nep-hea New Economics Papers
on Health Economics
Issue of 2014‒11‒17
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Is China Catching up Human Health-related Applications of Biotechnology? By Petr Hanel
  2. The Efficiency of Healthcare Systems in Europe: a Data Envelopment Analysis Approach By Asandului, Laura; Roman, Monica; Fatulescu, Puiu
  3. Estimating sign-dependent societal preferences for quality of life By Attema, Arthur; Brouwer, Werner; l'Haridon, Olivier; Pinto, Jose Luis
  4. Health and Child Labour By Fioroni, Tamara
  5. Are fruit and vegetables good for our mental and physical health? Panel data evidence from Australia By Mujcic, Redzo
  6. Low participation in national health insurance scheme in Central Region OF Ghana: underlying reasons and health seeking behaviour of both insured and uninsured. By Adu, Kofi Osei
  7. Reserve-Dependent Benefits and Costs in Life and Health Insurance Contracts By Marcus C. Christiansen; Michel M. Denuit; Jan Dhaene
  8. Diet quality, child health, and food policies in developing countries By Bhargava, Alok
  9. Patents and the Global Diffusion of New Drugs By Iain Cockburn; Jean O. Lanjouw; Mark Schankerman
  10. Regional mortality disparities in Germany: long-term dynamics and possible determinants By Eva U. B. Kibele; Sebastian Klüsener; Rembrandt D. Scholz
  11. Follow your Heart: Survival Chances and Costs after Heart Attacks - An Instrumental Variable Approach By Alice Sanwald; Thomas Schober
  12. The Effect of Acute and Intensive Exposure to Particulate Matter on Birth Outcomes in Montevideo By Ana Balsa; Juanita Bloomfield; Marcelo Caffera
  13. Quake'n and Shake'n...Forever! Long-Run Effects of Natural Disasters: A Case Study on the 1970 Ancash Earthquake By Sebastián J. Miller; Germán Caruso
  14. Obesity and Health-Related Decisions: An Empirical Model of the Determinants of Weight Status By Leonardo Fabio Morales; Penny Gordon-Larsen; David Guilkey
  15. Income Receipt and Mortality – Evidence from Swedish Public Sector Employees By Andersson, Elvira; Lundborg, Petter; Vikström, Johan
  16. Learning-by-Doing in a Highly Skilled Profession when Stakes are High: Evidence from Advanced Cancer Surgery By Avdic, Daniel; Lundborg, Petter; Vikström, Johan
  17. Maternal Employment, childcare and childhood overweight during infancy By Thérèse McDonnell; Orla Doyle

  1. By: Petr Hanel (Département d'économique, Université de Sherbrooke, Centre interuniversitaire de recherche sur la science et la technologie (CIRST), UQAM)
    Abstract: Biotechnology is still in the early stage of development. It offers a window of opportunity for emerging developing countries catching up. Scientific research and industrial applications of biotechnology in China have been rapidly developing. The paper examines whether Chinese biotechnology is catching up leaders in the field. The approach follows the conceptual framework of Malerba’s Sectoral System of Innovation and Production (Malerba and Nelson, 2012), complemented by Mathew’s (2002) insight into strategies for latecomer firms. The data for the empirical analysis are mostly from China’s Science and Technology and High Technology Industry Yearbooks and bibliographic data on Chinese scientific publications and patenting. Brief case studies of outstanding organizations complement the statistical analysis. The results of the study show that China is fast catching up in scientific research, and more moderately in industrial production of biotechnology-based manufacturing of drugs and medical devices.
    Date: 2014–11
  2. By: Asandului, Laura; Roman, Monica; Fatulescu, Puiu
    Abstract: This paper aims at evaluating the efficiency of public healthcare systems in Europe by applying a nonparametric method such is Data Envelopment Analysis. For this purpose, statistical data for 30 European states for 2010 have been used. We have selected three output variables: life expectancy at birth, health adjusted life expectancy and infant mortality rate and three input variables: number of doctors, number of hospital beds and public health expenditures as percentage of GDP. Findings reveal that there are a number of both developed and developing countries on the efficiency frontier, while the great majority of the countries in the sample are inefficient.
    Keywords: healthcare system, efficiency, data envelopment analysis, Europe
    JEL: I15 R11
    Date: 2013–10
  3. By: Attema, Arthur; Brouwer, Werner; l'Haridon, Olivier; Pinto, Jose Luis
    Abstract: This paper is the first to apply prospect theory to societal health-related decision making. In particular, we allow for utility curvature, equity weighting, sign-dependence, and loss aversion in choices concerning quality of life of other people. We find substantial inequity aversion, both for gains and losses, which can be attributed to both diminishing marginal utility and differential weighting of better-off and worse-off. There are also clear framing effects, which violate expected utility. Moreover, we observe loss aversion, indicating that respondents give more weight to one group’s loss than another group’s gain of the same absolute magnitude. We also elicited some information on the effect of the age of the studied group. The amount of inequity aversion is to some extent influenced by the age of the considered patients. In particular, more inequity aversion is observed for gains of older people than gains of younger people.
    Keywords: equity weighting, loss aversion, prospect theory, QALYs
    JEL: D63 I10
    Date: 2014–09–02
  4. By: Fioroni, Tamara
    Abstract: In this paper, we investigate the impact of child and adult survival on child labour. We find that, while a rise in adult longevity always has a negative effect on child labour because it increases the returns in education, the impact of child mortality reduction depends on the initial level of income. At a low income level, where parents choose zero or a very low level of education for their children, an increase in child survival, ceteris paribus, renders quantity more attractive than quality because it decreases the net cost of having children. Our results are in line with empirical evidence that suggests a non linear relationship between child labour and child survival. We therefore offer an additional explanation for the persistence of child labour at stagnant per capita income levels.
    Keywords: Child Labour, Fertility, Health.
    JEL: I0 I20 J1
    Date: 2014–09–01
  5. By: Mujcic, Redzo
    Abstract: This paper studies the effect of fruit and vegetable consumption on human well-being. Using individual-level panel data from a representative sample of Australian households, I estimate the intake of fruit and vegetables to have positive and statistically significant impacts on a wide range of subjective well-being measures, including life satisfaction, self-assessed health, mental health, psychological distress, and vitality. The estimated relationships are mainly non-monotonic in nature. For most well-being measures, the optimal consumption bundle consists of 4-5 daily portions of fruit and 4-5 daily portions of vegetables. The intake of fruit is predicted to have a greater relative impact (than vegetables) on overall mental health and psychological distress scores. There are also gender differences in the estimated effects, with the intake of fruit and vegetables increasing average happiness and self-reported health scores of women significantly more than that of men. Overall, the results imply that less than one-quarter of adults in Australia consume the optimal daily amount and mix of fruit and vegetables. I discuss the relevance of the findings for government policy-makers and health professionals, in reference to existing public health promotions and guidelines.
    Keywords: subjective well-being, fruit and vegetables, diet, life satisfaction, mental health, public health policy, panel data, fixed effects.
    JEL: C33 D12 I12 I18 I31
    Date: 2014–10–08
  6. By: Adu, Kofi Osei
    Abstract: This study investigated the reasons for low participation in national health insurance scheme and health seeking behaviour of both insured and uninsured in central Twifo hemang Lower Denkyira district in Central Region of Ghana. Data were collected from both household heads who are enrolled in NHIS and those who have not been enrolled in the district for the purpose of analysis. The researcher employed interview schedule as data collection instrument used for the collection of the data from the respondents. In total, 400 household heads were interviewed. The study found that the major barrier to national health insurance scheme enrollment is affordability of the premiums. If the annual premium is paid in a lump sum, household heads find it more difficult to pay. Therefore this study recommends that national health insurance scheme annul premium could be paid on installment basis rather than lump sum. Thus the payment of annual premium could be spread out over the year. Also, government should strengthen policies to enhance income level.
    Keywords: national health insurance, household heads, premium
    JEL: I13
    Date: 2014–09–10
  7. By: Marcus C. Christiansen (University of Ulm, Germany); Michel M. Denuit (Universit� Catholique de Louvain, Belgium); Jan Dhaene (Katholieke Universiteit Leuven, Belgium, and University of the Free State, South Africa)
    Abstract: Premiums and benefits associated with traditional life insurance contracts are usually specified as fixed amounts in policy conditions. However, reserve-dependent surrender values and reserve-dependent expenses are common in insurance practice. The famous Cantelli theorem in life insurance ensures that under appropriate assumptions surrendering can be ignored in reserve calculations provided the surrender payment equals the accumulated reserve. In this paper, more complex reserve-dependent payment patterns are considered, in line with insurance practice. Explicit formulas are derived for the corresponding reserve.
    Keywords: life insurance, multistate models, Markov process, surrender value, Cantelli theorem
    Date: 2014–08–29
  8. By: Bhargava, Alok
    Abstract: Although the importance of diet quality for improving child health is widely recognized, the roles of environmental factors and the absorption of nutrients for children's physical growth and morbidity have not been adequately integrated into a policy framework. Moreover, nutrient intakes gradually affect child health, so it is helpful to use alternative tools to evaluate short-term interventions versus long-term food policies. This article emphasizes the role of diet quality reflected in the intake of nutrients such as protein, calcium, and iron for children's physical growth. Vitamins A and C are important for reducing morbidity. Children's growth and morbidity affect their cognitive development, which is critical for the future supply of skilled labor and economic growth. Evidence on these issues from countries such as Bangladesh, India, Kenya, the Philippines, and Tanzania is summarized. The supply of nutritious foods is appraised from the viewpoint of improving diet quality. Finally, the roles of educational campaigns and indirect taxes on unhealthy processed foods consumed by the affluent in developing countries are discussed.
    Keywords: Health Monitoring&Evaluation,Food&Beverage Industry,Nutrition,Early Child and Children's Health,Population Policies
    Date: 2014–10–01
  9. By: Iain Cockburn; Jean O. Lanjouw; Mark Schankerman
    Abstract: This paper studies how patent rights and price regulation affect how fast new drugs are launched in different countries, using newly constructed data on launches of 642 new drugs in 76 countries for the period 1983-2002, and information on the duration and content of patent and price control regimes. Price regulation strongly delays launch, while longer and more extensive patent protection accelerates it. Health policy institutions, and economic and demographic factors that make markets more profitable, also speed up diffusion. The effects are robust to using instruments to control for endogeneity of policy regimes. The results point to an important role for patents and other policy choices in driving the diffusion of new innovations. This project was initiated by Jean (Jenny) Lanjouw. Tragically, Jenny died in late 2005, but had asked us to complete the project. This took much longer than expected because it involved complete reconstruction of the data set and empirical work. It is essentially a new paper in its current form, but it remains an important part of Jenny's legacy and a topic to which she devoted much of her intellectual and policy efforts. We hope she would be satisfied with our work which, for us, was a labor of love.
    Keywords: Patents, pharmaceuticals, diffusion, drug launches, price regulation
    JEL: O31 O33 O34 O38 I15 I18 K19 L65
    Date: 2014–09
  10. By: Eva U. B. Kibele (Max Planck Institute for Demographic Research, Rostock, Germany); Sebastian Klüsener (Max Planck Institute for Demographic Research, Rostock, Germany); Rembrandt D. Scholz (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: While regional mortality inequalities in Germany tend to be relatively stable in the short run, over the course of the past century marked changes have occurred in the country’s regional mortality patterns. These changes include not only the re-emergence of stark differences between eastern and western Germany after 1970, which have almost disappeared again in the decades after Germany’s unification in 1990; but also substantial changes in the patterns in northern and southern Germany. By the end of the 19th century, the northern regions in Germany had the highest life expectancy levels, while the southern regions had the lowest. Today, this mortality pattern is reversed. In this paper, we study these long-term trends in spatial mortality disparities in Germany since 1900, and link them with theoretical considerations and existing research on the possible determinants of these pattern. Our findings support the view that the factors which contributed to shape spatial mortality variation have changed substantially over time, and suggest that the link between regional socioeconomic conditions and mortality outcomes strengthened over the last 100 years.
    Keywords: Germany, mortality, socio-economic conditions, spatial analysis
    JEL: J1 Z0
    Date: 2014–10
  11. By: Alice Sanwald; Thomas Schober
    Abstract: We analyze mortality and follow-up costs of heart attack patients using administrative data from Austria from 2002-2011. As treatment intensity in a hospital largely depends on whether it has a catheterization laboratory, we focus on the effects of patients' initial admission to these specialized hospitals. To account for the nonrandom selection of patients into hospitals, we exploit individuals' place of residence as a source of exogenous variation in an instrumental variable framework. We find that the initial admission to specialized hospitals increases patients' survival chances substantially. The effect on 3-year mortality is -9.5 percentage points. A separation of the sample into subgroups shows the strongest effects in relative terms for patients below the age of 65. We do not find significant effects on long-term inpatient costs and find only marginal increases in outpatient costs.
    Keywords: Acute myocardial infarction, mortality, costs, instrumental variables
    JEL: I11 I12
    Date: 2014
  12. By: Ana Balsa; Juanita Bloomfield; Marcelo Caffera
    Abstract: This study explores the impact of air pollution on adverse birth outcomes. The study focuses on the effect of breathable particulate matter with diameter of 10 micrometers or less (PM10) on the likelihood of premature birth and low birth weight (LBW). The study exploits the fact that in 2011 the ashes and dust resulting from the eruption of the Puyehue volcano in Chile substantially increased exposure to PM10 in Montevideo, Uruguay. Using prenatal and birth data from the Perinatal Information System for 2010-2012, it is found that increases in quarterly averages of PM10 concentrations beyond 50 µg/m3 decrease birth weight and increase the likelihood of LBW and prematurity at increasing rates. The results also suggest that the effect of PM10 on birth weight works mainly through a higher likelihood of prematurity, rather than through intrauterine growth retardation. The effects increase with each trimester of pregnancy: exposure during the third trimester is the most dangerous.
    Keywords: Youth & Children, Human health, Pollution, Particulate matter, Pollution, Low birth weight, Pre-term birth
    Date: 2014–09
  13. By: Sebastián J. Miller; Germán Caruso
    Abstract: This study estimates the effects of the 1970 Ancash earthquake on human capital accumulation on the affected and subsequent generation, 37 years after the shock, using the Peruvian censuses of 1993 and 2007. The main finding is that males affected by the earthquake in utero completed on average 0. 5 years less schooling while females affected by the earthquake completed 0. 8 years less schooling. Surprisingly, those whose mothers were affected at birth by the earthquake have 0. 4 less years of education, while those whose fathers were affected by the earthquake at birth have no effects on their education. The evaluation of other outcomes also suggests that the level of welfare of the affected individuals has been negatively impacted in the long run. The present investigation supports previous literature on shocks in early childhood, providing evidence of the existence of intergenerational transmission of shocks.
    Keywords: Youth & Children, Education, Disasters, Poverty, Natural disasters, Intergenerational transmission, Long-term effects
    Date: 2014–10
  14. By: Leonardo Fabio Morales; Penny Gordon-Larsen; David Guilkey
    Abstract: Using Add Health, a very comprehensive longitudinal data set of teenagers and young adults in the United States, we estimate a structural dynamic model of the determinants of obesity. In addition to including many of the well-recognized endogenous factors mentioned in the literature as obesity determinants, i.e., physical activity, smoking, a proxy for food consumption, and childbearing, we also model the residential location as a choice variable, relevant to the young-to middle-aged adult, as a major component. This allows us to control for an individual’s self-selection into communities which possess the types of amenities in the built environment which in turn affect their behaviors such as physical activity and fast food consumption. We specify reduced form equations for all these endogenous demand decisions, together with an obesity structural equation. The whole system of equations is jointly estimated by a semi-parametric full information log-likelihood method that allows for a general pattern of correlation in the errors across equations. Simulations are then used to allow us to quantify the effects of these endogenous factors on the probability of obesity. A key finding is that controlling for residential self-selection has important substantive implications. To our knowledge, this has not been yet documented within a full information maximum likelihood framework.
    Keywords: Health Production, Public Health, Urban Analysis.
    JEL: I12 I14 R52
    Date: 2014–09–17
  15. By: Andersson, Elvira (Department of Economics, Lund University); Lundborg, Petter (Department of Economics, Lund University); Vikström, Johan (IFAU)
    Abstract: In this paper, we study the short-run effect of salary receipt on mortality among Swedish public sector employees. By using data on variation in paydays across work-places, we completely control for mortality patterns related to, for example, public holidays and other special days or events coinciding with paydays and for general within-month and within-week mortality patterns. We find a dramatic increase in mortality on the day salaries arrive. The increase is especially pronounced for younger workers and for deaths due to activity-related causes such as heart conditions and strokes. Additionally, the effect is entirely driven by an increase in mortality among low income individuals, who are more likely to experience liquidity constraints. All things considered, our results suggest that an increase in general economic activity on salary receipt is an important cause of the excess mortality.
    Keywords: Income; Mortality; Health; Consumption; Liquidity constraints; Permanent income hypothesis
    JEL: D91 H31 H55 I10 I12 I38
    Date: 2014–08–10
  16. By: Avdic, Daniel (Uppsala Center for Labor Studies); Lundborg, Petter (Lund University and IZA); Vikström, Johan (Uppsala Center for Labor Studies)
    Abstract: Although learning-by-doing is believed to be an important source of productivity growth, there is limited evidence that production volume affects productivity in a causal sense. We document evidence of learning-by-doing in a highly skilled profession where stakes are high; advanced cancer surgery. For this purpose, we introduce a novel instru- ment that exploits the closure and opening of entire cancer clinics which have given rise to sharp and exogenous changes in the cancer surgical volumes at Swedish public sec- tor hospitals. Using detailed register data on more than 100,000 episodes of advanced cancer surgery, our results suggest positive eects of surgery volumes on survival. In addition, we provide evidence on the mechanisms through which these improvements occur. We also show that the results are not driven by changes in patient composition or by other changes at the hospital level.
    Keywords: hospital volume; learning-by-doing; cancer surgery; survival; causal effect
    JEL: I11 I12 I18 L11
    Date: 2014–07–04
  17. By: Thérèse McDonnell (UCD School of Economics, University College Dublin); Orla Doyle (UCD School of Economics and UCD Geary Institute, University College Dublin)
    Abstract: This paper examines the relationship between maternal employment, childcare during infancy and the overweight status of pre-school children. Using data from the Infant Cohort of the Growing-Up in Ireland Survey, propensity score matching addresses the issue of potential selection bias, quantile regression allows the impact of both maternal employment and childcare to be examined throughout the weight distribution and multiple imputation is used to address the problem of missing data due to item non-response. The results suggest that both full-time and part-time maternal employment when a child is 9 months old increase the likelihood of being overweight at 3 years old, but only for children of mothers with higher levels of education. Informal childcare at 9 months also has harmful effects on child weight, but again only for children of more educated mothers. Quantile regression finds that the children most impacted by maternal employment are those at the upper percentiles of the weight distribution. When selection on observables is used to assess bias arising from selection on unobservables, maternal employment estimates are determined to be a lower bound, while informal childcare results could be attributed to selection bias. Overall findings are consistent with research from North America and the United Kingdom, and are in contrast to recent findings from the rest of Europe, suggesting the possible role of institutional factors.
    Keywords: Child overweight, obesity, maternal employment, childcare
    Date: 2014–10–23

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