nep-hea New Economics Papers
on Health Economics
Issue of 2015‒03‒13
23 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Health shocks and the intergenerational transmission of inequality: Evidence from Andhra Pradesh, India By Dhanaraj, Sowmya
  2. A unified structural equation modelling approach for the decomposition of rank-dependent indicators of socioeconomic inequality of health By Kessels, Roselinde; Erreygers, Guido
  3. The action of public power and Economic Development: Application to the health sector in the MENA region By Mtiraoui, Abderraouf
  4. Firm's response and unintended health consequences of industrial regulations By Christopher Hansman; Jonas Hjort; Gianmarco León
  5. Are Cancer Survivors who are Eligible for Social Security More Likely to Retire than Healthy Workers? Evidence from Difference-in-Differences By David Candon
  6. How Do Consumers Choose Health Insurance? – An Experiment on Heterogeneity in Attribute Tastes and Risk Preferences By Nadja Kairies-Schwarz; Johanna Kokot; Markus Vomhof; Jens Wessling
  7. Does moving to a system with a more generous public health insurance increase medical care consumption? By Léa Toulemon; Laurent Davezies
  8. Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response: Project Accomplishments By Olga Jonas; Lucas Warford
  9. The New HIV/AIDS Program in Peru: The Role of Prioritizing and Budgeting for Results By Veronica Vargas
  10. Public Health Insurance and Entry into Self-Employment By Frank M. Fossen; Johannes König
  11. Explaining the Mexican-American Health Paradox Using Selectivity Effects By Aguayo Téllez Ernesto; Martínez José N.; Rangel González Erick
  12. The Impact of Household Participation in Community Based Organizations on Child Health and Education in Rural India By Mugdha Vaidya; Meghna Katoch; Nabanita Datta Gupta
  13. Vaccines vs. Preventives By Kremer, Michael; Snyder, Christopher
  14. Can Health Insurance Competition Work? Evidence from Medicare Advantage By Jay Bhattacharya; Vilsa Curto; Liran Einav; Jonathan Levin
  15. The effects of over-indebtedness on individual health By Blázquez, Maite; Budría, Santiago
  16. Country-level cost-effectiveness thresholds: initial estimates and the need for further research By Beth Woods; Paul Revill; Mark Sculpher; Karl Claxton
  17. What Can We Learn About the Effects of Food Stamps on Obesity in the Presence of Misreporting? By Lorenzo Almada; Ian M. McCarthy; Rusty Tchernis
  18. How Does Health Promotion Work? Evidence From The Dirty Business of Eliminating Open Defecation By Paul Gertler; Manisha Shah; Maria Laura Alzua; Lisa Cameron; Sebastian Martinez; Sumeet Patil
  19. Retrospective and Prospective Benefit-Cost Analysis of US Anti-Smoking Policies By Lawrence Jin; Donald S. Kenkel; Feng Liu; Hua Wang
  20. Big Data for Advancing Dementia Research: An Evaluation of Data Sharing Practices in Research on Age-related Neurodegenerative Diseases By Ulrike Deetjen; Eric T. Meyer; Ralph Schroeder
  21. The impact of childhood obesity on health and health service use: an instrumental variable approach By Kinge, Jonas Minet; Morris, Stephan
  22. Institutional Deficit and Health Outcomes in Post-Communist States By Vladimir A. Kozlov; Dina Y. Balalaeva
  23. Unconditional transfers goes to health? Evidence from Brazilian Municipalities By MATTOS, Enlinson; RIBEIRO, Fernanda Patriota Salles

  1. By: Dhanaraj, Sowmya
    Abstract: This paper explores the intergenerational effects of parental health shocks using longitudinal data from the Young Lives project conducted in Andhra Pradesh, India. It is found that health shocks to poorer parents reduce investments in children thereby re
    Keywords: parental health shocks, school enrolment, grade attainment
    Date: 2015
  2. By: Kessels, Roselinde; Erreygers, Guido
    Abstract: We present a unified structural equation modelling framework for the regression-based decomposition of rank-dependent indicators of socioeconomic inequality of health and compare it with a simple ordinary least squares regression. The structural equation
    Keywords: inequality measurement, Concentration Index, decomposition methods, structural equation modelling
    Date: 2015
  3. By: Mtiraoui, Abderraouf
    Abstract: The interest of this paper is to show that the action of public power in the management of public expenditure on health for the majority of MENA countries. Indeed, our empirical attempt tries to clarify the direct and indirect effects of the effectiveness of government economic development through public spending in the health sector over the period 1984-2012 in the MENA region while using the model of simultaneous equations.
    Keywords: Public expenditure, Economic Growth, Government Effectiveness, Public expenditure on health, simultaneous equations model.
    JEL: I1 I18
    Date: 2015–03–05
  4. By: Christopher Hansman; Jonas Hjort; Gianmarco León
    Abstract: Regulations that constrain firms' externalities in one dimension can distort incentives and worsen externalities in other dimensions. In Peru's industrial fishing sector, the world's largest, fishing boats catch anchovy that plants along the coast convert into fishmeal. Matching administrative, daily data on plant production, ground-level air quality data, hospital admissions records, and survey data on individual health outcomes, we first show that fishmeal production negatively affects adult and child health through air pollution emitted by plants. We then analyze the industry's response to a 2009 reform that split the Total Allowable Catch (TAC) into boat-specific, transferable quotas (ITQs) to preserve fish stocks and reduce overcapacity. As predicted by a two-sector model with heterogeneous plants, on average across locations, fishmeal production was spread out in time, for two reasons: (i) boats' incentive to "race" for fish was removed, and (ii) production fell in inefficient plants (and locations) and increased, in the time dimension, in efficient plants (and locations). The reform greatly exacerbated the industry's impact on health, causing a loss of about 1.4 million disability-adjusted life years. We show that the reason is that longer periods of moderate air pollution are worse for health than shorter periods of higher intensity exposure. Our findings demonstrate the risks of piecemeal regulatory design, and that the common policy trade-off between duration and intensity of pollution exposure can be critical for industry's impact on health.
    Keywords: Industrial regulations, firms, externalities, air pollution, health, fishing, Peru, ITQs
    JEL: D2 L5 L7 O1 I1 Q5
    Date: 2015–02
  5. By: David Candon (University College Dublin)
    Abstract: Despite the fact that there are over a million new cancer cases detected in the U.S. every year, none of retirement-health literature focuses specifically on the effect that cancer has on retirement. Social Security may offer a pathway to retirement for eligible workers but the separate effects of both cancer, and Social Security, on retirement, need to be accounted for. I use the fact that some workers will be eligible for Social Security when they are diagnosed with cancer, while some will not, as a source of exogenous variation to identify the joint effect of cancer diagnosis and Social Security eligibility on retirement. With data from the Health and Retirement Study (HRS), I use a difference-in-differences model to show that being eligible for Social Security, and surviving cancer, increases the probability of retirement by 11.2% for male workers. Given the increase in both cancer survival rates, and the number of older workers in the labour force, it is important to know if cancer is causing permanent exits, in a population who otherwise would continue working.
    Keywords: Cancer; Employment; Retirement; Labour market
    JEL: I10 I18 J21 J26
    Date: 2015–02–27
  6. By: Nadja Kairies-Schwarz; Johanna Kokot; Markus Vomhof; Jens Wessling
    Abstract: Recent health policy reforms try to increase consumer choice. We use a laboratory experiment to analyze consumers’ tastes in typical contract attributes of health insurances and to investigate their relationship with individual risk preferences. First, subjects make consecutive insurance choices varying in the number and types of contracts offered. Then, we elicit individual risk preferences according to Cumulative Prospect Theory. Applying a latent class model to the choice data, reveals five classes of consumers with considerable heterogeneity in tastes for contract attributes. From this, we infer distinct behavioral strategies for each class. The majority of subjects use minimax strategies focusing on contract attributes rather than evaluating probabilities in order to maximize expected payoffs. Moreover, we show that using these strategies helps consumers to choose contracts, which are in line with their individual risk preferences. Our results reveal valuable insights for policy makers of how to achieve efficient consumer choice.
    Keywords: Health insurance; risk preferences; heterogeneity; heuristics; laboratory experiment; cumulative prospect theory
    JEL: C91 I13 D81
    Date: 2014–12
  7. By: Léa Toulemon (Département d'économie); Laurent Davezies (Laboratoire Ville, Mobilité, Transport)
    Abstract: We evaluate the impact of reimbursement rates on health expenditures, using a natural experiment. For historical reasons, reimbursement rates of public health insurance are higher in the French region Alsace Moselle than in other French regions. For both systems, affiliation is compulsory. Individuals moving between Alsace-Moselle and the rest of France undergo an exogenous change in reimbursement rates. We use a difference-in-difference method on a panel datasets of individuals. Our treatment group consists of individuals changing systems, our control group consists of individuals who move between other French regions. We study the impact of reimbursement rates on a broad range of health care expenditures: for dentist and doctor visits, drug consumption, and sickness absenteeism. We find heterogeneous impacts of reimbursement rates on those items. Overall, higher public reimbursement rates do not lead to an increase in spending for medical care.
    Keywords: Evaluation
    Date: 2015–02
  8. By: Olga Jonas; Lucas Warford
    Abstract: This report reviews some of the accomplishments of the Global Program for Avian Influenza Control and Human Pandemic Preparedness and Response (GPAI). This multisectoral program comprised 72 projects in 60 developing countries in all regions and received $1.3 billion in financing from the World Bank. This support for GPAI projects was one of the World Bank?s contributions to a coordinated global response to the threats of avian and pandemic influenzas, which benefited from financing of $4 billion from 35 donors in 2006-2013. Thanks to this support, developing countries strengthened their capacity for early and effective disease control, bringing substantial public health and economic benefits to the countries and to the world. According to Harvard University Professor and former US Treasury Secretary Lawrence Summers, "[veterinary and human public health systems are] probably the single most important area for productive investment on behalf of mankind." Indeed, circulation of the highly pathogenic avian flu virus was reduced, helping to lessen the likelihood of onset of a pandemic. Moreover, the projects improved public health systems for reducing locally-relevant health threats. The report presents a brief background on the global program and cross-country accomplishments and then highlights accomplishments for each project, by region.
    Keywords: active surveillance, acute respiratory syndrome, Agriculture Organization, Animal Disease, Animal Disease Surveillance, Animal Disease Surveillance System, animal diseases ... See More + ANIMAL HEALTH, ANIMAL HEALTH SYSTEMS, Animal Health Worker, animal health workers, animal origin, Animal Resources, antiviral, antiviral drugs, Avian Flu Emergency, Avian Flu Infections, avian flu virus, AVIAN INFLUENZA, AVIAN INFLUENZA CONTROL, avian influenza in humans, avian influenza in poultry, avian influenza outbreak, Avian influenza outbreaks, Avian Influenza Prevention, avian influenza surveillance, avian influenza vaccines, backyard farms, Backyard Poultry, backyard poultry producers, bio-security, bio-security measures, Biosecurity, birds, border control, chickens, commercial farms, commercial poultry, Communication materials, Communication Strategies, communication strategy, Community Animal Health, community development, community surveillance, confirmed case, confirmed cases, contagion, Containment, containment plan, containment plans, control measures, culled, diagnosis, diagnostic capacity, disaster risk management, disease burden, disease control, disease control measures, Disease Information, disease outbreaks, disease risk, disease spread, Disease Surveillance, disease-control, disinfectants, district veterinarians, Early Detection, eggs, Emergency Preparedness, Emergency Response, emerging diseases, Emerging infectious disease, epidemic, epidemics, Epidemiology, Epidemiology Training Program, exercises, fighting avian influenza, flu control efforts, flu pandemic, fowl, free-range poultry, H5N1, H5N1 virus, health capacities, health interventions, HIV/AIDS, hospital, hospitals, host, HPAI, human cases, human fatality, human flu, Human Influenza, HUMAN PANDEMIC, infection control, infections in humans, infectious disease outbreaks, infectious diseases, INFLUENZA, Influenza A, influenza diagnosis, Influenza Pandemic, Influenza Pandemic Preparedness, Influenza Plan, Influenza Preparedness, influenza program, influenza response, influenza vaccine, Influenza-like illness, international organizations, laboratories, laboratory, laboratory capacity, laboratory equipment, laboratory staff, labs, live bird, live bird markets, live birds, livestock, livestock development, M&E, migrants, Migration, migration patterns, Monitoring and Evaluation, movement of poultry, national laboratory, nurses, Nutrition, outbreak, outbreak communication, outbreak investigation, outbreaks of avian influenza, pandemic flu, pandemic influenza, Pandemic Planning, PANDEMIC PREPAREDNESS, pandemic prevention, Pandemic Response, Pandemic Risk, pandemics, pathogen, pathogenic avian flu, Pathogenic Avian Influenza, pathogens, Personal protective equipment, posters, Poultry Contact, poultry farmers, poultry farms, poultry industry, poultry production, poultry production systems, poultry products, poultry sector, Poultry Vaccination, preliminary results, preparedness plan, preparedness plans, preventive measures, Public Awareness Campaign, public awareness campaigns, public health, public health surveillance, quarantine, rabies, reagents, response capability, response capacity, Response Plan, response plans, risk assessment, risk assessments, risk communication, risk communications, safe poultry, sentinel, specimens, surveillance capacity, Surveillance Network, surveillance system, transmission, uncontrolled outbreaks, Vaccination, vaccination campaigns, vaccination policy, value of birds, veterinarian, Veterinarians, veterinary controls, veterinary infrastructure, veterinary laboratories, Veterinary Officers, Veterinary Services, veterinary staff, veterinary worker, Veterinary Workers, wild birds, workers, zoonotic disease, zoonotic diseases, zoonotic nature
    Date: 2014–09
  9. By: Veronica Vargas
    Abstract: XXX
    Keywords: access to care, access to health care, Acquired Immune Deficiency Syndrome, adolescents, aged, AIDS case, AIDS cases, AIDS deaths, AIDS Health, AIDS patients, allocation ... See More + of resources, antenatal care, ART therapy, babies, baby, behavioral change, behavioral interventions, birth rate, Burden of Disease, C-section, C-sections, case of AIDS, cases of AIDS, cell count, childbearing, chronic disease, civil society organizations, clinical trials, community health, condom, condom distribution, condom use, Condoms, cost effectiveness, delivery costs, diagnoses, diagnosis, disease burden, drug therapy, drug trafficking, Drugs, educational activities, epidemic, epidemics, Epidemiology, Family Health, fashion, father, Female, Female Sex Workers, Females, fetus, formal education, Global HIV/AIDS, Gross National Income, Health Care, health care services, health centers, health education, Health Insurance, health interventions, health sector, health service, health services, health system, health workers, healthy life, heterosexual intercourse, high risk groups, high-risk groups, HIV, HIV infection, HIV infections, HIV positive, HIV prevention, HIV testing, HIV transmission, HIV/AIDS, homosexuals, hospital, hospital discharge, hospitals, Human Development, human rights, Immune Deficiency, infection among women, infection rate, information services, information system, information systems, international cooperation, international organizations, international programs, intervention, Laboratory Services, laboratory testing, leading causes, leading causes of mortality, limited resources, local authorities, low prevalence, Malaria, male adolescents, Male Sex, mass media, medicines, Ministry of Health, mortality, mother, mother to child, mother to child HIV transmission, Mother to Child Transmission, mother-to-child, mother-to-child transmission, mothers, multiple partners, national policy, NATIONAL STRATEGY, new cases, new infections, newborn, number of AIDS deaths, number of children, Number of Deaths, number of new infections, number of people, number of women, Nutrition, orphan, orphan children, orphans, PATIENT, patients, peer education, People Living with AIDS, pharmaceutical companies, population projections, Population Sector, pregnancy, pregnant woman, Pregnant Women, premature death, prevention strategies, preventive actions, preventive activities, progress, promotion of condom use, prophylaxis, Public Health, PUBLIC POLICY, quality control, rates of infection, Reproductive Health, research centers, research communities, Resistant Tuberculosis, resource allocation, Risk behaviors, risk groups, risk populations, safe behaviors, SCREENING, SERVICE DELIVERY, sex education, sex with men, Sex Worker, Sex Workers, sexual activity, sexual contact, Sexual education, sexual exploitation, sexual initiation, Sexuality, Sexually Transmitted Disease, Sexually Transmitted Diseases, Sexually Transmitted Infections, social security, social services, socioeconomic status, Specialist, STD, STDS, STIs, TB, technical assistance, teens, treatment, treatment services, Tuberculosis, UNAIDS, urban areas, urban centers, vertical transmission, viral load, virus, vulnerability, vulnerable groups, women of childbearing age, workers, World Health Organization, young adults, young people, youth
    Date: 2015–01
  10. 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 non-random 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
  11. By: Aguayo Téllez Ernesto; Martínez José N.; Rangel González Erick
    Abstract: While typically socioeconomically disadvantaged, Mexican migrants in the United States tend to have better health outcomes than non-Hispanic Whites. This phenomenon is known as the Hispanic Health Paradox. Using data from Mexico and the United States, we examine several health outcomes for non-Hispanic Whites and Mexicans in the United States and in Mexico and employ Blinder-Oaxaca decompositions to help explain the paradox. We find evidence that selectivity is playing a significant role in the relatively healthy status of Mexican migrants in the United States. More importantly, there is evidence that health selectivity is a complex process and its effects typically do not work the same way for different health conditions and across genders. We also find evidence that some of migrants' health advantages are lost as they spend more time in the United States.
    Keywords: International Migration; Mexico; Selectivity; Health Paradox.
    JEL: I10 F22 O15
    Date: 2015–01
  12. By: Mugdha Vaidya (Department of Economics and Business, Aarhus University, Denmark); Meghna Katoch (IFMR-LEAD, Bangalore, India); Nabanita Datta Gupta (Department of Economics and Business, Aarhus University, Denmark)
    Abstract: This paper explores whether rural Indian households’ membership in community based organizations (CBOs) affect child human capital formation in terms of health and education. Using the 2005 Indian Human Development Survey (IHDS), both OLS and IV models show that membership in one or more CBOs improves child educational performance. When considering specific CBOs, women’s groups (Mahila Mandal) emerge as being best at reducing child malnourishment while youth clubs are beneficial for both child health and education. Religious groups have a negative impact on child health but improve school performance. Caste associations have a detrimental effect on both health and education.
    Keywords: community based organizations, child health and education
    Date: 2015–05–03
  13. By: Kremer, Michael; Snyder, Christopher
    Abstract: Preventives are sold ex ante, before disease status is realized, while treatments are sold ex post. Even if the mean of the ex ante distribution of consumer values is the same as that ex post, the shape of the distributions may differ, generating a difference between the surplus each product can extract. If, for example, consumers differ only in ex ante disease risk, then a monpolist would have more difficulty extracting surplus with a preventive than with a treatment because treatment consumers, having contracted the disease, no longer differ in disease risk. We show that the ratio of preventive to treatment producer surplus can be arbitrarily small, in particular when the distribution of consumer values has a Zipf shape and the disease is rare. The firm's bias toward treatments can be reversed, for example, if the source of private information is disease severity learned ex post. The difference between the producer surplus earned from the products can result in distorted R&D incentives; the deadweight loss from this distortion can be as large as the entire producer-surplus difference. Calibrations for HIV and heart attacks based on risk factors in the U.S. population suggest that the distribution of disease risk is sufficiently Zipf-similar to generate substantial differences between producer surplus from preventives and treatments. Empirically, we find that proxies for the Zipf-similarity of the disease-risk distribution are associated a significantly lower likelihood of vaccine development but not drug development.
    Keywords: drugs; pharmaceuticals; vaccines
    JEL: D42 I18 L11 O31
    Date: 2015–03
  14. By: Jay Bhattacharya (Stanford University); Vilsa Curto (Stanford University); Liran Einav (Stanford University); Jonathan Levin (Stanford University)
    Abstract: We estimate the economic surplus created by Medicare Advantage under its reformed competitive bidding rules. We use data on the universe of Medicare beneficiaries, and develop a model of plan bidding that accounts for both market power and risk selection. We find that private plans have costs around 12% below fee-for-service costs, and generate around $50 in surplus on average per enrollee-month, after accounting for the disutility due to enrollees having more limited choice of providers. Taxpayers provide a large additional subsidy, and insurers capture most of the private gains. We use the model to evaluate possible program changes.
    Date: 2014–12
  15. By: Blázquez, Maite (Departamento de Análisis Económico (Teoría e Historia Económica). Universidad Autónoma de Madrid.); Budría, Santiago (ICADE, CEEAplA and IZA.)
    Abstract: This paper uses data from the 2002-2005-2008 waves of the Spanish Survey of Household Finances (EFF) to investigate whether debts burdens hamper people's health. Several measures of debt strain are constructed, including debt-to-income ratios, the existence of debt arrears and amounts of outstanding debts. The paper also differentiates between mortgage and non-mortgage debts and explores the role of social norm effects in the debt-health relationship. The results, based on a random effects model extended to include a Mundlak term, show that nonmortgage debt payments and debt arrears affect significantly people's health. Furthermore, mild social norm effects are detected, according to which being less indebted than the reference group results, ceteris paribus, in better health.
    Keywords: Over-indebtedness; self-assessed health; random effects model; social norm effects.
    JEL: G01 I13 I22
    Date: 2015–03
  16. By: Beth Woods (Centre for Health Economics, University of York, UK); Paul Revill (Centre for Health Economics, University of York, UK); Mark Sculpher (Centre for Health Economics, University of York, UK); Karl Claxton (Centre for Health Economics, University of York, UK)
    Abstract: Healthcare systems in low- and middle-income countries (LMICs) face considerable population healthcare needs with markedly fewer resources than those in developed countries. The way in which available resources are allocated across competing priorities is crucial in affecting how much health is generated overall, who receives healthcare interventions and who goes without. Cost-effectiveness analysis (CEA) is one tool that can assist policy-makers in resource allocation. The central concern in CEA is whether the health gains offered by an intervention are large enough relative to its costs to warrant adoption. This requires some notion of the value that must be realized by an intervention, which is most frequently represented using a cost-effectiveness threshold (CET). CETs should be based on estimates of the forgone benefit associated with alternative priorities which consequently cannot be implemented as a result of the commitment of resources to an alternative. For most health care systems these opportunity costs fall predominantly on health as a result of fixed budgets or constraints on health systems’ abilities to increase expenditures. However, many CEAs to inform decisions in LMICs have used aspirational expressions of value, such as the World Health Organization’s (WHO) recommended CETs (of 1-3 times GDP per capita in a country) which are not based upon opportunity costs. In contrast, we estimate CETs for a number of countries based upon recent empirical estimates of foregone benefit (from the English NHS) and international income elasticities of the value of health. The resulting CETs are much lower than those previously posited by WHO. There is no intention to provide definitive CETs; rather, the study is intended to provoke further research in this area of crucial policy importance and outlines how more robust estimates of CETs could be generated.
    Date: 2015–03
  17. By: Lorenzo Almada; Ian M. McCarthy; Rusty Tchernis
    Abstract: The increasing rate of obesity in the U.S., particularly among low-income households, necessitates a thorough understanding of the relationship between obesity and in-kind federal benefits such as the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program. However, when examining this relationship, the existing literature often ignores evidence that respondents frequently misreport their participation in SNAP. This paper studies the impact of such misreporting on the estimated average treatment effect (ATE) of SNAP participation on adult obesity. Our analysis also synthesizes the current empirical techniques available for estimating ATEs in light of misreported treatment participation, adopting a range of parametric analyses as well as nonparametric bounds. The results highlight the inherent bias of common point estimates when ignoring misreporting, with treatment effects from instrumental variable methods exceeding the nonparametric bounds by over 200% in some cases. Accounting for misreporting, the estimated effects of SNAP participation on obesity are largely inconclusive. We find a slight negative effect of SNAP participation on the probability of being overweight, but the results specific to gender remain inconclusive due to the high rates of misreporting, particularly among men.
    Date: 2015–02
  18. By: Paul Gertler; Manisha Shah; Maria Laura Alzua; Lisa Cameron; Sebastian Martinez; Sumeet Patil
    Abstract: We investigate the mechanisms underlying health promotion campaigns designed to eliminate open defecation in at-scale randomized field experiments in four countries: India, Indonesia, Mali, and Tanzania. Health promotion works through a number of mechanisms, including: providing information on the return to better behavior, nudging better behavior that one already knows is in her self-interest, and encouraging households to invest in health products that lower the marginal cost of good behavior. We find that health promotion generally worked through both convincing households to invest in in-home sanitation facilities and nudging increased use of those facilities. We also estimate the causal relationship between village open defecation rates and child height using experimentally induced variation in open defecation for identification. Surprisingly we find a fairly linear relationship between village open defecation rates and the height of children less than 5 years old. Fully eliminating open defecation from a village where everyone defecates in the open would increase child height by 0.44 standard deviations. Hence modest to small reductions in open defecation are unlikely to have a detectable effect on child height and explain why many health promotion interventions designed to reduce open defecation fail to improve child height. Our results suggest that stronger interventions that combine intensive health promotional nudges with subsidies for sanitation construction may be needed to reduce open defecation enough to generate meaningful improvements in child health.
    JEL: I12 I15 O15
    Date: 2015–03
  19. By: Lawrence Jin; Donald S. Kenkel; Feng Liu; Hua Wang
    Abstract: Regulatory policies designed to improve societal welfare by “nudging” consumers to make better choices are increasingly popular. The application of benefit-cost analysis (BCA) to this sort of regulation confronts difficult theoretical and applied issues. In this analysis we contribute a worked example of behavioral BCA of US anti-smoking policies. Our conceptual framework extends the standard market-based approach to BCA to allow for individual failures to make lifetime utility-maximizing choices of cigarette consumption. We discuss how our market-based approach compares to the health benefits approach and the “consumer surplus offset” controversy in recent BCAs of several health-related regulations. We use a dynamic population model to make counterfactual simulations of smoking prevalence rates and cigarette demand over time. In our retrospective BCA the simulation results imply that the overall impact of antismoking policies from 1964 – 2010 is to reduce total cigarette consumption by 28 percent. At a discount rate of 3 percent the 1964-present value of the consumer benefits from anti-smoking policies through 2010 is estimated to be $573 billion ($2010). Although we are unable to develop a hard estimate of the policies’ costs, we discuss evidence that suggests the consumer benefits substantially outweigh the costs. We then turn to a prospective BCA of future anti-smoking FDA regulations. At a discount rate of 3 percent the 2010-present value of the consumer benefits 30 years into the future from a simulated FDA tobacco regulation is estimated to be $100 billion. However, the nature of potential FDA tobacco regulations suggests that they might impose additional costs on consumers that make it less clear that the net benefits of the regulations will be positive.
    JEL: I12 I18
    Date: 2015–03
  20. By: Ulrike Deetjen; Eric T. Meyer; Ralph Schroeder
    Abstract: Dementia is increasing in prevalence, and to date has no cure or treatment. One element in improving this situation is using and sharing data more widely to increase the power of research. Further, moving beyond established medical data into big data offers the potential to tap into routinely collected data from both within and outside the health system. In this report, we examine four exemplar data sharing initiatives to better understand data sharing practices in dementia research and recommend the next steps required to move forward, which will require addressing structural issues including aligning incentives and mindsets toward data sharing.
    Date: 2015–03–12
  21. By: Kinge, Jonas Minet (Norwegian Institute of Public Health); Morris, Stephan (University College London)
    Abstract: In the following paper we estimate the impact of obesity in childhood on health and health service use in England using instrumental variables. We use data on children and adolescents aged 3-18 years old from fifteen rounds of the Health Survey for England (1998-2012), which has measures of self-assessed health, primary care use, prescribed medication use, and nurse-measured height and weight. We use instruments for child obesity using genetic variation in weight. We detect a few potential issues with the validity of the instrument; however further testing does not suggest that this has an effect on our results. We find that obesity has a statistically significant and negative impact on self-rated health and a positive impact on health service use in girls, boys, younger children (aged 3-10) and adolescents (aged 11-18). We detect significant endogeneity, which suggest that previous studies underestimate the impact of childhood obesity on health and health service use. For example, obesity is associated with and increased probability of doctor utilisation of 2%, but the IV results show that obesity increase the probability of use by 10%. This suggests that obesity has consequences for health and health service use when the children are still young.
    Keywords: Children; Adolescents; Obesity; Body Mass Index; Self-assessed health; Doctor visits; Medication use
    JEL: H51 I10 I11 I12
    Date: 2015–03–04
  22. By: Vladimir A. Kozlov (National Research University Higher School of Economics); Dina Y. Balalaeva (National Research University Higher School of Economics)
    Abstract: In this paper we explore political-economic determinants of health. We draw upon the unique natural experiment of post-communist transitions to show the effect on health (measured as life expectancy and cause-specific mortality) of the interaction between institutions for political (democratic rules) and economic (free market entry) competitiveness. To analyze this relationship empirically, we employ panel regression analysis with country and time fixed effects. We find that, ceteris paribus, political and economic institutions exert cumulative positive impact upon health (even if their separate effects are negative or insignificant). One potential causal pathway is that political-economic liberalization increases certainty and people start investing in their health. Our findings are highly relevant to other countries that experience similar reforms
    Keywords: Democratization, Liberalization, Institutions, Mortality, Stress, Post-communist states
    JEL: P36 I15 J11
    Date: 2015
  23. By: MATTOS, Enlinson; RIBEIRO, Fernanda Patriota Salles
    Abstract: This study assesses the impact of unconditional transfer resources on the health indicators of Brazilian municipalities. This transfer refers to the Participation Fund of Municipalities (FPM) where at least 15% of its value should be spent on public health. Based on a discontinuity of the rules of transfers, we explore Regression Discontinuous Design for the years 2002 to 2010, and find: (i) no significant effect of FPM on mortality reduction; (ii) a robust and significant reduction in morbidity, treated municipalities – on the right side of thresholds – on average have a per capita rate of morbidity 0.00821% lower than those on the left side of the cutoff points; (iii) the mechanisms through which a reduction on morbidity could be operated would be due to estimated increases in preventive measures such as consultations and medical and nurses visits, these were bigger for the treated group in, respectively, 0.32%, 0.038% and 0.039%.
    Date: 2015–03–02

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