nep-hea New Economics Papers
on Health Economics
Issue of 2015‒02‒28
thirty-six papers chosen by
Yong Yin
SUNY at Buffalo

  1. Improving Health Through Nutrition Research: An Overview of the U.S. Nutrition Research System By Toole, Andrew ; Kuchler, Fred
  2. The impact of body weight on occupational mobility and career development By Harris, Matthew
  3. Orphans and Ebola : estimating the secondary impact of a public health crisis By Evans, David K. ; Popova, Anna
  4. Health Information Technology in the United States: Better Information Systems for Better Care, 2013 By Catherine M. DesRoches ; Michael W. Painter ; Ashish K. Jha
  5. Doctors without Hospitals: What to do about Specialists Who Can’t Find Work By Ake Blomqvist ; Colin Busby ; Will Falk ; Aaron Jacobs
  6. Language Barriers and Immigrant Health Production By Clarke, Andrew ; Isphording, Ingo E.
  7. Outsourcing Intensity and Ownership: Theory and Evidence from California General Care Hospitals By Dalton, Christina Marsh ; Warren, Patrick L.
  8. Health provider networks, quality and costs By Boone, Jan ; Schottmüller, Christoph
  9. Socioeconomic Differences in Adolescent Sexual and Reproductive Health: Marriage By Rafael Cortez ; Jennifer Yarger ; Mara Decker ; Claire Brindis
  10. Socioeconomic Differences in Adolescent Sexual and Reproductive Health: Family Planning By Jennifer Yarger ; Mara Decker ; Claire Brindis ; Rafael Cortez ; Meaghen Quinlan-Davidson
  11. Patient Responses to Incentives in Consumer-directed Health Plans: Evidence from Pharmaceuticals By Peter J. Huckfeldt ; Amelia Haviland ; Ateev Mehrotra ; Zachary Wagner ; Neeraj Sood
  12. Childhood Medicaid Coverage and Later Life Health Care Utilization By Laura R. Wherry ; Sarah Miller ; Robert Kaestner ; Bruce D. Meyer
  13. Heterogeneous effect of residency matching and prospective payment on labor returns and hospital scale economies By Galina Besstremyannaya
  14. Lifecycle Effects of a Recession on Health Behaviors: Boom, Bust, and Recovery in Iceland By Tinna Laufey Ásgeirsdóttir ; Hope Corman ; Kelly Noonan ; Nancy Reichman
  15. The implications of equal value of life and prioritarianism for the evaluation of population health By Moreno-Terneroy , Juan D ; Østerdal, Lars Peter
  16. Voluntary Work, Health and Subjective Wellbeing: a Resource for Active Ageing. By Bechetti, Leonardo ; Conzo, Pierluigi ; Di Febbraro, Mirko
  17. The (w)health of Nations: the Contribution of Health Expenditure to Active Ageing. By Leonardo, Bechetti ; Conzo, Pierluigi ; Salustri, Francesco
  18. International Careers of Researchers in Biomedical Sciences: A Comparison of the US and the UK. By Lawson, Cornelia ; Geuna, Aldo ; Ana Fernández-Zubieta ; Toselli, Manuel ; Kataishi, Rodrigo
  19. Education, Health and Subjective Wellbeing in Europe. By Leonardo, Bechetti ; Conzo, Pierluigi ; Pisani, Fabio
  20. Health Provider Networks, Quality and Costs By Boone, J. ; Schottmuller, C.
  21. The Moral and Fiscal Implications of Anti-Retroviral Therapies for HIV in Africa By Paul Collier ; Olivier Sterck ; Richard Manning
  22. The Effect of Leaded Aviation Gasonline on Blood Lead in Children By Zahran, Sammy ; Iverson, Terrence ; McElmurry, Shawn ; Weilar, Stephan
  23. What Kinds of Health Insurance Do Small Businesses Offer? Results from a Survey of Five States By Catherine McLaughlin Adam Swinburn
  24. Does Medicare Part D save lives? By Dunn, Abe ; Shapiro, Adam Hale
  25. Addressing Teen Pregnancy Risks for Youth Living in Out-of-Home Care: Implementing POWER Through Choices 2010 By Alicia Meckstroth ; Megan Barry ; Betsy Keating ; Ellen Kisker ; Kristine Andrews
  26. The Cost of Binge Drinking By Francesconi, Marco ; James, Jonathan
  27. The Pros and Cons of Sick Pay Schemes: A Method to Test for Contagious Presenteeism and Shirking Behavior By Pichler, Stefan ; Ziebarth, Nicolas R.
  28. Impacts of Informal Caregiving on Caregiver Employment, Health, and Family By Bauer, Jan M. ; Sousa-Poza, Alfonso
  29. Long-Term Health Effects of Vietnam-Era Military Service: A Quasi-Experiment Using Australian Conscription Lotteries By Johnston, David W. ; Shields, Michael A. ; Siminski, Peter
  30. Improving Public Health Safety Nets After an Economic Recession By Sanjay Basu
  31. The economic consequences of accidents at work By Gabriele Mazzolini
  32. Is caring for elderly parents detrimental to women’s mental health? The influence of the European North-South gradient By Elenka Brenna ; Cinzia Di Novi
  33. Aid Fragmentation and Effectiveness for Infant and Child Mortality and Primary School Completion By Furukawa, Mitsuaki
  34. Differential Mortality and Progressivity of Social Security By Ali Shourideh ; Roozbeh Hosseini
  35. Enhanced citizenship verification and children's medicaid coverage By Marton, James ; Snyder, Angela ; Zhou, Mei
  36. Pharmaceutical Drug Misuse, Industry of Employment and Occupation By Mark N Harris ; Jake Prendergast ; Preety Srivastava

  1. By: Toole, Andrew ; Kuchler, Fred
    Abstract: This report explores the structure and function of the U.S. nutrition research system, with an emphasis on trends in Federal support. It describes how nutrition research is used, especially for nutrition education and communication, but also for regulation and food assistance. The report uses the Human Nutrition Research Information Management database maintained by the National Institutes of Health to analyze longterm trends. Federal investments in nutrition research grew from 1985 to 2009 in real terms, but the portfolio of research changed. Over time, the share of nutrition research support by the U.S. Department of Health and Human Services increased while support by the U.S. Department of Agriculture decreased. This shift changed how research topics were selected and funded within the Federal portfolio. More research is funded through competitive grants than through intramural or formula funding, and a broader set of academic institutions now participates in nutrition research.
    Keywords: Federal research, research and development, public investment, nutrition information system, Human Nutrition Research Information Management (HNRIM), formula funding, competitive funding, Agricultural and Food Policy, Food Consumption/Nutrition/Food Safety, Health Economics and Policy,
    Date: 2015–01
  2. By: Harris, Matthew
    Abstract: This paper examines the relationship between individuals' weight and their employment decisions over the life cycle. I estimate a dynamic stochastic model of individuals' annual joint decisions of occupation, hours worked, and schooling. The model allows body weight to affect non-monetary costs, switching costs, and distribution of wages for each occupation; and also allows individuals' employment decisions to affect body weight. I use conditional density estimation to formulate the distributions of wages and body weight evolution. I find that heavier individuals face higher switching costs when transitioning into white collar occupations, earn lower returns to experience in white-collar occupations, and earn lower wages in socially intensive jobs. Simulating the model with estimated parameters, decreased occupational mobility accounts for 10 percent of the obesity wage gap. While contemporaneous wage penalties for body weight are small, the cost over the life cycle is substantial. An exogenous increase in initial body mass by 20 percent leads to a 10 percent decrease in wages over the life course.
    Keywords: Labor, occupational choice, obesity, dynamic discrete choice, productivity, switching costs
    JEL: D91 I14 J24 J3 J31
    Date: 2015–01–28
  3. By: Evans, David K. ; Popova, Anna
    Abstract: The 2014 Ebola Virus Disease outbreak in West Africa is the largest to date by far. Ebola Virus Disease causes disproportionate mortality among the working-age population, resulting in far more mortality for parents of young children than other health crises. This paper combines data on the age distribution of current and projected mortality from Ebola with the fertility distribution of adults in Guinea, Liberia, and Sierra Leone, to estimate the likely impact of the epidemic on the number of orphans in these three countries. Using the latest mortality estimates (from February 11, 2015), it is estimated that more than 9,600 children have lost one or both parents to Ebola Virus Disease. The absolute numbers of orphans created by the Ebola epidemic are significant, but represent a small fraction (1.4 percent) of the existing orphan burden in the affected countries. Ebola is unlikely to increase the numbers of orphans beyond extended family networks'capacities to absorb them. Nonetheless, the pressures of caring for increased numbers of orphans may result in lower quality of care. These estimates should be used to guide policy to support family networks to improve the capacity to provide high quality care to orphans.
    Keywords: Street Children,Youth and Governance,Population Policies,Primary Education,HIV AIDS
    Date: 2015–02–01
  4. By: Catherine M. DesRoches ; Michael W. Painter ; Ashish K. Jha
    Keywords: HIT, Health Information Technology, Health Care, United States , Health, Information Systems, Better Care
    JEL: I
    Date: 2013–07–02
  5. By: Ake Blomqvist ; Colin Busby ; Will Falk ; Aaron Jacobs
    Keywords: Social Policy, Health Policy, Doctors
    JEL: I10 I11 I18
    Date: 2015–02
  6. By: Clarke, Andrew (University of Melbourne ); Isphording, Ingo E. (IZA )
    Abstract: We study the impact of language deficiency on the health production of childhood migrants to Australia. Our identification strategy relies on a quasi-experiment comparing immigrants arriving at different ages and from different linguistic origins by utilising a measure of differences along a continuous range of linguistic distances. Our main results indicate a large negative effect of English deficiency on physical health that is robust to a range of different specifications. In the presence of considerable non-classical measurement error in self-reported language proficiency, our results provide lower and upper bounds for the true effect of English deficiency on health of one half and a full standard deviation in the health score respectively. The empirical analysis is framed in terms of a Grossman model which indicates a twofold role of language skills in health production: language deficiency directly affects the efficiency of health production and indirectly affects access to health inputs. We provide some suggestive evidence on the relative importance of these distinct roles.
    Keywords: international migration, language skills, health
    JEL: F22 I12 J24 J61
    Date: 2015–02
  7. By: Dalton, Christina Marsh ; Warren, Patrick L.
    Abstract: For-profit hospitals in California contract out services much more intensely than either public hospitals or private nonprofit hospitals. To explain why, we build a model in which the outsourcing decision is a trade-off between net revenues and some nonmonetary benefit to the manager, which we call “bias” in the manner of production. Since nonprofit firms must consume profits indirectly, they trade off differently than for-profit firms. This difference is exaggerated in services where nonmonetary benefits are particularly important but minimized when the firm is hit with a fixed-cost shock. We test these predictions in a panel of California hospitals, finding evidence for each. These results suggest that a model of public or nonprofit make-or-buy decisions should be more than a simple relabeling of a model derived in the for-profit context.
    Keywords: Hospitals, Make-or-Buy, Public versus Private, Nonprofit Firm Behavior
    JEL: L22 L24 L33
    Date: 2014–05–16
  8. By: Boone, Jan ; Schottmüller, Christoph
    Abstract: We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider quality through their choice of provider network. Selective contracting focuses on low cost providers. Contracting both providers signals high quality. Market power tends to lower quality and lead to inefficiency. In a dynamic extension of the model, providers under-invest in quality while there can be both over and under-investment in cost reductions if there is a monopoly insurer while an efficient investment equilibrium exists with insurer competition.
    Keywords: common contracts; exclusive contracts; health care quality; managed care; selective contracting; signaling
    JEL: D86 I11 L13
    Date: 2015–02
  9. By: Rafael Cortez ; Jennifer Yarger ; 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 schooling, future employment, and earnings (Greene & Merrick, 2005). Early marriage often marks the beginning of exposure to the risk of pregnancy and sexually transmitted infections (STIs). Research has shown that adolescent marriage is associated with unplanned pregnancy, rapid repeat childbirth, inadequate use of maternal health services, and poor birth outcomes, among other negative maternal and child health outcomes (Godha, Hotchkiss, and Gage, 2013; Raj & Boehmer, 2013; Santhya, 2011). Furthermore, research in Ethiopia has found that adolescent females who marry before the age of 15 are at higher risk of intimate partner violence and coercive sex than those who marry between ages 15-18 (Erulkar, 2013). At the 65th World Health Assembly, representatives agreed that early marriage is a violation of the rights of children and adolescents. Early marriage is illegal in most of the places where it occurs. It limits young girls' autonomy, knowledge, resources, and decision-making power (World Bank, 2014). Adolescent marriage is also much more likely to affect females than males: in the developing world, 16 percent of females are married in comparison to 3 percent of males (UNFPA, 2013).
    Keywords: access to health services, adolescence, ADOLESCENT, adolescent females, adolescent fertility, Adolescent Health, Adolescent Pregnancy, adolescent women, adolescents, ... See More + dulthood, aged, birth outcomes, child health, Child Marriage, childbearing, childbirth, coercive sex, Developing Countries, early adolescent, Early marriage, educational attainment, empowerment, families, family planning, female, fertility, fertility rates, gender, Girl Child, Gynecology, HIV, implications for poverty reduction, Infant, Infant Mortality, infections, International Center for Research on Women, intimate partner, laws, levels of fertility, life expectancy, lower fertility, maternal health, maternal mortality, maternal mortality rates, Nutrition, policy dialogue, poor health, Population Knowledge, primary education, provision of services, REPRODUCTIVE HEALTH, Reproductive Health Outcomes, rights of children, risk of pregnancy, rural areas, rural residence, Service Utilization, sex, sexually transmitted infections, SOCIOECONOMIC DIFFERENCES, socioeconomic status, STIs, UNFPA, unintended pregnancies, unplanned pregnancy, urban areas, use of maternal health services, violence, Violence Against Women, vulnerable populations, will, young girls, Young Women
    Date: 2015–01
  10. By: Jennifer Yarger ; Mara Decker ; Claire Brindis ; Rafael Cortez ; Meaghen Quinlan-Davidson
    Abstract: dolescent sexual and reproductive health (ASRH) is one of five areas of focus of the World Bank's reproductive health action plan (RHAP) 2010-2015, 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. This brief highlights the limited contraceptive use among adolescent women and the socioeconomic disparities in family planning among this population. The results indicate the importance of investing in programs aimed at increasing access to safe and effective contraceptive methods and expanding adolescents' knowledge of modern contraception, particularly among adolescent women in rural and poor areas and or those with limited or no education, regardless of marital status. Continued investment should be made in female education and empowerment as a means to reach economic development goals, as well as related goals, such as an increase in adolescent contraceptive use to reduce the incidence of unplanned pregnancies.
    Keywords: abortions, access to health services, adolescence, ADOLESCENT, adolescent contraceptive use, adolescent females, adolescent women, aged, barrier methods, child survival ... See More + childbearing, condoms, contraception, Contraception for Adolescents, contraceptive method, contraceptive prevalence, contraceptive prevalence rate, contraceptives, contraceptives to adolescents, developing countries, development goals, diaphragms, effective contraceptive, FAMILY PLANNING, family planning behavior, family planning services, family planning use, female, female condom, female education, female sterilization, health outcomes, HIV, implications for poverty reduction, infections, intrauterine devices, IUD, lack of knowledge, lactational amenorrhea, levels of education, marital status, married adolescent women, married adolescents, married women, maternal health, modern contraception, modern contraceptive methods, modern contraceptive use, mortality, neonatal morbidity, Nutrition, old girls, oral contraceptives, policy dialogue, Population Knowledge, primary education, primary school, provision of services, REPRODUCTIVE HEALTH, rural areas, Sexual Behaviour, sexually active, sexually transmitted infections, social norms, SOCIOECONOMIC DIFFERENCES, socioeconomic status, UNFPA, unintended pregnancies, United Nations Population Fund, unmarried adolescents, unplanned pregnancies, urban areas, use of family planning, vulnerable populations, young people, Young Women, Youth
    Date: 2015–01
  11. By: Peter J. Huckfeldt ; Amelia Haviland ; Ateev Mehrotra ; Zachary Wagner ; Neeraj Sood
    Abstract: Prior studies suggest that consumer-directed health plans (CDHPs) -characterized by high deductibles and health care accounts- reduce health costs, but there is concern that enrollees indiscriminately reduce use of low-value services (e.g., unnecessary emergency department use) and high-value services (e.g., preventive care). We investigate how CDHP enrollees change use of pharmaceuticals for chronic diseases. We compare two large firms where nearly all employees were switched to CDHPs to firms with conventional health insurance plans. In the first firm’s CDHP, pharmaceuticals were subject to the deductible, while in the second firm pharmaceuticals were exempt. Employees in the first firm shifted the timing of drug purchases to periods with lower cost sharing and were more likely to use lower-cost drugs, but the largest effect of the CDHP was to reduce utilization. Employees in the second firm also reduced utilization, but did not shift the timing or use of low cost drugs.
    JEL: I1 I13
    Date: 2015–02
  12. By: Laura R. Wherry ; Sarah Miller ; Robert Kaestner ; Bruce D. Meyer
    Abstract: Policy-makers have argued that providing public health insurance coverage to the uninsured lowers long-run costs by reducing the need for expensive hospitalizations and emergency department visits later in life. In this paper, we provide evidence for such a phenomenon by exploiting a legislated discontinuity in the cumulative number of years a child is eligible for Medicaid based on date of birth. We find that having more years of Medicaid eligibility in childhood is associated with fewer hospitalizations and emergency department visits in adulthood for blacks. Our effects are particularly pronounced for hospitalizations and emergency department visits related to chronic illnesses and those of patients living in low-income neighborhoods. Furthermore, we find suggestive evidence that these effects are larger in states where the difference in the number of Medicaid-eligible years across the cutoff birth date is greater. We do not find effects on hospitalizations related to appendicitis or injury, two conditions that are unlikely to be affected by medical intervention in childhood. Our calculations suggest that lower rates of hospitalizations and emergency department visits during one year in adulthood offset between 3 and 5 percent of the initial costs of expanding Medicaid. This implies substantial savings if the decline in utilization spans multiple years or grows with age.
    JEL: I12 I13 I28
    Date: 2015–02
  13. By: Galina Besstremyannaya (Stanford University )
    Abstract: The paper evaluates heterogeneous effect of participation in a residency matching program and changeover from fee-for-service to a prospective payment system on labor returns and economies of scale at acute-care public hospitals in Japan. A range of frontier technologies for multi-product output function is introduced with panel data quantile regression models, where endogenous treatment variables account for the fact that participation in both the residency matching program and the prospective payment reform was voluntary. The analysis exploits nationwide longitudinal databases on Japanese hospital participation in each of the reforms and on financial performance of regional and municipal hospitals in 2006-2012. The results demonstrate a labor-capital trade-off and lower labor intensity in the most productive hospitals. The residency matching program is positively associated with hospital production and labor productivity, especially in medium quantiles. Prospective payment has a negative effect on labor productivity, but it is only significant for hospitals in the highest quantiles.
    Keywords: quantile regressions, economies of scale, labor productivity, hospitals
    Date: 2015–02
  14. By: Tinna Laufey Ásgeirsdóttir ; Hope Corman ; Kelly Noonan ; Nancy Reichman
    Abstract: This study uses individual-level longitudinal data from Iceland, a country that experienced a severe economic crisis in 2008 and substantial recovery by 2012, to investigate the extent to which the effects of a recession on health behaviors are lingering or short-lived and to explore trajectories in health behaviors from pre-crisis boom, to crisis, to recovery. Health-compromising behaviors (smoking, heavy drinking, sugared soft drinks, sweets, fast food, and tanning) declined during the crisis, and all but sweets continued to decline during the recovery. Health-promoting behaviors (consumption of fruit, fish oil, and vitamin/ minerals and getting recommended sleep) followed more idiosyncratic paths. Overall, most behaviors reverted back to their pre-crisis levels or trends during the recovery, and these short-term deviations in trajectories were probably too short-lived in this recession to have major impacts on health or mortality. A notable exception is for alcohol consumption, which declined dramatically during the crisis years, continued to fall (at a slower rate) during the recovery, and did not revert back to the pre-crisis upward trend during our observation period. These lingering effects, which directionally run counter to the pre-crisis upward trend, suggest that alcohol is a potential pathway by which recessions improve health and/or reduce mortality.
    JEL: I12
    Date: 2015–02
  15. By: Moreno-Terneroy , Juan D (Department of Economics, Universidad Pablo de Olavide, ); Østerdal, Lars Peter (COHERE )
    Abstract: We analyze the implications of several principles related to the concepts of equal, or prioritarian, entitlement to continued life. These principles, when modeled as axioms for the evaluation of health distributions, and combined with some basic structural axioms, provide several characterization results of population health evaluation functions. Our analysis implies that the scope of the concepts of equal and prioritarian entitlement to continued life needs to be limited, in order to allow for morbidity (and not just mortality) concerns in the evaluation of population health.
    Keywords: equal value of life; priority; population Health; axioms; morbidity; mortality
    JEL: D63 I10
    Date: 2015–01–15
  16. By: Bechetti, Leonardo ; Conzo, Pierluigi ; Di Febbraro, Mirko (University of Turin )
    Abstract: The hypothesis that active community involvement is beneficial for health finds strong support in the medical literature and in most policy guidelines for active ageing in OECD countries. We testit empirically documenting that lagged voluntary work is significantly correlated with later changes in various aggregated and disaggregated health indicators. However, when controlling for panel attrition, endogeneity and reverse causality, the positive effect of voluntary work remains robust only for a limited number of indicators. We calculate the monetary equivalent of health-related subjective wellbeing benefits of volunteer work with the compensating variation approach and compare it with benefits in terms of the social value of increased longevity.
    Date: 2015–02
  17. By: Leonardo, Bechetti ; Conzo, Pierluigi ; Salustri, Francesco (University of Turin )
    Abstract: We investigate the impact of health expenditure on health outcomes on a large sample of Europeans aged above 50 on individual and country level data. We find a significant negative impact on changes in the number of chronic diseases which varies according to age, health styles, gender, income and education subgroups. Our findings indicate potentially heterogeneous support to health expenditure across interest groups and are robust when we instrument health expenditure with parliament political composition.
    Date: 2015–02
  18. By: Lawson, Cornelia ; Geuna, Aldo ; Ana Fernández-Zubieta ; Toselli, Manuel ; Kataishi, Rodrigo (University of Turin )
    Abstract: This chapter analyses the mobility of academic biomedical researchers in the US and the UK. Both countries are at the forefront of research in biomedicine, and able to attract promising researchers from other countries as well as fostering mobility between the US and the UK. Using a database of 292 UK based academics and 327 US based academics covering the period 1956 to 2012, the descriptive analysis shows a high level of international mobility at education level (BA, PhD and Postdoc) with small, but significant transatlantic exchanges, and shows high levels of cross-border mobility amongst senior academics based in the UK. There is a high level of career mobility with 50% of the sample having changed jobs at least once, and 40% having moved within academia. There is no significant difference in job-job mobility between the two countries although there are some interesting institutional differences concerning international and cross-sector mobility. The empirical analysis focuses on the importance of postdoctoral training in the US and the UK. The results indicate that working in the US is correlated to higher researcher performance in terms of both publication numbers and impact/quality adjusted publications (in top journals and average impact). The publications of researchers with postdoctoral experience are generally of a higher average impact. This applies especially to postdoc experience at top-quality US institutions although a postdoc at a UK top institution is associated with higher top journal publications and higher average impact. In relation to the UK sample, we find that a US postdoc (especially in a top institution) is correlated to subsequent performance in the UK academic market. Finally, we see that US postdocs that stay in the US publish more and publications with higher impact/quality than those that move to the UK; however, these effects are stronger for those who studied for their PhD degree outside the US. Therefore, we find some evidence that the US is able to retain high performing incoming PhD graduates.
    Date: 2015–02
  19. By: Leonardo, Bechetti ; Conzo, Pierluigi ; Pisani, Fabio (University of Turin )
    Abstract: The productive and allocative theories predict that education has positive impact on health: the more educated adopt healthier life styles and use more efficiently health inputs and this explains why they live longer. We find partial support for these theories with an econometric analysis on a large sample of Europeans aged above 50 documenting a significant and positive correlation among education years, life styles, health outputs and functionalities. We however find confirmation for an anomaly already observed in the US, namely the more educated are more likely to contract cancer. Our results are robust when controlling for endogeneity and reverse causality in IV estimates with instrumental variables related to quarter of birth and neighbours’ cultural norms.
    Date: 2015–02
  20. By: Boone, J. (Tilburg University, TILEC ); Schottmuller, C. (Tilburg University, TILEC )
    Abstract: We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider quality through their choice of provider network. Selective contracting focuses on low cost providers. Contracting both providers signals high quality. Market power tends to lower quality and lead to inefficiency. In a dynamic extension of the model, providers under-invest in quality while there can be both over and under-investment in cost reductions if there is a monopoly insurer while an efficient investment equilibrium exists with insurer competition.
    Keywords: selective contracting; exclusive contracts, common; common contracts; managed care; health care quality; signaling
    JEL: D86 I11 L13
    Date: 2015
  21. By: Paul Collier ; Olivier Sterck ; Richard Manning
    Abstract: Thanks to anti-retroviral therapies, people living with HIV in developing countries can now have a near-normal life at a cost of a few hundred dollars per year.  We postulate that given this newly low cost of maintaining lives, there is a moral duty to rescue those who are infected.  The core of the paper quantifies a reasonable lower bound for the fiscal consequences of this duty, which we show creates a financial quasi-liability which for some African countries is comparable to their debt-to-GDP ratios.  Expenditures on prevention can pre-empt some of these liabilities.  We construct a model to show that in some countries expenditure on prevention would be cost-effective, reducing liabilities by more than its cost.  In principle, prevention should be pursued at least up to the point at which expenditure on it reduces the quasi-liability sufficiently to minimize the overall cost of accepting the duty to rescue.  However, we show that even with optimal prevention the quasi-liability is likely to remain too high to be affordable for a significant number of African countries.  Extending the model to two players, we show that if the international community accepts part of the quasi-liability, (as it does), it should finance an equal share of prevention and treatment efforts.  Any imbalance in this distribuiton would introduce moral hazard and lead to a sub-optimal level of prevention.
    Date: 2015–02–01
  22. By: Zahran, Sammy ; Iverson, Terrence ; McElmurry, Shawn ; Weilar, Stephan
    Abstract: Lead is a neurotoxin with developmentally harmful effects in children. In the United States, over half of the current flow of lead into the atmosphere is attributable to lead-formulated aviation gasoline (avgas), used in a large fraction of piston-engine aircraft. Deposition of lead from avgas may pose a health risk to children proximate to airport facilities that service lead-emitting aircraft. Extrapolating from epidemiological evidence on the health and human capital costs of lead poisoning, various public interest firms have petitioned the EPA to find endangerment from and regulate lead emitted by piston-engine aircraft. In the absence of sufficient empirical evidence linking avgas to blood lead levels (BLLs) in children, the EPA has ruled against petitions to find endangerment. To address an EPA request for more evidence, we constructed a novel dataset that links time and spatially referenced blood lead data from 1,043,391 children to 448 nearby airports in Michigan, as well as a subset of airports with detailed data on the volume of piston-engine aircraft traffic. Across a series of tests, and adjusting for other known sources of lead exposure, we find that child BLLs: 1) increase dose-responsively in proximity to airports, 2) decline measurably in children residing in neighborhoods proximate to airports in the months after 9-11, and 3) increase dose-responsively in the flow of piston-engine aircraft traffic. To quantify the policy relevance of our results, we provide a conservative estimate of the social damages attributable to avgas consumption.
    Keywords: Child Health; Lead Exposure; Blood Lead Levels; Aviation Gasoline
    JEL: I12 I18 J13 Q51 Q53
    Date: 2014–08–15
  23. By: Catherine McLaughlin Adam Swinburn
    Abstract: This brief found that small businesses that continue to offer coverage will face changes in what plans are available to offer. As individual and Small Business Health Options Program (SHOP) exchanges are developed, employees of small businesses will likely receive more choices and more comprehensive coverage, possibly at more competitive prices.
    Keywords: Health Insurance, Small Businesses, Survey, Alabama, Colorado, Minnesota, New York, Oregon
    JEL: I
    Date: 2014–04–30
  24. By: Dunn, Abe (U.S. Bureau of Economic Analysis ); Shapiro, Adam Hale (Federal Reserve Bank of San Francisco )
    Abstract: This paper studies the impact of Medicare Part D on mortality for the population over the age of 65. We identify the effects of the reform using variation in drug coverage across counties before the reform was implemented. Studying mortality rates immediately before and after the reform, we find that cardiovascular-related mortality drops significantly in those counties most affected by Part D, while mortality rates for noncardiovascular diseases remain statistically unchanged. Estimates suggest that between 19,000 and 27,000 more individuals were alive in mid-2007 because of the Part D implementation in 2006.
    Date: 2015–02
  25. By: Alicia Meckstroth ; Megan Barry ; Betsy Keating ; Ellen Kisker ; Kristine Andrews
    JEL: I
    Date: 2014–12–15
  26. By: Francesconi, Marco (University of Essex ); James, Jonathan (University of Bath )
    Abstract: We estimate the effect of binge drinking on accident and emergency attendances, road accidents, arrests, and the number of police officers on duty using a variety of unique data from Britain and a two-sample minimum distance estimation procedure. Our estimates, which reveal sizeable effects of bingeing on all outcomes, are then used to monetize the short-term externalities of binge drinking. We find that these externalities are on average £4.9 billion per year ($7 billion), about £80 for each man, woman, and child living in the UK. The price that internalizes this externality is equivalent to an additional 9p per alcoholic unit, implying a 20% increase with respect to the current average price.
    Keywords: alcohol, health, road accidents, arrests, externalities
    JEL: I12 I18 K42
    Date: 2015–02
  27. By: Pichler, Stefan (ETH Zurich ); Ziebarth, Nicolas R. (Cornell University )
    Abstract: This paper proposes a test for the existence and the degree of contagious presenteeism and negative externalities in sickness insurance schemes. First, we theoretically decompose moral hazard into shirking and contagious presenteeism behavior. Then we derive testable conditions for reduced shirking, increased presenteeism, and the level of overall moral hazard when benefits are cut. We implement the test empirically exploiting German sick pay reforms and administrative industry-level data on certified sick leave by diagnoses. The labor supply adjustment for contagious diseases is significantly smaller than for non-contagious diseases, providing evidence for contagious presenteeism and negative externalities which arise in form of infections.
    Keywords: sickness insurance, sick pay, presenteeism, contagious diseases, infections, negative externalities, shirking
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2015–02
  28. By: Bauer, Jan M. (University of Hohenheim ); Sousa-Poza, Alfonso (University of Hohenheim )
    Abstract: As the aging population increases, the demand for informal caregiving is becoming an ever more important concern for researchers and policy-makers alike. To shed light on the implications of informal caregiving, this paper reviews current research on its impact on three areas of caregivers' lives: employment, health, and family. Because the literature is inherently interdisciplinary, the research designs, sampling procedures, and statistical methods used are heterogeneous. Nevertheless, we are still able to draw several conclusions: first, despite the prevalence of informal caregiving and its primary association with lower levels of employment, the affected labor force is seemingly small. Second, such caregiving tends to lower the quality of the caregiver's psychological health, which also has a negative impact on physical health outcomes. Third, the implications for family life remain under investigated. The research findings also differ strongly among subgroups, although they do suggest that female, spousal, and intense caregivers tend to be the most affected by caregiving.
    Keywords: informal care, employment, work hours, health, review
    JEL: E26 J14
    Date: 2015–02
  29. By: Johnston, David W. (Monash University ); Shields, Michael A. (Monash University ); Siminski, Peter (University of Wollongong )
    Abstract: This paper estimates the long-term health effects of Vietnam-Era military service using Australia's National conscription lotteries for identification. Our primary contribution is the quality and breadth of our health outcomes. We use several administrative sources, containing a near-universe of records on mortality (1994-2011), cancer diagnoses (1982-2008), and emergency hospital presentations (2005-2010). We also analyse a range of self-reported morbidity indicators (2006-2009). We find no significant long-term effects on mortality, cancer or emergency hospital visits. In contrast, we find significant detrimental effects on a number of morbidity measures. Hearing and mental health appear to be particularly affected.
    Keywords: military service, health, conscription, Australia, Vietnam War
    JEL: H56 I10 I13
    Date: 2015–02
  30. By: Sanjay Basu (Stanford Prevention Research Center )
    Date: 2014–09
  31. By: Gabriele Mazzolini (Università Cattolica del Sacro Cuore ; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore )
    Abstract: This paper investigates the economic consequences of workplace accidents in the British labour market. For the empirical analysis, I use data on employment and earnings from the British Household Panel Survey and exploit fixed effects estimators to control for time-invariant unobserved workers’ characteristics. I provide evidence that accidents at work negatively affect both job opportunities and workers’ earnings. First, employment probabilities following a state of injury are significantly lower. This effect persists over time and is stronger in those regions where the macroeconomic conditions are worse. Second, a serious workplace accident also results in significant delayed wage penalties, which increase with the accident’s seriousness. The effect is lower in the public sector and unionized firms, where job and earnings protection is higher and physically demanding working conditions are not widespread, or if the worker moves to a new job which suits his/her post-injury abilities better.
    Keywords: accident at work, employment, earnings losses, BHPS
    JEL: J28 J71 J17
    Date: 2014–06
  32. By: Elenka Brenna (Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore ); Cinzia Di Novi (Università Ca’ Foscari, Dipartimento di Economia, Venezia )
    Abstract: In the last decades, both the lengthening of life expectancy and an accentuated decline in birth rates have reduced the consistency of the younger generational cohorts. Due to an ageing population, the burden of care giving is expected to intensify in the next quarter of the century in Europe, especially for mature women. This paper investigates the impact of the provision of constant care for elderly parents on the mental health of adult daughters, between the ages of 50 and 65, living in different European countries. Data is collected from the Survey of Health, Ageing and Retirement in Europe (SHARE). Information on mental health status is provided by Euro-D depression scale, a standardized measure of depression employed across European countries. We focus on differences in the effects according to a North–South gradient: we test whether the relationship between informal caregiving and mental health differs across European macro- regions. Our results reveal the presence of a North-South gradient in the effect of caring on women’s mental health.
    Keywords: caregiver burden, depression, parent care, LTC systems, mature women
    JEL: I10 I12 D10
    Date: 2013–11
  33. By: Furukawa, Mitsuaki
    Abstract: This paper examined empirically the overall effect of the project aid fragmentation in the health and education sectors. It focused on the infant and child mortality rate for the health sector and the primary school completion rate for the education sector because they are flagged as important indicators of the MDGs. The research questions in this paper are whether the mitigation of project aid fragmentation leads to the improvement of the two indicators and whether the result differs between health and education. The major findings are the followings: Even if project aid fragmentation is reduced, there may be no reduction in infant and child mortality rates. On the contrary, The rate will be the worst at the mid-range of fragmentation. On the other hand, the reduction of aid fragmentation in countries which receive relatively high external aid will positively impact the primary school completion rate. These findings lead to the conclusion that the effectiveness of aid-fragmentation reduction differs from one sector to another and depends on the degree of aid dependence.
    Keywords: aid effectiveness , aid fragmentation , health sector , education sector , MDGs
    Date: 2014–10–30
  34. By: Ali Shourideh (University of Pennsylavnia ); Roozbeh Hosseini (Arizona State University )
    Abstract: Abstract This paper is motivated by two facts: 1) There is a significant difference in mortality across income groups. 2) This difference in mortality is getting larger. I study the extent in which progressively of social security is affected by differences in mortality across income groups and how changes in mortality differential affect the progressively of the social security and its budget. I use a life cycle overlapping generation model in which individuals are different in their lifetime earning profiles and higher earning individuals have lower mortality. I first calibrate the relation between earning and mortality using 1983-1997 data (reported in Cristia (Journal of Health Economics, 2009)) and compare current US system with a system in which there is a separate budget for each earning/mortality group (therefore by design there is no redistribution across earning/mortality groups). I find that these two systems have very similar replacement ratios, expect for the lowest 2% of earning distribution. To find the value of redistribution in current US social security system I calculate welfare differences between the resulting allocations. I find that the welfare gains from progressivity in current social security system are not monotone in lifetime earnings. Individuals in bottom two percent of earning distribution gain the most from it (up to 2.83% of their consumption) while those in second decile lose the most (up to 1% of their consumption). However, ex post gains and losses completely offset each other. There is no ex ante welfare gain. Using more recent earning and mortality relationship (1998-2003), I find that increase in the mortality differential will increase the cost of the social security by about 5%. Adjusting the benefit to maintain the cost will make the system even more regressive.
    Date: 2014
  35. By: Marton, James ; Snyder, Angela ; Zhou, Mei
    Abstract: This paper examines the impact of Deficit Reduction Act of 2005 mandated citizenship verification requirements on the Medicaid coverage of children using state administrative data from Georgia. Our analysis focuses on children enrolled in Medicaid prior to the reform in the eligibility category for which the reform is most likely to be binding. We find that these children were slightly more likely to exit during the first "high impact" recertification in which the enhanced citizenship verification was binding than children whose first recertification occurred just prior to the reform. In addition, we observe a slightly lower re-entry probability among children exiting during a "high impact" first recertification. Assuming at least some of the exiting children are non-citizens, the fact that the exit and re-entry rates associated with a “high impact” first recertification are only modestly different from other first recertification months suggests that the reform is probably not having a dramatic impact on citizens.
    Keywords: Medicaid; Child Health; Income Verification
    JEL: I18 I38 J13
    Date: 2015–02–03
  36. By: Mark N Harris (School of Economics and Finance, Curtin University ); Jake Prendergast (School of Economics and Finance, Curtin University ); Preety Srivastava (Department of Economics, RMIT )
    Abstract: We contribute to the existing literature on drug consumption by analysing the misuse of pharmaceutical drugs, which has attracted scant attention in the economics literature. Specifically, using individual level data, we explore the determinants of pharmaceutical drug misuse and focus on potential industry and occupation effects, which have been associated with the consumption of other (licit and illicit) drugs. In order to place the misuse of pharmaceutical drugs into context, we also consider other illicit drugs: namely cannabis, speed, and ecstasy. We find a positive association between the consumption of pharmaceutical drugs and employment in the hospitality industry, which contrasts with an inverse relationship in the case of the retail, and finance and insurance industries. In addition, our findings suggest that individuals employed in managerial, professional, sales and clerical/administration occupations are less likely to consume pharmaceuticals relative to labourers, indicating a clear disparity across white collar and blue collar occupations.
    Keywords: Industry, Labour Market Participation, Occupation, Pharmaceutical drugs
    JEL: C5 D1 I1 J00
    Date: 2015–01

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