nep-hea New Economics Papers
on Health Economics
Issue of 2013‒09‒06
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Adaptability and innovation in healthcare facilities. Lessons from the past for future developments By Barlow, JG; Koberle-Gaiser, M; Moss, R; Noble, A; Scher, P; Stow, D
  2. Remote Care plc. Developing the capacity of the remote care industry to supply Britain?s future needs. By Barlow, JG; Curry, R; Chrysanthaki, T; Hendy, J; Taher, N
  3. The Economic Impact of Non-communicable Disease in China and India: Estimates, Projections, and Comparisons By Bloom, David E.; Cafiero, Elizabeth T.; McGovern, Mark E.; Prettner, Klaus; Stanciole, Anderson; Weiss, Jonathan; Bakkila, Samuel; Rosenberg, Larry
  4. Long-Term Care and Lazy Rotten Kids By Cremer, Helmuth; Roeder, Kerstin
  5. The Causal Effect of Retirement on Mortality: Evidence from Targeted Incentives to Retire Early By Bloemen, Hans; Hochguertel, Stefan; Zweerink, Jochem
  6. Satisfaction of Patients in Health Care: Some Critical Issues with Research Projects that Measure Satisfaction By Ronald J. Degen
  7. Dynamics of obesity in Finland By Halicioglu, Ferda
  8. Inequality of Opportunity in Health Care in China: Suggestion on the Construction of the Urban-Rural Integrated Medical Insurance System By Sun, Jiawei; Ma, Chao; Song, Ze; Gu, Hai
  9. An Equilibrium Model of the African HIV/AIDS Epidemic By Philipp Kircher; Michele Tertilt; Cezar Santos; Jeremy Greenwood
  10. Crowding out of Solidarity? – Public Health Insurance versus Informal Transfer Networks in Ghana By Florian Klohn; Christoph Strupat
  11. Southern African Customs Union Revenue, Public Expenditures and HIV/AIDS in BLNS Countries By Harold Ngalawa
  12. The transmission of longevity across generations: The case of the settler Cape Colony By Patrizio Piraino; Sean Muller; Jeanne Cilliers; Johan Fourie
  13. Does Early Life Exposure to Cigarette Smoke Permanently Harm Childhood Health? Evidence from Cigarette Tax Hikes By David Simon
  14. Physiological Responses to Stressful Work Situations in Low-Immersive Virtual Environments By Valeria Faralla; Alessandro Innocenti; Stefano Taddei; Eva Venturini
  15. The impact of Migration on Infant Mortality Reduction in Albania By Narazani, Edlira
  16. The Trade and Health Effects of Tobacco Regulations By Gregmar Galinato; Aaron Olanie; Jon Yoder
  17. Bias in Measuring Smoking Behavior By Vidhura Tennekoon; Robert Rosenman

  1. By: Barlow, JG; Koberle-Gaiser, M; Moss, R; Noble, A; Scher, P; Stow, D
    Date: 2013–08–19
  2. By: Barlow, JG; Curry, R; Chrysanthaki, T; Hendy, J; Taher, N
    Date: 2013–08–19
  3. By: Bloom, David E. (Harvard University); Cafiero, Elizabeth T. (Harvard School of Public Health); McGovern, Mark E. (Harvard School of Public Health); Prettner, Klaus (University of Göttingen); Stanciole, Anderson (The Bill and Melinda Gates Foundation); Weiss, Jonathan (London School of Hygiene & Tropical Medicine); Bakkila, Samuel (Harvard School of Public Health); Rosenberg, Larry (Harvard School of Public Health)
    Abstract: This paper provides estimates of the economic impact of non-communicable diseases (NCDs) in China and India for the period 2012-2030. Our estimates are derived using WHO's EPIC model of economic growth, which focuses on the negative effects of NCDs on labor supply and capital accumulation. We present results for the five main NCDs (cardiovascular disease, cancer, chronic respiratory disease, diabetes, and mental health). Our undiscounted estimates indicate that the cost of the five main NCDs will total USD 27.8 trillion for China and USD 6.2 trillion for India (in 2010 USD). For both countries, the most costly domains are cardiovascular disease and mental health, followed by respiratory disease. Our analyses also reveal that the costs are much larger in China than in India mainly because of China's higher income and older population. Rough calculations also indicate that WHO's Best Buys for addressing the challenge of NCDs are highly cost-beneficial.
    Keywords: health and economic development, non-communicable disease, growth models, cost-effectiveness
    JEL: E13 I15 O40
    Date: 2013–08
  4. By: Cremer, Helmuth (Toulouse School of Economics); Roeder, Kerstin (University of Munich)
    Abstract: This paper studies the determination of informal long-term care (family aid) to dependent elderly in a worst case scenario concerning the "harmony" of family relations. Children are purely selfish, and neither side can make credible commitments (which rules out efficient bargaining). The model is based on Becker's "rotten kid" specification except that it explicitly accounts for the sequence of decisions. In Becker's world, with a single good, this setting yields efficiency. We show that when family aid (and long-term care services in general) are introduced, the outcome is likely to be inefficient. Still, the rotten kid mechanism is at work and ensures that a positive level of aid is provided as long as the bequest motive is operative. We identify the inefficiencies by comparing the laissez-faire (subgame perfect) equilibrium to the first-best allocation. We initially assume that families are identical ex ante. However, the case where dynasties differ in wealth is also considered. We study how the provision of long-term care (LTC) can be improved by public policies under various informational assumptions. Interestingly, crowding out of private aid by public LTC is not a problem in this setting. With an operative bequest motive, public LTC will have no impact on private aid. More amazingly still, when the bequest motive is (initially) not operative, public insurance may even enhance the provision of informal aid.
    Keywords: rotten kids, long-term care, family aid, optimal taxation
    JEL: D13 H21
    Date: 2013–08
  5. By: Bloemen, Hans (VU University Amsterdam); Hochguertel, Stefan (VU University Amsterdam); Zweerink, Jochem (VU University Amsterdam)
    Abstract: This paper identifies and estimates the impact of early retirement on the probability to die within five years, using administrative micro panel data covering the entire population of the Netherlands. Among the older workers we focus on, a group of civil servants became eligible for retirement earlier than expected during a short time window. This exogenous policy change is used to instrument the retirement choice in a model that explains the probability to die within five years. Exploiting the panel structure of our data, we allow for unobserved heterogeneity by way of individual fixed effects in modeling the retirement choice and the probability to die. We find for men that early retirement, induced by the temporary decrease in the age of eligibility for retirement benefits, decreased the probability to die within five years by 2.5 percentage points. This is a strong effect. We find that our results are robust to several specification changes.
    Keywords: instruments, retirement, mortality
    JEL: C26 I1 J26
    Date: 2013–08
  6. By: Ronald J. Degen (International School of Management Paris)
    Abstract: This paper presents three critical issues that researchers need to consider when preparing a research project that measures the satisfaction of patients in health care. These issues are: the correct interpretation of the research objective and formulation of the research questions, selection the appropriate research design, and the credibility of the research project and its conclusions.
    Keywords: virtual satisfaction of patients, formulating research questions, appropriate research design, credibility of research projects
    JEL: M0 M1
    Date: 2013–09–01
  7. By: Halicioglu, Ferda
    Abstract: The purpose of this research is to study empirically the dynamics of obesity in Finland and provide empirical evidence of temporal causality between obesity, health expenditure, unemployment, urbanization, alcohol consumption and calorie intake. The paper employs bounds testing cointegration procedure and augmented causality tests. The empirical results suggest the existence of cointegration amongst the variables. Augmented Granger causality tests indicate the existence of a long-run causality as well as three different pairs of short-run causalities. The study draws some important policy recommendations.
    Keywords: obesity, cointegration, causality, time series, Finland
    JEL: C22 H51 I1 I10
    Date: 2013
  8. By: Sun, Jiawei; Ma, Chao; Song, Ze; Gu, Hai
    Abstract: This paper investigates the urban-rural inequality of opportunity in health care in China based on the theory of equality of opportunity of Roemer (1998). Following the compensation principle proposed by Fleurbaey and Schokkaert (2011), this paper establishes a decomposition strategy of the fairness gap, which we use for the measurement of the inequality of opportunity in the urban-rural health care use. Empirical analysis using the CHNS data shows that the ratios of the fairness gap to the directly observed average urban-rural difference in health care are 1.167 during 1997-2000 and 1.744 during 2004-2006, indicating that the average urban-rural difference observed directly from original statistical data may underestimate the degree of the essential inequity. Meanwhile, the increasing fairness gap and the decomposition results imply that generally leveling the urban-rural reimbursement ratios is probably not sufficient, and pro-disadvantage policies should be put in place in order to mitigate or even eliminate the inequality of opportunity in health care use between urban and rural residents. The results are also illuminating for the experiments and establishment of the urban-rural integrated medical insurance system (URIMIS) in China. The pro-disadvantage policies will be more appreciated and effective in the promotion of the equality of opportunity in health care, within the background of urban-rural dualistic social structure and widening urban-rural income gap. This suggestion is supported by data from the URIMIS pilot regions in Jiangsu province. The results show that the fairness gap can be narrowed significantly via pro-disadvantage policies.
    Keywords: equality of opportunity; health care; fairness gap; urban-rural integrated medical insurance system
    JEL: D12 D63 I18
    Date: 2013–09–01
  9. By: Philipp Kircher (LSE and University of Edinburgh); Michele Tertilt (University of Mannheim); Cezar Santos (University of Mannheim); Jeremy Greenwood (University of Pennsylvania)
    Abstract: Eleven percent of the Malawian population is HIV infected. Eighteen percent of sexual encounters are casual. A condom is used one quarter of the time. A choice-theoretic general equilibrium search model is constructed to analyze the Malawian epidemic. In the developed framework, people select between different sexual practices while knowing the inherent risk. The analysis suggests that the efficacy of public policy depends upon the induced behavioral changes and general equilibrium effects that are typically absent in epidemiological studies and small-scale field experiments. For some interventions (some forms of promoting condoms or marriage), the quantitative exercise suggests that these effects may increase HIV prevalence, while for others (such as male circumcision or increased incomes) they strengthen the effectiveness of the intervention. The underlying channels giving rise to these effects are discussed in detail.
    Date: 2013
  10. By: Florian Klohn; Christoph Strupat
    Abstract: This paper delivers empirical evidence on how informal transfers are affected by a formal and country-wide health insurance scheme. Using the fifth wave of the Ghanaian Living Standard Household Survey, we investigate the extent to which the exogenous implementation of the National Health Insurance Scheme affects the probability of making or receiving informal transfers and their monetary equivalents. Our findings suggest that there is a significant crowding out of informal transfers. Members of weak transfer networks and individuals that run an enterprise are inclined to reduce their amount of remittances. We conclude that the provision of formal health insurance can reduce covariate risk in weak transfer networks and support business owners that are confronted by strong sharing obligations.
    Keywords: Public health insurance; informal transfer networks; crowding out; Ghana
    JEL: I15 O12
    Date: 2013–08
  11. By: Harold Ngalawa
    Abstract: This study sets out to investigate how revenue from the Southern African Customs Union (SACU) common revenue pool affect efforts to contain HIV/AIDS in Botswana, Lesotho, Namibia and Swaziland (BLNS countries). Using a panel data set of the BLNS countries covering the period 1990-2007 in annual frequency and a health production function, we show that an increase in either SACU revenue or aggregate government expenditure increases HIV prevalence rates. Disaggregating the government expenditures into health and non-health outlays reveals that the health expenditure component decreases HIV prevalence rates. We argue, therefore, that the type of public expenditure matters: public health expenditures decrease while public non-health expenditures increase HIV prevalence rates, with the ultimate direction of HIV prevalence rates determined by the dominant of the two effects.
    Keywords: Government expenditure, customs union, health, HIV prevalence
    JEL: H27 H51 I12
    Date: 2013
  12. By: Patrizio Piraino (Department of Economics, University of Cape Town); Sean Muller (Department of Economics, University of Cape Town); Jeanne Cilliers (Department of Economics, University of Stellenbosch); Johan Fourie (Department of Economics, University of Stellenbosch)
    Abstract: The literature on parent-child correlations in socioeconomic status provides little evidence on long-term multigenerational dynamics. This is because most studies of intergenerational status persistence are based on two (at most three) successive generations. Our analysis adds to the intergenerational mobility literature by studying the correlation in longevity across multiple generations of a historical population. By using information on birth and death dates of eighteenth and nineteenth century settlers in South Africa’s Cape Colony, we are able to estimate the intergenerational transmission of longevity, which is found to be positive and significant. Our analysis confirms one of the most consistent findings in the social sciences: the correlation between the status of parents and that of their offspring is positive and significant.
    Keywords: intergenerational mobility, persistence, social mobility, inequality, genealogical, Cape Colony
    JEL: J62 N37
    Date: 2013
  13. By: David Simon (University of Connecticut)
    Abstract: Recent evidence suggests that smoking during pregnancy has adverse effects on fetal health. However, it remains unknown if smoke exposure causes lasting harm to health through childhood. To mitigate omitted variables bias, I exploit variation in cigarette taxes. By leveraging cigarette tax hikes, I shed light on the ability of these taxes to change health behavior in a way that improves long-term child outcomes. In-utero exposure to a tax hike leads to large and significant improvements to a child’s wellbeing. I find that a one dollar increase (in 2009 dollars) in the state cigarette excise tax causes a 10% decrease in sick days from school, and a 4.5% decrease in the likelihood of having two or more doctor visits in the past 12 months. I also find suggestive evidence that early life exposure to a cigarette tax hike decreases hospitalizations and asthma attacks. I find support for my identifying assumptions in a number of falsification tests. This study supports the hypothesis that that in-utero exposure to cigarette smoke caries significant medium-term costs.
    JEL: J13 J18 I14
    Date: 2013–08
  14. By: Valeria Faralla; Alessandro Innocenti; Stefano Taddei; Eva Venturini
    Abstract: The paper analyzes physiological responses to different visual representations of stressful work activities. A between-subject experiment was conducted to analyze differences in heart rate (HR) and electromyography (EMG) between subjects watching videos featuring real actors and virtual videos with avatars representing the same situation. Findings show that exposure to real videos is associated with greater physiological activations than exposure to virtual videos. This evidence may suggest that, by inducing less emotional involvement, low-immersive virtual environments activate different cognitive mechanisms of stress perception.
    Keywords: work stress, physiological activations, perception, virtual reality.
    JEL: C91 D01 D81
    Date: 2013–07
  15. By: Narazani, Edlira (University of Turin)
    Abstract: In the last two decades, Albania went through a substantial reduction in infant mortality rates together with a widespread migration experience. In this paper we investigate whether migration has played any role in this decreasing trend of infant mortality in Albania by using the Albanian Demographic and Health Survey 2008-09 (ADHS). First we assess whether migration has affected fertility decisions, namely, number of children and child sex composition among women aged 15 to 49 who have ever been married, but find no statistically significant evidence for any impact even when migration is instrumented. Afterwards, migration impact on child health status is investigated and the estimations results show that migrant households have had lower rates of infant mortality than non-migrant househol ds but only once the endogeneity of migration is tackled with country-specific instrumental variables.
    Date: 2013–07
  16. By: Gregmar Galinato; Aaron Olanie; Jon Yoder (School of Economic Sciences, Washington State University)
    Abstract: This paper examines how domestic and foreign tobacco regulations affect tobacco trade flows and consumer health in importing countries. We develop a gravity equation incorporating domestic and foreign tobacco regulations into a country’s tobacco import demand. We estimate the bilateral trade effects of marketing, counter-advertising, age and smoking tobacco location regulations. There are two striking results: smoking location regulations reduce tobacco exports and imports, and marketing regulations may actually increase tobacco trade. The magnitude of these effects is larger when the trading partners are rich exporters and poor importers. Using existing health effect elasticities in conjunction with our results, we show how these changes affect tobacco-related mortality and morbidity in importing countries. Our results highlight the importance of implementing policies that account for potential spillover effects in an increasingly multilateral economy.
    Keywords: bilateral trade effect; gravity model; tobacco regulation; mortality
    JEL: F14 I18
    Date: 2013–08
  17. By: Vidhura Tennekoon; Robert Rosenman (School of Economic Sciences, Washington State University)
    Abstract: Researchers often use the discrepancy between the self-reported and biochemically assessed active smoking status to argue that self-reported smoking status is not reliable, ignoring the limitations of biochemically assessed measures and treating it as the gold standard in their comparisons. Here, we employ recent advances in econometric techniques to compare self-reported and biochemically assessed smoking data taking into account errors with both methods. Our results suggest that biochemical measures may not always be more reliable than self-reported data.
    Keywords: smoking prevalence, misclassification, social desirability, biochemical assessments
    JEL: C13 C18 I10 I18
    Date: 2013–08

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