nep-hea New Economics Papers
on Health Economics
Issue of 2015‒11‒21
eighteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. "Your Money or Your Life !" The Influence of Injury and Fine Expectations on Helmet Adoption among Motorcyclists in Delhi By Carole Treibich
  2. Hard to Forget: the Long-Lasting Impact of War on Mental Health By Massimiliano Bratti; Mariapia Mendola; Alfonso Miranda
  3. Health Shocks and Risk Aversion By Simon Decker; Hendrik Schmitz
  4. Birth Order and Health of Newborns: What Can We Learn from Danish Registry Data? By Anne Ardila Brenøe; Ramona Molitor
  5. Pathos & ethos: emotions and willingness to pay for tobacco products By Francesco Bogliacino; Cristiano Codagnone; Giuseppe Alessandro Veltri; Amitav Chakravarti; Pietro Ortoleva; George Gaskell; Andriy Ivchenko; Francisco Lupiáñez-Villanueva; Francesco Mureddu; Caroline Rudisill
  6. Interactions between state pension and long-term care reforms: an overview By John Adams; Chris Curry; Ferran Espuny-Pujol; Ruth Hancock; Bo Hu; Derek King; Sarah Luheshi; Marcello Morciano; Timothy Pike; Shamill Popat; Raphael Wittenberg
  7. Education and HIV incidence among young women: causation or selection? By Durevall, Dick; Lindskog, Annika; George, Gavin
  8. Forecasting Life Expectancy: Evidence from a New Survival Function By Wong, Chi Heem; Tsui, Albert K
  9. The Pros and Cons of Sick Pay Schemes: Testing for Contagious Presenteeism and Shirking Behavior By Stefan Pichler; Nicolas R. Ziebarth
  10. Development of an HCBS Pressure Ulcer Measure, Volume 1 By Andrea Wysocki; Alex Bohl; Chris Fleming; Jessica Ross
  11. Demand for a Transgenic Food with a Medical Benefit By Saito, Yoko; Saito, Hisamitsu
  12. Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends between 1995 and 2014 By Sharaf, Mesbah; Rashad, Ahmed
  13. Job Loss, Firm-Level Heterogeneity and Mortality: Evidence from Administrative Data By Hans Bloemen; Stefan Hochguertel; Jochem Zweerink
  14. Voluntary Health Plan Subsidies and Public Expenditure By Bardey, David; Buitrago, Giancarlo
  15. Financial incentives and physician prescription behavior: Evidence from dispensing regulations By Daniel Burkhard; Christian Schmid; Kaspar Wüthrich
  16. General budget support, health expenditures, and neonatal mortality rate: A synthetic control approach By Kaisa Alavuotunki
  17. Indirect fiscal effects of long-term care insurance By Geyer, Johannes; Haan, Peter; Korfhage, Thorben
  18. How are work-related characteristics linked to sickness absence and presenteeism? Theory and data By Arnold, Daniel; De Pinto, Marco

  1. By: Carole Treibich (Aix-Marseille University (Aix-Marseille School of Economics), CNRS, & EHESS)
    Abstract: Road mortality is a growing burden in many developing countries, although many of these crashes are preventable. Behaviors adopted by road users while traveling is one key dimension on which governments usually play to reduce road accidents, either by stressing the potential injuries or by implementing fines if individuals do not adopt safe behaviors. This paper exploits original data collected among Delhi motorcyclists in 2011. I study the influence of perceived consequences of helmet non-use on the decision whether to wear or not such protective device. I also explore the role of previous experiences in the formation of these beliefs. I find that expected injuries are correlated with helmet use on long distance trips while expectations of financial sanctions are linked with helmet adoption on short distance journeys. Women react more than men to a given level of expected medical expenditures. Furthermore, poorer individuals are more likely to use a helmet for given levels of health costs and traffic fines. Simulations of policies influencing individuals' subjective expectations show that an intensification of police threat and information campaigns would increase helmet adoption among motorcyclists.
    Keywords: subjective expectations, road safety, risky behaviors, India
    JEL: C81 D84 I15 K42 R41
    Date: 2015–11–16
  2. By: Massimiliano Bratti (University of Milan, IZA and Centro Studi Luca d'Agliano); Mariapia Mendola (University of Milan Bicocca, IZA and Centro Studi Luca d'Agliano); Alfonso Miranda (Centro de Investigación y Docencia Económicas (CIDE) and IZA)
    Abstract: In this paper we examine the impact of war trauma experienced during the 1992-1995 Bosnia and Herzegovina conflict on individual mental health and labor market outcomes. By using a medically-validated depression scale and an instrumental-variable approach we show that, six years after the conflict, traumatized individuals are more likely to be at risk of depression(by 60 percentage points) and have worse labor-market outcomes. Our results are robust to a number of sensitivity checks accounting for individual geographical mobility and different treatment intensities, and suggest that the negative effects of war trauma are not mainly mediated by physical health problems.
    Keywords: war trauma, mental health, depression, Bosnia and Herzegovina
    JEL: I1 O1
    Date: 2015–11–10
  3. By: Simon Decker; Hendrik Schmitz
    Abstract: Risk preferences are typically assumed to be constant for an individual across the life cycle. In this paper we empirically assess if they are time varying. Specifically, we analyse whether health shocks influence individual risk aversion. We follow an innovative approach and use grip strength data to obtain an objective health shock indicator. In order to account for the non-random nature of our data we employ regression-adjusted matching. Health shocks are found to increase individual risk aversion. The finding is robust to a series of sensitivity analyses.
    Keywords: Risk Preferences, Health Shocks, Hand Grip Strength, Regression-Adjusted Matching
    JEL: C81 D01 D81 I10 I12
    Date: 2015
  4. By: Anne Ardila Brenøe (University of Copenhagen, Department of Economics, Økonomisk Institut); Ramona Molitor (University of Passau, Chair of Economic Policy)
    Abstract: Research has shown a strong negative correlation between birth order and cognitive test scores, IQ, and educational outcomes. We ask whether birth order differences in health are present at birth using matched administrative data for more than 1,000,000 children born in Denmark between 1981 and 2010. Using family fixed effects models, we find a positive and robust birth order effect; lower parity children are less healthy at birth. Looking at the potential mechanisms, we find that during earlier pregnancies women have higher labor market attachment, behave more risky in terms of smoking, receive more prenatal care, and are diagnosed with more medical pregnancy complications. Yet, none of these factors explain the birth order differences at birth. This positive birth order effect at birth stands in stark contrast to a negative birth order effect in educational performance. Once we control for health at birth, the negative birth order effect in educational performance further increases.
    Keywords: Birth order, parity, child health, fetal health, health at birth, education
    JEL: I10 I12 J12 J13
    Date: 2015–10
  5. By: Francesco Bogliacino; Cristiano Codagnone; Giuseppe Alessandro Veltri; Amitav Chakravarti; Pietro Ortoleva; George Gaskell; Andriy Ivchenko; Francisco Lupiáñez-Villanueva; Francesco Mureddu; Caroline Rudisill
    Abstract: In this article we use data from a multi-country Randomized Control Trial study on the effect of anti-tobacco pictorial warnings on an individual’s emotions and behavior. By exploiting the exogenous variations of images as an instrument, we are able to identify the effect of emotional responses. We use a range of outcome variables, from cognitive (risk perception and depth of processing) to behavioural (willingness to buy and willingness to pay). Our findings suggest that the odds of buying a tobacco product can be reduced by 80% if the negative affect elicited by the images increases by one standard deviation. More importantly from a public policy perspective, not all emotions behave alike, as eliciting shame, anger, or distress proves more effective in reducing smoking than fear and disgust.
    JEL: C99 I18
    Date: 2015–10–20
  6. By: John Adams; Chris Curry; Ferran Espuny-Pujol; Ruth Hancock; Bo Hu; Derek King; Sarah Luheshi; Marcello Morciano; Timothy Pike; Shamill Popat; Raphael Wittenberg
    Abstract: In April 2016 major reforms to state pensions and long-term care will be implemented in Great Britain and England respectively. Their combined effects have received little attention despite interactions between the two systems. The long-term effects of both sets of reforms will depend on how details of the systems are set in the intervening years, and on how policies in other parts of the welfare system evolve. We will investigate the long-term impacts of alternative ways in which current pensions and long-term care financing reforms may evolve over the next 40 years to ensure that that there is widespread appreciation of the implications of any changes which may have significant long-term effects.
    JEL: E6
    Date: 2015–11
  7. By: Durevall, Dick (Department of Economics, School of Business, Economics and Law, Göteborg University); Lindskog, Annika (Department of Economics, School of Business, Economics and Law, Göteborg University); George, Gavin (HEARD, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000 South Africa)
    Abstract: Several studies report that schooling protects against HIV infection in Sub-Saharan Africa. This study examines the effect of secondary school attendance on the probability of HIV incidence among young women aged 15-24, using panel data from rural KwaZulu-Natal in South Africa. Three approaches are used to distinguish causation from selection: instrumentation to identify the causal effect, a fixed effects model to control for constant unobserved factors and assessments of the bias from selection on unobserved variables. Although there is a strong negative association between secondary school attendance and HIV incidence, we are not able to find support for a causal effect. Thus, there is no evidence that interventions that increase secondary school attendance in KwaZulu-Natal would mechanically reduce HIV risk for young women. Our focus on school attendance, in contrast to studies that analyze school attainment, might explain the negative finding.<p>
    Keywords: HIV/AIDS; Education; Schooling; South Africa
    JEL: I12 I29 O12
    Date: 2015–11
  8. By: Wong, Chi Heem; Tsui, Albert K
    Abstract: We propose a new survival function to forecast life expectancies at various ages. The proposed model comprises the youth-to-adulthood component and the old-to-oldest-old component. It is able to closely fit adult survivorship of the US men and women in the period from 1950 to 2010. We find evidence that the forecasting performance of life expectancies by the proposed model compares favorably with those obtained from the popular Lee-Carter model (1992) and the shifting logistic model proposed by Bongaarts (2005).
    Keywords: Lee-Carter model, Life expectancy, Mortality, Survival probability
    Date: 2015–06
  9. By: Stefan Pichler (KOF Swiss Economic Institute, ETH Zurich, Switzerland); Nicolas R. Ziebarth (Cornell University)
    Abstract: This paper proposes a test for the existence and degree of contagious presenteeism and negative externalities in sickness insurance schemes. First, we theoretically decompose moral hazard into shirking and contagious presenteeism behavior and derive testable conditions. Then, we implement the test exploiting German sick pay reforms and administrative industry-level data on certified sick leave by diagnoses. The labor supply adjustment for contagious diseases is significantly smaller than for non-contagious diseases. Lastly, using Google Flu data and the staggered implementation of US sick leave reforms, we show that flu rates decrease after employees gain access to paid sick leave.
    Keywords: Sickness Insurance, Paid Sick Leave, Presenteeism, Contagious Diseases, Infections, Negative Externalities, Shirking, US, Germany
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2015–09
  10. By: Andrea Wysocki; Alex Bohl; Chris Fleming; Jessica Ross
    Keywords: HCBS, Pressure Ulcers, Medicaid, Avoidable Hospitalizations
    JEL: I
    Date: 2015–08–26
  11. By: Saito, Yoko; Saito, Hisamitsu
    Abstract: The perceived health and environmental risks of genetically modified (GM) technology have impeded its diffusion in developed countries. However, GM crops, which can provide direct consumer as well as producer value, have recently been developed. This study applies a stated choice experiment to examine whether the addition of a medical benefit can improve the welfare of the beneficiaries of the newly developed GM variety. Our results show a tradeoff between general worries over GM technology and GM food’s specific health benefits. A marketing program should therefore be designed to inform and persuade consumers of these features.
    Keywords: genetically modified research design, health, stated-preference method.
    JEL: D12 I10 Q13
    Date: 2015–11–18
  12. By: Sharaf, Mesbah (University of Alberta, Department of Economics); Rashad, Ahmed (Philipps University Marburg)
    Abstract: This paper examines the trends in the socio-economic inequalities of infant mortality rates in Egypt during the period 1995-2014, using repeated cross sectional data from the National Demographic and Health Survey. A multivariate logistic regression model, concentration curves, and concentration indices are used to examine the demographic and socio-economic correlates of infant mortality, and how the degree of socio-economic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socio-economic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socio-economic inequality in child mortality rates was not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. No statistically significant association was found between infant mortality and access to safe water, gender, and mothers' education. Infant mortality was negatively associated with household wealth, receiving a regular health care during pregnancy by mothers, having more than two under- five children. By identifying the correlates of child mortality, the findings of this paper inform intervention measures that aim at reducing child mortality rates and socio-economic inequalities in Egypt.
    Keywords: Infant Mortality; Inequality; Trend Analysis; Millennium Development Goals; Egypt
    JEL: I14 I15
    Date: 2015–11–16
  13. By: Hans Bloemen (VU University Amsterdam); Stefan Hochguertel (VU University Amsterdam, the Netherlands); Jochem Zweerink (Utrecht University, the Netherlands)
    Abstract: This paper estimates the effect of job loss on mortality for older male workers with strong labor force attachment. Using Dutch administrative data, we find that job loss due to sudden firm closure increased the probability to die within five years by a sizable 0.60 percentage points. Importantly, this effect is estimated using a model that controls for firm-level worker characteristics, such as firm-level average mortality rates for mortality during the four years prior to the year of observation. On the mechanism driving the effect of job loss on mortality, we provide evidence for an effect running through stress and changes in life style.
    Keywords: job loss; mortality; treatment effect
    JEL: C21 I10 J63
    Date: 2015–11–16
  14. By: Bardey, David; Buitrago, Giancarlo
    Abstract: Countries that seek to provide universal health coverage deal with considerable publicly funded expenses. This article discusses if a private health insurance subsidy policy can reduce the expenses covered by the public system. A theoretical model is developed in which individuals are characterized by two dimensions: inherited risk of illness and preferences for prevention activities. It is shown that when beneficiaries of a voluntary plan have lower risk, i.e. advantageous selection scenario, a subsidy raises heath expenses if articulation between coverage is complementary. On the contrary, in adverse selection scenarios a subsidy reduces expenditure if articulation is supplementary. Intermediate scenarios are also considered where articulations between coverages have both complementary and supplementary components, which is apparently the case for the Colombian health system. Calibrated numerical simulations are provided using the Colombian system data. The calibration strategy employed reveals that selection is adverse in the Colombian voluntary health insurance market. Furthermore, we identify the level of subsidy and changes in articulation (towards supplementarity) that could lead to a reduction in public spending.
    Keywords: Health insurance, Regulation, Subsidies
    JEL: G22 I13 I18
    Date: 2015–10
  15. By: Daniel Burkhard; Christian Schmid; Kaspar Wüthrich
    Abstract: In many healthcare markets, physicians can influence the volume (volume response) and the composition of the services provided (substitution response). The goal and main contribution of this paper is to empirically assess the relative importance of these two behavioral channels. Our analysis is based on the market for ambulatory care in Switzerland in which different drug dispensing regimes (banned/allowed) co-exist at the regional level but many important other features are regulated at the federal level. Dispensing creates financial incentives for physicians to sell more drugs and to substitute towards more expensive drugs thus providing an ideal setup for our empirical analysis. We combine the regional variation in the dispensing regime with comprehensive physician-level prescription data to empirically disentangle the volume and the substitution response. The estimated average effects suggest that physician dispensing increases drug costs on the order of 25% for general practitioners and 15% for medical specialists. A decomposition of this overall effect indicates that the cost increase can mainly be attributed to a volume increase, while average drug prices are not or even negatively affected in some specifications. In addition, we document substantial effect heterogeneity along the outcome distributions.
    Keywords: physician agency; drug expenditures; volume response; substitution response; physician dispensing
    JEL: I11 I18
    Date: 2015–11
  16. By: Kaisa Alavuotunki
    Abstract: I examine impacts of general budget support in 12 countries using the synthetic control approach. First, I analyse changes in government expenditures on health before and after the introduction of budget support. Second, I look at neonatal mortality (a presumed proxy for improvements in health services), concentrating on the countries that increased their health spending following the introduction of general budget support. The results indicate that, at least in Tanzania, Burkina Faso, Rwanda, and Malawi, budget support did have a positive effect on health spending and, except for Rwanda, neonatal mortality rate declined relatively faster than in the synthetic control countries.
    Keywords: general budget support, health sector expenditures, neonatal mortality, developing countries, synthetic control method
    Date: 2015
  17. By: Geyer, Johannes; Haan, Peter; Korfhage, Thorben
    Abstract: Informal care by close family members is the main pillar of most long-term care systems. However, due to demographic ageing the need for long-term care is expected to increase while the informal care potential is expected to decline. From a budgetary perspective, informal care is often viewed as a cost-saving alternative to subsidized formal care. This view, however neglects that many family carers are of working age and face the difficulty to reconcile care and paid work which might entail sizable indirect fiscal effects related to forgone tax revenues, lower social security contributions and higher transfer payments. In this paper we use a structural model of labor supply and the choice of care arrangement to quantify these indirect fiscal effects of informal care. Moreover, based on the model we discuss the fiscal effects related to non-take-up of formal care.
    Abstract: Die Organisation der Altenpflege stützt sich in vielen Ländern auf die Bereitstellung informeller Pflege durch Familienangehörige. In alternden Gesellschaften gerät dieses System jedoch zunehmend unter Druck, da die Nachfrage nach Pflege steigt und gleichzeitig das Potenzial für Familienpflege sinkt. Die informelle Pflege wird aus fiskalpolitischer Sicht häufig als die kostengünstigste Variante der Altenpflege wahrgenommen. Die Bestimmung der gesamten fiskalischen Kosten erfordert jedoch eine Berücksichtigung von indirekte Kosten der informellen Pflege. Diese entstehen dadurch, dass viele pflegende Angehörige ihr Arbeitsangebot reduzieren, um auf die Doppelbelastung aus Pflege und Lohnarbeit zu reagieren. Dies führt zu geringeren Steuereinnahmen, reduzierten Sozialversicherungsbeiträgen und höheren Transferzahlungen. In dieser Studie nutzen wir ein strukturelles Modell des Arbeitsangebots und der Pflegearrangements, um diese indirekten fiskalischen Kosten zu quantifizieren. Darüber hinaus nutzen wir das Modell, um zusätzliche fiskalischen Effekte zu diskutieren, die durch eine Nichtinanspruchnahme (non-take up) von formeller ambulanter Pflege entstehen können.
    Keywords: labor supply,fiscal effects,long-term care insurance,structural model
    JEL: J22 H31 I13
    Date: 2015
  18. By: Arnold, Daniel; De Pinto, Marco
    Abstract: This paper investigates how changes in work-related factors affect workers' absence and presenteeism behavior. Previous studies (implicitly) assume that there is a substitutive relationship, i.e. a change in a work-related factor decreases the level of absence and simultaneously increases presenteeism (or vice versa). We set up a theoretical model in which work-related characteristics not only affect a worker's absence decision but also the individual-specific sickness definition. Since workrelated factors affect presenteeism through these two channels, nonsubstitutive relationships between absence and presenteeism are also conceivable. Using European cross-sectional data, we find only few substitutive and complementary relationships, while the bulk of the work-related characteristics is related only to one of the two sickness states.
    Keywords: sickness absence,presenteeism,annual duration,workrelated characteristics,health at work
    JEL: J22 J28 I1 M50
    Date: 2015

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