nep-hea New Economics Papers
on Health Economics
Issue of 2014‒07‒28
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Income versus Sanitation; Mortality Decline in Paris, 1880-1914 By Lionel Kesztenbaum; Jean-Laurent Rosenthal
  2. The Cost of Pollution on Longevity, Welfare and Economic Stability By Natacha Raffin; Thomas Seegmuller
  3. Myeloid Clusters Are Associated with a Pro-Metastatic Environment and Poor Prognosis in Smoking-Related Early Stage Non-Small Cell Lung Cancer By Zhang, Wang; Pal, Sumanta K.; Liu, Xueli; Yang, Chunmei; Allahabadi, Sachin; Bhanji, Shaira; Figlin, Robert A.; Yu, Hua; Reckamp, Karen L.
  4. Testimonials Do Not Convert Patients from Brand to Generic Medication By Laibson, David I.; Madrian, Brigitte; Reynolds, Gwendolyn; Beshears, John Leonard; Choi, James J.
  5. Workplace Health Promotion and Labour Market Performance of Employees By Huber, Martin; Lechner, Michael; Wunsch, Conny
  6. Wealth Shocks and Health Outcomes: Evidence from Stock Market Fluctuations By Schwandt, Hannes
  7. Does Job Insecurity Deteriorate Health? A Causal Approach for Europe By Caroli, Eve; Godard, Mathilde
  8. The economic burden of cancer survivorship in the UK: a patient-level analysis By Joachim Marti; Peter Hall; Patrick Hamilton; Claire Hulme; Helen Jones; Galina Velikova; Laura Ashley; Penny Wright
  9. The Price Sensitivity of Health Plan Choice: Evidence from Retirees in the German Social Health Insurance By Wuppermann, Amelie C.; Bauhoff, Sebastian; Grabka, Markus M.
  10. Health Promotion 2.0: The Future of Wellness Programs in America By Rajiv Kumar, M.D.
  11. CHIPRA Quality Demonstration States Help School-Based Health Centers Strengthen Their Medical Home Features. By Mynti Hossain; Rebecca Coughlin; Joseph Zickafoose
  12. Firms' Sickness Costs and Workers' Sickness Absences By René Böheim; Thomas Leoni
  13. The Persistence and Heterogeneity of Health among Older Americans By Florian Heiss; Steven F. Venti; David A. Wise
  14. Expanding the School Breakfast Program: Impacts on Children's Consumption, Nutrition and Health By Diane Whitmore Schanzenbach; Mary Zaki
  15. Trade in Health Services and Globalization: The Role of Infinitesimal Changes of Trade Policy By Chatterjee, Tonmoy; Gupta, Kausik
  16. Health Insurance Generosity and Conditional Coverage: Evidence from Medicaid Managed Care in Kentucky By Marton, James; Yelowitz, Aaron
  17. The Science of Making Better Decisions about Health: Cost-Effectiveness and Cost-Benefit Analysis By Louise Russell

  1. By: Lionel Kesztenbaum (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - École des Hautes Études en Sciences Sociales (EHESS) - École des Ponts ParisTech (ENPC) - École normale supérieure [ENS] - Paris - Institut national de la recherche agronomique (INRA), EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris, INED - Institut National d'Etudes Démographiques Paris - INED); Jean-Laurent Rosenthal (HSS CALTECH - Division of the Humanities and Social Sciences - California Institute of Technology)
    Abstract: After 1850, mortality began its long-term fall in most industrialized countries, a process that has been linked to rising incomes and improved water infrastructure. The problem, however, is that these contribution are jointly determined and feedback into each other. Here we estimate their impact using a longitudinal data set on mortality and income for each of Paris' 80 neighborhoods. Income and sanitation both contributed to the decrease in mortality, a standard deviation increase in either variable produces a two years gain in life expectancy. These results give insights on the determinants of the health transition but also on the long-term evolution of health inequality.
    Keywords: Differential mortality ; Wealth ; Urbanization ; Paris ; Sanitation
    Date: 2014–06
  2. By: Natacha Raffin (EconomiX - CNRS : UMR7166 - Université Paris X - Paris Ouest Nanterre La Défense, Climate Economics Chair - University Paris Dauphine); Thomas Seegmuller (AMSE - Aix-Marseille School of Economics - Centre national de la recherche scientifique (CNRS) - École des Hautes Études en Sciences Sociales (EHESS) - Ecole Centrale Marseille (ECM))
    Abstract: This paper presents an overlapping generations model where pollution, private and public healths are all determinants of longevity. Public expenditure, financed through labour taxation, provide both public health and abatement. We study the complementarity between the three components of longevity on welfare and economic stability. At the steady state, we show that an appropriate fiscal policy may enhance welfare. However, when pollution is heavily harmful for longevity, the economy might experience aggregate instability or endogenous cycles. Nonetheless, a fiscal policy, which raises the share of public spending devoted to health, may display stabilizing virtues and rule out cycles. This allows us to recommend the design of the public policy that may comply with the dynamic and welfare objectives.
    Keywords: longevity; pollution; welfare; complex dynamics
    Date: 2014–07
  3. By: Zhang, Wang; Pal, Sumanta K.; Liu, Xueli; Yang, Chunmei; Allahabadi, Sachin; Bhanji, Shaira; Figlin, Robert A.; Yu, Hua; Reckamp, Karen L.
    Abstract: Background: This study aimed to understand the role of myeloid cell clusters in uninvolved regional lymph nodes from early stage non-small cell lung cancer patients. Methods: Uninvolved regional lymph node sections from 67 patients with stage I–III resected non-small cell lung cancer were immunostained to detect myeloid clusters, STAT3 activity and occult metastasis. Anthracosis intensity, myeloid cluster infiltration associated with anthracosis and pSTAT3 level were scored and correlated with patient survival. Multivariate Cox regression analysis was performed with prognostic variables. Human macrophages were used for in vitro nicotine treatment. Results: \(CD68^+\) myeloid clusters associated with anthracosis and with an immunosuppressive and metastasis-promoting phenotype and elevated overall STAT3 activity were observed in uninvolved lymph nodes. In patients with a smoking history, myeloid cluster score significantly correlated with anthracosis intensity and pSTAT3 level (P
    Date: 2013
  4. By: Laibson, David I.; Madrian, Brigitte; Reynolds, Gwendolyn; Beshears, John Leonard; Choi, James J.
    Abstract: Objectives: To assess whether the addition of a peer testimonial to an informational mailing increases conversion rates from brand-name prescription medications to lower-cost therapeutic equivalents, and whether the testimonial’s efficacy increases when information is added about an affiliation the quoted individual shares with the recipient. Research Design and Methods: 5,498 union members were randomly assigned to receive one of three different informational letters: one without a testimonial (No Testimonial Group), one with a testimonial from a person whose shared union affiliation with the recipient was not disclosed (Unaffiliated Testimonial Group), and one with a testimonial from a person whose shared union affiliation with the recipient was disclosed (Affiliated Testimonial Group). Results: The conversion rate for the No Testimonial Group was 12.2%, which is higher than the Unaffiliated Testimonial Group rate of 11.3% and the Affiliated Testimonial Group rate of 11.7%. The differences between the groups are not statistically significant. Conclusions: Short peer testimonials do not increase the impact of a mailed communication on conversion rates to lower-cost, therapeutically equivalent medications, even when the testimonial is presented as coming from a more socially proximate peer.
    Date: 2013
  5. By: Huber, Martin (University of St. Gallen); Lechner, Michael (University of St. Gallen); Wunsch, Conny (University of Basel)
    Abstract: This paper investigates the average effects of (firm-provided) workplace health promotion measures in form of the analysis of sickness absenteeism and health circles/courses on labour market out-comes of the firms' employees. Exploiting linked employer-employee panel data that consist of rich survey-based and administrative information on firms, workers and regions, we apply a flexible propensity score matching approach that controls for selection on observables as well as on time-constant unobserved factors. While the effects of analysing sickness absenteeism appear to be rather limited, our results suggest that health circles/courses increase tenure and decrease the number of job changes across various age groups. A key finding is that health circles/courses strengthen the labour force attachment of elderly employees (51-60), implying potential cost savings for public transfer schemes such as unemployment or early retirement benefits.
    Keywords: firm health policies, health circles, health courses, analysis of sickness absenteeism, matching
    JEL: I10 I19 J32
    Date: 2014–06
  6. By: Schwandt, Hannes (Princeton University)
    Abstract: Do wealth shocks affect the health of the elderly in developed countries? The economic literature is skeptical about such effects which have so far only been found for poor retirees in poor countries. In this paper I show that wealth shocks also matter for the health of wealthy retirees in the US. I exploit the booms and busts in the US stock market as a natural experiment that generated considerable gains and losses in the wealth of stock-holding retirees. Using data from the Health and Retirement Study I construct wealth shocks as the interaction of stock holdings with stock market changes. These constructed wealth shocks are highly predictive of changes in reported wealth. And they strongly affect health outcomes. A 10% wealth shock leads to an improvement of 2-3% of a standard deviation in physical health, mental health and survival rates. Effects are heterogeneous across physical health conditions, with most pronounced effects for the incidence of high blood pressure, smaller effects for heart problems and no effects for arthritis, diabetes, lung diseases and cancer. The comparison with the cross-sectional relationship of wealth and health suggests that the estimated effects of wealth shocks are larger than the long-run wealth elasticity of health.
    Keywords: retiree health, wealth shocks, stock market
    JEL: G10 I10 J14
    Date: 2014–06
  7. By: Caroli, Eve (Université Paris-Dauphine); Godard, Mathilde (CREST)
    Abstract: This paper estimates the causal effect of perceived job insecurity – i.e. the fear of involuntary job loss – on health in a sample of men from 22 European countries. We rely on an original instrumental variable approach based on the idea that workers perceive greater job security in countries where employment is strongly protected by the law, and relatively more so if employed in industries where employment protection legislation is more binding, i.e. in industries with a higher natural rate of dismissals. Using cross-country data from the 2010 European Working Conditions Survey, we show that when the potential endogeneity of job insecurity is not accounted for, the latter appears to deteriorate almost all health outcomes. When tackling the endogeneity issue by estimating an IV model and dealing with potential weak-instrument issues, the health-damaging effect of job insecurity is confirmed for a limited subgroup of health outcomes, namely suffering from headaches or eyestrain and skin problems. As for other health variables, the impact of job insecurity appears to be insignificant at conventional levels.
    Keywords: job insecurity, health, instrumental variables
    JEL: I19 J63
    Date: 2014–06
  8. By: Joachim Marti (Leeds Institute of Health Sciences, University of Leeds); Peter Hall (Leeds Institute of Health Sciences, University of Leeds); Patrick Hamilton (Leeds Institute of Health Sciences, University of Leeds); Claire Hulme (Leeds Institute of Health Sciences, University of Leeds); Helen Jones (Leeds Institute of Cancer and Pathology, Bexley Wing, St James University Hospital, Beckett Street, Leeds); Galina Velikova (Leeds Institute of Cancer and Pathology, Bexley Wing, St James University Hospital, Beckett Street, Leeds); Laura Ashley (School of Social, Psychological and Communication Sciences, Faculty of Health and Social Sciences, Leeds Metropolitan University); Penny Wright (Leeds Institute of Cancer and Pathology, Bexley Wing, St James University Hospital, Beckett Street, Leeds)
    Abstract: Purpose: To describe the economic burden of cancer survivorship for disease-free breast, colorectal and prostate cancer patients in the UK, one year post-diagnosis. Methods: Patient-level data were collected over a three months period 12-15 months post diagnosis to estimate the monthly societal costs incurred by disease-free cancer survivors. Self-reported resource utilisation data were obtained via the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system and included community-based health and social care, medications, travel costs and carers’ time. Hospital costs were retrieved through data linkage with the patient-level information and costing systems (PLICS). Patients also provided information on their pre-diagnostic and current employment status. Multivariate regression analysis was used to examine cost predictors. Results: Overall 296 patients were included in the analysis, including 135 breast cancer, 83 colorectal cancer and 78 prostate cancer patients. The average monthly societal cost was £260 (95% CI: £198-£322) and was incurred by 92% of patients. These were divided into costs to the NHS (mean: £177, 95% CI: £131-£224), patients’ out-of-pocket (OOP) costs (mean: £25, 95% CI: £9-£42) and costs of informal care (mean: £70, 95% CI: £38-£102).The distribution of societal costs was skewed with a small number of patients incurring very high monthly costs. Of 144 patients working pre-diagnosis, 110 (76.4%) were still working 15 months post-diagnosis. Multivariate analyses showed higher NHS costs for breast cancer patients. Significant predictors of OOP costs included age and socioeconomic status. Conclusions: In the UK, the population of cancer survivors is increasing and the full economic consequences of the disease are still poorly understood. This study found that the economic burden of cancer survivorship is unevenly distributed in the population and that disease-free cancer survivors still required substantial support from family and friends over 1 year post-diagnosis. In addition, this study illustrates the feasibility of using an innovative online data collection platform to routinely collect patient-reported resource utilisation information.
    Keywords: cancer survivorship; societal cost; resource use; out-of-pocket expenses; informal care; patient-reported outcomes; online data collection;
    Date: 2014
  9. By: Wuppermann, Amelie C.; Bauhoff, Sebastian; Grabka, Markus M.
    Abstract: We investigate two determinants of the price sensitivity of health plan demand: the size of the choice set and the salience of premium differences. Using variation in both features in the German Social Health Insurance (SHI) and information on health plan switches of retirees in the German Socio Economic Panel, augmented with information on individuals’ choice sets we find that retirees react less to potential savings from switching when they have more plans to choose from and when differences between premiums are less salient. Simplifying choices could save consumers money and improve the functioning of the health insurance market.
    Keywords: health plan choice; choice architecture; German social health insurance
    JEL: I11 D12 I18
    Date: 2014–07
  10. By: Rajiv Kumar, M.D. (ShapeUp, Inc.)
    Date: 2013–10
  11. By: Mynti Hossain; Rebecca Coughlin; Joseph Zickafoose
    Keywords: CHIPRA, School-Based Health Centers, Medical Home, Health
    JEL: I
    Date: 2014–05–30
  12. By: René Böheim; Thomas Leoni
    Abstract: In many countries, social security insures firms against their workers' sickness absences. The insurance may create a moral hazard for firms, leading to inefficient monitoring of absences or to an underinvestment in the prevention of absences. We exploit an administrative threshold in the Austrian social security that defined whether a firm had to pay a deductible for its blue-collar workers sicknesses or not. The quasi-experimental situation around the threshold provides causal evidence on the extent of moral hazard induced by the deductible. We apply a regression discontinuity design to estimate the differences in the incidences and durations of sicknesses for firms that faced the deductible and those who did not. We find that the deductible did not lead to different sickness outcomes and conclude that relatively low deductibles have little impact on forms' management of sicknesses.
    JEL: H51 I18
    Date: 2014–07
  13. By: Florian Heiss; Steven F. Venti; David A. Wise
    Abstract: We consider how age-health profiles differ by demographic characteristics such as education, race, and ethnicity. A key feature of the analysis is the joint estimation of health and mortality to correct for the effect of mortality selection on observed age-health profiles. The model also allows for heterogeneity in individual health at a point in time and the persistence of the unobserved component of health over time. The observed component of health is based on a multidimensional index based on 27 indicators of health. Most of the key results are shown by simulations that illustrate the range of issues that can be addressed using the model. Differences in health by education and racial-ethnic group at age 50 persist throughout the remainder of life. Based on observed profiles, the health of whites is about 8 percentile points greater than the health of blacks at age 50 but by age 90 the gap is only 5 percentile points. However, when corrected for mortality selection, the health of blacks is actually declining more rapidly with age than the health of whites; the true gap widens with age. We also find that much of the difference in age-health profiles by racial-ethnic group is accounted for by differences in the levels of education between race-ethnic groups--from two-thirds to 85 percent for men and about half for women. We also simulate differences in survival probabilities by level of education and health and use these probabilities to calculate the expected present discounted value (EPDV) of an immediate annuity with first payout at age 66 for persons by gender, level of education, and health decile. The range of EPDVs is over two-fold for both men and women suggesting enormous potential for adverse selection.
    JEL: I10 I19 J14
    Date: 2014–07
  14. By: Diane Whitmore Schanzenbach; Mary Zaki
    Abstract: School meals programs are the front line of defense against childhood hunger, and while the school lunch program is nearly universally available in U.S. public schools, the school breakfast program has lagged behind in terms of availability and participation. In this paper we use experimental data collected by the USDA to measure the impact of two popular policy innovations aimed at increasing access to the school breakfast program. The first, universal free school breakfast, provides a hot breakfast before school (typically served in the school’s cafeteria) to all students regardless of their income eligibility for free or reduced-price meals. The second is the Breakfast in the Classroom (BIC) program that provides free school breakfast to all children to be eaten in the classroom during the first few minutes of the school day. We find both policies increase the take-up rate of school breakfast, though much of this reflects shifting breakfast consumption from home to school or consumption of multiple breakfasts and relatively little of the increase is from students gaining access to breakfast. We find little evidence of overall improvements in child 24-hour nutritional intake, health, behavior or achievement, with some evidence of health and behavior improvements among specific subpopulations.
    JEL: I12 I21
    Date: 2014–07
  15. By: Chatterjee, Tonmoy; Gupta, Kausik
    Abstract: This paper attempts to integrate the issues related to health care, consumption efficiency hypothesis and international trade in the context of a developing economy. In this article we have framed a hybrid type of three sector general equilibrium trade model in the presence of a nutritional efficiency factor of health consumption, where first two sectors form a Heckscher-Ohlin nugget and the third one is a non-traded health service producing sector. Overall, we find little harm from trade, and potential gains from welfare aspect.
    Keywords: Health sector, Trade Policy, Social Welfare and General equilibrium.
    JEL: D58 F11 F13 I11 I15 I31
    Date: 2013–10–03
  16. By: Marton, James; Yelowitz, Aaron
    Abstract: This paper estimates the impact of the introduction of Medicaid managed care (MMC) on the formal Medicaid participation of children. We employ a quasi-experimental approach exploiting the location-specific timing of MMC implementation in Kentucky. Using data from the March Current Population Survey from 1995-2003, our findings suggest that the introduction of MMC increases the likelihood of being uninsured and decreases formal Medicaid participation. This finding is consistent with an increase in “conditional coverage” – waiting until medical care is needed to sign up or re-enroll in Medicaid. These effects are concentrated among low-income children and absent for high-income children. We find no evidence of “crowd-in” – substituting private coverage for Medicaid. These results are robust to multiple placebo tests and imply the potential for less formal participation (i.e. more conditional coverage) among the ACA Medicaid expansion population (which is likely to be primarily covered under MMC) than is typically predicted.
    Keywords: Medicaid; Managed Care; Child Health; Conditional Coverage
    JEL: I1 I18 I3 I38 J13
    Date: 2014–05
  17. By: Louise Russell (Rutgers University)
    Abstract: Despite spending far more on medical care, Americans live shorter lives than the citizens of other high-income countries. The situation has been getting worse for at least three decades. This paper describes the main scientific methods for guiding the allocation of resources to health – cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA), sketches their methodological progress over the last several decades, and presents examples of how medical practice in other high-income countries, where people live longer, follows the priorities indicated by cost-effectiveness analysis. CEA and CBA support democratic decision-making processes, which have themselves benefited from scientific inquiry; these are touched on at the end of the paper.
    Keywords: cost-effectiveness analysis, cost-benefit analysis
    JEL: H4 I1 D61
    Date: 2014–05–26

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