nep-hea New Economics Papers
on Health Economics
Issue of 2014‒04‒18
sixteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness By G. Fiorentini; G. Ragazzi; S. Robone
  3. The Economic and Demographic Transition, Mortality, and Comparative Development By Cervellati, Matteo; Sunde, Uwe
  4. Workers' Mental Health, Long Work Hours, and Workplace Management: Evidence from workers' longitudinal data in Japan (Japanese) By KURODA Sachiko; YAMAMOTO Isamu
  5. Workers' Mental Health and Firm Performance: Evidence from firms' longitudinal data in Japan (Japanese) By KURODA Sachiko; YAMAMOTO Isamu
  6. Globalization and Child Health in Developing Countries: The Role of Democracy By Welander, Anna; Lyttkens, Carl Hampus; Nilsson, Therese
  7. Refining Population Health Comparisons: A Multidimensional First Order Dominance Approach By Hussain, M. Azhar; Jørgensen, Mette Møller; Østerdal, Lars Peter
  8. How long Japanese mothers quit smoking when they start raising children? New evidences from a very large national data By Ogura, Seiritsu; Nakazono, Sanae
  9. Health Status, Disability and Retirement Incentives in Belgium By Alain Jousten; Mathieu Lefebvre; Sergio Perelman
  10. Health Care in a Multipayer System: The Effects of Health Care Service Demand among Adults under 65 on Utilization and Outcomes in Medicare By Sherry A. Glied
  11. Regional differences in life expectancy at birth in Mexican municipalities, 1990-2000 By Flores, Miguel; Bradshaw, Benjamin; Hoque, Nazrul
  12. Valuation of Small and Multiple Health Risks: A Critical Analysis of SP Data Applied to Food and Water Safety By Henrik Andersson; Arne Risa Hole; Mikael Svensson
  13. Inequity in long-term care use and unmet need: two sides of the same coin By Garcia-Gomez, P.;; Hernandez-Quevedo, C.;; Jimenez-Rubio, D.;; Oliva, J.;
  14. Formal and informal volunteering and health across European countries By Fiorillo, D.;; Nappo, N.;
  15. Social Interactions and Malaria Preventive Behaviors in Sub-Saharan Africa By Apouey, B.;; Picone, G.;
  16. A synthesis of the Grossman and Becker-Murphy models of health and addiction: theoretical and empirical implications By Jones, A. M.;; Laporte, A.;; Rice, N.;; Zucchelli, E.;

  1. By: G. Fiorentini; G. Ragazzi; S. Robone
    Abstract: This paper considers the influence of patients’ characteristics on their evaluation of a health system’s responsiveness, that is, a system’s ability to respond to the legitimate expectations of potential users regarding non-health enhancing aspects of care (Valentine et al. 2003a). Since responsiveness is evaluated by patients on a categorical scale, their selfevaluation can be affected by the phenomenon of reporting heterogeneity (Rice et al. 2012). A few studies have investigated how standard socio-demographic characteristics influence the reporting style of health care users with regard to the question of the health system’s responsiveness (Sirven et al. 2012, Rice et al. 2012). However, we are not aware of any studies that focus explicitly on the influence that both the patients’ state of health and their experiencing of pain have on the way in which they report on system responsiveness. This paper tries to bridge this gap by using data regarding a sample of patients hospitalized in four Local Health Authorities (LHA) in Italy’s Emilia-Romagna region between 2010 and 2012. These patients have evaluated 27 different aspects of the quality of care, concerning five domains of responsiveness (communication, social support, privacy, dignity and quality of facilities). Data have been stratified into five sub-samples, according to these domains. We estimate a generalized ordered probit model (Terza, 1985), an extension of the standard ordered probit model which permits the reporting behaviour of respondents to be modelled as a function of certain respondents’ characteristics, which in our analysis are represented by the variables “state of health” and “pain”. Our results suggest that unhealthier patients are more likely to report a lower level of responsiveness, all other things being equal, while patients experiencing pain are more likely to make use of the extreme categories of responsiveness, that is, to choose the category “completely dissatisfied” or the category “completely satisfied”. These results hold across all five domains of responsiveness.
    JEL: I1 I11 I19 C50 C25
    Date: 2014–03
  2. By: Jason M. Fletcher
    Abstract: A growing literature in economics and other disciplines has tied exposure to early health shocks, particularly in utero influenza, to reductions in a variety of socioeconomic and health outcomes over the life course. However, no current evidence exists that examines this health shock on mortality because of lack of available data. This paper uses newly released files from the large, representative National Longitudinal Mortality Study to explore the mortality effects of the 1918 influenza pandemic for those in utero. While the results on socioeconomic outcomes mimic those in the literature, showing reductions in completed schooling and income fifty years following influenza exposure, the findings also suggest no effect on overall mortality or by categories of cause-of-death. These results are counter-intuitive in their contrast with the many reported effects on cardiovascular health as well as the literature linking education with later mortality
    Date: 2014–03
  3. By: Cervellati, Matteo (University of Bologna); Sunde, Uwe (University of Munich)
    Abstract: We propose a unified growth theory to investigate the mechanics generating the economic and demographic transition, and the role of mortality differences for comparative development. The framework can replicate the quantitative pat- terns in historical time series data and in contemporaneous cross-country panel data, including the bi-modal distribution of the endogenous variables across coun- tries. The results suggest that differences in extrinsic mortality might explain a substantial part of the observed differences in the timing of the take-off across countries and the worldwide density distribution of the main variables of interest.
    Keywords: Economic and Demographic Transition, Adult Mortality, Child Mortality, Quantitative Analysis, Unified Growth Model, Heterogeneous Human Capital, Comparative Development, Development Traps
    Date: 2013
  4. By: KURODA Sachiko; YAMAMOTO Isamu
    Abstract: Using workers' longitudinal data, this paper investigates the relationship between long work hours and workers' mental health. The number of workers suffering from mental disorders has increased significantly in this decade, and many believe that overwork is the primary reason for deterioration in mental wellness in Japan. Nevertheless, most of the previous studies in social science and epidemiology investigating the effect of work hours on mental health control neither individuals' fixed factors nor detailed information of workers and workplace characteristics. By tracing 700 workers' mental health conditions for two consecutive years along with collecting detailed information related to the workplace, this paper examines whether there are any work-related causes that may damage workers' mental health. Our main findings are summarized as follows. First, assessing workers' mental health by the General Health Questionnaire (GHQ12), we found that workers' mental health changes drastically within a two-year period. Second, even after controlling for workers' fixed effect and other detailed characteristics, we establish that long work hours is one of the principal causes which deteriorate workers' mental health. We also found that unpaid overwork especially worsens workers' mental health. This trend is observed particularly among highly educated male workers under the age of 40. On the other hand, regardless of being paid or unpaid, long work hours tend to damage the mental health of female and low-educated workers. This may imply that time constraint differs among the workers' group. Third, we also found that job characteristics and workplace practices influence workers' mental health significantly. These findings suggest that good workplace practices, including management of work hours, would be influential to improve workers' mental health.
    Date: 2014–04
  5. By: KURODA Sachiko; YAMAMOTO Isamu
    Abstract: Using firms' longitudinal data, this paper investigates the relationship among workers' mental health, firms' profit and productivity, and preventive measures at the workplace. In Japan, the number of workers suffering from mental disorders has grown significantly in this decade. From the advice given by the Japanese government, firms have introduced various preventive measures to cope with this problem. To our knowledge, however, there is almost no cost-and-benefit quantitative analysis when implementing such measures. Furthermore, there is also no evidence, besides numerous literature focusing on presenteeism and absenteeism, to assess to what extent firms' profit and productivity are affected when there are workers with mental disorders at the workplace. By using data from 451 Japanese firms with rich information related to mental health and firm performance, we found the following. First, we found that medium-sized firms (300-999 employees), the information technology industry, and firms with relatively longer average work hours tend to have a higher ratio of workers taking long-term sick leave due to mental disorders. Second, many firms seem to be reluctant to introduce costly measures, such as hiring occupational doctors or nurses and screening surveys. Third, we found that, in general, introducing firm-level measures does not decrease the ratio significantly. Fourth, firms with a higher ratio of such workers may decrease their profit-to-sales ratio compared to those with a lower ratio with more than a two-year lag. This implies that the ratio of workers taking long-term sick leave due to mental disorders may become a proxy of bad workplace management and also a leading indicator of a firm's future profit/loss situation.
    Date: 2014–04
  6. By: Welander, Anna (Lund University); Lyttkens, Carl Hampus (Lund University); Nilsson, Therese (Research Institute of Industrial Economics (IFN))
    Abstract: Good health is crucial for human and economic development. In particular poor health in childhood seems to be of utmost concern since it causes irreversible damage and have implications later in life. Recent research suggests globalization is a strong force affecting adult and child health outcomes. Yet, there is much unexplained variation with respect to the globalization effect on child health, in particular in low- and middle-income countries. One factor that could explain such variation across countries is the quality of democracy. Using panel data for 70 developing countries between 1970 and 2009 this paper disentangles the relationship between globalization, democracy, and child health. Specifically the paper examines how globalization and a country's democratic status and historical experience with democracy, respectively, affect infant mortality. In line with previous economic research, results suggest that globalization reduces infant mortality and that the level of democracy in a country generally improves child health outcomes. We also find that democracy matters for the size of the globalization effect on child health. If e.g. Côte d'Ivoire was a democracy in the 2000–2009 period, this effect would translate into 1,200 fewer infant deaths in an average year compared to the situation without democracy.
    Keywords: Globalization; Democracy; Health; Developing Countries
    JEL: I15 P16
    Date: 2014–04–08
  7. By: Hussain, M. Azhar (Department of Society and Globalisation, Roskilde University); Jørgensen, Mette Møller (John F. Kennedy School of Government); Østerdal, Lars Peter (COHERE, Department of Business and Economics)
    Abstract: How to determine if a population group has better overall (multidimensional) health status than another is a central question in the health and social sciences. We apply a multidimensional first order dominance concept that does not rely on assumptions about the relative importance of each dimension or the complementarity/substitutability across dimensions. In particular, we suggest that one can explore the “depth” of dominances by sequentially refining the health dimensions to see which dominances persist. Using The Danish National Health Interview Survey, we conduct dominance comparisons between population groups based on education, gender, marital status, and ethnicity for given age intervals. Our empirical illustration shows that it is possible to operationalize and meaningfully apply the multidimensional first order dominance concept with sequential refinements of health status to as much as ten health dimensions.
    Keywords: Multidimensional first order dominance; population health comparisons; refinement; inequalities in health; The Danish National Health Survey
    JEL: D63 I14
    Date: 2014–04–01
  8. By: Ogura, Seiritsu; Nakazono, Sanae
    Abstract: Background: The exposure of children to secondhand smoke at home and elsewhere has been largely an overlooked problem in Japan, regardless of widely well spread knowledge about health risk of secondhand smoke exposure to children. Furthermore, evidence and study are limited and little is known about relationship between smoking behavior and socio-economic factors in Japan. Objectives: Our broad perspective is to identify the important risk factors of women’s smoking. We first focus on mother who has greater impact on child health. Thus, our main interest here is to demonstrate mothers’ behavior during the course of one year after child birth. We also address association between women’s smoking behavior from several different point of views including their characteristic, family or social environments. Methods: The four different years (2001, 2004, 2007, 2010) of Comprehensive Survey of Living Conditions, a nationally representative data, are used. Multivariate logistic regression is conducted as setting one for smoking and zero for non-smoking. Followed by this, marginal effects of each variable are estimated. Results: Mothers cessation of smoking after delivery is unstable in Japan, depending on the age and the parity of a child. For a first child, more than two-thirds of women who used to smoke, abstain from smoking at least for one year. For a second child, compared with a first child, only a half of the mothers quits temporarily in its first year. In both cases, cessation efforts decline rapidly over time. By the time a mother has a third child, she barely quits smoking. Although an increasing proportion of mothers are quitting in the first year, the difference narrows considerably in subsequent years. We also found that, among Japanese women, such factors as marital status, husband’s smoking status, other smokers in household are strongly related to smoking, while job-types, living with head of household’s parents, and housing have differential impacts on it.
    Date: 2014–03
  9. By: Alain Jousten; Mathieu Lefebvre; Sergio Perelman
    Abstract: Many Belgian retire well before the statutory retirement age. Numerous exit routes from the labor force can be identified: old-age pensions, conventional early retirement, disability insurance, and unemployment insurance are the most prominent ones. We analyze the retirement decision of Belgian workers adopting an option value framework, and pay special attention to the role of health status. We estimate probit models of retirement using data from SHARE. The results show that health and incentives matter in the decision to exit from the labor market. Based on these results, we simulate the effect of potential reforms on retirement.
    JEL: H55 J21 J26
    Date: 2014–04
  10. By: Sherry A. Glied
    Abstract: Doctors and hospitals in the United States serve patients covered by many types of insurance. This overlap in the supply of health care services means that changes in the prices paid or the volume of services demanded by one group of patients may affect other patient groups. This paper examines how marginal shifts in the demand for services among the adult population under 65 (specifically, factors that affect the uninsurance rate) affect use in the Medicare population. I provide a simple theoretical framework for understanding how changes in the demand for care among adults under 65 may affect Medicare spending. I then examine how two demand factors–recent coverage eligibility changes for parents and the firm size composition of employment–affect insurance coverage among adults under 65 and how these factors affect per beneficiary Medicare spending. Factors that contribute to reductions in uninsurance rates are associated with contemporaneous decreases in per beneficiary Medicare spending, particularly in high variation Medicare services. Reductions in the demand for medical services among adults below age 65 are not associated with reductions in the total quantity of physician services supplied. The increased Medicare utilization that accompanies lower demand among those under 65 has few, if any, benefits for Medicare patients.
    JEL: I1 I11 I13
    Date: 2014–04
  11. By: Flores, Miguel; Bradshaw, Benjamin; Hoque, Nazrul
    Abstract: The purpose of this study is to provide life expectancy estimates at birth for states and aggregates of municipalities by population size within regions of Mexico. A regression-based technique is used to estimate life expectancy for these populations from 1990 to 2000. Our findings suggest that the greatest increase in life expectancy among population size groups occurred in “extended-rural” municipalities (those with a population of 2,500 to 14,999) with an average of 7 years. The capital region showed the highest increase in life expectancy among all the regions, with considerable increases in extended-rural municipalities. Our estimates are consistent with expectations with respect to urban advantages in life expectancy, which probably reflect the concentration of public health services, as well as primary, secondary and tertiary medical care. This analysis may be useful in evaluating the public health policies of the Mexican authorities that have focused on diminishing health inequalities between well and poorly served populations. In general, the life expectancies prepared by the regression method are quite close to those prepared from age-specific mortality rates, and our results show the utility of this shortcut method compared with life expectancies estimated from complete sets of age-specific mortality rates.
    Keywords: Health disparities, mortality rates, life expectancy, Mexican municipalities
    JEL: I19
    Date: 2013–08
  12. By: Henrik Andersson (Toulouse School of Economics (LERNA)); Arne Risa Hole (University of Sheffield); Mikael Svensson (Karlstad University)
    Abstract: This study elicits individual preferences for reducing morbidity and mortality risk in the context of an infectious disease (campylobacter) using choice experiments. Respondents are in the survey asked to choose between different policies that, in addition to the two health risks, also vary with respect to source of disease being targeted (food or water), when the policy takes place (in time), and the monetary cost. Our results in our baseline model are in line with expectations; respondents prefer the benefits of the program sooner than later, programs that reduce both the mortality and morbidity risk, and less costly programs. Moreover, our results suggest that respondents prefer water- compared with food-safety programs. However, a main objective of this study is to examine scope sensitivity of mortality risk reductions using a novel approach. Our results from a split-sample design suggest that the value of the mortality risk reduction, defined as the value of a statistical life, is SEK 3 177 (USD 483 million) and SEK 50 million (USD 8 million), respectively, in our two sub-samples. This result cast doubt on the standard scope sensitivity tests in choice experiments, and the results also cast doubt on the validity and reliability of VSL estimates based on stated preference (and revealed preference) studies in general. This is important due to the large empirical literature on non-market evaluation and the elicited values' central role in policy making, such as benefit-cost analysis.
    Keywords: choice experiments; morbidity risk; mortality risk; scope sensitivity; willingness to pay
    JEL: D61 H41 I18 Q51
    Date: 2014–04
  13. By: Garcia-Gomez, P.;; Hernandez-Quevedo, C.;; Jimenez-Rubio, D.;; Oliva, J.;
    Abstract: International studies have shown evidence on inequity in use of health services of different kinds, depending on the type of health care service analysed. However, equity in the access to long-term care (LTC) services has received much less attention. We investigate the determinants of several LTC services and the existence of unmet need by the disabled population using unique data from a survey conducted on the disabled population in Spain in 2008. We further measure the level of horizontal inequity using methods based on the Concentration Index, a widely used indicator of income-related inequality in health. At the time of the analysis, only those respondents with the highest dependency level were covered by the recently introduced universal LTC system, which allows us to explore whether inequities remain for this subgroup of the population. In addition, we compare results using self-reported versus a more objective indicator of unmet needs. Evidence suggests that after controlling for a wide set of need variables, there is not an equitable distribution of use and unmet need of LTC services in Spain, with socioeconomic status being an important factor in access to LTC. We find that individuals at the higher end of the income distribution utilize a relatively larger share of formal services (provided by a professional), while intensive informal care (provided by friends and family) is concentrated among the worst-off. In terms of unmet needs for LTC services, their distribution depends on the service considered as well as on whether we focus on subjective or objective measures. Interestingly, for the population covered by the new universal LTC system, inequities in most LTC services and unmet needs remain statistically significant and even increase for certain services, in particular, formal services provided by professionals.
    Keywords: Disability, equity in utilisation, dependency, long-term care, unmet needs, Spain
    JEL: I14 I38 J14
    Date: 2014–01
  14. By: Fiorillo, D.;; Nappo, N.;
    Abstract: In this paper we compare the correlation among formal and informal volunteering and self-perceived health across 14 European countries after controlling for socio-economic characteristics, housing features, neighborhood quality, size of municipality, social participation and regional dummies. we find that formal volunteering has a significantly positive association with self-perceived health in Finland and the Netherlands, but none in the other countries. By contrast, informal volunteering has a significantly positive correlation with self-perceived health in the Netherlands, France, Spain, Portugal and Greece, and a significantly negative relationship in Italy. Our conclusion is that formal and informal volunteering measure two different aspects of volunteering whose correlations with perceived health seem to depend on specific cultural and institutional characteristics of each country.
    Keywords: Attrition; self-perceived health, formal and informal volunteering, European countries
    JEL: I10 P5 Z1
    Date: 2014–03
  15. By: Apouey, B.;; Picone, G.;
    Abstract: This paper examines the existence of social interactions in malaria preventive behaviors in Sub-Saharan Africa, i.e. whether an individual's social environment has an influence on the individual's preventive behaviors. We focus on the two population groups which are the most vulnerable to malaria (children under 5 and pregnant women) and on two preventive behaviors (sleeping under a bednet and taking intermittent preventive treatment during pregnancy). We define the social environment of the individual as people living in the same region. To detect social interactions, we calculate the size of the social multiplier by comparing the effects of anexogenous variable at the individual level and at the regional level. Our data come from 92 surveys for 29 Sub-Saharan countries between 1999 and 2012, and they cover approximately 660,000 children and 95,000 women. Our results indicate that social interactions are important in malaria preventive behaviors, since the social mulitpliers for women's education and household wealth are greater than one - which means that education and wealth generates larger effects on preventive behaviors in the long run than we would expect from the individual-level specifications, once we account for social interactions.
    Keywords: social interactions; social multiplier; malaria preventive behavior;
    JEL: I12
    Date: 2014–01
  16. By: Jones, A. M.;; Laporte, A.;; Rice, N.;; Zucchelli, E.;
    Abstract: This paper develops and estimates a model that integrates two fundamental theories of individual health behavior: the Becker-Murphy model of rational addiction and the Grossman model of health investment. We define an individual's lifetime smoking consumption pattern and investments in health capital as simultaneous choices within a single optimisation problem allowing for the presence of an addiction stock and investments in preventive medical care. The resulting system of first-order difference equations is reduced to a single fourth-order difference equation defined both for smoking and health and which preserve the dynamic roots of the system. GMM systemsestimation using the British Household Panel Survey reveals strong persistence in the evolution of both smoking consumption and health capital with direct effects of past health and smoking observed for up to three and four lagged periods for men and women respectively. Conditional on dynamics there is a limited role for the direct effects of socio-economic status. A convincing understanding of an individual's optimal lifetime health trajectory requires an appreciation of how both investments and accumulated disinvestments in health separately impact on the dynamics of health capital. The integrated approach presented here offers such a framework.
    Keywords: Addiction; Health capital; Smoking; Dynamic panel data models;
    JEL: C1 C3 C5 C6 I1
    Date: 2014–04

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