nep-hea New Economics Papers
on Health Economics
Issue of 2014‒12‒24
thirteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Break-ups of municipal health centre federations: Expenditure and efficiency effects By Mika Kortelainen; Kalevi Luoma; Antti Moisio
  2. A Golden Rule of Health Care By Marias H. Gestsson; Henrique Gylfi Zoega
  3. A matter of life and death? Hospital distance and quality of care: Evidence from emergency room closures and myocardial infarctions* By Avdic, D.;
  4. Health Expenditure, education and Economic Growth in MENA Countries By Lacheheb, Miloud; Med Nor, Norashidah; Baloch, Imdadullah
  5. Formal and informal volunteering and health across European countries By Fiorillo, Damiano; Nappo, Nunzia
  6. Public Health Expenditures, Income and Health Outcomes in the Philippines By Deluna, Roperto Jr; Peralta, Tiffany Faith
  7. The Health Effects of Retirement By Peter Eibich
  8. Cannabis Use and its Effects on Health, Education and Labor Market Success By van Ours, J.C.; Williams, J.
  9. An Analysis of Sibling Correlations in Health Using Latent Variable Models By Halliday, Timothy J.; Mazumder, Bhashkar
  10. Does Marriage Make You Healthier? By Guner, Nezih; Kulikova, Yuliya; Llull, Joan
  11. Welfare Reform and Children's Health By Baltagi, Badi H.; Yen, Yin-Fang
  12. Unemployment and Health Behaviors Over the Business Cycle: a Longitudinal View By Gregory Colman; Dhaval Dave
  13. Aging and the governance of the healthcare system in Japan By Yukihiro Matsuyama

  1. By: Mika Kortelainen; Kalevi Luoma; Antti Moisio
    Abstract: Empirical evidence on economies of scale in healthcare is mostly based on the cost effects of hospital mergers. In contrast to earlier studies, this paper approaches the economies of scale issue by analysing the break-ups of municipal health centre federations. We use the difference-in-difference models to evaluate the break-up impacts on costs, outputs and efficiency of health centres in Finland between 1990 and 2003. To address potential non-random or endogenous treatment assignment we also utilize propensity score difference-in-difference approach. For cost efficiency estimation we use the non-parametric order-alpha method that is more suitable for small samples than the traditional efficiency estimators. Our results show that healthcare costs have grown considerably faster for the seceded health centres than for the similar non-seceded ones, while outputs have increased more for the former than for the latter group. Interestingly, we find the impact of break-ups to be insignificant on the productive efficiency of health centres.
    Keywords: economies of scale; health care; municipalities; difference-in-difference;
    JEL: C21 D24 I11 R50
    Date: 2014–11
  2. By: Marias H. Gestsson (Department of Economics, University of Iceland); Henrique Gylfi Zoega (Department of Economics, University of Iceland; Department of Economics, Mathematics & Statistics, Birkbeck)
    Abstract: We derive a golden rule for the level of health care expenditures and find that the optimal level of life-extending health care expenditures should increase with rising productivity and retirement age, while the effects of improvement in medical technology are ambiguous.
    Keywords: Health care, golden rule, productivity.
    JEL: E62 I12
    Date: 2014–12
  3. By: Avdic, D.;
    Abstract: Recent health care centralization trends raise the important question of the extent to which the quality of emergency medical services may offset effects from decreased access to emergency health care. This article analyzes whether residential proximity from an emergency room affects the probability of surviving an acute myocardial infarction (AMI). The critical time aspect in AMI treatment provides an ideal application forevaluating this proximity-outcome hypothesis. Previous studies have encountered empirical difficulties relating to potential endogenous health-based spatial sorting of involved agents and data limitations on out-of-hospital mortality. Using policy-induced variation in hospital distance arising from emergency room closures in the highly regulated Swedish health care sector and data on all AMI deaths in Sweden over two decades, estimation results show a clear and gradually declining probability of surviving an AMI as residential distance from an emergency room increases. The results further show that spatial sorting is likely to significantly attenuate the distance effect unless accounted for.
    Keywords: myocardial infarction; geographical access; hospital closure;, health policy; spatial sorting; self-selection; causal effect;
    JEL: I14 I18
    Date: 2014–08
  4. By: Lacheheb, Miloud; Med Nor, Norashidah; Baloch, Imdadullah
    Abstract: This study examines the relationship between health expenditure, education and economic growth in MENA countries using panel data estimation. Our results based on random effect estimation endorse a relationship between health expenditure, education and economic growth. Data were obtained from the World Bank Development Indicators for the period of 1995 to 2010 for 20 countries from Middle East and North Africa region. Importantly, our results reveal that health expenditure and education have significantly positive effect on economic growth. Also gross fixed capital formation positively, but insignificantly, related to economic growth of MENA countries. Therefore, investment in human capital, namely health and education, will increase income in these countries.
    Keywords: Economic growth; Education; Health expenditure; MENA countries
    JEL: E61 I1 I15 I25
    Date: 2014–06–06
  5. By: Fiorillo, Damiano; Nappo, Nunzia
    Abstract: In this paper we compare the correlation among formal and informal volunteering and self-perceived health across 14 European countries after controlling for socio-economic characteristics, housing features, neighborhood quality, size of municipality, social participation and regional dummies. We find that formal volunteering has a significantly positive association with self-perceived health in Finland and the Netherlands, but none in the other countries. By contrast, informal volunteering has a significantly positive correlation with self-perceived health in the Netherlands, France, Spain, Portugal and Greece, and a significantly negative relationship in Italy. Our conclusion is that formal and informal volunteering measure two different aspects of volunteering whose correlations with perceived health seem to depend on specific cultural and institutional characteristics of each country.
    Keywords: Self-perceived health, formal and informal volunteering, European countries
    JEL: D64 I10 P5 Z10
    Date: 2014–01–31
  6. By: Deluna, Roperto Jr; Peralta, Tiffany Faith
    Abstract: This paper studied the relationship among public health expenditures, income and health outcomes in the Philippines. Infant mortality rate, under five mortality rate and life expectancy were used as proxy for health outcomes. Specifically, this paper presented the profile of government health expenditures, income and health outcomes from 1981 to 2010. The study used Vector Autoregressive Analysis and Granger Causality test to determine the direction of relationship of the variables. Results revealed that health expenditure per capita followed an overall increasing trend with an average growth rate of 6.49% and GDP per capita with an average growth rate of 11% from 1981 to 2010. These correspond to the reduction of infant mortality rate by 1.64% on average, under five mortality by 1.76% and the increase in life expectancy with an average growth of 0.17% from 1981 to 2010. However, VAR results revealed that the past values of public health expenditure has no effect on under-five mortality rates but affects infant mortality rate. This may suggest that the past and present level of health expenditure is not sufficient enough to affect under five mortality rate but is effective enough on alleviating infant mortality rate. Conversely, past and present values of GDP per capita is not sufficient enough to affect infant mortality rate but affects under five mortality rate in the Philippines. VAR estimation also revealed that both health expenditure and GDP per capita has a positive and significant effect on life expectancy. Thus, to improve life expectancy and to reduce child mortality rates in line with the Millennium Development Goals, it requires effective and sufficient health expenditure and a sustainable economic growth.
    Keywords: VAR, Health Outcomes, Health Expenditures, Income, MDG
    JEL: C32 H5 H51 I15
    Date: 2014–04
  7. By: Peter Eibich
    Abstract: Retirement leads to changes in daily life that may affect health positively or negatively. Existing empirical evidence is inconclusive: While a few studies identify negative health effects, the majority of studies find no or positive effects of retirement on health. The mechanisms behind these effects remain unclear, as is the question of which parts of the population benefit most from retirement. Recent studies indicate that retirees use their increased leisure time for healthier behavior.
    Date: 2014
  8. By: van Ours, J.C. (Tilburg University, Center For Economic Research); Williams, J. (Tilburg University, Center For Economic Research)
    Abstract: Cannabis is the most popular illegal drug. Its legal status is typically justified on the grounds that cannabis use has harmful consequences. Empirically investigating this issue has been a fertile topic for research in recent times. We provide an overview of this literature, focusing on studies which seek to establish the causal eect of cannabis use on health, education and labor market success. We conclude that there do not appear to be serious harmful health eects of moderate cannabis use. Nevertheless, there is evidence of reduced mental well-being for heavy users who are susceptible to mental health problems. While there is robust evidence that early cannabis use reduces educational attainment, there remains substantial uncertainty as to whether using cannabis has adverse labor market eects.
    Keywords: Cannabis use; Health; Education; Labor market
    Date: 2014
  9. By: Halliday, Timothy J. (University of Hawaii at Manoa); Mazumder, Bhashkar (Federal Reserve Bank of Chicago)
    Abstract: We investigate sibling correlations in health status using the Panel Study of Income Dynamics and Bayesian methods that allow us to estimate the covariance structure of a system of latent variable equations. Across a battery of outcomes, we estimate that between 50% and 60% of health status can be attributed to familial or neighborhood characteristics. Taking the principal component across all outcomes, we obtain a sibling correlation of about 53%. These estimates, which are larger than previous estimates of sibling correlations in health that rely on linear models, are more in-line with sibling correlations in income and suggest that health status, like other measures of socioeconomic success, is strongly influenced by family background. Therefore, efforts to improve the circumstances of families and communities may potentially lead to improved childhood health today and also reduce future health disparities.
    Keywords: sibling correlations, intergenerational mobility, health, latent variable
    JEL: I0 I12 J0 D3 J62
    Date: 2014–11
  10. By: Guner, Nezih (MOVE, Barcelona); Kulikova, Yuliya (Universitat Autònoma de Barcelona); Llull, Joan (MOVE, Barcelona)
    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: selection, marriage, health
    JEL: I10 I12 J10
    Date: 2014–11
  11. By: Baltagi, Badi H. (Syracuse University); Yen, Yin-Fang (Southwestern University of Finance and Economics)
    Abstract: This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children's health outcomes using data from the Survey of Income and Program Participation (SIPP) over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children's medical utilization among low-income families. These health measures include a rating of the child's health status reported by the parents; the number of times that parents consulted a doctor; and the number of nights that the child stayed in a hospital. We compare the overall changes of health status and medical utilization for children with working and nonworking mothers. We find that the child's health status as reported by the parents is affected by the maternal employment status.
    Keywords: maternal employment, children's health, welfare reform, fixed effects
    JEL: I1 I3
    Date: 2014–11
  12. By: Gregory Colman; Dhaval Dave
    Abstract: We examine the first-order internal effects of unemployment on a range of health behaviors during the most recent recession using longitudinal data from the Panel Study of Income Dynamics (PSID) and the National Longitudinal Survey of Youth 1979 (NLSY79). Consistent with prior studies based on cross-sectional data, we find that becoming unemployed is associated with a small increase in leisure-time exercise and in body weight, a moderate decrease in smoking, and a substantial decline in total physical activity. We also find that unemployment is associated with a decline in purchases of fast food. Together, these results imply that both energy consumption and expenditure decline in the U.S. during recessions, the net result being a slight increase in body weight. There is generally considerable heterogeneity in these effects across specific health behaviors, across the intensive and extensive margins, across the outcome distribution, and across gender.
    JEL: E32 I12 J22
    Date: 2014–12
  13. By: Yukihiro Matsuyama
    Abstract: Japan is the most rapidly aging country in the world. This is evidence that the social security system, which consists of the pension system, healthcare system and other programmes, has been working well. The population is shrinking because of a falling birth rate. It is expected that the population will fall from 128 million in 2010 to 87 million in 2060. During this period, the ratio of people aged 65 or over will rise from 23 percent to 39.9 percent. Japanâ??s age dependency ratio was 62 in 2013, the highest among advanced nations. It is expected to rise sharply to 94 in 2050 (see Figure 1 on page 4). A total reform of the Japanese social security system, therefore, is inevitable. From the point of view of fiscal reconstruction, reform of the healthcare system is the most important issue. The biggest problem in the healthcare system is that both the funding system and the care-delivery system are extremely fragmented. The government is planning its reform of the healthcare system based on the principle of integration. Other advanced economies could learn from the Japanese experience.
    Date: 2014–12

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