nep-hea New Economics Papers
on Health Economics
Issue of 2014‒11‒28
twenty papers chosen by
Yong Yin
SUNY at Buffalo

  1. What shapes patient's satisfaction in countries' health care systems? By Xesfingi, Sofia; Vozikis, Athanasios
  2. Employee engagement of managerial staff in hospitals - An Indian pilot study By J, Swaminathan; S, Aramvalarthan
  3. Efficiency of health systems in sub-Sahara Africa: a comparative analysis of time varying stochastic frontier models By Novignon, Jacob; Lawanson, Akanni
  4. Successful Scientific Replication and Extension of Levitt (2008): Child Seats Are Still No Safer than Seat Belts By Jones, Lauren E.; Ziebarth, Nicolas R.
  5. Modelling Heaped Duration Data: An Application to Neonatal Mortality By Arulampalam, Wiji; Corradi, Valentina; Gutknecht, Daniel
  6. Peer Effects on Childhood and Adolescent Obesity in China By Nie, Peng; Sousa-Poza, Alfonso; He, Xiaobo
  7. Insurance Markets for the Elderly By Hanming Fang
  8. The Effects of Mortality on Fertility: Population Dynamics after a Natural Disaster By Jenna Nobles; Elizabeth Frankenberg; Duncan Thomas
  9. Estimating the Value Added of Attending Physicians on Patient Outcomes By Jason M. Fletcher; Leora I. Horwitz; Elizabeth Bradley
  10. Investment Subsidies and the Adoption of Electronic Medical Records in Hospitals By David Dranove; Craig Garthwaite; Bingyang Li; Christopher Ody
  11. Health, Austerity and Economic Crisis: Assessing the Short-term Impact in OECD countries By Kees van Gool; Mark Pearson
  12. Heterogeneity of the effects of health insurance on household savings: Evidence from rural China By Diana Cheung; Ysaline Padieu
  13. Malaria and protective behaviours: is there a malaria trap? By Jean-Claude Berthélemy; Josselin Thuilliez; Ogobara Doumbo; Jean Gaudart
  14. The disabled beggar literature review: begging as an overlooked issue of disability and poverty By Groce, Nora; Loeb, Marie; Murray, Barbara
  15. Efficiency and competition in the Dutch non-life insurance industry: Effects of the 2006 health care reform By Jacob Bikker; Adelina Popescu
  16. Higher Quality and Lower Cost from Improving Hospital Discharge Decision Making By James C. Cox; Vjollca Sadiraj; Kurt E. Schnier; John F. Sweeney
  17. Health Status and Labor Force Participation: Evidence for Urban Low and Middle Income Individuals in Colombia By Ana María Iregui-Bohórquez; Ligia Alba Melo-Becerra; María Teresa Ramírez-Giraldo
  18. New Evidence on the Risk of Requiring Long-Term Care By Leora Friedberg; Wenliang Hao; Wei Sun; Anthony Webb; Zhenyu Li
  19. Longevity and technological change By Gehringer, Agnieszka; Prettner, Klaus
  20. Physical activity of adults: A survey of correlates, determinants, and effects By Cabane, Charlotte; Lechner, Michael

  1. By: Xesfingi, Sofia; Vozikis, Athanasios
    Abstract: Patient satisfaction is an important measure of health care quality as it offers information on the provider’s success at meeting clients’ expectations and is a key determinant of patients’ perspective behavioral intention. This paper studies the relationship between patient’s satisfaction of healthcare system and a set of socio-economic and health provision indicators. We first construct an index of patient’s satisfaction and then, at a second stage, this index is related to economic and health provision variables. Our empirical analysis relies on 31 countries and for four years. Our findings support a strong positive association between citizens’ satisfaction and public health expenditures, number of physicians and nurses, and the age of the patient, while there is a negative evidence for private health spending and number of hospital beds.
    Keywords: patient’s satisfaction, health care provision, public health, private health, healthcare quality
    JEL: I11 I15 I18
    Date: 2014–10–05
  2. By: J, Swaminathan; S, Aramvalarthan
    Abstract: Employee engagement is a state of emotional and intellectual involvement that employees have in an organization. An engaged employee is aware of business context, and works with colleagues to improve performance within the job for the benefit of the organization. It is a positive attitude held by the employees towards the organization and its values. This study focused on how employee engagement is an antecedent of job involvement and what should the management of hospitals do to make their managers engaged. This study conducted was to find out the levels of employee engagement, the drivers of it, which includes Employee Empowerment, Communication, Team Work, Training and Development,Recognition, Leadership Quality, and Work Life Balance to analyze their impact and to offer suggestions to improve the same. The study adopted non-probability sampling using systematic method to collect primary data. The samples of the study constituted 100 managerial staff from various hospitals in Nagapattinam District, Tamil Nadu, India. Anova,Chi square and Paired t test were employed in the analysis of data. The results of the study indicated that the Employee Engagement of Managerial Staff in Hospitals of Nagapattinam District is moderate and Recognition helps to attain Employee Engagement.. The hospitals should concentrate on dimensions like Recognition and Team work to improve Employee Engagement of the hospitals.
    Keywords: Employee empowerment, Team work, Recognition, Communication, Work life Balance
    JEL: I19
    Date: 2013–01
  3. By: Novignon, Jacob; Lawanson, Akanni
    Abstract: The purpose of the current study was to estimate efficiency of health systems in sub-Sahara Africa (SSA) and to compare efficiency estimates from various time-varying frontier models. The study used data for 45 countries in SSA from 2005 to 2011 sourced from the Word Bank World Development Indicators. Parametric time-varying stochastic frontier models were used in the analysis. Infant survival rate was used as the outcome variable, while per-capita health expenditure was used as main controllable input. The results show some variations in efficiency estimates among the various models. Estimates from the ‘true’ random effect model were however preferable after controlling for unobserved heterogeneity which was captured in the inefficiency terms of the other frontier models. The results also suggest a wide variation in the efficiency of health systems in sub-Sahara Africa. On average health system efficiency was estimated to be approximately 0.80 which implies resource wastage of about 0.20. Cape Verde, Mauritius and Tanzania were estimated to be relatively efficient while Angola, Equatorial Guinea and Sierra Leone were among the least performers in terms of health system efficiency. The findings suggest that the omission of unobserved heterogeneity may lead to bias in estimated inefficiency. The ‘true’ random effect model was identified to address the problem of unobserved heterogeneity. The findings also suggest a generally poor performance of health systems in terms of efficiency in the use of resources. While resource commitment to the health sector is critical, it is important to also ensure the efficient use of these resources. Improving the performance of institutions in the health sector may go a long way in improving the general health status of the African population
    Keywords: Efficiency, Health systems, health expenditure, SSA, SFA, 'True' random effect
    JEL: I00 I1 I12
    Date: 2014–07–11
  4. By: Jones, Lauren E. (Cornell University); Ziebarth, Nicolas R. (Cornell University)
    Abstract: Using US fatality data from 1975 to 2003, Levitt (2008) shows that child safety seats do not significantly reduce fatalities for children aged two to six as compared to standard seat belts. Although we were unable to gain access to the original programs and dataset used, we were able to replicate Levitt's (2008) findings almost exactly. We extend Levitt (2008) by showing that the findings also hold for the years 2004 to 2011 despite changing driver characteristics and restraint use patterns. We fail to find evidence that SUVs provide additional safety for children.
    Keywords: scientific replication, Steven Levitt, child safety seats, improper use, SUVs, fatalities, FARS
    JEL: I18 I31 Z13 Q54
    Date: 2014–10
  5. By: Arulampalam, Wiji (University of Warwick); Corradi, Valentina (University of Surrey); Gutknecht, Daniel (University of Oxford)
    Abstract: In 2005, the Indian Government launched a conditional cash-incentive program to encourage institutional delivery. This paper studies the effects of the program on neonatal mortality using district-level household survey data. We model mortality using survival analysis, paying special attention to the substantial heaping present in the data. The main objective of this paper is to provide a set of sufficient conditions for identification and consistent estimation of the baseline hazard accounting for heaping and unobserved heterogeneity. Our identification strategy requires neither administrative data nor multiple measurements, but a correctly reported duration and the presence of some flat segments in the baseline hazard which includes this correctly reported duration point. We establish the asymptotic properties of the maximum likelihood estimator and provide a simple procedure to test whether the policy had (uniformly) reduced mortality. While our empirical findings do not confirm the latter, they do indicate that accounting for heaping matters for the estimation of the baseline hazard.
    Keywords: discrete time duration model, heaping, measurement error, neonatal mortality, parameters on the boundary
    JEL: C12 C21 C24 C41
    Date: 2014–09
  6. By: Nie, Peng (University of Hohenheim); Sousa-Poza, Alfonso (University of Hohenheim); He, Xiaobo (University of Adelaide)
    Abstract: Using data from the China Health and Nutrition Survey (CHNS), this study analyzes peer effects on obesity in a sample of 3- to 18-year-old children and adolescents in China. Even after a rich set of covariates and unobserved individual heterogeneity are controlled for, it is evident that such peer effects do indeed exist. These effects are stronger in rural areas, among individuals at the upper end of the BMI distribution, and especially among females. All else being equal, female adolescents whose peers have a higher BMI are less likely to consider themselves overweight, suggesting that peer effects may be working through changed societal bodyweight norms.
    Keywords: peer effects, children and adolescents, BMI, China
    JEL: I10 I15 J13 C14
    Date: 2014–10
  7. By: Hanming Fang
    Abstract: We describe the risks faced by the ageing population and survey the corresponding insurance markets for these risks. We focus on income risk, health expenditure risk, long-term care expenditure risk and mortality risk. We also discuss the interactions between social insurance and private insurance markets.
    JEL: D14 G22 H51 H55 I13
    Date: 2014–10
  8. By: Jenna Nobles; Elizabeth Frankenberg; Duncan Thomas
    Abstract: Understanding how mortality and fertility are linked is essential to the study of population dynamics. We investigate the fertility response to an unanticipated mortality shock that resulted from the 2004 Indian Ocean tsunami, which killed large shares of the residents of some Indonesian communities but caused no deaths in neighboring communities. Using population-representative multilevel longitudinal data, we identify a behavioral fertility response to mortality exposure, both at the level of a couple and in the broader community. We observe a sustained fertility increase at the aggregate level following the tsunami, which is driven by two behavioral responses to mortality exposure. First, mothers who lost one or more children in the disaster are significantly more likely to bear additional children after the tsunami. This response explains about 13 percent of the aggregate increase in fertility. Second, women without children before the tsunami initiated family-building earlier in communities where tsunami-related mortality rates were higher, indicating that the fertility of these women is an important route to rebuilding the population in the aftermath of a mortality shock. Such community-level effects have received little attention in demographic scholarship.
    JEL: J11 J13 O1
    Date: 2014–09
  9. By: Jason M. Fletcher; Leora I. Horwitz; Elizabeth Bradley
    Abstract: Despite increasing calls for value-based payments, existing methodologies for determining physicians' "value added" to patient health outcomes have important limitations. We incorporate methods from the value added literature in education research into a health care setting to present the first value added estimates of health care providers in the literature. Like teacher value added measures that calculate student test score gains, we estimate physician value added based on changes in health status during the course of a hospitalization. We then tie our measures of physician value added to patient outcomes, including length of hospital stay, total charges, health status at discharge, and readmission. The estimated value added varied substantially across physicians and was highly stable for individual physicians. Patients of physicians in the 75th versus 25th percentile of value added had, on average, shorter length of stay (4.76 vs 5.08 days), lower total costs ($17,811 vs $19,822) and higher discharge health status (8% of a standard deviation). Our findings provide evidence to support a new method of determining physician value added in the context of inpatient care that could have wide applicability across health care setting and in estimating value added of other health care providers (nurses, staff, etc).
    JEL: I11 I12
    Date: 2014–10
  10. By: David Dranove; Craig Garthwaite; Bingyang Li; Christopher Ody
    Abstract: In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH.
    JEL: H2 I1 O33
    Date: 2014–10
  11. By: Kees van Gool; Mark Pearson
    Abstract: The economic crisis that started in 2008 has had a profound impact on the lives of citizens. Millions of people lost their job, saw their life-savings disappear and experienced prolonged financial hardship. The economic crisis has also led a number of OECD governments to introduce austerity measures to reduce public deficits. The health sector, like many other social welfare programmes, has witnessed extensive spending cuts and has also been the subject of substantial reforms. The combined effects of economic crisis, austerity and reforms have led many OECD health systems into unchartered territory.<p> This paper looks at the impact of economic crisis on health and health care. It summarises findings from the published literature on the effects of economic crisis that took place over the past few decades and also describes recent health policy reforms, focusing on those countries where the economic crisis has hit hardest. Finally, this paper analyses the empirical relationship between unemployment and health care use, quality and health outcomes, using data from OECD Health Statistics. In doing so, it investigates whether the effects of unemployment on health outcomes have been extenuated by austerity measures...<BR>La crise économique qui a débuté en 2008 a eu d’importantes répercussions pour des millions de personnes, qui ont perdu leur travail ou l’épargne de toute leur vie et se trouvent confrontées à des difficultés financières de longue durée. La crise a également conduit plusieurs pays de l’OCDE à adopter des mesures d’austérité pour réduire leur déficit public. Le secteur de la santé, comme beaucoup d’autres programmes de protection sociale, a ainsi été soumis à d’importantes restrictions budgétaires et a fait l’objet de réformes de grande ampleur. Suite à l’effet conjugué de la crise économique, des mesures d’austérité et des réformes, les systèmes de santé de nombre de pays de l’OCDE doivent aujourd’hui se réinventer.<p> Ce document passe en revue les retombées de la crise économique sur la santé et les soins de santé. Il fait la synthèse des résultats de diverses publications sur les effets des crises économiques des dernières décennies et décrit les récentes réformes des politiques de santé, en s’intéressant plus particulièrement aux pays les plus touchés. Enfin, il analyse, à partir des Statistiques de l’OCDE sur la santé, les relations empiriques qui existent entre le chômage et l’utilisation, la qualité et l’efficacité des soins de santé. Dans cette optique, il s’interroge sur la question de savoir si les mesures d’austérité ont contribué à atténuer les effets du chômage sur les résultats en matière de santé...
    JEL: C23 H51 I10 I18
    Date: 2014–09–01
  12. By: Diana Cheung (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne); Ysaline Padieu (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne)
    Abstract: This paper estimates the impact of the New Cooperative Medical Scheme (NCMS) on household saving across income quartiles in rural China. We use data from the China Health and Nutrition Survey for the 2006 wave and we run an ordinary least squares regression. We control for the endogeneity of NCMS participation by using an instrumental variable strategy. We find evidence that NCMS has a negative impact on savings of lower-middle-income participants, while it does not affect the poorest households. The negative effect of NCMS on savings of middle-income participants holds when we use propensity score matching estimations as a robustness check.
    Keywords: Rural China; New Cooperative Medical Scheme; health insurance; Chinese savings and consumption; propensity score matching
    Date: 2013–07
  13. By: Jean-Claude Berthélemy (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne, FERDI - Fondation pour les Etudes et Recherches sur le Développement International - FERDI); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne, FERDI - Fondation pour les Etudes et Recherches sur le Développement International - FERDI); Ogobara Doumbo (DEAP - Département d'épidémiologie des affections parasitaires - Université du Mali - CNRS : UMI3189 - Malaria Research and Training Center (MRTC) - Facultés de Médecine, de Pharmacie et d'Odonto-Stomatologie); Jean Gaudart (SE4S - Sciences économiques et sociales, systèmes de santé, sociétés - INSERM : U912 - Institut de recherche pour le développement [IRD] - Université de la Méditerranée - Aix-Marseille II - ORS PACA)
    Abstract: BackgroundIn spite of massive efforts to generalize efficient prevention, such as insecticide-treated mosquito nets (ITN) or long-lasting insecticidal nets (LLINs), malaria remains prevalent in many countries and ITN/LLINs are still only used to a limited extent.MethodsThis study proposes a new model for malaria economic analysis by combining economic epidemiology tools with the literature on poverty traps. A theoretical model of rational protective behaviour in response to malaria is designed, which includes endogenous externalities and disease characteristics. Survey data available for Uganda provide empirical support to the theory of prevalence-elastic protection behaviours, once endogeneity issues related to epidemiology and poverty are solved.ResultsTwo important conclusions emerge from the model. First, agents increase their protective behaviour when malaria is more prevalent in a society. This is consistent with the literature on "prevalence-elastic behaviour". Second, a 'malaria trap' defined as the result of malaria reinforcing poverty while poverty reduces the ability to deal with malaria can theoretically exist and the conditions of existence of the malaria trap are identified.ConclusionsThese results suggest the possible existence of malaria traps, which provides policy implications. Notably, providing ITN/LLINs at subsidized prices is not sufficient. To be efficient an ITN/LLINs dissemination campaigns should include incentive of the very poor for using ITN/LLINs.
    Keywords: Protective behaviours ; Poverty ; Economic epidemiology ; Malaria ; ITN
    Date: 2013
  14. By: Groce, Nora; Loeb, Marie; Murray, Barbara
    Abstract: This literature review originated as part of an exploratory study of beggars with disabilities in Ethiopia, reported on in ILO Working Paper No. 141 published in 2013. It has been updated and is published separately here, as a contribution to debates on the social and economic inclusion of persons with disabilities, on poverty reduction and social protection. Beggars with disabilities are among the poor and disadvantaged in society. Yet they are virtually invisible in the policy agenda of countries around the world, and indeed are overlooked in advocacy efforts to improve opportunities for people with disabilities in general. This is the case, even in countries that have ratified and are moving to implement the UN Convention on the Rights of Persons with Disabilities (CRPD). The CRPD requires States to promote the right of persons with disabilities to work on an equal basis with others; and emphasises the importance of fostering respect for their rights and dignity, and raising awareness of their capabilities and contributions, as well as the need to combat prejudices and stereotype in all areas of life. Coming to an understanding of why people with disabilities end up as beggars on the streets of towns and cities around the world is important if the vision of the CRPD is to make a difference to persons with disabilities at all levels of society. It is also relevant to the discussions taking place about the adoption of a post-2015 development framework, in which poverty reduction and the promotion of decent work opportunities for all women and men are likely to feature prominently.
    Keywords: disabled person, begging, rights of disabled people, poverty, forced labour, social exclusion, literature survey, handicapé, mendicité, droits des personnes handicapées, pauvreté, travail forcé, exclusion sociale, revue de littérature, persona con discapacidad, mendicidad, derechos de las personas con discapacidad, pobreza, trabajo forzoso, exclusión social, artículo bibliográfico
    Date: 2014
  15. By: Jacob Bikker; Adelina Popescu
    Abstract: This paper investigates the cost efficiency and competitive behaviour of the non-life - or property and casualty - insurance market in the Netherlands over the period 1995-2012. We focus on the 2006 health care reform, where public health care insurance has been included in the non-life insurance sector. We start with estimating unused scale economies and find that after the health care reform in 2006, unused scale economies are, at 21%, much higher than before the reform (4%), pointing to a relative increase of fixed costs. Scale inefficiencies are generally higher for smaller insurance and lower for large insurance companies. As a benchmark, we also estimate scale economies for non-health lines of business (LOB), which range from 5% to 10%. To measure competition directly, we apply a novel approach that estimates the impact of marginal costs as indicator of inefficiency on either market shares or profits. Over time, competition in health insurance has increased significantly, but the inclusion of the (non-competitive) public health care funds in the health insurance sector in 2006 caused a fall in the average level of competitive pressure. After the reform, competition continued to improve. In the non-health LOB non-life insurance, we find similar significant effects of efficiency on both market shares. The non-life effects are weaker than in life insurance, banking and non-financial sectors, suggesting less heavy competition.
    Keywords: competition; concentration; efficiency; non-life insurance; health care insurance; performance-conduct-structure model; scale economies; scope economies
    JEL: G22 H51 L11 L12 L13
    Date: 2014–09
  16. By: James C. Cox; Vjollca Sadiraj; Kurt E. Schnier; John F. Sweeney
    Abstract: null
    Keywords: Healthcare, Experiment, Clinical Decision Support System, Risk, Default Option
    JEL: C91 D81 I10
    Date: 2014–11
  17. By: Ana María Iregui-Bohórquez; Ligia Alba Melo-Becerra; María Teresa Ramírez-Giraldo
    Abstract: This paper uses the first wave of the Colombian Longitudinal Survey (ELCA) to analyze the relationship between individual health status and labor force participation. The empirical modeling strategy accounts for the presence of potential endogeneity between these two variables. The results show that there is a positive relationship between health and labor force participation in both directions, indicating that better health is likely to lead to a higher probability of participation in the labor market, and also that those who are in the labor market are more likely to report better health. Moreover, interesting differences arise when the database is further divided by gender and/or age groups. Our findings highlight the importance of public policy to guarantee good health conditions of the population which could also have a positive impact on labor productivity and consequently on long-run economic growth.
    Keywords: Health status, labor force participation, endogeneity, Colombia
    JEL: C35 C36 I10 J21
    Date: 2014–11–06
  18. By: Leora Friedberg; Wenliang Hao; Wei Sun; Anthony Webb; Zhenyu Li
    Abstract: Long-term care is one of the major expenses faced by many older Americans. Yet, we have only limited information about the risk of needing long-term care and the expected duration of care. The expectations of needing to receive home health care, live in an assisted living facility or live in a nursing home are essential inputs into models of optimal post-retirement saving and long-term care insurance purchase. Previous research has used the Robinson (1996) transition matrix, based on National Long Term Care Survey (NLTCS) data for 1982-89. The Robinson model predicts that men and women aged 65 have a 27 and 44 percent chance, respectively, of ever needing nursing home care. Recent evidence suggests that those earlier estimates may be extremely misleading in important dimensions. Using Health and Retirement Study (HRS) data from 1992-2010, Hurd, Michaud, and Rohwedder (2013) estimate that men and women aged 50 have a 50 and 65 percent chance, respectively, of ever needing care. But, they also estimate shorter average durations of care, resulting, as we show, from a greater chance of returning to the community, conditional on admission. If nursing home care is a high-probability but relatively low-cost occurrence, models that treat it as a lower-probability, high-cost occurrence may overstate the value of insurance. We update and modify the Robinson model using more recent data from both the NLTCS and the HRS. We show that the low lifetime utilization rates and high conditional mean durations of stay in the Robinson model are artifacts of specific features of the statistical model that was fitted to the data. We also show that impairment and most use of care by age has declined and that the 2004 NLTCS and the 1996-2010 HRS yield similar cross-sectional patterns of care use. We revise and update the care transition model, and we show that use of the new transition matrix substantially reduces simulated values of willingness-to-pay in an optimal long-term care insurance model.
    Date: 2014–10
  19. By: Gehringer, Agnieszka; Prettner, Klaus
    Abstract: We analyze the impact of increasing longevity on technological progress within an R&D-based endogenous growth framework and test the model´s implications on OECD data from 1960 to 2011. The central hypothesis derived in the theoretical part is that - by raising the incentives of households to invest in physical capital and in R&D - decreasing mortality positively impacts upon technological progress and thereby also on productivity growth. The empirical results clearly confirm the theoretical prediction which implies that the ongoing demographic changes in industrialized economies are not necessarily detrimental to economic prosperity, at least as far as technological progress and productivity growth are concerned.
    Keywords: demographic change,longevity,productivity,technological progress,economic prosperity
    JEL: J11 O11 O40 O41
    Date: 2014
  20. By: Cabane, Charlotte; Lechner, Michael
    Abstract: We survey the literature on the link of labour market related outcomes to individ-ual physical activity and sports participation. The first part of the survey is devoted to the individual participation decision and is based on papers from various disciplines. The sec-ond part summarises parts of the epidemiological literature on health effects and the eco-nomic literature on the labour market effects as well as on the effects on well-being and so-cial capital. Somewhat surprisingly, at least for studies in empirical economics, all the papers seem to agree that individual leisure sports participation and physical activity has positive effects for adults.
    Keywords: physical activity,leisure time physical activity,sports participation,labour market effects,unemployment,earnings
    JEL: I12 I18 J20 J30 J68 L83
    Date: 2014

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