nep-hea New Economics Papers
on Health Economics
Issue of 2015‒09‒18
fourteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Spatial effects in hospital expenditures: a district level analysis By M. Lippi Bruni; I. Mammi
  2. The contribution of improved joint survival conditions to living standards: An equivalent consumption approach By Grégory Ponthière
  3. Body mass index and employment status: a new look By Kinge, Jonas Minet
  4. Effect of upfront payment on utilization and health: Evidence from a nationwide physician strike in Japan By Shun-ichiro Bessho; Reo Takaku
  5. Factor decomposition of inter-prefectural health care expenditure disparities in Japan By Masayoshi Hayashi; Akiko Oyama
  6. Fetal Malnutrition And Academic Success: Evidence From Muslim Immigrants In Denmark By Jane Greve; Marie Louise Schultz-Nielsen; Erdal Tekin
  7. Emergency Care Services: Trends, Drivers and Interventions to Manage the Demand By Caroline Berchet
  8. Comparative Analysis of Factor Affecting Child Mortality in Pakistan By Rabbani, Sarah; Qayyun, Abdul
  9. Interacting effects of state cigarette taxes on smoking participation By Bishop, James
  10. Employee Health and Employer Incentives By Patrick Hullegie; Pierre Koning
  11. Essays in health economics and labor economics By Palali, Ali
  12. Demand of Long-Term Care and benefit eligibility across European countries By Ludovico Carrino; Cristina Elisa Orso; Giacomo Pasini
  13. The impact of acute health shocks on the labour supply of older workers: evidence from sixteen European countries By Elisabetta Trevisan; Francesca Zantomio
  14. An econometric model of health care demand with non-linear pricing By Johannes S. Kunz; Rainer Winkelmann

  1. By: M. Lippi Bruni; I. Mammi
    Abstract: Geographical clusters in health expenditures are well documented and accounting for spatial interactions may contribute to properly identify the factors affecting the use of health services the most. As for hospital care, spillovers may derive from strategic behaviour of hospitals and from patients’ preferences that may induce mobility across jurisdictions, as well as from geographically-concentrated risk factors, knowledge transfer and interactions between different layers of care. Our paper focuses on a largely overlooked potential source of spillovers in hospital expenditure: the heterogeneity of primary care providers’ behaviour. To do so, we analyse expenditures associated to avoidable hospitalisations separately from expenditures for highly complex treatments, as the former are most likely affected by General Practitioners, while the latter are not. We use administrative data for Italy’s Region Emilia Romagna between 2007 and 2010. Since neighbouring districts may belong to different Local Health Authorities (LHAs), we employ a spatial contiguity matrix that allows to investigate the effects of geographical and institutional proximity and use it to estimate Spatial Autoregressive and Spatial Durbin Models.
    JEL: I11 R12 C23
    Date: 2015–09
  2. By: Grégory Ponthière (ERUDITE - Equipe de Recherche sur l’Utilisation des Données Individuelles en lien avec la Théorie Economique - UPEM - Université Paris-Est Marne-la-Vallée - UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12, PSE - Paris-Jourdan Sciences Economiques - CNRS - Institut national de la recherche agronomique (INRA) - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC), EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics)
    Abstract: Individuals care not only about their own survival, but also about the survival of other persons. However, little attention has been paid so far to measuring the contribution of longer coexistence time to living standards. For that purpose, we develop a measure of coexistence time - the joint life expectancy -, which quantifies the average duration of existence for a group of persons. Then, using a lifecycle model with risky lifetime, we construct an equivalent consumption measure incorporating gains in single and joint life expectancies. An empirical application to France (1820-2010) shows that, assuming independent individual mortality risks, the rise in joint life expectancies contributed to improve standards of living significantly. We examine the robustness of that result to the introduction of dependent mortality risks using copulas, and we show that equivalent consumption patterns are robust to introducing risk dependence.
    Keywords: Mortality,Joint survival,Coexistence,Measurement,Standards of living
    Date: 2015–09
  3. By: Kinge, Jonas Minet (Norwegian Institute of Public Health, Norway)
    Abstract: Earlier literature has usually modelled the impact of obesity on employment status as a binary choice (employed, yes/no). I provide new evidence on the impact of obesity on employment status by treating the dependent variable as a as a multinomial choice variable. Using data from a representative English survey, with measured height and weight on parents and children, I define employment status as one of four: working; looking for paid work; permanently not working due to disability; and, looking after home or family. I use a multinomial logit model controlling for a set of covariates and I instrument for BMI based on genetic variation in weight. I find that BMI and obesity has a statistically significant impact on the probability of “not working due to disability”. The results for the other employment outcomes are less clear. My findings also suggest that the reason for the impact of obesity on employment is due to obesity being a deliberating health condition. Factors other than health may be less important in explaining the impact of BMI/obesity on employment.
    Keywords: Adolescents; Obesity; Body Mass Index
    JEL: H51 I10 I11 I12
    Date: 2015–08–31
  4. By: Shun-ichiro Bessho (Faculty of Economics, Keio University); Reo Takaku (Institute for Health Economics and Policy)
    Abstract: Japan Medical Association (JMA), a lobby of physicians, went on strike in July 1971 against the medical reform led by the government. While physicians of JMA resigned from the health insurance doctor, they continued to provide medical care, and even virtually continued to provide the health insurance treatment in some areas. This paper uses the regional difference of resignation as a natural experiment to examine the effect of payment method of health insurance on medial service utilization and health status. Our results suggest that the resignation substantially decreased the medical service utilization, but not affected significantly health status measured by gross mortality rate and infant mortality rate.
    Keywords: health insurance, medical service utilization, payment method, physicians strike
    JEL: I13 I18 I12
    Date: 2014–10
  5. By: Masayoshi Hayashi (Faculty and Graduate School of Economics, University of Tokyo, Japan); Akiko Oyama (Policy Research Institute, Ministry of Finance, Japan)
    Abstract: Despite frequent discussions on regional variations in health care expenditure (HCE), few studies account for the sources of such regional disparities. This study bridges this gap in the body of knowledge by taking the following two steps. First, we explore the determinants of regional HCE in Japan, covering a data period that expands the scope of previous studies (i.e., the 2000s). Second, we decompose the variations in regional HCE into contributions explained by the HCE determinants examined in the first step, utilizing a regression-based decomposition method. In the regression analysis, we find that the effect of the number of hospital beds on per capita HCE is larger than that of the other determinants, except the proportion of the elderly population. In particular, a 1% increase in the number of hospital beds induces a .22?.43% increase in HCE, in line with Roemerfs Law. The decomposition analysis also finds the salient effect of the number of hospital beds. In particular, this variable accounts for a large proportion of inequality (between 37.6% and 83.9%). This finding also corroborates Roemerfs Law. Our results strongly suggest that the national policy in Japan of reducing hospital beds regionally has been an effective instrument for containing rapidly increasing HCE.
    Keywords: regional health care expenditure, regression-based inequality decomposition, Japan
    JEL: I18 I14 H51 H73
  6. By: Jane Greve; Marie Louise Schultz-Nielsen; Erdal Tekin
    Abstract: This paper examines the impact of potential fetal malnutrition on the academic proficiency of Muslim students in Denmark. We account for the endogeneity of fetal malnutrition by using the exposure to the month of Ramadan during time in utero as a natural experiment, under the assumption that some Muslim women might have fasted during Ramadan when they were pregnant. In some of our specifications, we use a sample of students from predominantly non-Muslim countries as an additional control group to address potential seasonality in cognitive outcomes in a difference-in-differences framework. Our outcome measures are the standardized test scores from the national exams on the subjects of Danish, English, Math, and Science administered by the Danish Ministry of Education. Our results indicate that fetal exposure to Ramadan has a negative impact on the achievement scores of Muslim students, especially females. Our analysis further reveals that most of these effects are concentrated on the children with low socioeconomic status (SES) background. These results indicate that fetal insults such as exposure to malnutrition may not only hamper the cognitive development of children subject to such conditions, but it may also complicate the efforts of policy-makers in improving the human capital, health, and labor market outcomes of low-SES individuals. Our findings highlight the importance of interventions designed to help economically disadvantaged women during pregnancy.
    JEL: I12 I14 I24 J15
    Date: 2015–09
  7. By: Caroline Berchet
    Abstract: Emergency departments are the front line of health care systems and play a critical role in ensuring an efficient and high-quality response for patients in stress or crisis situations. A growing demand for emergency care might however reduce patients’ satisfaction (through waiting times), increase health provider workload and adversely affect quality of care. This working paper begins with an overview of the trends in the volume of emergency department visits across 21 OECD countries. It then explores the main drivers of emergency department visits in hospital settings, paying attention to both demand and supply side determinants. Thereafter, national approaches instituted by countries to reduce the demand for emergency care and to guarantee a more efficient use of emergency resources are presented.
    JEL: H51 I10 I18
    Date: 2015–08
  8. By: Rabbani, Sarah; Qayyun, Abdul
    Abstract: This study is investigated determinants of child mortality in the Pakistan. The Pakistan is amongst one of the five countries who have the highest child mortality rates in the world. Literature on the subject has found extensive variation in causes of child death. We used micro-data of Pakistan Demographic Health Survey (PDHS) of 2006-07 collected by National Institute of Population Studies (NIPS). In the descriptive analysis, it is founded that neo-natal mortality rate is high for Pakistan. In econometric analysis, binary logit model was estimated using Maximum Likelihood Method (MLM). The study puts particular emphasis on the effect of wealth, mother’ education, exposure to media and ethnicity. Effect of mothers’ education, wealth, and exposure to media found significant determinants of child mortality in Pakistan. Knowledge on condition of a subject at national and local level gives a prerequisite for shaping efficient polices addressing the Problem.
    Keywords: Child Mortality, PDHS, Binary Logit Model, Maximum Likelihood Method (MLM), Pakistan
    JEL: C25 C54 I00 I1
    Date: 2015
  9. By: Bishop, James
    Abstract: A state cigarette tax increase may deter some residents from smoking, but other residents may avoid the higher tax by purchasing cigarettes from another state. Using U.S. health survey microdata from 1999 to 2012, this paper measures how border-crossing opportunities affect the smoking deterrence achieved by a cigarette tax increase. I estimate by two-way fixed effects regression that a $1 state cigarette tax increase decreases the smoking rate by an additional 0.58 percentage points for each dollar of cigarette tax in the nearest lower-tax state. However, each successive $1 tax increase decreases the smoking rate by 0.38 fewer percentage points than the last. I show that the signs of these terms can be theoretically derived without parametric assumptions. I observe that, as both home and nearest lower taxes rose from 1999 to 2012, the mean effectiveness of a home state tax increase remained roughly constant over the period. My results imply that the lowest-tax states are those with the greatest power to reduce the national smoking rate.
    Keywords: Cigarette Taxes; Smoking; Tax Avoidance; Border-crossing
    JEL: H26 H73 I12 I18
    Date: 2015–09–13
  10. By: Patrick Hullegie (VU University Amsterdam); Pierre Koning (VU University Amsterdam)
    Abstract: In the past two decades the OECD has regularly voiced concern about the labor market exclusion of people with disabilities and about the cost of disability insurance programs. This paper examines whether the fundamental disability insurance reforms that were implemented in the Netherlands have helped or hindered employment opportunities of workers with health problems or disability. An important component of the Dutch reforms was to enhance employer incentives, which was done by making them responsible for paying sickness benefits and by strengthening their sickness monitoring obligations. These employer incentives may stimulate preventive and reintegration activities by firms, thereby improving the employment opportunities of disabled workers. However, the reforms also impose substantial costs on employers when an employee gets sick and may therefore reduce employme nt opportunities of disabled workers. We use data from the Dutch Labor Force Survey and rich administrative data from hospital admission records, social security records, and the municipality registers containing demographic information to examine whether the disability reforms have in fact improved the economic situation for the disabled. On balance, we conclude that the DI reforms implemented by the Dutch government have mainly protected those who already have a job, and may have inadvertently reduced the hiring opportunities of people with a disability.
    Keywords: Disability Insurance; employer incentives; policy evaluation
    JEL: H53 J14 J18
    Date: 2015–09–11
  11. By: Palali, Ali (Tilburg University, School of Economics and Management)
    Abstract: The economics literature presents a growing number of studies focusing<br/>on risky health behaviors such as tobacco use or cannabis use. One of the<br/>most important characteristics of these risky health behaviors is that they<br/>harm the users and the people around the users, causing great social<br/>and economic costs. Therefore, in this dissertation, the author focuses on<br/>research questions on tobacco and cannabis use. <br/>The first two chapters focus on tobacco use. The first chapter investigates<br/>the spousal peer effects on the decision to quit smoking in couples to see<br/>if the quit decision of one partner affects the other. The second chapter<br/>investigates the effects of early smoking on labor market performance,<br/>by paying special attention to the possible effects through educational<br/>attainment.<br/>The last two chapters focus on cannabis, or as it is called in the USA<br/>marijuana use. The third chapter investigates the effects of geographical<br/>distance to Dutch coffeeshops, retail outlets from which residents can<br/>purchase cannabis, on the starting age of cannabis use. Finally, the last<br/>chapter analyzes the determinants of the support for cannabis legalization<br/>policies to see if the personal experience with cannabis use shapes the<br/>opinions.<br/>
    Date: 2015
  12. By: Ludovico Carrino (Department of Economics, University Of Venice Cà Foscari); Cristina Elisa Orso (Department of Economics, University Of Venice Cà Foscari); Giacomo Pasini (Department of Economics, University Of Venice Cà Foscari, Networks for Studies on Pensions, Aging and Retirement, The Netherlands)
    Abstract: In the context of an unprecedented aging process, the role of domiciliary care for older adults is becoming increasingly essential. In order to design effective and proactive policies of formal elderly-care, it is crucial to understand how vulnerable elderly individuals would adjust their informal long-term care utilization to changes in the formal-care provision. Although theoretical frameworks have been proposed, showing that a positive relationship could arise when the elderly exhibit an excess demand of care, empirical evidence is scant, due to the lack of credible instruments to account for the endogenous nature of formal-care decisions. We propose a novel instrument, an index that capture individuals’ eligibility status to the LTC domiciliary programmes implemented in their own nation or region. That is, a dummy variable - being eligible or not - which is grounded on the LTC regulation context at national or regional level, but still has individual within region variation due to differences in health conditions and vulnerability assessment. We estimate an IV two-part model using a representative sample of the over 60 population for non-institutionalised individuals in Austria, Germany, France and Belgium. Our results, which are robust to a number of different specifications, point at the lack of crowding-out of the informal- by the formal-care, thus suggesting the existence of a substantial unmet demand of LTC among the elderly.
    Keywords: home care, instrumental variables, unmet demand, SHARE data
    JEL: C36 I13 J14
    Date: 2015
  13. By: Elisabetta Trevisan (Department of Economics and Management, University Of Venice Cà Foscari); Francesca Zantomio (Department of Economics, University Of Venice Cà Foscari)
    Abstract: We investigate the consequences of experiencing an acute health shock, namely the first onset of myocardial infarction, stroke or cancer, on the labour supply of older workers in Europe. Despite its policy relevance to social security sustainability, the question has not yet been empirically addressed in the European context. We combine data from the the English Longitudinal Study of Ageing and the Survey of Health, Ageing and Retirement in Europe and cover sixteen European countries, representative of different institutional settings, in the years spanning from 2002 to 2013. The empirical strategy builds on the availability of an extremely rich set of health and labour market information as well as of panel data. To remove the potential confounding bias, a selection on observables strategy is adopted, while the longitudinal dimension of data allows controlling for time invariant unobservables. Implementation is based on a combination of stratification and propensity score matching methods. Results reveal that experiencing an acute health shock on average doubles the risk of an older worker leaving the labour market, and is accompanied by a deterioration in physical functioning and mental health, as well as by a reduction in perceived life expectancy. Men’s labour market response appears driven by the onset of impairment acting as a barrier to work. In in the case of women, preferences for leisure and financial constraints seem to play a prominent role. Heterogeneity in behavioural responses across countries – with the largest labour supply reductions observed in the Nordic and Eastern countries, and England – are suggestive of a relevant role played by social security generosity.
    Keywords: health shocks, labour supply, Europe, older workers, propensity score matching
    JEL: J22 J18 I10 C14
    Date: 2015
  14. By: Johannes S. Kunz; Rainer Winkelmann
    Abstract: From 2004 to 2012, the German social health insurance levied a co-payment for the first doctor visit in a calendar quarter. We develop a new model for estimating the effect of such a co-payment on the individual number of visits per quarter. The model allows for a one time increase in the otherwise constant hazard rate determining the timing of doctor visits, and uses a difference-in-differences strategy to identify the reform effect. The model can be adapted to a situation where the reporting period and the calendar quarter differ. Using data from the German Socio-Economic Panel, we do not find an effect of the co-payment on demand for doctor visits.
    Keywords: Count data, Poisson process, co-payment, hurdle model
    JEL: I10 C25
    Date: 2015–09

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