nep-hea New Economics Papers
on Health Economics
Issue of 2015‒10‒10
twenty-six papers chosen by
Yong Yin
SUNY at Buffalo

  1. A Cross-State Comparison of Measures of Subjective Well-Being By Song, Younghwan
  2. Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer By Obermeyer, Ziad; Makar, Maggie; Abujaber, Samer; Dominici, Francesca; Block, Susan Dale; Cutler, David M.
  3. Competitive Grant-Making: Lessons for Funders to Help Local Governments Increase Health Coverage By Cara Orfield; Sheila Hoag; Debra Lipson
  4. Explaining the body mass index gaps between Turkish immigrants and Germans in West Germany 2002-2012: A decomposition analysis of socio-economic causes By Dang, Rui
  5. Health Expenditure and its Impact on health Status By KEYA Sengupta
  6. Healthier lifestyles after retirement in Europe? Evidence from SHARE By Martina Celidoni; Vincenzo Rebba
  7. Impact of Long Term Care for the Elderly in Urban Area of Thailand By thanach kanokthet
  8. Impact of the Fukushima nuclear accident on obesity of children in Japan, using data from 2008 to 2014. By Yamamura, Eiji
  9. Impact on Health on Labour Force Participation in South Africa By Chijioke O. Nwosu and Ingrid Woolard
  10. Incremental willingness to pay By Lamiraud, Karine; Oxoby, Robert; Donaldson, Cam
  11. Long-term care reform and the labor supply of household members: Evidence from a quasi-experiment By Geyer, Johannes; Korfhage, Thorben
  12. Love Conquers All but Nicotine : Spousal Peer Effects on the Decision to Quit Smoking By Palali, Ali; van Ours, Jan
  13. On the Way to Good Health? Rural Roads and Morbidity in Upland Orissa By Bell , Clive; van Dillen , Susanne
  14. Regional Patterns in Medical Technology Utilization By Anne E. Hall
  15. Report to Congress: The Centers for Medicare & Medicaid Services' Evaluation of For-Profit PACE Programs Under Section 4804(b) of the Balanced Act of 1997 By David Jones
  16. Social long-term care insurance with two-sided altruism By Cremer, Helmuth; Pestieau, Pierre; Roeder, Kerstin
  17. Social Networks and Maternal Health Care Utilisation in Tanzania By Alfred K. Mukong and Justine Burns
  18. Stress among Medical Students in the Deep South of Thailand By Norman Mudor; Adhhiyah Mudor
  19. Study of Access and Quality of Care in For-Profit PACE By David Jones; Nancy Duda; Bob Schmitz; Sandi Nelson; Chelsea Swete; Alex Bryce; Jared Coopersmith; Karen CyBulski
  20. The Demand for Reproductive Health Care By Gauthier Tshiswaka-Kashalala and Steven F. Koch
  21. The Effects of Immigration on NHS Waiting Times By Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos
  22. The Financial Support for Long-Term Elderly Care and Household Savings Behaviour By Asako OHINATA; Matteo PICCHIO
  23. The Impact of Rural-Urban Migration on the Health of the Left-behind Parents By Ao, Xiang; Jiang, Dawei; Zhao, Zhong
  24. The Relationship between Health and Schooling: What's New? By Grossman, Michael
  25. The Youngest Get the Pill: ADHD Misdiagnosis and the Production of Education in Germany By Schwandt, Hannes; Wuppermann, Amelie
  26. Using American Community Survey Disability Data to Improve the Behavioral Risk Factor Surveillance System Accuracy By Jack Gettens; Pei-Pei Lei; Alexis D. Henry

  1. By: Song, Younghwan (Union College)
    Abstract: Using data drawn from the 2010 American Time Use Survey Well-Being Module, this study examines the relationship between three measures of subjective well-being based on time-use data and an objective measure of well-being. Whereas the measures of affect – net affect and the U-index – are uncorrelated with the objective quality-of-life ranking of the fifty states in the United States, the measure of meaningfulness shows a significant correlation with objective ranking. The reason for the significant correlation between the measure of meaningfulness and the objective measure of well-being is because, when engaged in similar activities, people living in states with better quality of life felt, after controlling for their individual characteristics, their lives to be more meaningful than those living in states with poor amenities, not because time use varies substantially by state.
    Keywords: time use, subjective well-being, U-index, net affect, meaningfulness
    JEL: I31 J22
    Date: 2015–09
  2. By: Obermeyer, Ziad; Makar, Maggie; Abujaber, Samer; Dominici, Francesca; Block, Susan Dale; Cutler, David M.
    Abstract: Importance More patients with cancer use hospice currently than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. Uncertainties regarding how hospice affects health care utilization and costs have hampered efforts to promote it. Objective To compare utilization and costs of health care for patients with poor-prognosis cancers enrolled in hospice vs similar patients without hospice care. Design, Setting, and Participants Matched cohort study of patients in hospice and nonhospice care using a nationally representative 20% sample of Medicare fee-for-service beneficiaries who died in 2011. Patients with poor-prognosis cancers (eg, brain, pancreatic, metastatic malignancies) enrolled in hospice before death were matched to similar patients who died without hospice care. Exposures Period between hospice enrollment and death for hospice beneficiaries, and the equivalent period of nonhospice care before death for matched nonhospice patients. Main Outcomes and Measures Health care utilization including hospitalizations and procedures, place of death, cost trajectories before and after hospice start, and cumulative costs, all during the last year of life. Results Among 86 851 patients with poor-prognosis cancers, median time from first poor-prognosis diagnosis to death was 13 months (interquartile range [IQR], 3-34), and 51 924 patients (60%) entered hospice before death. Matching yielded a cohort balanced on age, sex, region, time from poor-prognosis diagnosis to death, and baseline care utilization, with 18 165 patients in the hospice group and 18 165 in the nonhospice group. After matching, 11% of nonhospice and 1% of hospice beneficiaries who had cancer-directed therapy after exposure were excluded. Median hospice duration was 11 days. After exposure, nonhospice beneficiaries had significantly more hospitalizations (65% [95% CI, 64%-66%], vs hospice with 42% [95% CI, 42%-43%]; risk ratio, 1.5 [95% CI, 1.5-1.6]), intensive care (36% [95% CI, 35%-37%], vs hospice with 15% [95% CI, 14%-15%]; risk ratio, 2.4 [95% CI, 2.3-2.5]), and invasive procedures (51% [95% CI, 50%-52%], vs hospice with 27% [95% CI, 26%-27%]; risk ratio, 1.9 [95% CI, 1.9-2.0]), largely for acute conditions not directly related to cancer; and 74% (95% CI, 74%-75%) of nonhospice beneficiaries died in hospitals and nursing facilities compared with 14% (95% CI, 14%-15%) of hospice beneficiaries. Costs for hospice and nonhospice beneficiaries were not significantly different at baseline, but diverged after hospice start. Total costs over the last year of life were $71 517 (95% CI, $70 543-72 490) for nonhospice and $62 819 (95% CI, $62 082-63 557) for hospice, a statistically significant difference of $8697 (95% CI, $7560-$9835). Conclusions and Relevance In this sample of Medicare fee-for-service beneficiaries with poor-prognosis cancer, those receiving hospice care vs not (control), had significantly lower rates of hospitalization, intensive care unit admission, and invasive procedures at the end of life, along with significantly lower total costs during the last year of life.
    Date: 2014
  3. By: Cara Orfield; Sheila Hoag; Debra Lipson
    Keywords: Competitive Grant Making, Local Governments, Health Coverage
    JEL: I
    Date: 2015–05–20
  4. By: Dang, Rui
    Abstract: In this paper, we decompose body mass index (BMI) differences between Turkish immigrants and Germans in West Germany for women and men. We focus on isolating the part of BMI differences that can be explained by differences in observed socioeconomic status from the part attributable to differences in coefficients. Our results reveal that female Turkish immigrants are on average more obese than female Germans; however, there exists no significant difference in obesity among males. Our results also indicate that differences in socioeconomic status between female Turkish immigrants and Germans explain significant parts of the obesity disparities between these two groups.
    Abstract: Diese Studie gibt Aufschluss über die Unterschiede des Body-Mass-Index (BMI) zwischen türkischen Einwanderern und Deutschen in Westdeutschland, sowohl bei Männern als auch bei Frauen. Wir grenzen dabei den Bereich des BMI, der sich mit den Differenzen des beobachteten sozioökonomischen Status erklären lässt, einschließlich Alter, Bildungsgrad, Einkommen und beruflicher Stellung, von dem Bereich ab, der Unterschieden in den Koeffizienten zuzuordnen ist. Unsere Ergebnisse zeigen, dass weibliche, türkische Einwanderer durchschnittlich fettleibiger sind als weibliche Deutsche, jedoch besteht hinsichtlich von Übergewicht jedoch signifikanter Unterschied zwischen männlichen türkischen Einwanderern und männlichen Deutschen. Unsere Ergebnisse zeigen außerdem, dass Unterschiede im sozioökonomischen Status zwischen weiblichen, türkischen Einwanderern und gebürtigen Deutschen signifikante Bereiche der Unterschiede beim Übergewicht zwischen diesen beiden Gruppen erklären.
    Keywords: BMI disparity,Turkish immigrants in Germany,decomposition,quantile regression
    JEL: J15 I14 C21
    Date: 2015
  5. By: KEYA Sengupta (Indian Institute of Management)
    Abstract: Health expenditure is an important determinant of the health status and economic development of a nation. Experience has revealed that countries which assign due recognition to this aspect have healthier and more productive human capital. This in turn raises the GDP of a nation, in contrast to countries which spend less on health sector. Health care users, particularly in poor and developing countries have to spend more on ‘out of pocket’ expenses, because in such countries public health expenditure falls short perhaps due to inadequate resources. Expenditure on health sector therefore has higher return in terms of health outcomes and economic development in poor and developing countries in comparison to already developed countries.The present work with the help of data from all the states and union territories of India examined the impact of per capita health expenditure on infant and child mortality separately for the urban and rural sector of India using lagged multiple regression models. The findings of the study reveal that health expenditure taken alone do not have any impact on the health parameters. However, inclusion of mother’s education and the poverty level of the household represented by per capita income, increases the effectiveness of health expenditure, which then becomes an effective tool for improving the health parameters of infant and child mortality. This implies that where the health beneficiaries are poor, level of education is low, awareness is less, and particularly in the rural sector public health expenditure is not incurred judiciously. However, consciousness of educated health beneficiaries make the ones who incur the health expenditure to be more careful as how the money is spent. Proper management, supervision and monitoring thereby assumes more importance. Ultimately therefore it is not always the amount of finance, but more important becomes how the money is spent. The study also reveals that there is a clear dichotomy in India between the rural and urban sector. Rural sector representing the less developed nations of the world, whereas urban India has situation similar to the developed world. This clearly focuses attention to the fact that uniform policies of health expenditure for the entire country may not be very effective and separate policies which should be based on the specific need and problems of spatial differences needs to be devised.
    Keywords: infant and child mortality,per capita health expenditure,female education,poverty,health policies
    JEL: I14
  6. By: Martina Celidoni (University of Padova); Vincenzo Rebba (University of Padova)
    Abstract: This paper investigates changes in health behaviours upon retirement, using data drawn from the Survey of Health Aging and Retirement in Europe (SHARE). By exploiting changes in eligibility rules for early and normal retirement, we identify the causal effect of retiring from work on smoking, alcohol drinking, engagement in physical activity and visits to the general practitioner or specialist. We provide evidence about heterogeneous effects related to gender, education, net wealth, early-life conditions and job characteristics. Results show that changes in health behaviours occur upon retirement and may be a key mechanism through which the latter affects health. We find heterogenous effects related especially to gender, education and job characteristics.
    Keywords: retirement, health behaviour, fixed effects, instrumental variables.
    JEL: I12 J14 J26
    Date: 2015–09
  7. By: thanach kanokthet (Naresuan University)
    Abstract: This study was a qualitative research aiming to study the experience of long-term care, its associated impact as well as the role of organizations involved in long – term care for the elderly. Data were collected, from January of 2015 to June of 2015, through in-depth interview, focus group discussion, and direct observation of 362 elderly persons and 85 caregivers, at 6 municipality of four provinces of Thailand. The data were analyzed using content analysis, thematic analysis, and frequency and percentage.The results of long-term dependency of the elderly with stroke, dementia, co-morbidity, and chronic health problem, were documented. The care givers who provided long-term care for the elderly in Urban Area showed that the majority of them feel relative powerless; most of them (85%) were female; 30 percent had a chronic health problem; and 35 percent were elderly caregivers. 70 percent of caregivers also work, about 15 percent people need to provide long-term care for more than one person, it was found that the pattern of family caregivers for long-term elderly care in Urban Area of Thailand that the caring was subject of gratitude.Regarding the effect of care, Half of caregivers who care for the elderly with stroke and co-morbidity experienced the economic burden, due to costs of care, financial debt, and a lack of opportunities for career development.The psychological burden and emotional problems were the most common ,among those who provided care to elderly people with dementia. there is a lack of continuity of care for the elderly in the long term health care system, a lack of assurance for the quality of home care, and the lack of integration of missions of the organizations involved in the care of the elderly in a community.In conclusion, the long-term care for the elderly in Thailand results in tremendous burden on caregivers and families amidst the unavailability of family and community support systems. Therefore, support system development and system design for long-term elderly care options for caregivers and families in the community include; development of primary care services, promote the role of local government in the long term care system for the elderly, development potential family caregivers, and standardization and quality control long-term elderly care nationality.Thus, leading to the development of a sustainable aged care that is in accord with urban area of Thailand.
    Keywords: Long Term Care , Elderly ,Urban Area
    JEL: I14 I18 I19
  8. By: Yamamura, Eiji
    Abstract: This study uses prefecture-level panel data from Japan for the period 2008?2014 to investigate the influence of the 2011 Fukushima nuclear accident on the z-score of body mass index (BMI z-score) and obesity rates of children over time. A difference-in-differences approach was used to show that: (1) For cohorts aged between 5 and 7 years old in 2010, BMI z-score and obesity rates in disaster-damaged areas were higher than those in other areas, although this was not observed for other cohorts; (2) For cohorts aged between 5 and 7 years old in 2010, the influence of the accident persisted even after 3 years; and (3) The differences in BMI z-score and obesity rate before and after the accident were larger for Fukushima Prefecture than other damaged areas (Iwate and Miyagi prefectures). We infer that health-conscious parents, whose children had lower BMIs, may have moved from Fukushima, increasing the BMI z-score of the population of children living in Fukushima by around 0.05 for the cohort aged 5?7. The enforced reduction in physical activity increased the BMI z-score of children living in Fukushima by around 0.19 for the cohort.
    Keywords: Fukushima, Nuclear accident; Body mass index; Obesity
    JEL: H12 I18
    Date: 2015–09–21
  9. By: Chijioke O. Nwosu and Ingrid Woolard
    Abstract: This paper quantifies the impact of health on labour force participation, using South Africa as a case study. This is important given the essential role the labour market plays in economic growth and the potential for poor health to adversely affect labour market outcomes. South Africa has experienced significant disease burden especially due to communicable diseases like HIV/AIDS and tuberculosis. Moreover, conditions like obesity remain a public health concern. Furthermore, the country has witnessed declining labour force participation in recent years. These health and labour market outcomes, coupled with relatively scant literature on the impact of health on the labour market in South Africa, motivate this study. Data is sourced from the first and third waves of the National Income Dynamics Study, a nationally representative panel dataset of South African households and a rich source of health and socio-economic data. Endogenous treatment of self-assessed health in a contemporaneous setting suggests positive and significant impact of health on labour force participation. The hypothesis of exogeneity of self-assessed health in a labour force participation equation is however not rejected. Finally, positive and significant association between health and LFP persists even four years after health assessment.
    Keywords: Labour force participation, health, Instrumental variables, average treatment effect, treatment effect on the treated, Local average treatment effect
    JEL: I15 J21
    Date: 2015
  10. By: Lamiraud, Karine (ESSEC Business School); Oxoby, Robert (University of Calgary, Department of Economics); Donaldson, Cam (Glasgow Caledonian University, Yunus Centre for Social Business & Health)
    Abstract: Applications of willingness to pay (WTP) have shown the difficultly to discriminate between various options. This reflects the problem of embedding in both its specific sense, of options being nested within one another, and its more-general sense, whereby respondents cannot discriminate between close substitutes or between more-disparate rivals for the same budget. Furthermore, high proportions of reversals between WTP-value and simple preference based rankings of options are often highlighted. Although an incremental WTP approach was devised to encourage more differentiated answers and a higher degree of consistency among respondents, a theoretical basis for this approach has not been elucidated, and there is little evidence to show that this approach might indeed achieve greater consistency between explicit and implicit rankings inferred from WTP values. We address both these issues. Following our theoretical exposition, standard and incremental approaches were compared with explicit ranking in a study assessing preferences for different French emergency care services. 280 persons, representative of the French adult population, were interviewed. Half received the incremental version, the other half the standard version. Results suggest that the incremental approach provides a ranking of options fully in line with explicit ranking. The standard approach was reasonably consistent with explicit ranking but proved unable to differentiate between the five most preferred providers, as predicted by theory. Our findings suggest that the incremental approach provides results which can be used in priority-setting contexts.
    Keywords: WTP; contingent valuation; reference points; embedding effect; incremental approach; emergency care
    JEL: D60 H40 I10
    Date: 2015–09
  11. By: Geyer, Johannes; Korfhage, Thorben
    Abstract: Germany introduced a new mandatory insurance for long-term care in 1995 as part of its social security system. It replaced a system based on means tested social welfare. Benefits from the long-term care insurance are not means tested and depend on the required level of care. The insurance provides both benefits in kind and cash benefits. The new scheme improved the situation for households to organize informal care at home. This was one goal of the reform since policymakers view informal care as a cost-saving alternative to formal care. This view however neglects possible opportunity costs of reduced labor supply of carers. We exploit this reform as a quasi-experiment and examine its effect on the labor supply of caregivers who live in the same household as the care recipient. We find strong negative labor market effects for men but not for women. We conduct a series of robustness tests and find results to be stable.
    Abstract: Im Jahr 1995 wurde in Deutschland eine neue Pflegeversicherung eingeführt. Als Pflichtversicherung ist sie eine eigenständige Säule der Sozialversicherung und ersetzte ein System der einkommensabhängigen Sozialhilfe. Leistungen der neuen Pflegeversicherung werden durch den Grad der Pflegebedürftigkeit bestimmt und sind einkommensunabhängig. Da anspruchsberechtigte Pflegebedürftige zwischen Geld- und Sachleistungen wählen können, wurde die Situation von Haushalten, die häusliche, informelle Pflege organisieren müssen verbessert. Die informelle Pflege zu stärken war eines der wichtigsten Ziele der Pflegereform, da sie häufig als die kostengünstige Alternative im Vergleich zu formellen Pflege wahrgenommen wird. Diese Sichtweise ignoriert jedoch Opportunitätskosten, die entstehen, wenn Pflegende ihr Arbeitsangebot reduzieren, um die Doppelbelastung aus Pflege und Lohnarbeit abzuschwächen. Wir nutzen die Reform als Quasi-Experiment und untersuchen ihren Einfluss auf das Arbeitsangebot von Pflegenden, die mit einer pflegebedürftigen Person in einem Haushalt wohnen. Wir finden starke negative Arbeitsangebotseffekte für Männer, jedoch keine Effekte für Frauen.
    Keywords: labor supply,long-term care,long-term care insurance,natural experiment,quasi-experiment
    JEL: J22 H31 I13
    Date: 2015
  12. By: Palali, Ali (Tilburg University, Center For Economic Research); van Ours, Jan (Tilburg University, Center For Economic Research)
    Abstract: If two partners smoke, their quit behavior may be related through correlation in un-<br/>observed individual characteristics and common external shocks. However, there may also be a causal effect whereby the quit behavior of one partner is affected by the quit decision of the other partner. We use data on Dutch partnered individuals to study the relevance of such spousal peer effects. After controlling for common unobserved heterogeneity and common external shocks, we find that such spousal peer effects in the decision to quit smoking do not exist. Apparently, love conquers all but nicotine addiction.
    Keywords: smoking cessation; causal partner effects
    JEL: C31 I0
    Date: 2015
  13. By: Bell , Clive; van Dillen , Susanne
    Abstract: This paper investigates the effects of India’s rural roads program (PMGSY) on morbidity, using data on 279 households drawn from 30 villages in a region of upland Orissa. The households were surveyed in 2010 and 2013, yielding an unbalanced panel of 1580 individuals, 1076 of whom were present in both years. Ten villages had received a direct all-weather road connection by 2013. Treating the village as a unit within the whole road network, the provision of a connection, whether direct or in the neighbourhood, is estimated to have reduced an inhabitant’s probability of falling sick by an estimated 3.6 percentage points, and the expected duration of incapacitating illness by 0.46 days, for each km. of unpaved track so replaced.
    Keywords: Rural roads; morbidity; India
    Date: 2015–10–02
  14. By: Anne E. Hall (Bureau of Economic Analysis)
    Date: 2015–09
  15. By: David Jones
    Abstract: Summary for publication Report to Congress The Centers for Medicare Medicaid Services Evaluation of ForProfit PACE Programs
    Keywords: PACE, Report to Congress
    JEL: I
    Date: 2015–05–19
  16. By: Cremer, Helmuth; Pestieau, Pierre; Roeder, Kerstin
    Abstract: This paper studies the design of a social long-term care (LTC) insurance when altruism is two-sided. The laissez-faire solution is not efficient, unless there is perfect altruism. Under full information, the rst-best can be decentralized by a linear subsidy on informal aid, a linear tax on bequests when the parent is dependent and state specic lump-sum transfers which provide insurance. We also study a second-best scheme comprising a LTC benet, a payroll tax on childrens earnings and an inheritance tax. This scheme redistributes resources across individuals and between the states of nature and the tax on childrens labor enhances informal care to compensate for the childrens possible less than full altruism.
    Keywords: Long-term care, Two-sided altruism
    JEL: H2 H5
    Date: 2015–07
  17. By: Alfred K. Mukong and Justine Burns
    Abstract: Social networks are increasingly being recognised as having an important influence on the health market outcomes, as they facilitate the exchange of information on health care related issues. Networks reduce search costs by providing information to peers about the appropriate health care providers and details about the functioning of the health care system. In this paper, we examine the impact of information externalities generated through network membership on maternal health care utilisation in Tanzania. We further propose new approaches for quantifying the size of one's network. We adopt an econometric approach that minimises the problems of omitted variable bias. Using the Demographic and Health Survey data for Tanzania, a country characterised by low levels of maternal health care utilisation we find that social networks may enhance antenatal completion and early antenatal check-up probabilities by an additional 6-35 percent and sometimes up to 59 percent. The results suggest that failure to adequately control for omitted variables would lead to substantial under-estimation of the network eect. Finally, we show that irrespective of the measure of the size of the networks, high qualitynetworks have better outcomes than low quality networks.
    Keywords: Maternal Healthcare, Social Networks, Tanzania
    JEL: I11 Z13
    Date: 2015
  18. By: Norman Mudor (Medical Education Center, Yala Hospital); Adhhiyah Mudor (Sirindhorn College of Public Health Yala)
    Abstract: Medicine has been widely known as a high stress profession and medical school is often where stress begins. Identifying the common stressors among the medical students in our Medical Education Center, would help the supervisors to develop the suitable curriculum structure. This study aims to investigate the perceived sources of stress among 4th and 5th year medical student at Medical Education Center, Yala Hospital, Thailand, and to compare if the student with different gender, religion and study year perceives the source of stress differently. A descriptive cross sectional quantitative study was conducted using a 40 items self administered questionnaire adapted from the Medical Student Stressor Questionnaire (MSSQ). The determinants are gender, religion and the study year. T-test was used for analyzing the difference in group. A 92.73% response rate was obtained. The results indicated that falling behind in reading schedule, test and examination, large amount of content to be learnt, national test exam, and lack of time to review what have been learnt were the first five commonest stressors for students. Interestingly, the Muslim students had significantly higher total stress scores than Buddhist students, and the fifth year students had significantly higher stress than the fourth year students. In contrast, gender did not associated with the total stress scores. Medical instructor should design and develop a curriculum structure which is enhancing the student’s well being and focus on academic and clinical performance for producing graduates with a positive professional attitude.
    Keywords: stress, the Medical Student Stressor Questionnaire, medical student.
  19. By: David Jones; Nancy Duda; Bob Schmitz; Sandi Nelson; Chelsea Swete; Alex Bryce; Jared Coopersmith; Karen CyBulski
    Keywords: PACE, Quality of Care
    JEL: I
    Date: 2013–10–11
  20. By: Gauthier Tshiswaka-Kashalala and Steven F. Koch
    Abstract: This research formalizes the interactions between the various determinants of a woman's reproductive health behavior during her reproductive years, and, using nonparametric control functions, examines those determinants. The theoretical model is developed from Grossman's (2000) model of health as a form of human capital, focusing on the cyclicality and volatility of fecundity, as well as the potential costs (such as lost wages and direct costs of purchase) and benets (such as the ability to invest in her education and/or career) of being able to control or at least mitigate it. The empirical model, which controls for the endogeneity between sexual activity and contracepting decsions supports our theoretical model of reproductive health-seeking behavior.
    Keywords: Health Production, Contraception Efficiency, Nonparametric Analysis
    Date: 2015
  21. By: Giuntella, Osea (University of Oxford); Nicodemo, Catia (University of Oxford); Vargas-Silva, Carlos (University of Oxford)
    Abstract: This paper analyses the effects of immigration on waiting times in the National Health Service (NHS) in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. These results are explained by the fact that immigration increases natives' internal mobility and that immigrants tend to be healthier than the natives moving to different areas. On the contrary, we show that outpatient waiting times tend to increase in areas where native internal migrants moved into. Finally, we find evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside London. The increase in average waiting times in more deprived areas is concentrated in the years immediately following the 2004 EU enlargement and vanished in the medium-run (e.g., 3 to 4 years).
    Keywords: immigration, waiting times, NHS, access to health care, welfare
    JEL: I10 J61
    Date: 2015–09
  22. By: Asako OHINATA (University of Leicester, UK, Department of Economics); Matteo PICCHIO (Universit… Politecnica delle Marche, Dipartimento di Scienze Economiche e Sociali)
    Keywords: Long-term elderly care, ageing, difference-in-difference, means tested financial support, saving, wealth
    JEL: C21 D14 I18 J14
    Date: 2015–09
  23. By: Ao, Xiang (Renmin University of China); Jiang, Dawei (Renmin University of China); Zhao, Zhong (Renmin University of China)
    Abstract: Since the reform and opening up in 1978, China has begun a period of rapid industrialization and urbanization. Along with an increasing number of rural people migrating to urban area for jobs, there are a considerable number of elderly parents left behind in the rural area. The impact of migration of the adult children on the health of their left-behind parents is ambiguous. On the one hand, the additional income from the children's jobs can allow their parents to afford better health care and nutrition; on the other hand, the migration necessarily reduces the amount of time the children have to take care of their parents. This paper uses the Rural Urban Migration in China data to empirically investigate the effect of adult children's migration on the health of the left-behind parents. Based on a linear probability model with instrumental variable correction, we find that having one additional adult child migrated to an urban area increases the probability of the left-behind elderly parents being in poor health condition by about 8%. Furthermore, parents having only one child, from low-income households, or aged above 60 years are affected more. Our results point out that the parents with only one child is the most vulnerable group and highlight the importance of establishing a formal care system for the rural elderly to complement the traditional family care in rural China.
    Keywords: left-behind parents, health, rural-urban migration, China
    JEL: O15 J14 I15
    Date: 2015–09
  24. By: Grossman, Michael (CUNY Graduate Center)
    Abstract: Many studies suggest that years of formal schooling completed is the most important correlate of good health. There is much less consensus as to whether this correlation reflects causality from more schooling to better health. The relationship may be traced in part to reverse causality and may also reflect "omitted third variables" that cause health and schooling to vary in the same direction. The past five years (2010-2014) have witnessed the development of a large literature focusing on the issue just raised. I deal with that literature and what can be learned from it in this paper. I conclude that there is enough conflicting evidence in the studies that I have reviewed to warrant more research on the question of whether more schooling does in fact cause better health outcomes.
    Keywords: schooling, health, causality, efficiency, time preference
    JEL: I10 I20
    Date: 2015–09
  25. By: Schwandt, Hannes (University of Zurich); Wuppermann, Amelie (University of Munich)
    Abstract: Attention Deficit/Hyperactivity Disorder (ADHD) is a leading diagnosed health condition among children in many developed countries but the causes underlying these high levels of ADHD remain highly controversial. Recent research for the U.S., Canada and some European countries shows that children who enter school relatively young have higher ADHD rates than their older peers, suggesting that ADHD may be misdiagnosed in the younger children due to their relative immaturity. Using rich administrative health insurance claims data from Germany we study the effects of relative school entry age on ADHD risk in Europe's largest country and relate the effects for Germany to the international evidence. We further analyze different mechanisms that may drive these effects, focusing on physician supply side and demand side factors stemming from the production of education. We find robust evidence for school-entry age related misdiagnosis of ADHD in Germany. Within Germany and internationally, a higher share of misdiagnoses are related to a higher overall ADHD level, suggesting that misdiagnoses may be a driving factor of high ADHD levels. Furthermore, the effects in Germany seem to be driven by teachers and parents in an attempt to facilitate and improve the production of education.
    Keywords: ADHD, misdiagnosis, age cutoff, education
    JEL: I1 I2 J1
    Date: 2015–09
  26. By: Jack Gettens; Pei-Pei Lei; Alexis D. Henry
    Abstract: Starting in 2013, the Behavioral Risk Factor Surveillance System (BRFSS) included five of the six disability questions that are now common across national surveys including the American Community Survey (ACS).
    Keywords: DRC, Behavioral Risk Factor Surveillance System, Disability Data
    JEL: I J
    Date: 2015–09–30

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