nep-hea New Economics Papers
on Health Economics
Issue of 2014‒12‒03
twenty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Tobacco Consumption Determinants in Russia By Juraev, Nosirjon
  2. Workplace health promotion and labour market performance of employees By Martin Huber; Michael Lechner; Conny Wunsch
  3. Gary Becker's Contributions in Health Economics By Soares, Rodrigo R.
  4. Domestic Abuse and Child Health By Rawlings, Samantha; Siddique, Zahra
  5. Fetus, Fasting, and Festival: The Persistent Effects of in Utero Social Shocks By Chen, Xi
  6. A Family Affair: Job Loss and the Mental Health of Spouses and Adolescents By Bubonya, Melisa; Cobb-Clark, Deborah A.; Wooden, Mark
  7. Secular trends in tobacco consumption: the case of Italy, 1871-2010 By Carlo Ciccarelli; Pierpaolo Pierani; Silvia Tiezzi
  8. Should Hospitals Keep Their Patients Longer? The Role of Inpatient and Outpatient Care in Reducing Readmissions By Ann P. Bartel; Carri W. Chan; Song-Hee (Hailey) Kim
  9. Gray Matters: Fetal Pollution Exposure and Human Capital Formation By Prashant Bharadwaj; Matthew Gibson; Joshua Graff Zivin; Christopher A. Neilson
  10. Vaccine Approvals and Mandates Under Uncertainty: Some Simple Analytics By Charles F. Manski
  11. Long-Term Care Insurance and Carers' Labor Supply: A Structural Model By Johannes Geyer; Thorben Korfhage
  12. Rewarding safer sex : conditional cash transfers for HIV/STI prevention By de Walque, Damien; Dow, William H.; Nathan, Rose
  13. The Impact of Obesity on Employment in South Africa By Modeste Some, Naiefa Rashied & Abieyuwa Ohonba
  14. Social Capital and Health: Evidence That Ancestral Trust Promotes Health among Children of Immigrants By Ljunge, Martin
  15. Deterministic and stochastic trends in the Lee-Carter mortality model By Laurent Callot; Niels Haldrup; Malene Kallestrup Lamb
  16. Does Marriage Make You Healthier? By Nezih Guner; Yuliya Kulikova; Joan Llull
  17. The Determinants of the Propensity to Receive Publicly Funded Home Care Services for the Elderly in Canada By Gustavo Mery; Walter Wodchis; Audrey Laporte
  18. Custom-made healthcare: An experimental investigation By Keser, Claudia; Montmarquette, Claude; Schmidt, Martin; Schnitzler, Cornelius
  19. Longevity and technological change By Gehringer, Agnieszka; Prettner, Klaus
  20. Smart home care platforms: Where is the added value? By Vannieuwenborg, Frederic; Van Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier; Pickavet, Mario

  1. By: Juraev, Nosirjon
    Abstract: The following paper aims to contribute the existing literature on Russian tobacco use by analysing the determinants of smoking, and comparing the results to previous researches. We are also one of the few, if not the first to test the significance of BMI (Body Mass Index) with smoking habits. Our results mostly compromise with the results of previous English literature. Smokers generally tend to lose weight, and obese people naturally do not practice smoking. Educated people, religion believer smoke significantly less than school leavers, nonbelievers and army servers do.
    Keywords: Tobacco determinants, Russia
    JEL: A1 A10 D0 D00
    Date: 2014–03–25
  2. By: Martin Huber; Michael Lechner; Conny Wunsch (University of Basel)
    Abstract: <p style="margin-bottom:12.0pt; line-height:150%"><span lang="EN-GB">This paper investigates the average effects of (firm-provided) workplace health promotion measures in form of the analysis of sickness absenteeism and </span><span lang="EN-GB">health circles/courses</span><span lang="EN-GB"> on labour market out­comes 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 </span><span lang="EN-GB">decrease the number of job changes across various age groups. A key finding is that </span><span lang="EN-GB">health circles/courses</span><span lang="EN-GB"> 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.  </span>
    Keywords: Firm health policies, health circles, health courses, analysis of sickness absenteeism, matching
    JEL: I10 I19 J32
    Date: 2014
  3. By: Soares, Rodrigo R. (Sao Paulo School of Economics)
    Abstract: This short essay reviews Gary Becker's contributions and influence in health economics. It was originally prepared for the collection of short papers in honor of Gary Becker that is scheduled to appear in the inaugural issue of the Journal of Demographic Economics.
    Keywords: Gary Becker, health, human capital
    JEL: I1 J1
    Date: 2014–10
  4. By: Rawlings, Samantha (University of Reading); Siddique, Zahra (University of Reading)
    Abstract: We examine the effects of different kinds of domestic abuse (physical violence, emotional abuse, sexual abuse and physical violence while the victim is pregnant) on health outcomes of children born to victims. We use data on approximately 0.6 million children born between 1975 and 2013 across thirty different developing countries to investigate this relationship. Comparing children of abused mothers with otherwise similar children whose mothers were not victims of abuse, we find these children are 0.4 percentage points more likely to die within thirty days, 0.9 percentage points more likely to die within a year and 1.5 percentage points more likely to die within the first five years of being born. They are also 1.8 percentage points more likely to be low birth weight and, conditional on survival, 1.1 percentage points more likely to be stunted. Our findings allow us to quantify the costs of domestic abuse beyond costs borne directly by victims (or mothers) and gain a better understanding of the child health production process in a developing country context.
    Keywords: child health, domestic violence
    JEL: I14 I15 J12 J13
    Date: 2014–10
  5. By: Chen, Xi (Yale University)
    Abstract: The fetal origins hypothesis (hereafter FOH), put forward in the epidemiological literature and later flourished in the economics literature, suggests that the time in utero is a critical period for human development. However, much attention has been paid to the consequences of fetal exposures to more extreme natural shocks, while less is known about fetal exposures to milder but more commonly experienced social shocks. Using two examples of under-nutrition due to mild social shocks, i.e. Ramadan fasting and festival overspending, this paper summarizes our current knowledge, especially the contribution from economics, and key challenges in exploring fetal exposures to milder social shocks. I also discuss the salient added value of identifying milder versus more extreme fetal shocks. Finally, implications are drawn on individual decisions and public policy to improve children's well-being before they are born or even before their mothers realize that they are pregnant.
    Keywords: in Utero, maternal fasting, Ramadan, gift, ceremonies, early childhood development
    JEL: I14 I18 Z12
    Date: 2014–09
  6. By: Bubonya, Melisa (Melbourne Institute of Applied Economic and Social Research); Cobb-Clark, Deborah A. (University of Melbourne); Wooden, Mark (Melbourne Institute of Applied Economic and Social Research)
    Abstract: This study examines the impact of involuntary job loss on the mental health of family members. Estimates from fixed-effects panel data models, using panel data for Australia, provide little evidence of any negative spillover effect on the mental health of husbands as a result of their wives' job loss. The mental well-being of wives, however, declines following their husbands' job loss, but only if that job loss results in a sustained period of non-employment or if the couple experienced financial hardship or relationship strain prior to the husband's job loss. A negative effect of parental job loss on the mental health of co-resident adolescent children is also found, but appears to be restricted to girls.
    Keywords: unemployment, involuntary job loss, mental health, families, spouses, adolescents, HILDA Survey
    JEL: I31 J10 J65
    Date: 2014–10
  7. By: Carlo Ciccarelli; Pierpaolo Pierani; Silvia Tiezzi
    Abstract: This paper presents the first ever statistical reconstruction of annual tobacco consumption in Italy from 1871 to 2010. The time series of total tobacco is disaggregated into its four major components (cigars, cigarettes, cut tobacco, and snuff), both in physical and monetary term. Our task was largely facilitated by the peculiar institutional setting concerning the Italian case. From 1862 to recent years, the tobacco sector has been managed by the State under a regime of public monopoly so that a rich and detailed documentation is available. Using standard estimation techniques, demand models for aggregate tobacco are estimated for three separate sub-periods: 1871-1913, 1919-39, and 1946-2010. Price elasticities, estimated over a time period covering about one and a half centuries, belong constantly to a narrow [-.25, -.75] set. The result that the demand for tobacco is not elastic to its price constitutes apparently a re-invention of the wheel. Less so, when one considers that over the last 150 years policy perspectives and individual attitudes towards consumption of tobacco have changed dramatically.
    Keywords: Long-run, tobacco consumption, price and income elasticity of demand
    JEL: N43 N44 D12 C22
    Date: 2014–06
  8. By: Ann P. Bartel; Carri W. Chan; Song-Hee (Hailey) Kim
    Abstract: Twenty percent of Medicare patients are readmitted to the hospital within 30 days of discharge, resulting in substantial costs to the U.S. government. As part of the 2010 Affordable Care Act, the Hospital Readmissions Reduction Program financially penalizes hospitals with higher than expected readmissions. Utilizing data on the over 6.6 million Medicare patients treated between 2008 and 2011, we estimate the reductions in readmission and mortality rates of an inpatient intervention (keeping patients in the hospital for an extra day) versus providing outpatient interventions. We find that for heart failure patients, the inpatient and outpatient interventions have practically identical impact on reducing readmissions. For heart attack and pneumonia patients, keeping patients for one more day can potentially save 5 to 6 times as many lives over outpatient programs. Moreover, we find that even if the outpatient programs were cost-free, incurring the additional costs of an extra day may be a more cost-effective option to save lives. While some outpatient programs can be very effective at reducing hospital readmissions, we find that inpatient interventions can be just as, if not more, effective.
    JEL: I10 I13 I18 L38
    Date: 2014–09
  9. By: Prashant Bharadwaj; Matthew Gibson; Joshua Graff Zivin; Christopher A. Neilson
    Abstract: This paper examines the impact of fetal exposure to air pollution on 4th grade test scores in Santiago, Chile. We rely on comparisons across siblings which address concerns about locational sorting and all other time-invariant family characteristics that can lead to endogenous exposure to poor environmental quality. We also exploit data on air quality alerts to help address concerns related to short-run time-varying avoidance behavior, which has been shown to be important in a number of other contexts. We find a strong negative effect from fetal exposure to carbon monoxide (CO) on math and language skills measured in 4th grade. These effects are economically significant and our back of the envelope calculations suggest that the 50% reduction in CO in Santiago between 1990 and 2005 increased lifetime earnings by approximately 100 million USD per birth cohort.
    JEL: I10 Q53
    Date: 2014–11
  10. By: Charles F. Manski
    Abstract: Social interactions make communicable disease a core concern of public health policy. A prevalent problem is scarcity of empirical evidence that are informative about how interventions affect population behavior and illness. Randomized trials, which have been important to evaluation of treatments for non-infectious diseases, are less informative about treatment of communicable diseases because they do not shed light on population-wide disease transmission. In particular, trials do not reveal the indirect preventive (herd immunity) effect of vaccination on persons who are not vaccinated or who are unsuccessfully vaccinated. This paper studies the decision problems faced by health planners who must choose whether to approve a new vaccine or mandate an approved one, but who do not know the indirect effect of vaccination. I study vaccine approval as a choice between a zero vaccination rate (rejection of the new vaccine) and whatever vaccination rate the health-care system will yield if the vaccine is approved. I study the decision to mandate an approved vaccine as a choice between vaccinating the entire population (the mandate) and the vaccination rate that would be generated by decentralized health-care decisions. Considering decision making with partial knowledge, I show that it may be possible to determine optimal policies in some cases where the planner can only bound the indirect effect of vaccination. Considering settings where optimal policy is indeterminate, I pose several criteria for decision making--expected utility, minimax, and minimax-regret--and derive the policies they yield.
    JEL: H23 H51 I18
    Date: 2014–08
  11. By: Johannes Geyer; Thorben Korfhage
    Abstract: In Germany, individuals in need of long-term care receive support through benefits of the long-term care insurance. A central goal of the insurance is to support informal care provided by family members. Care recipients can choose between benefits in kind (formal home care services) and benefits in cash. From a budgetary perspective family care is a cost-saving alternative to formal home care and to stationary nursing care. However, the opportunity costs resulting from reduced labor supply of the carer are often overlooked. We focus on the labor supply decision of family carers and the incentives set by the long-term care insurance. We estimate a structural model of labor supply and the choice of benefits of family carers. We find that benefits in kind have small positive effects on labor supply. Labor supply elasticities of cash benefits are larger and negative. If both types of benefits increase, negative labor supply effects are offset to a large extent.
    Keywords: Labor supply, long-term care, long-term care insurance, structural model
    JEL: J22 H31 I13
    Date: 2014
  12. By: de Walque, Damien; Dow, William H.; Nathan, Rose
    Abstract: Incentive-based policies have been shown to be powerful in many areas of behavior, but have rarely been tested in the sexual domain. The Rewarding Sexually Transmitted Infection Prevention and Control in Tanzania (RESPECT) study is a randomized controlled trial testing the hypothesis that a system of rapid feedback and positive reinforcement that uses cash as the primary incentive can be used to reduce risky sexual activity among young people, male and female, who are at high risk of HIV infection. The study enrolled 2,399 participants in 10 villages in rural southwest Tanzania. The intervention arm received conditional cash transfers that depended on negative results of periodic screenings for sexually transmitted infections, an objectively measured marker for risky sexual behavior. The intervention arm was further divided into two subgroups, one receiving a high value payment of up to $60 over the course of the study ($20 payments every four months) and the other receiving a lower value payment of up to $30 ($10 payments every four months). At the end of the one year of intervention, the results showed a significant reduction in sexually transmitted infections in the group that was eligible for the $20 payments every four months, but no such reduction was found for the group receiving the $10 payments. The effects were stronger among the lower socioeconomic and higher risks groups. The results of a post-intervention follow-up survey conducted one year after discontinuing the intervention indicate a sustained effect among males, but not among females.
    Keywords: Disease Control&Prevention,Health Monitoring&Evaluation,Population Policies,Adolescent Health,Gender and Health
    Date: 2014–11–01
  13. By: Modeste Some, Naiefa Rashied & Abieyuwa Ohonba
    Abstract: Obesity is a growing health problem in South Africa. This health problem could have various implications for the South African economy. The aim of this study was to investigate the impact of obesity on employment status in South Africa with the use of household survey data. The study followed a quantitative research design that involved household survey data analysis through the use of a bivariate probit model to validate the relationship between obesity and employment. The data was gathered in the National Income Dynamic Study (NIDS) and administered by the South African Labour and Development Research Unit (SALDRU). The fiÂ…ndings suggest that obesity has a negative impact on employment status in South Africa.
    Keywords: Health Economics, Obesity, health, Employment
    JEL: I10 J64 J71 J82
    Date: 2014
  14. By: Ljunge, Martin (Research Institute of Industrial Economics (IFN))
    Abstract: This paper presents evidence that generalized trust promotes health. Children of immigrants in a broad set of European countries with ancestry from across the world are studied. Individuals are examined within country of residence using variation in trust across countries of ancestry. There is a significant positive estimate of ancestral trust in explaining selfassessed health. The finding is robust to accounting for individual, parental, and extensive ancestral country characteristics. Individuals with higher ancestral trust are also less likely to be hampered by health problems in their daily life, providing evidence of trust influencing real life outcomes. Individuals with high trust feel and act healthier, enabling a more productive life.
    Keywords: Trust; Social capital; Self assessed health; Subjective health; Self reported health; Cultural transmission; Children of immigrants
    JEL: D13 D83 I12 Z13
    Date: 2014–11–03
  15. By: Laurent Callot (VU University Amsterdam, the Tinbergen Institute and CREATES); Niels Haldrup (Aarhus University and CREATES); Malene Kallestrup Lamb (Aarhus University and CREATES)
    Abstract: The Lee and Carter (1992) model assumes that the deterministic and stochastic time series dynamics loads with identical weights when describing the development of age specific mortality rates. Effectively this means that the main characteristics of the model simplifies to a random walk model with age specific drift components. But restricting the adjustment mechanism of the stochastic and linear trend components to be identical may be a too strong simplification. In fact, the presence of a stochastic trend component may itself result from a bias induced by properly fitting the linear trend that characterizes mortality data. We find empirical evidence that this feature of the Lee-Carter model overly restricts the system dynamics and we suggest to separate the deterministic and stochastic time series components at the benefit of improved fit and forecasting performance. In fact, we find that the classical Lee-Carter model will otherwise over estimate the reduction of mortality for the younger age groups and will under estimate the reduction of mortality for the older age groups. In practice, our recommendation means that the Lee-Carter model instead of a one-factor model should be formulated as a two (or several)-factor model where one factor is deterministic and the other factors are stochastic. This feature generalizes to the range of models that extend the Lee-Carter model in various directions.
    Keywords: Mortality modelling, factor models, principal components, stochastic and deterministic trends
    JEL: C2 C23 J1 J11
    Date: 2014–11–19
  16. By: Nezih Guner; Yuliya Kulikova; Joan Llull
    Abstract: We use the Panel Study of Income Dynamics (PSID) and the Medical Expenditure Panel Survey (MEPS) to study the relationship between marriage and health for working-age (20 to 64) individuals. In both data sets married agents are healthier than unmarried ones, and the health gap between married and unmarried agents widens by age. After controlling for observables, a gap of about 12 percentage points in self-reported health persists for ages 55-59. We estimate the marriage health gap non-parametrically as a function of age. If we allow for unobserved heterogeneity in innate permanent health, potentially correlated with timing and likelihood of marriage, we find that the effect of marriage on health disappears at younger (20-39) ages, while about 6 percentage points difference between married and unmarried individuals, about half of the total gap, remains at older (55-59) ages. These results indicate that association between marriage and health is mainly driven by selection into marriage at younger ages, while there might be a protective effect of marriage at older ages. We analyze how selection and protective effects of marriage show up in the data.
    Keywords: health, marriage, selection
    JEL: I10 I12 J10
    Date: 2014–10
  17. By: Gustavo Mery; Walter Wodchis; Audrey Laporte
    Abstract: Increases in Home Care (HC) services for the elderly have been a policy priority in recent decades. HC services include Home Health Care (HHC) and Homemaking/Personal Support (HM). We explored the interrelationship between receipt of publicly funded HM and HHC, and the determinants of the receipt of each type of services. A household home care decision model was extended, to develop an understanding of the demand for HHC and HM services separately and to include different household arrangements. Individual panel data for those aged 65 and over were derived from 9 biannual waves of the Canadian National Population Health Survey (1994-95 to 2010-11). A Panel Two-Stage Residual Inclusion method was used to estimate the likelihood of the receipt of HC services. Receipt of publicly funded HM is complementary with receipt of publicly funded HHC services after adjusting for functional and health status. Dependence on help with activities of daily living, health status, household arrangement, and income are determinants of the propensity to receive publicly funded HHC and HM services.
    Keywords: home care, elderly, long-term care, public provision, complementary effect, determinants
    JEL: I11 I12 I18
    Date: 2014–11
  18. By: Keser, Claudia; Montmarquette, Claude; Schmidt, Martin; Schnitzler, Cornelius
    Abstract: In this paper, we investigate in a controlled laboratory experiment physician behavior in the case of payment heterogeneity. In the experiment, each physician provides medical care to patients whose treatments are paid for either under fee-for-service (FFS) or capitation (CAP). We observe that physicians customize care in response to the payment system. A FFS patient receives considerably more medical care than the corresponding CAP patient with the same illness and treatment preference. Physicians over-serve FFS patients and under-serve CAP patients. After a CAP payment reduction in the experiment we observe neither a quantity reduction under CAP nor a spillover into the treatment of FFS patients.
    Keywords: experimental economics,physician reimbursement,capitation,Fee-For-Service,customization,fee regulation
    JEL: C91 I12 I18
    Date: 2014
  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: Vannieuwenborg, Frederic; Van Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier; Pickavet, Mario
    Abstract: Due to changes in the demographic situation of most Western European countries, interest in ICT supported care services grows fast. eCare services that foster a better care information exchange, social involvement, lifestyle monitoring services, etc., offered via smart care platforms integrated in the homes of the elderly are believed to be cost-effective and could lead to an increased quality of life of both care receiver and (in)formal care giver. Currently adoption and integration of these smart care platforms is slowed down by several barriers such as an unclear added value, a lack of regulations or a sustainable financial model. In this work the added value of smart home care platforms is identified for the several involved key-actors such as the care receiver, the (in)formal care providers and the care organizations. In a second step several go to market strategies are formulated and are supported by the quantification of the potential impact on current care processes in terms of time and financial resources. Because the gap between the current way of providing home care and providing home care supported by a fully integrated smart care platform seems too big to bridge in one effort, a migration path is provided for stepwise adoption and integration of smart care platforms in the current way of home care provisioning.
    Keywords: smart care platform,multi-actor analysis,value network analysis,impact quantification
    Date: 2014

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