nep-hea New Economics Papers
on Health Economics
Issue of 2014‒07‒05
nineteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Maternal Mortality, Religion and the Enrolment of Girls and Boys: Is there a Link? By Arusha Cooray; Stephan Klasen
  2. Biomarkers and Long-term Market Outcomes: The Case of Creatine By Petri Bockerman; Alex Bryson; Christian Hakulinen; Jaakko Pehkonen; Laura Pulkki-Raback; Olli Raitakari; Jutta Viinikainen
  3. Peer Review of Social Science Research in Global Health- A View Through Correspondence Letters to The Lancet - Working Paper 371 By Victoria Fan, Rachel Silverman, David Roodman, and William Savedoff
  4. Medicaid and the Elderly By Mariacristina De Nardi; Eric French; John Bailey Jones
  5. The height production function from birth to maturity By De Cao, Elisabetta
  6. The Short-Term Population Health Effects of Weather and Pollution: Implications of Climate Change By Nicolas R. Ziebarth; Maike Schmitt; Martin Karlsson
  7. A Dynamic Hurdle Model for Zero-Inflated Count Data: With an Application to Health Care Utilization By Gregori Baetschmann; Rainer Winkelmann
  8. Do Immigrants Bring Good Health? By Osea Giuntella; Fabrizio Mazzonna
  9. Understanding the Effect of Retirement on Health Using Regression Discontinuity Design By Peter Eibich
  10. Parental Leave Benefits and Breastfeeding in Germany: Effects of the 2007 Reform By Anita Kottwitz; Anja Oppermann; C. Katharina Spieß
  11. How You Ask Is What You Get: Willingness-to-Pay for a QALY in Germany By Marlies Ahlert; Friedrich Breyer; Lars Schwettmann
  12. Did the Economic Crisis have Impacts on the Health and Well-being of Ireland's Older People? By Barrett, Alan; O'Sullivan, Vincent
  13. When more does not necessarily mean better: Health-related illfare comparisons with non-monotone welbeing relationship By Mauricio Apablaza; Florent Bresson; Gaston Yalonetzky
  14. Frequency and Intensity of Alcohol Consumption: New Evidence from Sweden By Heckley, Gawain A.; Jarl, Johan; Gerdtham , Ulf-G.
  15. Hospital Mergers with Regulated Prices. By Brekke, Kurt R.; Siciliani, Luigi; Straume, Odd Rune
  16. The Relative Contribution of Genetic and Environmental Factors to Cancer Risk and Cancer Mortality in Norway By Leuven, Edwin; Plug, Erik; Marte, Rønning
  17. Education and Cancer Risk By Leuven, Edwin; Plug, Erik; Rønning, Marte
  18. Do Remittances Help Smooth Consumption During Health Shocks? Evidence From Jamaica By Diether Beuermann; Inder J. Ruprah; Ricardo Sierra
  19. Attitudes of Germans towards distributive issues in the German health system By Ahlert, Marlies; Pfarr, Christian

  1. By: Arusha Cooray; Stephan Klasen
    Abstract: Abstract We investigate empirically the impact of maternal mortality on the enrolment rate of girls and boys at the primary and secondary levels. We also examine whether the effect of maternal mortality on enrolment is strengthened or weakened by religion. Evidence shows that at both the primary and secondary levels, maternal mortality has a negative impact on the enrolment of girls and boys, with the negative greater for girls than for boys. For girls, the negative effect of maternal mortality is compounded by religion and increased fertility.
    Date: 2014
  2. By: Petri Bockerman; Alex Bryson; Christian Hakulinen; Jaakko Pehkonen; Laura Pulkki-Raback; Olli Raitakari; Jutta Viinikainen
    Abstract: Using the Young Finns Study (YFS) combined with the Finnish Linked Employer-Employee Data (FLEED) we show that quantities of creatine measured in 1980 prior to labour market entry affect labour market outcomes over the period 1990-2010. Those with higher levels of creatine (proxied by urine creatinine) prior to labour market entry spend more time in the labour market in the subsequent two decades and earn more. Creatine is not associated with high educational attainment. The associations between creatine and labour market outcomes are robust to controlling for other biomarkers, educational attainment and parental background. Creatine is a naturally occurring nitrogenous organic acid which supplies energy to body cells, including muscles. Our findings are consistent with high energy levels, induced by creatine, leading to productivity-enhancing traits such as a high propensity for effort, perseverance, and high-commitment.
    Keywords: Biomarkers, creatine, creatinine, labour market, earnings, employment
    JEL: I19 J3
    Date: 2014–06
  3. By: Victoria Fan, Rachel Silverman, David Roodman, and William Savedoff
    Abstract: In recent years, the interdisciplinary nature of global health has blurred the lines between medicine and social science. As medical journals publish non-experimental research articles on social policies or macro-level interventions, controversies have arisen when social scientists have criticized the rigor and quality of medical journal articles, raising general questions about the frequency and characteristics of methodological problems and the prevalence and severity of research bias and error. Published correspondence letters can be used to identify common areas of dispute within interdisciplinary global health research and seek strategies to address them. To some extent, these letters can be seen as a “crowd-sourced” (but editor-gated) approach to public peer review of published articles, from which some characteristics of bias and error can be gleaned. In December 2012, we used the online version of The Lancet to systematically identify relevant correspondence in each issue published between 2008 and 2012. We summarize and categorize common areas of dispute raised in these letters. The five concerns most frequently cited in correspondence letters are as follows- measurement error (51% of papers); omitted variables and confounding (45%); implausibility and lack of external validity (43%); missing or low-quality data (32%); and lack of transparency of methods (30%). We recommend better documentation of areas of potential bias with checklists and guidelines to facilitate more rigorous peer review, drawing on experts with econometric expertise as reviewers, and explicitly and thoroughly linking all correspondence letters to the original articles in The Lancet. Most importantly, we recommend The Lancet adopts the replication standard, whereby the data and the coding used to produce the estimates are provided at least to the journal, for reviewers to analyze and replicate the estimates reported by the authors.
    Keywords: global health, The Lancet, medical journals, economics journals, research, social science, error
    Date: 2014–06
  4. By: Mariacristina De Nardi; Eric French; John Bailey Jones
    Abstract: The brief’s key findings are: *Medicaid covers not only the low-income elderly but also those with higher incomes who become impoverished by health costs, such as nursing home care. *The percentage of high-income single retirees receiving Medicaid rises with age – from near zero for those in their 70s to 20 percent for those in their late 90s. *Even higher-income retirees who never receive Medicaid benefit from the insurance value that it provides, which allows them to maintain smaller reserves. *The analysis suggests that single retirees of all incomes value current Medicaid benefits at more than their cost but an expansion at less than its cost.
    Date: 2014–06
  5. By: De Cao, Elisabetta (Groningen University)
    Abstract: Height is the result of a complex process of growth that begins at birth and reaches the end in early adulthood. This paper studies the determinants of height from birth to maturity. A height production function is specified whose structure allows height to be the result of the accumulation of inputs (i.e., nutrition and diseases) over time. The empirical specification allows the causal identifcation of the age specific effects of both nutrition and diseases on height. Rich longitudinal data on Filipino children followed for more than 20 years is used. Considering the differences in growth patterns between boys and girls, the results show the existence of two critical periods for the formation of height: infancy and puberty. In particular, diseases play a major role. Diseases experienced in the second year of life have a large and negative impact on height, but the largest reduction in height is due to diseases experienced during puberty.
    Date: 2014
  6. By: Nicolas R. Ziebarth; Maike Schmitt; Martin Karlsson
    Abstract: This study comprehensively assesses the immediate effects of extreme weather conditions and high concentrations of ambient air pollution on population health. For Germany and the years 1999 to 2008, we link the universe of all 170 million hospital admissions, along with all 8 million deaths, with weather and pollution data reported at the day-county level. Extreme heat significantly increases hospitalizations and deaths. Extreme cold has a negligible effect on population health. High ambient PM10, O3 and NO2 concentrations are associated with increased hospitalizations and deaths, particularly when ignoring simultaneous weather andpollution conditions. We find strong evidence for "harvesting", and that the instantaneous heat-health relationship is only present in the short-term. We calculate that one "Hot Day" with a temperature higher than 30 ° C (86 ° F) triggers adverse health effects valued between EUR 0.07 and EUR 0.52 per resident.
    JEL: I12 I18 Q51 Q53 Q54 Q58
    Date: 2014
  7. By: Gregori Baetschmann; Rainer Winkelmann
    Abstract: A Dynamic Hurdle Model for Zero-Inflated Count Data: With an Application to Health Care UtilizationExcess zeros are encountered in many empirical count data applications. We provide a new explanation of extra zeros, related to the underlying stochastic process that generates events. The process has two rates, a lower rate until the first event, and a higher one thereafter. We derive the corresponding distribution of the number of events during a fixed period and extend it to account for observed and unobserved heterogeneity. An application to the socio-economic determinants of the individual number of doctor visits in Germany illustrates the usefulness of the new approach.
    Keywords: excess zeros, Poisson process, exposure, hurdle model
    JEL: C25 I10
    Date: 2014
  8. By: Osea Giuntella; Fabrizio Mazzonna
    Abstract: This paper studies the effects of immigration on health. We merge information on individual characteristics from the German Socio-Economic Panel (1984-2010) with detailed local labour market characteristics and exploit the longitudinal component of the data to analyse how immigration affects the health of both immigrants and natives over time. Upon their arrival, immigrants are found to be healthier than the natives (healthy immigrant effect), but their health deteriorates over time spent in Germany. We show that the convergence in health is heterogeneous across immigrants and occurs more rapidly among those working in more physically demanding jobs. Immigrants are significantly more likely to work in strenuous occupations. In light of these facts, we investigate whether changes in the spatial concentration of immigrants affect the health of the native population. Our results suggest that immigration reduces the likelihood that residents report negative health outcomes. We show that these effects are concentrated in blue-collar occupations and are larger among low educated natives and previous cohorts of immigrants. The improvement in the average working conditions and workload of natives contributes to explain the positive effect of immigration on the health of the native population.
    Keywords: Health, immigration, occupational choice
    JEL: I12 J24 J61
    Date: 2014
  9. By: Peter Eibich
    Abstract: This paper estimates the causal effect of retirement on health, health behavior, and healthcare utilization. Using Regression Discontinuity Design to exploit financial incentives in the German pension system for identification, I investigate a wide range of health behaviors (e.g. alcohol and tobacco consumption, physical activity, diet and sleep) as potential mechanisms. The results show a long-run improvement in health upon retirement. Relief from work-related stress and strain, increased sleep duration and more frequent physical exercise seem to be key mechanisms through which retirement affects health. Moreover, the improvement in health caused by retirement leads to a reduction in healthcare utilization.
    Keywords: retirement, health, regression discontinuity design, health behavior, healthcare
    JEL: I12 J14 J26
    Date: 2014
  10. By: Anita Kottwitz; Anja Oppermann; C. Katharina Spieß
    Abstract: While the health benefits of breastfeeding for both mothers and children are well known, breastfeeding may make it difficult for mothers to return early to the labor market. Maternity and parental leave regulations have been designed to reduce this conflict. In 2007, Germany put into effect a new parental leave benefit (Elterngeld). The related reform increased the number of parents eligible for benefits and changed the amount and duration of the benefits. The reform sought to decrease the pressure to return to the labor market soon after childbirth, especially for those parents who did not benefit under the old system. The current paper investigates whether this reform of parental leave impacted breastfeeding initiation and duration in Germany. We draw on representative survey data from the German Socio-Economic Panel Study (SOEP) from 2002 through 2012. Three breastfeeding measures are exploited 1) breastfeeding at birth or no breastfeeding initiation; 2) breastfeeding for at least four months; and 3) breastfeeding for at least six months. We find no effect of the Elterngeld reform on breastfeeding initiation or breastfeeding for at least six months, but do find an effect on breastfeeding for at least four months. Applying a difference-in-difference approach, it is shown that mothers who were not affected by the reform did not change their breastfeeding behavior. Breastfeeding duration increased among mothers who benefited from the reform. The results were robust over various sensitivity tests including placebo regressions and controlling for regional indicators, among others. Thus, our empirical results provide evidence that the reform's goal of allowing parents to spend more time with their children during the first year of life also impacted breastfeeding behavior.
    Keywords: Breastfeeding, parental leave, reform effects, Germany
    Date: 2014
  11. By: Marlies Ahlert; Friedrich Breyer; Lars Schwettmann
    Abstract: We report results of a survey of a representative sample of the German population in which respondents were asked for their willingness-to-pay (WTP) for either an extension of their life or an improvement in their health corresponding to a gain of one quality-adjusted life year (QALY). While one version of the survey exactly copied the questionnaire used in the EuroVaQ project (Pennington et al. 2014), in other versions the wording and the survey technique were modified. The findings show first that Germans have no higher WTP for health gains than other Europeans. Second, the technique of posing the questions plays an important role when respondents are asked to imagine being in hypothetical situations. This clearly refers to the wording of the questions and the survey setting (personal or online interview). But even simple design elements such as offering an explicit option to say "No" right away greatly affect the answers, as does the position in the questionnaire that a particular question is given. This shows that in any attempts to base health care rationing decisions on the WTP of the population, where the latter is to be elicited using surveys, great care must be taken in designing the questionnaires.
    Keywords: Willingness to Pay, QALY, Survey, Germany, EuroVaQ
    JEL: I18
    Date: 2014
  12. By: Barrett, Alan; O'Sullivan, Vincent
    Keywords: crisis/impacts/Ireland/older
    Date: 2014–04
  13. By: Mauricio Apablaza (OPHI - Oxford Poverty & Human Development Initiative - Oxford University Press Office); Florent Bresson (LEO - Laboratoire d'économie d'Orleans - CNRS : UMR7322 - Université d'Orléans); Gaston Yalonetzky (University of Leeds - University of Leeds)
    Abstract: Most welfare studies are based on the assumption that wellbeing is monotonically related to the variables used for the analysis. While this assumption can be regarded as reasonable for many dimensions of wellbeing like income, education, or empowerment, there are some cases where it is definitively not relevant, in particular with respect to health. For instance, health status is often proxied using the Body Mass Index (BMI). Low BMI values can capture undernutrition or the incidence of severe illness, yet a high BMI is neither desirable as it indicates obesity. Usual illfare indices derived from poverty measurement are then not appropriate. This paper proposes illfare indices that are consistent with some situations of non-monotonic wellbeing relationships and examines the partial orderings of different distributions derived from various classes of illfare indices. An illustration is provided for health-related illfare as proxied by the BMI and weight-for-age indicators using DHS data for Bangladesh during the period 1997-2007. It is shown inter alia that the gains from the decline of undernutrition for Bangladeshi mothers are undermined by the rapid increase of obesity.
    Keywords: Illfare comparisons ; poverty measurement ; stochastic dominance ; monotonicity ; Bangladesh ; Nutrition transition
    Date: 2014–06–25
  14. By: Heckley, Gawain A. (Dept. of Clinical Science, Lund University); Jarl, Johan (Dept. of Clinical Science, Lund University); Gerdtham , Ulf-G. (Department of Economics, Lund University)
    Abstract: This paper provides an extensive analysis of the demand for alcohol in terms of total quantity and quantity subdivided into frequency and intensity demand. The analysis compares across alcohol types (beer, wine and spirits), alcohol drinking pattern (average drinker vs. binge drinkers) and also how these decisions differ across gender. The analysis is based on a large sample of cross-sectional data from Sweden 2004-11. The results show a positive socioeconomic (income and education) gradient in quantity. This gradient is generally positive in the frequency decision while negative in the intensity decision. Women predominantly choose to drink wine and show a strong positive socioeconomic gradient in both frequency and intensity demand for wine. Binge drinkers show less of a differentiation across alcohol types and this is true even of binge drinking women. Smoking is universally positively associated with quantity, frequency and intensity of alcohol demand with the exception of wine binge drinkers. The results highlight that while quantity consumed has a positive socioeconomic gradient, policies targeted at the less affluent and less educated are likely to have the greatest impact in reducing the social cost of alcohol and in reducing the socioeconomic gradient in health and socioeconomic related health inequality.
    Keywords: Alcohol; demand; drinking pattern; binge drinking
    JEL: I10 I12 I14
    Date: 2014–06–27
  15. By: Brekke, Kurt R. (Dept. of Economics, Norwegian School of Economics and Business Administration); Siciliani, Luigi (University of York); Straume, Odd Rune (University of Minho)
    Abstract: We study the effects of a hospital merger using a spatial competition framework with semialtruistic hospitals that invest in quality and expend cost-containment effort facing regulated prices. We find that the merging hospitals always reduce quality, whereas non-merging hospitals respond by increasing (reducing) quality if qualities are strategic substitutes (complements). A merger leads to higher average treatment cost efficiency and, if qualities are strategic substitutes, might also increase average quality in the market. If a merger leads to hospital closure, the resulting effect on quality is positive (negative) for all hospitals in the market if qualities are strategic substitutes (complements). Whether qualities are strategic substitutes or complements depends on the degree of altruism, the effectiveness of cost-containment effort, and the degree of cost substitutability between quality and treatment volume.
    Keywords: Hospital mergers; Quality competition; Cost efficiency; Antitrust.
    JEL: I11 I18 L13 L44
    Date: 2014–06–30
  16. By: Leuven, Edwin (Dept. of Economics, University of Oslo); Plug, Erik (University of Amsterdam); Marte, Rønning (Statistics Norway, Research Department)
    Abstract: Using Norwegian cancer registry data we study twin and non-twin siblings to decompose variation in cancer at most common sites and cancer mortality into a genetic, shared environment and individual (unshared environmental) component. Regardless the source of sibling variation, our findings indicate that genes dominate over shared environment in explaining relatively more of the variation in cancer at most common cancer sites (but lung and skin cancer) and cancer mortality. The vast majority of the variation in cancer and cancer mortality, however, is explained by individual (unshared environmental) factors.
    Keywords: Cancer; Twins; Heritability; Environment;
    JEL: I12 J62
    Date: 2014–02–01
  17. By: Leuven, Edwin (Dept. of Economics, University of Oslo); Plug, Erik (University of Amsterdam); Rønning, Marte (Statistics Norway, Research Department (SSB))
    Abstract: There exists a strong educational gradient in cancer risk, which has been documented in a wide range of populations. Yet relatively little is known about the extent to which education is causally linked to cancer incidence and mortality. This paper exploits a large social experiment where an education reform expanded compulsory schooling during the 1960s in Norway. The reform led to a discontinuous increase in educational attainment, which we exploit to estimate the effect of the reform on various cancer outcomes. Our main finding is that education has little if any impact on cancer risk. This holds for all cancer sites together as well as the most common cancer sites in isolation, with two exceptions. The compulsory school reform lowered the risk of lung cancer for men, but increased the risk of colorectal cancer for women.
    Keywords: Education; Causality; Health; Cancer;
    JEL: I12 I21
    Date: 2014–07–04
  18. By: Diether Beuermann; Inder J. Ruprah; Ricardo Sierra
    Abstract: We identify whether remittances facilitate consumption smoothing during health shocks in Jamaica. In addition, we investigate whether remittances are subject to moral hazard by receivers, how the informal insurance provided by remittances interacts with formal health insurance, and whether there are differential effects by gender of the household head. We find that remittances offer complete insurance toward decreased consumption during health shocks and that moral hazard is weak. The role of remittances as a social insurance mechanism, however, is relevant only in the absence of private health insurance. No differential effects by gender of the household head are found.
    Keywords: Income, Consumption & Saving, Health Policy, Remittances, Remittances, Consumption, Health insurance, Social insurace
    Date: 2014–06
  19. By: Ahlert, Marlies; Pfarr, Christian
    Abstract: Social health care systems are inevitably confronted with the scarcity of resources and the resulting distributional challenges. Since prioritization implies distributional effects, decisions on respective rules should take citizens’ preferences into account. Thus, knowledge about citizens’ attitudes and preferences regarding different distributional issues implied by the type of financing health care is necessary to judge the public acceptance of a health system. In this study we concentrate on two distributive issues in the German health system: First, we analyse the acceptance of prioritizing decisions concerning the treatment of certain patient groups, in this case patients who all need a heart operation. Here we focus on the fact that a patient is strong smoker or a non-smoker, the criteria of age or the fact that a patient has or does not have young children. Second, we investigate Germans’ opinions towards income dependent health services. The results reveal strong effects of individuals’ attitudes regarding general aspects of the health system on priorities, e.g. that individuals behaving health demanding should not be preferred. In addition, experiences of limited access to health services are found to have a strong influence on citizens’ attitudes, too. Finally, decisions about different prioritization criteria are found to be not independent.
    Keywords: health care priority-setting; distributive preferences; quality of health care
    JEL: D63 D71 I14 I18
    Date: 2014–06

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