nep-hea New Economics Papers
on Health Economics
Issue of 2014‒09‒25
eight papers chosen by
Yong Yin
SUNY at Buffalo

  1. Cigarette Taxation and Pregnancy: Policy Based Estimates of the Price Elasticity of Smoking During Pregnancy By David Simon
  2. Does care to dependent elderly people living at home increase their mental health? By Thomas Barnay; Sandrine Juin
  3. Has the introduction of NHS health checks increased the prescription of statins for CVD prevention? By Gaelle Jamet; Sandy Tubeuf; David Meads
  4. Health Care Demand in the Presence of Discrete Price Changes By Gerfin, M.;; Kaiser, B.;; Schmid, C.;
  5. On the Use and Misuse of Child Height-for-Age Z-score in the Demographic and Health Surveys By Joseph Cummins
  6. The Costs of Specialised Care By Chris Bojke; Katja Grasic; Andrew Street
  7. The Dynamics of Depression from Adolescence to Early Adulthood By Paul Contoyannis; Jinhu Li
  8. The Relationship between Mental Health and Self-rated Health in Older Adults By Ai Nakano

  1. By: David Simon (University of Connecticut)
    Abstract: Cigarette taxation has long been a policy tool used to incentivize healthier behavior. Pregnant women are a group of particular interest in this context due to their unique position to pass health capital down to the next generation. This paper reviews the literature on the tax and price responsiveness of pregnant women to smoking during pregnancy. I first discuss the use of cigarette taxes as a natural experiment and the econometric specifications typically used in the literature. I continue to review overall trends in the tax responsiveness of smoking during pregnancy as well as results by subgroups. Next, I discuss evidence on how facing a tax during pregnancy might uniquely effect women’s decision to smoke. I conclude with a discussion of how taxes have been extended into second-stage effects on birth outcomes and future avenues of research. I generally find evidence of pregnant women responding to tax increases, although the elasticities have decreased in magnitude in more recent years. This is consistent with the story suggesting that the least addicted smokers quit in the 1990s, leaving less elastic smokers in the 2000s. Furthermore, women seem to be more responsive to taxes during pregnancy than before pregnancy. Overall, cigarette taxes can be used to evaluate health outcomes, which is a fertile area for future research.
    Keywords: Smoking, pregnancy, health, cigarettes, tax policy, price elasticity
    JEL: H2 H3 I1 J1
    Date: 2014–07
  2. By: Thomas Barnay; Sandrine Juin
    Date: 2014
  3. By: Gaelle Jamet (68 Boulevard de Brandebourg 94200 Ivry-sur-Seine); Sandy Tubeuf (Leeds Institute of Health Sciences, University of Leeds); David Meads (Leeds Institute of Health Sciences, University of Leeds)
    Abstract: Background: Over four millions people in England are estimated to have a CVD and they are responsible for over one third of deaths and a fifth of hospital admissions in England every year. In prioritising the reduction of premature mortality there has been a focus on improving prevention and early diagnosis and in 2009 the Department of Health implemented the NHS Health Checks (HC) policy. In the past years, the prescriptions of statins have increased and it is interesting to see whether these increases have continued or intensified with changes in CVD detection. Aim: Uncover the association existing between the prescriptions of high and low doses statins and the number of health checks provided across PCTs and see whether this association persists after controlling for a number of characteristics strongly associated with statin prescriptions. Data: Our analysis relies on the British National Formulary data, which give information about statins prescription in each PCT in 2012. We extracted health checks data from NHS England statistics and we collected additional statistics to control for the socioeconomic and health context. Method: We consider a log linear regression model respectively for high dose and low dose statins in 144 PCTs. Results: We found a positive, robust and significant association between NHS HC received and high dose prescription while the associations observed for low dose statin in all models are not significant. Conclusion: To our knowledge, this study is the first to associate high and low dose statins prescription with the NHS health checks programme three years after the implementation of the programme in all PCTs in England. The higher significance association for high dose statins suggests that health check programme was effective at targeting people at high risk.
    Keywords: health Check; statin prescription; NHS England;
    Date: 2014
  4. By: Gerfin, M.;; Kaiser, B.;; Schmid, C.;
    Abstract: Deductibles in health insurance generate nonlinear budget sets and dynamic incentives. This paper uses detailed individual claims data from a large Swiss insurance company to estimate the response in health care demand to the discrete price increase that is generated by resetting the deductible at the start of each calendar year. We use a regression discontinuity type framework based on daily data to estimate the change in health care demand right before and right after the turn of the year. We find that for individuals with high deductibles health care demand drops by 27%, which translates into an elasticity of −.21. The decrease is most pronounced for inpatient care and prescription drugs. By contrast, for individuals with low deductibles there is no significant change in health care demand (except for prescription drugs). A remaining open question is whether the observed behavioral responses can be attributed to intertemporal substitution or whether they constitute a classic moral hazard effect.
    Keywords: health care demand; nonlinear pricing; dynamic incentives; health insurance;
    JEL: C31 D12 I13
    Date: 2014–08
  5. By: Joseph Cummins (Department of Economics, University of California Riverside)
    Abstract: This paper addresses the problem of model misspecification bias when estimating cohort-level determinants of child height-for-age z-score (HAZ) using data from the Demographic and Health Surveys (DHS). I show that the combination of DHS survey design and the biological realities of child health in developing countries create an artifact that can strongly bias regression estimates when identification relies on seasonal, annual or spatio-temporal variation associated with a subject's birth cohort. I formalize the econometric problem and show that flexible specifications of the HAZ-age profile can greatly mitigate the bias. When regression models can exploit within-cohort variation in the covariate of interest, appropriate fixed-effects models can effectively purge the bias. I also provide Monte Carlo evidence that DHS recommended inference strategies produce standard errors that are too small when estimating birth cohort determinants of HAZ.
    Keywords: Demographic and Health Surveys; Height; Z-score; Child Health
    JEL: O15 C23 I15
    Date: 2013–08
  6. By: Chris Bojke (Centre for Health Economics, University of York, UK); Katja Grasic (Centre for Health Economics, University of York, UK); Andrew Street (Centre for Health Economics, University of York, UK)
    Abstract: Patients requiring specialised care are usually treated by specialist teams with particular expertise and equipment. Concentrating services in this way should be cost-effective but there is concern that national tariffs might fail to fully reflect the true costs associated with treating patients that require specialised care. This is because the Healthcare Resource Groups (HRGs), used to categorise patients and on which national tariffs are based, may not perfectly differentiate between patients that do and do not receive specialised care. In this analysis we identify whether or not a patient received specialised care and evaluate whether and by how much such patients have higher costs than those allocated to the same HRG.
    Date: 2014–09
  7. By: Paul Contoyannis; Jinhu Li
    Abstract: This paper employs a conditional quantile regression approach to quantify the dynamics of depression among adolescents, and examine the extent of true state dependence in youth depression conditional on unobserved individual heterogeneity and family socio5economic status. We use data on the children of the US National Longitudinal Survey of Youth 79 cohort (CNLSY79) and employ a recently5developed instrumental variable approach for the estimation of dynamic quantile regression models with fixed effects. Our results suggest that true state dependence in youth depression is very low and the observed positive association between previous depression and current depression is mainly due to time5invariant unobserved individual heterogeneity. The results also show heterogeneity in true state dependence in youth depression across quantiles of the depression distribution.
    Keywords: adolescence, depression, dynamic quantile regressions, health dynamics, instrumental variables, quantile regression, panel data models
    JEL: I12 C23 C22
    Date: 2014–09
  8. By: Ai Nakano (Graduate School of Economics, Kobe University)
    Abstract: In this study, the relationship between mental health measured by the CES-D scale and self-rated health (SRH) in older Japanese adults was examined using longitudinal micro datasets from the National Survey of the Japanese Elderly (NLSG). Two equations for the relationship between mental health and SRH are estimated simultaneously, and the results showed that SRH had an effect on mental health, and mental health had an effect on SRH. Thus, the mind and body are connected and influence each other. We also determine other important factors that influence health. Age, gender, physical activity, functional abilities such as ADL and IADL, and economic status are associated with both mental and perceived health; having a chronic illness is strongly associated with perceived health; and interpersonal relationships have an effect on mental health. he results suggest that older adults should work on both mind and body to live healthy lives.
    Keywords: mental health, self-rated health, the mutual dependence of mind and body
    Date: 2014–09

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