nep-hea New Economics Papers
on Health Economics
Issue of 2015‒02‒22
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo

  1. Reference dependent utility from health and the demand for medical care By Harris, Matthew; Kohn, Jennifer
  2. Reducing Health Care Disparities: Where Are We Now? By Marsha Gold
  3. Why Do Firms Use Insurance to Fund Worker Health Benefits? The Role of Corporate Finance By Dalton, Christina Marsh; Holland, Sara B.
  4. Formal volunteering and self-perceived health. Causal evidence from the UK-SILC By Fiorillo, Damiano; Nappo, Nunzia
  5. The Coalition's Record on Health: Policy, Spending and Outcomes 2010-2015 By Polina Obolenskaya; Polly Vizard
  6. Socioeconomic Differences in Adolescent Sexual and Reproductive Health: Sexually Transmitted Infections By Jennifer Yarger; Mara Decker; Claire Brindis; Meaghen Quinlan-Davidson
  7. Socioeconomic Differences in Adolescent Sexual and Reproductive Health: Sexual Activity By Jennifer Yarger; Diana Lara; Mara Decker; Claire Brindis
  8. Dental Use and Expenditures for Older Uninsured Americans: The Simulated Impact of Expanded Coverage By Richard J. Manski; John F. Moeller; Haiyan Chen; Jody Schimmel; John V. Pepper Patricia A. St. Clair
  9. Soft Budget Constraints in Public Hospitals By Wright, Donald J.
  10. The Price Sensitivity of Health Plan Choice among Retirees: Evidence from the German Social Health Insurance By Wuppermann, Amelie; Bauhoff, Sebastian; Grabka, Markus
  11. The impact of extreme weather events on child health: Evidence from Mongolia By Schindler, Kati; Groppo, Valeria
  12. The long-run relationship between trade and population health: evidence from five decades By Herzer, Dierk
  13. How do Non-Monetary Performance Incentives for Physicians Affect the Quality of Medical Care? A Laboratory Experiment By Kairies-Schwarz, Nadja; Krieger, Miriam
  14. Comparing the Costs of the Veterans' Health Care System with Private-Sector Costs By Congressional Budget Office
  15. The fungibility of health aid reconsidered By Nicolas Van de Sijpe
  16. Health information, treatment, and worker productivity: Experimental evidence from Malaria testing and treatment among Nigerian sugarcane cutters By Andrew Dillon; Jed Friedman; Pieter Serneels
  17. The Impact of Playworks on Boys' and Girls' Physical Activity During Recess By Martha Bleeker; Nicholas Beyler; Susanne James-Burdumy; Jane Fortson
  18. Parents' Preferences for Enhanced Access in the Pediatric Medical Home: A Discrete Choice Experiment By Joseph S. Zickafoose; Lisa R. DeCamp; Lisa A. Prosser
  19. Childhood Cancer Survivor Study Participants' Perceptions and Understanding of the Affordable Care Act By Elyse R. Park; Anne C. Kirchhoff; Giselle K. Perez; Wendy Leisenring; Joel S. Weissman; Karen Donelan; Ann C. Mertens; James D. Reschovsky; Gregory T. Armstrong; Leslie L. Robison; Mariel Franklin; Kelly A. Hyland; Lisa R. Diller; Christopher J. Recklitis; Karen A. Kuhlthau
  20. Medicare 101 and 201: Key Issues for States By James Verdier; Alexandra Kruse; Michelle Herman Soper
  21. What Drives the Increase in Health Care Costs with Age By Maciej Lis

  1. By: Harris, Matthew; Kohn, Jennifer
    Abstract: We examine the effect of reference health on the demand for medical care. We propose and empirically implement a dynamic model of demand for medical care that includes reference health, an average of previous health states. We find that gain or loss from reference health significantly affects the demand for medical care. The effect is stronger for losses than gains. The effect is strongest in the upper tail of medical care consumers. We compare the predictions of our dynamic model with one that omits reference health. Including reference health improves our ability to match individuals in the top 5 percent by 65 percent.
    Keywords: Reference Dependence, Human Capital, Demand for Medical Care, Health Dynamics, Semi-Parametric, Conditional Density Estimation
    JEL: C14 I10
    Date: 2015–02–05
  2. By: Marsha Gold
    Abstract: This issue brief for the Robert Wood Johnson Foundation gives an overview of how the field of health care disparities has evolved in recent years to identify emerging perspectives, progress and current activity, and outstanding needs.
    Keywords: Health Care Disparities Health
    JEL: I
    Date: 2014–03–30
  3. By: Dalton, Christina Marsh; Holland, Sara B.
    Abstract: When a firm offers health benefits to workers, it exposes the firm to the risk of making payments when workers get sick. A firm can either pay health expenses out of its general assets, keeping the risk inside the firm, or it can purchase insurance, shifting the risk outside the firm. We analyze the firm’s decision to manage this risk. Using data on the insurance decisions of publicly-traded firms, we find that smaller firms, firms with more investment opportunities, and firms that face a convex tax schedule are more likely to hedge the risk of health benefit payments. Health risk is common to all firms, making this application an important contribution to understanding firms’ hedging decisions. Additionally, we reveal new and important determinants of the hedging decision relative to regulatory regimes. We also show that hedging health risk mitigates investment-cash flow sensitivities.
    Keywords: Self-insure, self-fund, hedging, human capital risk, health insurance risk, investment
    JEL: G3 I13
    Date: 2015–02–02
  4. By: Fiorillo, Damiano; Nappo, Nunzia
    Abstract: The paper assesses the causal relationship between formal volunteering and individual health. The econometric analysis employs data provided by the Income and Living Conditions Survey for the United Kingdom carried out by the European Union’s Statistics (UK-SILC) in 2006. Based on 2SLS, treatment effect and recursive bivariate probit models, and religious participation as instrument variable, and controlling for social and cultural capital, our results show a positive and causal relationship between formal volunteering and self-perceived health.
    Keywords: health, formal volunteering, social capital, instrumental variable, treatment effect model, recursive bivariate probit model, UK
    JEL: C3 C31 C35 C36 D6 D64 I1 I10 I18 Z10 Z12
    Date: 2015–01
  5. By: Polina Obolenskaya; Polly Vizard
    Abstract: David Cameron promised in 2010 to "cut the deficit, not the NHS". But how have the Coalition's policies - including health reforms which are widely viewed as going beyond election commitments - impacted on health?
    Keywords: health, health inequalities, primary care quality, adult mortality, social policy
    Date: 2015–01
  6. By: Jennifer Yarger; Mara Decker; Claire Brindis; Meaghen Quinlan-Davidson
    Abstract: Adolescent Sexual and Reproductive Health (ASRH) is one of five areas of focus of the World Bank's Reproductive Health Action Plan 2010 - 2015 (RHAP), which recognizes the importance of addressing ASRH as a development issue with important implications for poverty reduction. A couple key messages relayed in this brief as follows: Sexually transmitted infections (STIs), including HIV, present a serious challenge to the health and well-being of adolescents, particularly young women, who are at greater risk of infection; An analysis of data from six countries namely, Bangladesh, Burkina Faso, Ethiopia, Nepal, Niger, and Nigeria found that self-reported STIs and symptoms are low among adolescents. Although less than a third of adolescents in any of the countries have comprehensive knowledge about HIV/AIDS, more never-married adolescent women have comprehensive knowledge about HIV transmission and prevention as compared to their ever-married counterparts. Knowledge of STIs is higher in urban than rural areas.
    Keywords: Adolescence, adolescent females, adolescent women, adolescents, aged, barrier methods, cervical cancer, complications, developing countries, family planning, female, ... See More + ertility, health care, Health Services, HIV, HIV testing, HIV transmission, HIV/AIDS, infertility, married adolescents, married counterparts, married women, microbicides, Nutrition, Population Knowledge, prevalence, primary education, radio, REPRODUCTIVE HEALTH, Reproductive Healthcare, risk of infection, rural areas, screening, sexual activity, Sexual Behavior, SEXUALLY TRANSMITTED INFECTIONS, SOCIOECONOMIC DIFFERENCES, socioeconomic status, STIs, symptom, symptoms, treatment, Unintended Pregnancy, urban areas, vulnerable populations, young people, young women
    Date: 2015–01
  7. By: Jennifer Yarger; Diana Lara; Mara Decker; Claire Brindis
    Abstract: Adolescent Sexual and Reproductive Health (ASRH) is one of five areas of focus of the World Bank's Reproductive Health Action Plan 2010 - 2015 (RHAP), which recognizes the importance of addressing ASRH as a development issue with important implications for poverty reduction. Delaying childbearing and preventing unintended pregnancies during adolescence has been shown to improve health outcomes and increase opportunities for schooling, future employment, and earnings (Greene & Merrick, 2005). The key messages relayed in this brief are as follows: Early age at sexual debut puts young people - particularly females - at an increased risk for unplanned pregnancies, sexually transmitted infections, maternal mortality and morbidity; An analysis of data from six countries showed that adolescent sexual activity is closely tied to marital status. In all six countries studied, nearly all ever-married adolescent women have had sexual intercourse, but almost all those never-married have abstained, except in Burkina Faso and Nigeria where less than one quarter of never-married women have had sexual intercourse; The age at sexual debut is also closely linked to age at marriage. Over one third of ever-married women had sexual intercourse before age 15 in Nigeria (38 percent), Bangladesh (37 percent), and Niger (37 percent); In Burkina Faso and Nigeria, sexual activity is lowest among never-married adolescent women with no education (15 percent and 7 percent, respectively).
    Keywords: access to health services, adolescence, ADOLESCENT, Adolescent Fertility, Adolescent Girls, adolescent sexual activity, adolescent women, adolescents, Advocacy, age at ... See More + marriage, aged, childbearing, Congenital Syphilis, developing countries, early sexual debut, Economic Empowerment, family planning, female, female education, females, First Sexual Intercourse, gender, gender roles, Health of Adolescents, health outcomes, HIV, implications for poverty reduction, infections, Journal of Epidemiology, marital status, married adolescent women, married women, maternal mortality, morbidity, Mother, Mother-to-Child, Mother-to-Child Transmission, Nutrition, policy dialogue, Population Knowledge, Premarital sex, primary education, Progress, provision of services, Public Health, REPRODUCTIVE HEALTH, Reproductive Health of Adolescents, rural areas, rural residence, SEXUAL ACTIVITY, sexual intercourse, sexually transmitted infections, SOCIOECONOMIC DIFFERENCES, socioeconomic status, STIs, unintended pregnancies, unplanned pregnancies, unplanned pregnancy, urban areas, vulnerable populations, Young Adults, Young Age, young people
    Date: 2015–01
  8. By: Richard J. Manski; John F. Moeller; Haiyan Chen; Jody Schimmel; John V. Pepper Patricia A. St. Clair
    Abstract: Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users.
    Keywords: Dental utilization, insurance, coverage, retirement
    JEL: I
    Date: 2015–02–01
  9. By: Wright, Donald J.
    Abstract: A soft budget constraint arises when a government is unable to commit to not `bailout' a public hospital if the public hospital exhausts its budget before the end of the budget period. It is shown that if the political costs of a `bailout' are relatively small, then the public hospital exhausts the welfare maximising budget before the end of the budget period and a `bailout' oc- curs. In anticipation, the government offers a budget to the public hospital which may be greater than or less than the welfare maximising budget. In either case, the public hospital treats "too many" elective patients before the `bailout' and "too few" after. The introduction of a private hospital reduces the size of any `bailout' and increases welfare.
    Keywords: soft budget constraint, public hospital, welfare
    Date: 2015–02
  10. By: Wuppermann, Amelie; Bauhoff, Sebastian; Grabka, Markus
    Abstract: We investigate two determinants of the price sensitivity of health plan demand among retirees in the German social health insurance (SHI): the size of the choice set and the salience of premium differences. We use variation in the choice set over time and between regions, and an increase in the salience of premium differences introduced by a recent reform that changed how premiums are framed. Using information on health plan switches in the German Socio Economic Panel, augmented with information on individuals choice sets we find that retirees are less likely to react to potential savings from switching when they have more plans to choose from and when differences between premiums are less salient. The results imply that simplifying choices could save retirees money and also improve the functioning of the health insurance market.
    JEL: I11 D12 C23
    Date: 2014
  11. By: Schindler, Kati; Groppo, Valeria
    Abstract: This paper investigates the impact of a devastating weather shock on child anthropometrics, using data from Mongolia. We employ a diff-in-diff strategy to identify the effect of an extremely harsh winter in 2010, which caused the death of about 20 percent of the national livestock. Results indicate that cohorts of children exposed to the 2010 winter and who lived in districts in which the shock was particularly harsh are significantly shorter two years after the shock. The negative effect of the shock is strongest for children from herding households. Moreover, we explore the role of mitigation channels to cushion the impact of the weather shock. In households where the head has more experience in herding, children suffer less from the consequences of the shock. Similarly, households having access to alternative sources of income are better able to protect their children from the effect of the shock. Finally, both the amount of emergency aid delivered per district and the presence of an international organization in a given district relieve the negative impact of the shock. Our findings are robust to different measures of shock intensity and to endogenous migration.
    JEL: I10 O12 J13
    Date: 2014
  12. By: Herzer, Dierk
    Abstract: In recent years, the increase in international trade has sparked a debate about the impact of international trade on population health. To date, however, there has been very little econometric research on the relationship between these two variables. This paper examines the long-run relationship between trade openness and population health for a sample of 74 countries over five decades, from 1960 to 2010. Using panel time-series techniques, it is shown that international trade in general has a robust positive long-run effect on health, as measured by life expectancy and infant mortality. This effect tends to be greater in countries with lower development levels, higher taxes on income, profits, and capital gains, and less restrictive business and labor market regulations. The results also show that long-run causality runs in both directions, suggesting that increased trade is both a consequence and a cause of increased life expectancy.
    JEL: O11 F40 I12
    Date: 2014
  13. By: Kairies-Schwarz, Nadja; Krieger, Miriam
    Abstract: In recent years, several countries have introduced non-monetary performance incentives for health care providers to improve the quality of medical care. Evidence on the effect of non-monetary feedback incentives, predominantly in the form of public quality reporting, on the quality of medical care is, however, ambiguous. This is often because empirical research to date has not succeeded in distinguishing between the effects of monetary and non-monetary incentives, which are usually implemented simultaneously. We use a controlled laboratory experiment to isolate the impact of non-monetary performance incentives: subjects take on the role of physicians and make treatment decisions for patients, receiving feedback on the quality of their treatment. The subjects decisions result in payments to real patients. By giving either private or public feedback we are able to disentangle the motivational effects of self-esteem and social reputation. Our results reveal that public feedback incentives have a significant and positive effect on the quality of care that is provided. Private feedback, on the other hand, has no impact on treatment quality. These results hold for medical students and for other students.
    JEL: I11 C91 L15
    Date: 2014
  14. By: Congressional Budget Office
    Abstract: Legislation enacted in 2014 calls for the Veterans Health Administration (VHA) to expand the availability of health care to eligible veterans. The structure of VHA and published studies suggest that VHA care has been less expensive than care provided by the private sector. However, limited evidence and substantial uncertainty make it difficult to reach firm conclusions about whether it would be cheaper to expand veterans' access to health care in the future through VHA facilities or the private sector.
    JEL: I13 I18
    Date: 2014–12–10
  15. By: Nicolas Van de Sijpe
    Abstract: This paper draws further attention to the importance of taking into account off-budget aid when estimating the degree of foreign aid fungibility.  It does so by re-evaluating the results of a recent, influential paper which concluded that health aid is fully fungible in the long run.  Allowing for the presence of off-budget aid indicates that the degree of fungibility of health aid is much more uncertain than at first blush appears.  Under plausible assumptions about the role of off-budget aid, the conclusion of full fungibility is overturned and at most only a limited degree of fungibility is found.
    Keywords: foreign health aid, fungibility, publish health expenditure
    JEL: E62 F35 H51 I18 O23
    Date: 2013–06–09
  16. By: Andrew Dillon; Jed Friedman; Pieter Serneels
    Abstract: Agricultural and other physically demanding sectors are important sources of growth in developing countries but prevalent diseases such as malaria adversely impact the productivity, labor supply, and occupational choice of workers in these sectors by reducing physical capacity.  This study identifies the impact of malaria on worker earnings, labor supply, and daily productivity by randomizing the temporal order at which piece-rate workers at a large sugarcane plantation in Nigeria are offered malaria testing and treatment.  The results indicate a significant and substantial intent to treat effect of the intervention - the offer of a workplace based malaria testing and treatment program increases worker earnings by approximately 10% over the weeks following the mobile clinic visit.  The study further investigates the effect of health information by contrasting program effects by workers revealed health status.  For workers who test positive for malaria, the treatment of illness increases labor supply, leading to higher earnings.  For workers who test negative, and especially for those workers most likely to be surprised by the healthy diagnosis, the health information also leads to increased earnings via increased productivity.  Possible mechanisms for this response include selection into higher return occupations as a result of changes in the perceived cost of effort.  A model of the worker labor decision that includes health perceptions in the decisions to supply effort suggests that, in endemic settings with poor quality health services, inaccurate health perceptions may lead workers to misallocate labor thus resulting in sub-optimal production and occupational choice.  The results underline the importance of medical treatment but also of access to improved information about one's health status, as the absence of either may lead workers to deliver lower than optimal effort levels in lower return occupations.
    Keywords: malaria, labor supply, labor productivity, randomized experiment
    JEL: I12 J22 J24 O12
    Date: 2014–03–02
  17. By: Martha Bleeker; Nicholas Beyler; Susanne James-Burdumy; Jane Fortson
    Abstract: School-based programs, such as Playworks, that guide students in organized activities during recess and make improvements to the recess play yard may lead to significant increases in physical activity—especially for girls. This study builds on past research by investigating the impact of Playworks separately for girls and boys.
    Keywords: physical activity, recess, elementary school, Playworks, girls, boys
    JEL: I
    Date: 2015–03–01
  18. By: Joseph S. Zickafoose; Lisa R. DeCamp; Lisa A. Prosser
    JEL: I
    Date: 2015–02–02
  19. By: Elyse R. Park; Anne C. Kirchhoff; Giselle K. Perez; Wendy Leisenring; Joel S. Weissman; Karen Donelan; Ann C. Mertens; James D. Reschovsky; Gregory T. Armstrong; Leslie L. Robison; Mariel Franklin; Kelly A. Hyland; Lisa R. Diller; Christopher J. Recklitis; Karen A. Kuhlthau
    Abstract: The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown.
    Keywords: Childhood Cancer, Affordable Care Act, Health
    JEL: I
    Date: 2015–02–02
  20. By: James Verdier; Alexandra Kruse; Michelle Herman Soper
    Keywords: Medicare, States
    JEL: I
    Date: 2015–01–29
  21. By: Maciej Lis (Instytut Badañ Strukturalnych)
    Abstract: The aim of the article is to show the role of the drivers of health care costs increases with age. An innovative decomposition strategy has been proposed and applied to the population-wide data on health care expenditure in Poland. We have found that the health care costs dynamics with age are driven by the rise in prevalence and the frequency of the use of the health care system. The cost of procedures and the share of decedents play minor roles here. If the pattern of morbidity remains constant, mortality constitutes an important restraint that prevents the costs of care exploding.
    Keywords: healthcare expenditure, ageing, red herring, death related costs
    JEL: H51 I12 I18 J14
    Date: 2015–01

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