nep-hea New Economics Papers
on Health Economics
Issue of 2015‒02‒11
six papers chosen by
Yong Yin
SUNY at Buffalo

  1. 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
  2. Public Health Insurance and Entry into Self-employment By Frank M. Fossen; Johannes König
  3. Saving lives with stem cell transplants By Bergstrom, Ted; Sheehan-Connor, Damien; Garratt, Rodney J
  4. Cost-Effectiveness and Heterogeneity: Using Finite Mixtures of Disease Activity Models to Identify and Analyze Phenotypes By Borg, Sixten; Gerdtham, Ulf-G.; Rydén, Tobias; Munkholm, Pia; Odes, Selwyn; Moum, Bjørn; Stockbrügger, Reinhold; Lindgren, Stefan
  5. The effects of prospective mate quality on investments in healthy body weight among single women By Harris, Matthew; Cronin, Christopher
  6. Taxation and Economic Incentives on Health-Related Commodities: Alcohol, Tobacco and Food By Alemanno , Alberto; Sassi , Franco

  1. 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. Classification JEL: C35, C36, I10, J21
    Date: 2014–11
  2. By: Frank M. Fossen; Johannes König
    Abstract: We estimate the impact of a differential treatment of paid employees versus self-employed workers in a public health insurance system on the entry rate into entrepreneurship. In Germany, the public health insurance system is mandatory for most paid employees, but not for the self-employed, who usually buy private health insurance. Private health insurance contributions are relatively low for the young and healthy, and until 2013 also for males, but less attractive at the other ends of these dimensions and if membership in the public health insurance system allows other family members to be covered by contribution-free family insurance. Therefore, the health insurance system can create incentives or disincentives to starting up a business depending on the family’s situation and health. We estimate a discrete time hazard rate model of entrepreneurial entry based on representative household panel data for Germany, which include personal health information, and we account for nonrandom sample selection. We estimate that an increase in the health insurance cost differential between self-employed workers and paid employees by 100 euro per month decreases the annual probability of entry into self-employment by 0.38 percentage points, i.e. about a third of the average annual entry rate. The results show that the phenomenon of entrepreneurship lock, which an emerging literature describes for the system of employer provided health insurance in the USA, can also occur in a public health insurance system. Therefore, entrepreneurial activity should be taken into account when discussing potential health care reforms, not only in the USA and in Germany.
    Keywords: Health insurance, entrepreneurship lock, self-employment
    JEL: L26 I13 J2
    Date: 2015
  3. By: Bergstrom, Ted; Sheehan-Connor, Damien; Garratt, Rodney J
    Keywords: Social and Behavioral Sciences
    Date: 2015–02–04
  4. By: Borg, Sixten (Health Economics Unit, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University); Rydén, Tobias (Department of Information Technology, Uppsala University); Munkholm, Pia (Department of Gastroenterology, North Zealand University Hospital); Odes, Selwyn (Faculty of Health Sciences, Ben-Gurion University of the Negev); Moum, Bjørn (University of Oslo, Institute of Clinical Medicine); Stockbrügger, Reinhold (Department of Gastroenterology and Hepatology, University Hospital Maastricht); Lindgren, Stefan (Department of Clinical Sciences Malmö, Lund University)
    Abstract: Heterogeneity in patient populations is an important issue in health economic evaluations, as the cost-effectiveness of an intervention can vary between patient subgroups, and an intervention which is not cost-effective in the overall population may be cost-effective in particular subgroups. Identifying such subgroups is of interest in the allocation of healthcare resources. Our aim was to develop a method for cost-effectiveness analysis in heterogeneous chronic diseases, by identifying subgroups (phenotypes) directly relevant to the cost-effectiveness of an intervention, and by enabling cost-effectiveness analyses of the intervention in each of these phenotypes. We identified phenotypes based on healthcare resource utilization, using finite mixtures of underlying disease activity models: first, an explicit disease activity model, and secondly, a model of aggregated disease activity. They differed with regards to time-dependence, level of detail, and what interventions they could evaluate. We used them for cost-effectiveness analyses of two hypothetical interventions. Allowing for different phenotypes improved model fit, and was a key step towards dealing with heterogeneity. The cost-effectiveness of the interventions varied substantially between phenotypes. Using underlying disease activity models for identifying phenotypes as well as cost-effectiveness analysis appears both feasible and useful in that they guide the decision to introduce an intervention.
    Keywords: Cost-effectiveness; Disease heterogeneity; Phenotypes; Latent classes; Disease activity model; Crohn's disease
    JEL: C18 D70
    Date: 2015–02–06
  5. By: Harris, Matthew; Cronin, Christopher
    Abstract: This paper examines how a single female's investment in healthy body weight is affected by the quality of single males in her marriage market. A principle concern in estimation is the presence of market-level unobserved heterogeneity that may be correlated with changes in single male quality. To address this concern, we employ a differencing strategy that normalizes the exercise behaviors of single women to those of their married counterparts. Our main results suggest that when potential mate quality in a marriage market decreases, single black women invest less in healthy body weight. For example, we find that a ten percentage point increase in the proportion of low quality single black males leads to a 5% to 10% decrease in vigorous exercise taken by single black females. No significant response is found for single white women. These results highlight the relationship between male and female human capital acquisition that is driven by participation in the marriage market. Our results suggest that programs designed to improve the economic prospects of single males may yield positive externalities in the form of improved health behaviors, such as more exercise, particularly for single black females.
    Keywords: I14,I12,J12,J15
    JEL: I12 I14 J12 J15
    Date: 2014–10–29
  6. By: Alemanno , Alberto; Sassi , Franco
    Abstract: This chapter provides a detailed analysis of the economic, legal and public policy rationales for the application of taxes and other fiscal measures on health-related commodities. The motivation for such taxes has been more often linked to the fiscal revenues generated than to their potential public health benefits. However, especially in more recent times, an increased emphasis has been placed on the latter by many governments, as evidence emerged of the adverse public health, social and economic consequences of the consumption of certain commodities. An increasing number of governments are seeking to expand their use of fiscal measures to promote healthier behaviours, not only by increasing tax rates on commodities such as tobacco products and alcoholic beverages, but also by exploring the scope for taxing selected foods and non-alcoholic beverages as a way to make people’s diets healthier. A number of countries apply different tax rates to certain food categories, and some have specific taxes on foods high in salt, sugar or fat, and on sugary drinks. Only in the past two years, countries such as Denmark, Hungary, Finland and France introduced taxes on various foods and non-alcoholic beverages, and many more have been debating the possible use of similar measures. The key public health rationale for the use of taxes on health-related commodities lies in their ability to change people’s consumption behaviours. Additional health benefits may derive from the role possibly played by taxes as incentives to product reformulation. For instance, in 2012, many beer producers in the United Kingdom decreased the alcohol content of their brands sold in the United Kingdom by 0.2% to avoid an increase in duties. As with other attempts to use taxes to prevent some adverse outcome (e.g. environmental taxes), a key issue becomes the proximity of the tax point to the behaviour being targeted. The closer is the tax point to the behaviour, then (other things being equal) the more likely is the tax to have a beneficial impact. Excises introduced for public health purposes illustrate the dilemma clearly. Although for administrative reasons the tax may be levied earlier in the supply chain, the tax point is generally the purchase of the product by a consumer. Tobacco is always harmful, in whatever way and quantity it is consumed (although the harm will be even greater in an environment which results in secondary smoking). The relationship is less strong with alcohol, because the quantity consumed and the manner in which it is consumed (e.g. regular vs. binge drinking) determines the harm which may be caused. This relationship is even looser with diet-related taxes. This does not mean that taxation is an inappropriate instrument, but rather that, in addition to the harms discouraged by the tax, the welfare of a broader group of consumers will be affected.
    Keywords: Taxation; Public Health; Fat Tax; Risk Regulation; Lifestyle Risk; Non Communicable diseases; EU Law; WTO law; Paternalism; Nudge
    JEL: I18 K23 K32 K33 K34 K42 L51 L66
    Date: 2014–02–25

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