health status, retirement age, tagging, disability tests
    JEL: H21 H55
    Date: 2013–02–22
  4. By: DE DONDER, Philippe (Toulouse School of Economics (GREMAQ-CNRS and IDEI), France); LEROUX, Marie-Louise (UQAM, Canada; Université catholique de Louvain, CORE, B-1348 Louvain-la-Neuve, Belgium)
    Abstract: We develop a model where individuals all have the same probability of becoming dependent and vote over the social long term care insurance contribution rate before buying additional private insurance and saving. We study three types of behavioral biases, all having in common that agents under-weight their dependency probability when taking private decisions. Sophisticated procrastinators anticipate their mistake when voting, while optimistic and myopic agents have preferences that are consistent across choices. Optimists under-estimate their own probability of becoming dependent but know the average probability while myopics underestimate both. Sophisticated procrastinators attain the first-best allocation while myopics and optimists insure too little and save too much. Myopics and optimists more (resp., less) biased than the median are worse off (resp., better off), at the majority voting equilibrium, when private insurance is available than when it is not.
    Keywords: majority voting, myopia, optimism, sophisticated procrastinators, complementary private insurance, dependency linked annuity
    JEL: H55 D91
    Date: 2013–05–17
  5. By: Christian Gouriéroux (Crest, University of Toronto); Yang Lu (SCOR and Crest)
    Abstract: We introduce new models for analyzing the mortality dependence between individuals in a couple. The mortality risk dependence is usually taken into account in the actuarial literature by introducing an Archimedean copula. This practice implies symmetric effects on the remaining lifetime of the surviving spouse. The new model allows for both asymmetric reactions by means of a Freund model, and risk dependence by means of an unobservable common risk factor (or frailty). These models allow for distinguishing in the lifetime dependence the component due to common lifetime (frailty) from the broken-heart syndrome (Freund model). The model is applied to insurance products such as joint life policy, last survivor insurance, or contracts with reversionary annuities
    Keywords: Life Insurance, Coupled Lives, Frailty, Freund Model, Broken-Heart, Copula, Last Survivor Insurance, Reversionary Annuities.
    Date: 2013–04
  6. By: Supon Limwattananon (International Health Policy Program, Ministry of Public Health, Thailand); Sven Neelsen (Institute of Health Policy and Management, Erasmus University Rotterdam); Owen O'Donnell (Erasmus University Rotterdam); Phusit Prakongsai (International Health Policy Program, Ministry of Public Health, Thailand); Viroj Tangcharoensathien (International Health Policy Program, Ministry of Public Health, Thailand); Eddy van Doorslaer (Erasmus University Rotterdam)
    Abstract: We estimate the impact on health care utilization and out-of-pocket (OOP) expenditures of a major reform in Thailand that extended health insurance to one-quarter of the population to achieve universal coverage while keeping health spending below 4% of GDP. Identification is through comparison of changes in outcomes of groups to whom coverage was extended with those of public sector employees and their dependents whose coverage was not affected. The reform is estimated to have reduced the probability that a sick person goes without formal treatment by 3.2 percentage points (11%). It increased the probability of receiving public ambulatory care by 2.7 ppt (5%) and of admission to a public hospital by 1 ppt (18%). OOP expenditures were reduced by one-third on average, as was the probability of spending more than 10% of the household budget on health care, while spending at the very top of the OOP distribution was reduced by one-half representing substantial reductio ns in exposure to medical expenditure risk. Supply-side measures implemented with the coverage extension are likely to have helped realize these effects from an increased, but still very tight, budget.
    Keywords: Health Insurance, Health Care, Medical Expenditures, Universal Coverage, Thailand
    JEL: H42 H51 I18
    Date: 2013–05–16
  7. By: Reinhard Schunck; Benedikt G. Rogge
    Abstract: Background: This study investigates possible mechanisms that can explain the association between unemployment and smoking, that is a) unemployment increases smoking probability (causation), b) smoking increases the probability to become unemployed (selection), and c) differences in both smoking and unemployment probabilities trace back to differences in socio-economic position (common cause). Methods: Longitudinal data from the German Socio-Economic Panel (SOEP) from the years 1998, 1999, 2001, 2002, 2004, 2006, and 2008 were used to examine the effect of unemployment on smoking probability and vice versa (65,823 observations from 18,735 respondents, aged 18-60 years). Effects were estimated by using random and fixed effects logistic panel regressions. Results: Results from the random effects logistic regression model suggest that unemployed have a higher probability to smoke and that smokers have a higher probability to become unemployed. However, the fixed effects models indicate that the observed associations are driven by unobserved factors. Results indicate that both smoking and unemployment probability co-vary systematically with (childhood) socio-economic position. Conclusion: In contrast to previous studies, the present investigation suggests that there is neither a direct causal effect of unemployment on smoking behaviour nor a direct effect of smoking on unemployment probability. Rather, smoking and unemployment seem to be related through a common cause, with people from low socio-economic backgrounds being more likely to smoke as well as to become unemployed. These findings are interpreted in the frame of a life course perspective on the development of socially unequal health behaviours.
    Keywords: Health behaviour, smoking, unemployment, longitudinal analysis, life course, health inequality, fixed effects, random effects
    JEL: I12 J64
    Date: 2012
  8. By: Sakari Lemola; David Richter
    Abstract: Objective: Older adults more often complain about sleep disturbances compared to younger adults. However, it is not clear whether there is still a decline of sleep quality after age 60 and whether changes in sleep quality in old age are mere reflections of impaired physical health or whether they represent a normative age dependent development. Method: Subjective sleep quality and perceived physical health were assessed in a large representative sample of 14,179 participants (52.7% females; age range 18-85) from the German Socio-Economic Panel Study across 4 yearly measurement time points. Results: Subjective sleep quality linearly declined from young adulthood until age 60. After age 60 a transient increase in subjective sleep quality occurred that coincides with retirement. Physical health prospectively predicted subjective sleep quality and vice versa. These relations were similar for participants above and below age 60. Discussion: Around retirement a transient increase in subjective sleep quality occurs, which may reflect a decrease in work related distress or an increase in flexibility to organize the day according to one¿s circadian preferences. Perceived physical health is important for subjective sleep quality in old adults, but not more important than at younger age.
    Keywords: Sleep quality, Physical health, Old age, Retirement, German Socio-Economic Panel Study
    Date: 2012
  9. By: Johansson, Per (IFAU - Institute for Evaluation of Labour Market and Education Policy); Laun, Lisa (IFAU - Institute for Evaluation of Labour Market and Education Policy); Laun, Tobias (Department of Economics, Uppsala University)
    Abstract: We propose a strategy for assessing how the inflow to the disability insurance program has been governed over time. We analyze the ex-ante health of individuals entering the program, compared to individuals not entering the program in the same year, by using ex-post mortality. Applying the strategy to Sweden, we find large variation in the relative health of new beneficiaries compared to non-beneficiaries over time. Some of the fluctuations correspond well to formal changes to screening stringency. However, we also find large variation in health during periods when no changes to formal eligibility criteria have been pursued.
    Keywords: Disability insurance; screening stringency; proportional hazard model
    JEL: C41 I18 J14
    Date: 2013–05–02
  10. By: Sagiri Kitao (Hunter College; Hunter College)
    Abstract: The paper builds a life-cycle model of heterogeneous agents with search frictions, in which individuals choose a sequence of saving and labor supply faced with uncertainty in longevity, employment, health status and medical expenditures. Unemployed individuals decide search intensity and whether to apply for disability insurance (DI) benefits if eligible. We investigate, first, the effects of cash and Medicare benefits of the DI system on the life-cycle pattern of employment. Without in-kind benefits through Medicare, the DI coverage could fall by 30%. Second, the impact of a change in labor market conditions and roles of the DI are studied. A rise in exogenous job separation rates or a fall in job finding rates by 20% each can lead to a drop in employment rate by 1.7 and 2.1 percentage points, respectively. A model without the DI could underestimate the effect on employment by more than 30%.
    Keywords: Disability insurance, labor force participation, life-cycle, Medicare, unemployment insurance.
    JEL: E2 E6 J2 J6
    Date: 2013
  11. By: Eibich, Peter (DIW Berlin); Ziebarth, Nicolas R. (Cornell University)
    Abstract: This paper exploits rich SOEP microdata to analyze state-level variation in health care utilization in Germany. Unlike most studies in the field of the Small Area Variation (SAV) literature, our approach allows us to net out a large array of individual-level and state-level factors that may contribute to the geographic variation in health care utilization. The raw data suggest that state-level hospitalization rates vary from 65 percent to 165 percent of the national mean. Ambulatory doctor visits range from 90 percent to 120 percent of the national mean. Interestingly, in the former GDR states doctor visit rates are significantly below the national mean, while hospitalization rates lie above the national mean. The significant state-level differences vanish once we control for individual-level socio-economic characteristics, the respondents' health status, their health behavior as well as supply-side state-level factors.
    Keywords: SOEP, small area variation, health care utilization
    JEL: I12 I14 I18
    Date: 2013–05
  12. By: Bloom, David E. (Harvard University); Fink, Günther (Harvard School of Public Health)
    Abstract: The world has enjoyed huge improvements in population health during the last half century. But major health problems persist, particularly in tropical countries, which are still struggling with infectious diseases while increasingly having to deal with noncommunicable diseases. Several classic arguments for public spending on health have buttressed governments' efforts to improve health. These efforts have now been further spurred by new economic arguments that better population health may promote economic well-being – via beneficial changes in labor productivity, education, and investment, and through demographic change. The economic consequences of improved health can be large, but realizing them depends on the policies adopted in myriad other arenas.
    Keywords: investment in health, labor productivity, education, demographic change, health gaps
    JEL: I15 I14 I18 H51
    Date: 2013–05
  13. By: Bärnighausen, Till (Harvard School of Public Health); Bloom, David E. (Harvard University); Humair, Salal (Harvard School of Public Health)
    Abstract: Global Health Governance (GHG) comprises the means adopted to promote decision making on actions to protect and promote global health, along with the underlying architecture of global health institutions, initiatives, and actors that facilitate these means. GHG is a key factor influencing health outcomes throughout the world. Over the past decade, the GHG system has increased dramatically in size and complexity. In the past half century, GHG has achieved successes against some tropical diseases, but going forward, it faces new challenges. The current GHG system has several weaknesses – lack of participation, transparency, accountability, and efficiency – but the system also has several strengths – capacity for innovation, flexibility, and the ability to attract a motivated workforce and to encourage entrepreneurship. To adequately address tropical diseases in the future, GHG reforms will need to address some of the weaknesses while preserving the strengths.
    Keywords: development assistance, tropical disease, global health governance
    JEL: F35 I18
    Date: 2013–05
  14. By: Allison Hedley Dodd; Ronette Briefel; Charlotte Cabili; er Wilson; Mary Kay Crepinsek
    Keywords: child, overweight, sugar-sweetened beverages, racial/ethnic disparities
    JEL: I0 I1
    Date: 2013–05–30
  15. By: Marsha Gold; Maria Cupples Hudson
    Abstract: The Affordable Care Act has altered payment policy for private Medicare Advantage (MA) plans, with the goal of lowering costs to bring them closer to the costs of traditional Medicare. Using new information on 2009 MA costs, an issue brief compares plans’ estimates of per capita costs for providing Parts A and B benefits to their enrollees, on a risk-adjusted basis, against government data on the same costs for traditional Medicare program beneficiaries in the same county. On average, risk-adjusted MA plan costs were 4 percent higher than traditional Medicare costs (104 percent). Among plan types, only HMOs had lower average costs than traditional Medicare. The wide variation in costs for MA plans relative to those for traditional Medicare suggests room for greater efficiency in care delivery.
    Keywords: Medicare Advantage, Efficiency, Variation, Health
    JEL: I
    Date: 2013–04–24
  16. By: Yonatan Ben-Shalom; David Stapleton
    Keywords: Medicare Beneficiaries, Disability, Claims-Based Algorithms, CEDR
    JEL: I J
    Date: 2013–03–11
  17. By: Jung Y. Kim; Angela M. Gerolamo; Jonathan Brown
    Keywords: Physical Health Care, Behavioral Health Care , Medicaid Beneficiaries, Pennsylvania, CEDR
    JEL: I J
    Date: 2013–03–11
  18. By: Greg Peterson; Randy Brown; Allison Barrett
    Keywords: Home, Community Based Services, Consumers, Medicaid Costs, Iowa
    JEL: I J
    Date: 2013–03–11
  19. By: Kate Stewart; Henry Ireys; Dana Petersen; Joe Zickafoose; Lisa Schottenfeld
    Keywords: NCQA, Medical Home, Health Care Utilizaiton, Children in Medicaid
    JEL: I J
    Date: 2013–03–11
  20. By: Maggie Colby
    Keywords: Health-e-app Public Access, Children's Health Care Coverage, California, Low-Income Families
    JEL: I
    Date: 2013–05–30
  21. By: Jelena Zurovac; Randy Brown; Bob Schmitz
    Keywords: Care Coordination, Medicare, Dual Eligibles, Special Needs Plans
    JEL: I J
    Date: 2013–03–11
  22. By: Carol V. Irvin; Rosemary Borck; Wilfredo Lim
    Keywords: Medicare, Medicaid Enrollees, Medicaid Coverage, Medicare Beneficiaries
    JEL: I J
    Date: 2013–03–11
  23. By: Marsha Gold
    Keywords: Medicare Advantage, Affordable Care Act, HMOs; PPOs, Health
    JEL: I
    Date: 2013–05–30
  24. By: Katherine Baicker; Michael Chernew; Jacob Robbins
    Abstract: More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial – offsetting more than 10% of increased payments to Medicare Advantage plans.
    JEL: I1 I18
    Date: 2013–05
  25. By: Rong Hai (Department of Economics, University of Pennsylvania)
    Abstract: I develop and structurally estimate a non-stationary overlapping generations equilibrium model of employment and workers' health insurance and wage compensation, to investigate the determinants of rising inequality in health insurance and wages in the U.S. over the last 30 years. I find that skill-biased technological change and the rising cost of medical care services are the two most important determinants, while the impact of Medicaid eligibility expansion is quantitatively small. I conduct counterfactual policy experiments to analyze key features of the 2010 Patient Protection and Affordable Care Act, including employer mandates and further Medicaid eligibility expansion. I find that (i) an employer mandate reduces both wage and health insurance coverage inequality, but also lowers the employment rate of less educated individuals; and (ii) further Medicaid eligibility expansion increases employment rate of less educated individuals, reduces health insurance coverage disparity, but also causes larger wage inequality.
    Keywords: Labor Market, Health Insurance, Health Care Policies, Inequality
    JEL: J2 J3 I1 I24
    Date: 2013–01–16
  26. By: Kauhanen, Antti; Kulvik, Martti; Maijanen, Sirpa; Martikainen, Olli; Ranta, Paula; Kulvik, Silja
    Abstract: This report is an overview to the presentations and discussions in the seminar Survival or performance? Healthcare viewed through organization, information management, and personnel held on 3.9.2012. The seminar provided an interdisciplinary forum for the question how the health care system may overcome its present challenges
    Keywords: health care, work organization, processes, information technology
    JEL: I11 I12 M15
    Date: 2013–05–23
  27. By: Kauhanen, Antti; Kulvik, Martti; Kulvik, Silja; Maijanen, Sirpa; Martikainen, Olli; Ranta, Paula
    Abstract: This paper utilizes queuing models to analyze health care processes. We extend previous queuing models to allow for i) heterogeneous resources, ii) resource allocation to various tasks, and iii) teams (complementary resources). We model a process of one clinical unit. We use the model to analyze how resource allocation affects both process performance and utilization of resources. This approach emphasizes how allocation of resources to tasks affects process performance. We illustrate how the model can be used to analyze how variations in resources affect process performance and for example how ICT affects process performance.
    Keywords: processes, queues, performance, information and communication technology
    JEL: I12 C61 D24
    Date: 2013–05–23
  28. By: Andy Sumner (King's International Development Institute, King's College London)
    Abstract: This paper discusses the evolution of education and health poverty in Indonesia during a period of substantial economic development. The paper reviews the existing empirical research and provides new estimates of the evolution of education and health poverty using the Demographic and Health Survey. The case of Indonesia suggests that poverty may urbanize but remains largely rural in nature, concentrated among those in households with heads with no or incomplete primary education and in households with heads not in work or employed in agriculture suggesting public policy priorities for the poor remain agriculture support, primary education expansion and employment generation.
    Keywords: Indonesia, poverty, education, health, inequality, economic development
    JEL: I32 D63
    Date: 2013–05
  29. By: Cole, Harold L.; Kim, Soojin; Krueger, Dirk
    Abstract: This paper constructs a dynamic model of health insurance to evaluate the short- and long run effects of policies that prevent firms from conditioning wages on health conditions of their workers, and that prevent health insurance companies from charging individuals with adverse health conditions higher insurance premia. Our study is motivated by recent US legislation that has tightened regulations on wage discrimination against workers with poorer health status (Americans with Disability Act of 2009, ADA, and ADA Amendments Act of 2008, ADAAA) and that will prohibit health insurance companies from charging different premiums for workers of different health status starting in 2014 (Patient Protection and Affordable Care Act, PPACA). In the model, a trade-off arises between the static gains from better insurance against poor health induced by these policies and their adverse dynamic incentive effects on household efforts to lead a healthy life. Using household panel data from the PSID we estimate and calibrate the model and then use it to evaluate the static and dynamic consequences of no-wage discrimination and no-prior conditions laws for the evolution of the cross-sectional health and consumption distribution of a cohort of households, as well as ex-ante lifetime utility of a typical member of this cohort. In our quantitative analysis we find that although a combination of both policies is effective in providing full consumption insurance period by period, it is suboptimal to introduce both policies jointly since such policy innovation induces a more rapid deterioration of the cohort health distribution over time. This is due to the fact that combination of both laws severely undermines the incentives to lead healthier lives. The resulting negative effects on health outcomes in society more than offset the static gains from better consumption insurance so that expected discounted lifetime utility is lower under both policies, relative to only implementing wage nondiscrimination legislation. --
    Keywords: Health,Insurance,Incentive
    JEL: E61 H31 I18
    Date: 2012

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