nep-hea New Economics Papers
on Health Economics
Issue of 2013‒08‒16
ten papers chosen by
Yong Yin
SUNY at Buffalo

  1. Timing of Prenatal Smoking Cessation or Reduction and Infant Birth Weight: Evidence from the United Kingdom Millennium Cohort Study By Ji Yan; Peter A. Groothuis
  2. Remedies for Sick Insurance By Daniel McFadden; Carlos Noton; Pau Olivella
  3. The child health implications of privatizing Africa’s urban water supply: By Kosec, Katrina
  4. Socioeconomic Determinants of Child Health - Empirical Evidence from Indonesia By Subha Mani
  5. A new perspective on the economic valuation of informal caare: The well-being approach revisited By Konstantin Kehl; Stephan Stahlschmidt; ;
  6. Does Changing the Legal Drinking Age Influence Youth Behaviour? By Boes, Stefan; Stillman, Steven
  7. Poverty and Transitions in Health By Adena, Maja; Myck, Michal
  8. Community Effects on Elderly Health: Evidence from CHARLS National Baseline By Smith, James P.; Tian, Meng; Zhao, Yaohui
  9. Health and Health Behaviors during the Worst of Times: Evidence from the Great Recession By Tekin, Erdal; McClellan, Chandler; Minyard, Karen Jean
  10. Surviving the Genocide: The Impact of the Rwandan Genocide on Child Mortality By Ciani, Federico; Giannelli, Gianna Claudia

  1. By: Ji Yan; Peter A. Groothuis
    Abstract: Objectives: Smoking during pregnancy is a key preventable risk contributor to poor infant health. Our study presents a full dynamic relationship between the timing of prenatal smoking cessation or reduction and infant birth weight. Methods: Using a large representative dataset of birth cohort in the United Kingdom, we apply multiple linear regressions to examine how smoking cessation or reduction at different stages especially different months of pregnancy affects infant birth weight. For robustness checks, a rich set of covariates are controlled and a series of variable selection procedures are used. Results: We find robust evidence that mothers who quit smoking before the fourth month of pregnancy have infants of the same weight as those of nonsmokers. However, cessation after the fourth month or smoking beyond this threshold month is associated with substantially lower infant birth weights. Two third of the total adverse smoking impact on infant birth weight occurs in the second trimester. Our study also shows heavy persistent smokers should cut smoking intensity before the fourth month during pregnancy, in order to deliver infants as heavy as those born to persistent light smokers. Conclusions: Overall, our research suggests that the cost effectiveness of prenatal smoking cessation services can be significantly improved, if they can encourage more pregnant women to quit or reduce smoking by the end of the first trimester. Promoting timely smoking cessation or reduction can help policy makers and medical practitioners reduce the huge healthcare costs of poor birth outcomes attributable to prenatal smoking. Key Words: Prenatal Smoking; Timing of Smoking Cessation; Timing of Smoking Reduction; Infant Birth Weight
    JEL: I12 I18
    Date: 2013
  2. By: Daniel McFadden; Carlos Noton; Pau Olivella
    Abstract: This expository paper describes the factors that contribute to failure of health insurance markets, and the regulatory mechanisms that have been and can be used to combat these failures. Standardized contracts and creditable coverage mandates are discussed, along with premium support, enrollment mandates, guaranteed issue, and risk adjustment, as remedies for selection-related market damage. An overall conclusion of the paper is that the design and management of creditable coverage mandates are likely to be key determinants of the performance of the health insurance exchanges that are a core provision of the PPACA of 2010. Enrollment mandates, premium subsidies, and risk adjustment can improve the stability and relative efficiency of the exchanges, but with carefully designed creditable coverage mandates are not necessarily critical for their operation.
    Date: 2013
  3. By: Kosec, Katrina
    Abstract: Can private-sector participation (PSP) in the urban piped water sector improve child health? The author uses child-level data from 39 African countries during 1986–2010 to show that introducing PSP decreases diarrhea among urban dwelling children under five years of age by 5.6 percentage points, or 35 percent of its mean prevalence.
    Keywords: Privatization, Public health, Water supply, urban population, Children, Government policy, Water management, Water policies, Public policy,
    Date: 2013
  4. By: Subha Mani (Fordham University)
    Abstract: This paper characterizes the socioeconomic determinants of child health using height-for-age z-score (HAZ) - a long-run measure of chronic nutritional deficiency. We construct a panel data set that follows children between 3 and 59 months in 1993 through the 1997 and 2000 waves of the Indonesian Family Life Survey. We use this data to identify the various child level, household level and community level factors that affect children’s health. Our findings indicate that household income has a large and statistically significant role in explaining improvements in HAZ. We also find a strong positive association between parental height and HAZ. At the community level, we find that provision of electricity and availability of a paved road is positively associated with improvements in HAZ. Finally, in comparison to community level factors, household level characteristics have a large role in explaining the variation in HAZ. These findings suggest that policies that address the demand side constraints will have a greater potential to improve children's health outcomes in the future.
    Keywords: Child health, Panel data, Indonesia, Height
    JEL: I R D
    Date: 2013
  5. By: Konstantin Kehl; Stephan Stahlschmidt; ;
    Abstract: Informal care has drawn much attention among scholars and policymakers as it concerns an essential but hard to evaluate resource of welfare. Albeit several studies addressed the monetary value of informal care, dierences in the relationship between caregivers and recipients have often been ignored. We report on a profound and formerly unobserved distinction between care in the household and non-household care for a family member or in a voluntary framework. According to our results caregivers within the household perceive care as a burden and a positive shadow price arises. By contrast in the family but non-household context { and especially in the voluntary case { care is (at least partly) understood as an enriching experience which extends well-being and leads to negative shadow prices. This distinction calls a marketized view of informal care into question and may contribute to explaining the limitations of monetary incentive policies to encourage informal care.
    Keywords: informal care, well-being, economic valuation, shadow price
    JEL: D61 I11 I31
    Date: 2013–07
  6. By: Boes, Stefan (University of Lucerne); Stillman, Steven (University of Otago)
    Abstract: This paper examines the impact of a reduction in the legal drinking age in New Zealand from 20 to 18 on alcohol use, and alcohol-related hospitalisations and vehicular accidents among teenagers. We use both a difference-in-differences approach and a regression discontinuity design (RDD) to examine the impact of the law change. Our main findings are that lowering the legal drinking age did not appear to have led to, on average, an increase in alcohol consumption or binge drinking among 15-17 or 18-19 year-olds. However, there is evidence that the law change led to a significant increase in alcohol-related hospital admission rates for 18-19 year-olds, as well as for 15-17 year-olds. While these increases are large in relative magnitude, they are small in the absolute number of affected teenagers. Finally, we find no evidence for an increase in alcohol-related vehicular accidents at the time of the law change for any teenagers. In an important methodological contribution, we show that one approach commonly used to estimate the impact of changing the legal drinking age on outcomes, an RDD that compares individuals just younger than the drinking age to those just older, has the potential to give misleading results. Overall, our results support the argument that the legal drinking age can be lowered without leading to large increases in detrimental outcomes for youth.
    Keywords: drinking age, alcohol consumption, hospitalization, vehicular accidents, New Zealand
    JEL: I18 K42 C25
    Date: 2013–07
  7. By: Adena, Maja (WZB - Social Science Research Center Berlin); Myck, Michal (Centre for Economic Analysis, CenEA)
    Abstract: Using a sample of Europeans aged 50+ from twelve countries in the Survey of Health, Ageing and Retirement in Europe (SHARE) we analyse the role of poor material conditions as a determinant of changes in health over a four-year period. We find that poverty defined with respect to relative incomes has no effect on changes in health. However, broader measures of poor material conditions such as subjective poverty or low relative value of wealth significantly increase the probability of transition to poor health among the healthy and reduce the chance of recovery from poor health over the time interval analysed. In addition to this the subjective measure of poverty has a significant effect on mortality, increasing it by 40.3% among men and by 58.3% among those aged 50–64. Material conditions matter for health among older people. We suggest that if monitoring of poverty in old age and corresponding policy targets are to focus on the relevant measures, they should take into account broader definitions of poverty than those based only on relative incomes.
    Keywords: health transitions, material conditions, poverty, mortality
    JEL: I14 I32 J14
    Date: 2013–07
  8. By: Smith, James P. (RAND); Tian, Meng (Peking University); Zhao, Yaohui (Peking University)
    Abstract: There is increasing interest in neighborhood or area effects on health and individual development. China, due to its vast regional variations in health infrastructure and geography and relative immobility of older residents, provides a rare opportunity to study such effects. Utilizing China Health and Retirement Longitudinal Study (CHARLS) baseline survey 2011-2012 which covered over 17,000 individuals in 450 randomly selected communities/villages, this paper addresses two questions: whether community/village characteristics matter for individual health and SES (Socio-Economic Status), and why they matter. Our statistical results indicate that community/village characteristics have strong associations with individual health and SES.
    Keywords: China, neighborhood effects, health
    JEL: I10 I14
    Date: 2013–07
  9. By: Tekin, Erdal (Georgia State University); McClellan, Chandler (Georgia State University); Minyard, Karen Jean (Georgia State University)
    Abstract: While previous studies have shown that recessions are associated with better health outcomes and behaviors, the focus of these studies has been on the relatively milder recessions of the late 20th century. In this paper, we examine if the previously established counter-cyclical pattern in health and heath behaviors is held during the Great Recession. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) between 2005 and 2011 and focusing on a wide range of outcomes capturing health and health behaviors, we show that the association between economic deterioration and these outcomes has weakened considerably during the recent recession. In fact, majority of our estimates indicate that the relationship has practically become zero, though subtle differences exist among various sub-populations. Our results are consistent with the evidence emerging from several recent studies that suggests that the relationship between economic activity and health and health behaviors has become less noticeable in the recent years.
    Keywords: health, recession, business cycle, health behavior
    JEL: E32 I00 I10 I12 I14 I15
    Date: 2013–07
  10. By: Ciani, Federico (University of Florence); Giannelli, Gianna Claudia (University of Florence)
    Abstract: Between April and July 1994 Rwanda experienced a tremendous wave of inter-ethnic violence that caused at least 500,000 deaths. Combining birth history data drawn from the 2000 Rwanda Demographic and Health Survey with prefecture-level information on the intensity of the conflict, we examine the impact of the civil war on infant and child mortality. War exposure is measured exploiting the differential effects of timing of birth and genocide intensity at the household and geographic level. Considering both in utero and postnatal war exposure, we estimate discrete time proportional hazard models of child mortality for the exposed and the unexposed birth cohorts. We find large positive effects of exposure to the conflict on infant and child mortality. Moreover, restricting our sample to the survivors, we find that child mortality is significantly impacted by war exposure, increasing the hazard rate by nearly 6 percentage points on average. This result holds true also for children who were only exposed while in utero. This evidence points to the existence of long-term disruptive effects on the cohorts of children exposed to the violence.
    Keywords: genocide, child mortality, child health, survival analysis, Rwanda
    JEL: I20 J13 O12 Z13
    Date: 2013–07

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