nep-hea New Economics Papers
on Health Economics
Issue of 2014‒08‒02
eleven papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Direct Effect of Obesity on Emotional Well-Being: Evidence from Mexico By Olivier Bargain; Jinan Zeidan
  2. The Cost of Pollution on Longevity, Welfare and Economic Stability By Natacha Raffin; Thomas Seegmuller
  3. Why Have Urban Villages Shorter Life Expectancies? Observations in Three Chinese Cities and Economic Explanations By Nie, Zhigang Albert; Wong, Kwok Chun
  4. The Effect of Further Liberalisation in the Healthcare Industry on the (Healthcare) Real Estate in the Netherlands: A Comparison to Germany By Lim, Ivonne
  5. Self discrimination: A field experiment on obesity By Antonios Proestakis; Pablo Branas-Garza; Praveen Kujal
  6. Retirement, Early Retirement and Disability: Explaining Labor Force Participation after 55 in France. By L. Behaghel; D. Blanchet; M. Roger
  7. Because I'm Worth It: A Lab-Field Experiment on the Spillover Effects of Incentives in Health By Paul Dolan; Matteo M. Galizzi
  8. Non-Adherence In Health Care: A Positive and Normative Analysis By Mark Egan; Tomas J. Philipson
  9. Health behaviors and education in Turkey By Tansel, Aysit; Karaoglan, Deniz
  10. Standards of living and health status: the socioeconomic determinants of life expectancy gain in sub-Saharan Africa By Keita, Moussa
  11. Survival Analysis of Very Low Birth Weight Infant Mortality in Taiwan By Chia-Lin Chang; Wei-Chen Chen; Michael McAleer

  1. By: Olivier Bargain (Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS); Jinan Zeidan (Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS)
    Abstract: Obesity spreads more easily if is not perceived negatively. This may be the case among the poor, for whom fatness can be an external sign of wealth. We estimate the direct effect of overweight on emotional well-being in Mexico, a country facing the highest obesity rate in the world. Individual fatness is instrumented using variation in genetic predisposition. Results confirm a positive or insignificant effects of obesity among the poor and point to a depressing effect among the rich. This is consistent with contrasted norms, related to unequal development levels, which may exacerbate health inequality and justify targeted communication by health authorities.
    Keywords: emotional well-being, obesity, waist-to-height ratio
    JEL: D1 I12 I31
    Date: 2014–07–16
  2. By: Natacha Raffin (Université Paris Ouest Nanterre la Défense EconomiX); Thomas Seegmuller (Aix-Marseille University (Aix-Marseille School of Economics), CNRS-GREQAM & EHESS)
    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
    JEL: J10 O40 Q56 C62
    Date: 2014–07–16
  3. By: Nie, Zhigang Albert; Wong, Kwok Chun
    Abstract: It has been identified in Nie and Wong (2012) that substantial rental value losses can be induced by excessive land exploitation in urban villages in the mainland of China. It has also been suggested that incomplete and unclearly delineated property rights, transaction cost, and consequently the absence of effective building regulations have played an important role leading to such tragic results. Through a comparison of 96 pairs of cases collected from three major Chinese cities (Shenzhen, Guangzhou, and Xi'an), it has been found that compare to non-village estates, an average of 72% of urban villages have been overbuilt, which leads to a problem of 'more construction but less rental values'. The overdevelopment problem can be viewed as, according to institution theories, a production change (a distortion of resource combination), given the constraint of defective institutional environment. It is natural then a different timing of contract change may follow, since certain conditions for renewal projects can be met differently. Throughout the lifetime of a building community, natural rent dissipation happens due to outdated design, changing market condition, or simply building aging. As a result, a building community has an economic life (a type of economic selection), which may be shorter than its physical life. An empirical test conducted in this study on 16 demolished non-village estates in Shenzhen, 14 in Guangzhou, and 10 in Xi'an in the recent years shows that the average economic lifetimes for non-village residential estates in the three cities are respectively 19.8, 22.5, and 28.9 years. However, urban villages have shortened life expectancies. An empirical study of 1054 online samples in Shenzhen, 138 samples in Guangzhou, and 134 sample in Xi'an shows a paradox that the average building ages in urban villages in the above three cities are quite new, respectively only 12.1, 12.2, and 13.8 years, but many such villages are already demolished or planned for demolition soon. The data for non-village buildings were collected through a scan of the official renewal documents on the governments' websites. The data for urban villages were collected online from real estate websites, on which landlords post their 'for rent' information. Such a paradox can be explained in connection to the previous pattern identified in Nie and Wong (2012), that in comparison to non-village estates, urban villages suffer a problem of more severe rent dissipation induced by defective initial institutional settings. The problem can make the critical condition for renewal due earlier, thereby shortening the life expectancies for urban villages. Besides, the income transfer effect caused by the state-villager interaction and the possible cost difference for negotiation can also bring forward renewal schedules. The combination of the three reasons then leads to earlier renewals.
    Date: 2013
  4. By: Lim, Ivonne
    Abstract: Up until recently, there have been two kinds of elderly living in the Netherlands: ‘care complex’ (light care) and nursing complex (intensive care), mostly located outside the city. Elderly could have been living there and receiving care from a care institution (almost) for free, if being referred by a special indication centre for healthcare. The care institution has been financed by a special public funding (for healthcare including living) that comes from the working citizens.At this moment, due to the shortage of the budget, the living subsidy for the light care patients is being stopped. (Elderly) care patients have to pay the rent for the living themselves. As a result, elderly are free to decide where and how they want to live. The contemporary care complexes are out and various new living shapes have come to existence like patio, domotica and senior living. But there is also a ‘lifetime proof apartments complex’, a trendy new shape of living, where younger and elder citizens can live for a lifetime. These new complexes are mostly located inside the city, near by healthcare, shopping and culture facilities. This (on-going) research analyses the impact to nursing complexes, when the living subsidy of the intensive care patients are also being revoked. Will nursing complexes also disappear and be replaced by many shapes of living like care complexes? Which shape of living will make the biggest chance in the future market of (care) real estate? Interviews have been held with economists, real estate investors, healthcare experts and retirement experts to find out what their long term visions are. Also a survey has been conducted to find out how and where the potential care consumers want to live.Many kinds of living will come into existence, but the lifetime proof apartment complexes will have the biggest chance to grow in the new market of (care) real estate.
    Date: 2013
  5. By: Antonios Proestakis (Institute for Health and Consumer Protection); Pablo Branas-Garza (Middlesex University); Praveen Kujal (Middlesex University)
    Abstract: Empirical evidence suggests that physical characteristics such as obesity can result in a salary gap in the work place. It is, however, not clear how much of this (gap) is due to factors emanating from the demand or supply side of the market. In this paper we use a field experiment to study whether a part of this wage gap can be attributed to personality traits of individuals on the supply side. Monitors randomly select individuals to respond to a questionnaire. Individuals can make money requests for completing the questionnaire. In the questionnaire they also self-report several personality chracteristics. We find that the more obese individuals perceive themselves to be, lesser is the money they request. The negative association between money requests and obesity is mostly driven by female participants. The effect of (self-perceived) non-obese individuals is asymmetric across gender. Self perceived "normal" females, perceived thin by the monitors, request more, meanwhile, males in this category request less relative to those that do not overstate their obesity levels. Our results suggest that lower salary request may anchor obese individuals to lower thresholds and may partly explain the wage gap.
    Date: 2014–07
  6. By: L. Behaghel; D. Blanchet; M. Roger
    Abstract: We analyze the influence of health and financial incentives on the retirement behavior of older workers in France, building upon Stock and Wise (1990) option value approach. The model accounts for three main retirement routes: the normal retirement, disability insurance (DI) and unemployment/preretirement pathways, and is estimated with a combination of microeconomic datasets that include the French data of the European SHARE survey. The estimates confirm that a decrease in the generosity of the pension and DI schemes induces people to stay longer in the labor market, and that people with better health tend to retire later. We present extreme situations simulating what individual's retirement behavior would have been if only one retirement route had existed and in the absence of constraints on work capabilities. We show that average years of work between 55 and 64 are nearly 14% greater when regular retirement incentives are applied to the whole population than when it is DI rules that are systematically applied.
    Keywords: Pensions, Social Security, Disability, Labor force participation, Senior.
    JEL: H55 J14 J26
    Date: 2014
  7. By: Paul Dolan; Matteo M. Galizzi
    Abstract: We conduct a controlled lab-field experiment to directly test the short-run spillover effects of one-off financial incentives in health. We consider how incentives affect effort in a physical activity task - and then how they spillover to subsequent eating behaviour. Compared to a control group, we find that low incentives increase effort and have little effect on eating behaviour. High incentives also induce more effort but lead to significantly more excess calories consumed. The key behavioural driver appears to be the level of satisfaction associated with the physical activity task, which 'licensed' highly paid subjects to indulge in more energy-dense food.
    Keywords: Incentives in health, spillover effects, licensing, hidden costs of incentives
    JEL: C91 C93 D03 I10
    Date: 2014–07
  8. By: Mark Egan; Tomas J. Philipson
    Abstract: Non-adherence in health care results when a patient does not initiate or continue care that has been recommended by a provider. Previous researchers have identified non-adherence as a major source of waste in US healthcare, totaling approximately 2.3% of GDP, and have proposed a plethora of interventions to improve adherence. However, little explicit analysis exists in health economics of the dynamic demand behavior that drives non-adherence. We argue that while providers may be more informed about the population-wide effects of treatments, patients are more informed about their individual treatment effect. We interpret a patient’s adherence decision as an optimal stopping problem where patients learn the value of a treatment through experience. Our positive analysis derives an “adherence survival function” and shows how various observable factors affect adherence. Our normative analysis derives the efficiency effects of non-adherence, the conditions under which adherence is too high or too low, and why many common interventions aimed at raising adherence produce indeterminate welfare effects. We calibrate these welfare effects for one of the largest US drug categories, cholesterol reducing drugs. Contrary to frequent normative claims of under-adherence, our estimates suggest that the ex-post efficiency loss from over-adherence is over 80% larger than from under-adherence.
    JEL: I1 I10 I18
    Date: 2014–07
  9. By: Tansel, Aysit; Karaoglan, Deniz
    Abstract: This is the first study which provides empirical analysis of the variation in health behaviors for adult men and women in Turkey which is a developing country. The health behaviors considered are smoking, drinking, fruit and vegetable consumption, exercise and body mass index (BMI). We find that in Turkey education is the most important factor that affects the health behaviors. The results indicate that smoking is positively associated with education at all levels with a decreasing effect with the level of education unlike in the developed countries. This result indicates that smoking is a serious public health problem in Turkey at all levels of education. Further, alcohol consumption and schooling are positively related and it increases by the level of education. Higher educated individuals clearly eat more fruits, vegetables and exercise more and their BMI levels are in the normal range compared to less educated and illiterate. We also highlight the importance of demographic factors, labor market status and household income. We use Health Survey of Turkish Statistical Institute (TURKSTAT) for years 2008, 2010 and 2012. This study will provide a baseline for further studies on the various aspects of health behaviors in Turkey.
    Keywords: Health Behaviors, Education, Demographic Factors, Turkey
    JEL: I10 I12 I2 I20
    Date: 2014–06–20
  10. By: Keita, Moussa
    Abstract: Using a panel dataset on 45 sub-Saharan Africa countries (SSA), this study analyzes empirically the socioeconomic determinants of life expectancy gain (considered as an indicator of global health improvement at country level). In order to treat heterogeneity and endogeneity concerns, we use multiple estimation methods including pooling, fixed-effect, long difference and system GMM. Our analyses show that income is critical for health enhancement. Particularly, we find that GDP per capita is strongly and positively correlated with life expectancy gain. Furthermore, variables such as adult literacy, access to improved sanitation and safe water appear positively correlated health gain. In contrast the high incidence of extreme poverty is negatively correlated with heath gain while the impact of income inequality seems ambiguous.
    Keywords: Standards of living, health, life expectancy at birth
    JEL: C12 C51 I11 I12
    Date: 2013–06
  11. By: Chia-Lin Chang (Department of Applied Economics, Department of Finance, National Chung Hsing University, Taiwan); Wei-Chen Chen (Department of Applied Economics National Chung Hsing University); Michael McAleer (Econometric Institute, Erasmus School of Economics, Erasmus University Rotterdam and Tinbergen Institute, The Netherlands, Department of Quantitative Economics, Complutense University of Madrid, and Institute of Economic Research, Kyoto University.)
    Abstract: This paper examines the determinants of very low birth weight infant (or neonatal) mortality using the Taiwan National Health Insurance Research database from 1997 to 2009. After infants are discharged from hospital, it is not possible to track their mortality, so the Cox proportional hazard model is used to analyze the very low birth weight infant mortality rate. In order to clarify treatment responsibility and to avoid selective referral effects, we use the number of infants treated in the preceding five years to observe the effect of a physician’s and hospital’s medical experience on the mortality rate of hospitalized minimal birth weight infants. The empirical results show that, given disease control variables, a higher infant weight, higher quality hospitals, increased hospital medical experience, and higher investment in pediatrics can reduce the mortality rate significantly. However, an increased physician’s medical experience does not seem to influence significantly the very low birth weight infant mortality rate.
    Keywords: Very low birth weight, Neonatal mortality, Physician’s infant experience, Hospital infant experience, Statistical analysis, Cox proportional hazard model, Selective referral, Taiwan National Health Insurance Scheme.
    JEL: N C41 I10 I13 I18
    Date: 2014–06

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