nep-hea New Economics Papers
on Health Economics
Issue of 2015‒12‒08
forty-six papers chosen by
Yong Yin
SUNY at Buffalo

  1. Status of Industrial Noise Levels and Impact on Workers’ Health: A Case Study of Kalurghat Heavy Industrial Area in Bangladesh By Kamrul Islam; Sahadeb Chandra Majumder
  2. Stressed by your job: What is the role of personnel policy? By Michael Beckmann; Elena Shvartsman
  3. Information Frictions and Adverse Selection: Policy Interventions in Health Insurance Markets By Handel, Benjamin R.; Kolstad, Jonathan; Spinnewijn, Johannes
  4. Indirect Fiscal Effects of Long-Term Care Insurance By Johannes Geyer; Peter Haan; Thorben Korfhage
  5. Awareness and AIDS :A Political Economy Perspective By Gani Aldashev; Jean-Marie Baland
  6. Asia and the Pacific: Health Policy Challenges of a Region in Transition By Kelley Lee; Tikki Pang
  7. China's Seasonal Influenza Vaccination Policy in a Post-Health Care Reform Era By Ningzhen Ruan; Thao Nguyen; Kellynn Khor
  8. Water, Sanitation and Hygiene: Moving the Policy Agenda Forward in the Post-2015 Asia By Aidan A. Cronin; Chander Badloe; Harriet Torlesse; Robin K. Nandy
  9. Tackling Substandard and Falsified Medicines in the Mekong: National Responses and Regional Prospects By Marie Lamy; Marco Liverani
  10. Determinants of Tobacco Consumption in Papua New Guinea: Challenges in Changing Behaviours By Xiaohui Hou; Xiaochen Xu; Ian Anderson
  11. The Political Economy of Mental Health in Vietnam: Key Lessons for Countries in Transition By Kelley Lee; Rebecca Zappelli; Elliot M. Goldner; Nguyen Cong Vu; Kitty K. Corbett; Jill Murphy
  12. The Rising Tide of Mental Disorders in the Pacific Region: Forecasts of Disease Burden and Service Requirements from 2010 to 2050 By Fiona J. Charlson; Sandra Diminic; Harvey A. Whiteford
  13. How Can We Strengthen Governance of Non-communicable Diseases in Pacific Island Countries and Territories? By Roger S. Magnusson; David Patterson
  14. Strengthening Trade and Health Governance Capacities to Address Non-Communicable Diseases in Asia: Challenges and Ways Forward By Phillip Baker; Adrian Kay; Helen Walls
  15. Health in All Policies Approaches: Pearls from the Western Pacific Region By Sharon Friel1; Patrick Harris; Sarah Simpson; Anjana Bhushan; Britta Baer
  16. South Korea's Global Health Outreach through Official Development Assistance: Analysis of Aid Activities of South Korea's Leading Aid Agencies, 2008–2012 By Eun-mee Kim; Eun-hee Ha; Mi-jin Kwon
  17. Comparing the Health Care Systems of High-Performing Asian Countries By Amanda Smullen; Phua Kai Hong
  18. Explaining the Role of Parental Education in the Regional Variations in Infant Mortality in India By Pradeep Kumar Choudhury
  19. Walk this way: estimating impacts of Walk in Centres at hospital emergency departments in the English National Health Service By Ted Pinchbeck
  20. Subjective expectations of medical expenditures and insurance in rural Ethiopia By Debebe, Z.Y.; O'Donnell, O.A.; Mebratie, A.D.; Alemu, G.; Bedi, A.S.
  21. Health-care reform or labor market reform? A quantitative analysis of the affordable care act By Nakajima, Makoto; Tuzemen, Didem
  22. Universal Childcare and Longer-Run Effects on Parental Health and Behaviors: Evidence from a Canadian Universal Child Care Program By Laetitia Lebihan; Catherine Haeck; Pierre Lefebvre; Philip Merrigan
  23. Education Choices, Longevity and Optimal Policy in a Ben-Porath Economy By Yukihiro Nishimura; Pierre Pestieau; Gregory Ponthiere
  24. «Your Money or Your Life !» The Influence of Injury and Fine Expectations on Helmet Adoption among Motorcyclists in Delhi By Carole Treibich
  25. Long-term consequences of access to well-child visits By Bütikofer, Aline; Løken, Katrine V.; Salvanes, Kjell G.
  26. Social Distortion in Weight Perception: A Decomposition of the Obesity Epidemic By Barbieri, Paolo Nicola
  27. Health, Work Capacity and Retirement in Sweden By Johansson, Per; Laun, Lisa; Palme, Marten
  28. Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3) - Cross-case analysis: models of organisation By Fabienne Abadie; Wilhelmus Cornelis Graafmans; Francisco Lupianez Villanueva; Cristiano Codagnone
  29. Longer opening ours, alcohol consumption and health By Colin Peter Green; Bruce Philip Hollingsworth; Maria Navarro Paniagua
  30. Understanding the Probability of a Disability Resulting from Work-Related Injuries By Nan L. Maxwell; Nathan Wozny
  31. Assessing the Accuracy of Three National Physician Sampling Frames By Catherine M. DesRoches; Kirsten Barrett
  32. Cognitive Ability in Childhood and the Chronicity and Suicidality of Depression By Galen Chin-Lun Hung; Stefanie A. Pietras; Hannah Carliner; Laurie Martin; Larry J. Seidman; Stephen L. Buka; Stephen E. Gilman
  33. Consumer Engagement in Health IT: Distinguishing Rhetoric from Reality By Marsha Gold; Mynti Hossain; Amy Mangum
  34. Characteristics of Disability Beneficiaries with High Earnings By Gina Livermore; Maura Bardos
  35. Improving the Coordination of Services for Adults with Mental Health and Substance Use Disorders: Profiles of Four State Medicaid Initiatives By Matthew Kehn; Rebecca Kleinman; Allison Wishon Siegwarth; Jonathan Brown
  36. State Strategies for Coordinating Medicaid Services and Housing for Adults with Behavioral Health Conditions By Rebecca Kleinman; Matthew Kehn; Allison Wishon Siegwarth; Jonathan Brown
  37. The Effect of Health Reform on Retirement By Helen Levy; Thomas Buchmueller; Sayeh Nikpay
  38. Intergenerational transmission in health: Causal estimates from fixed effects instrumental variables models for two cohorts of Australian children By Le, Huong; Nguyen, Ha
  39. BMI is not related to altruism, fairness, trust or reciprocity: Experimental evidence from the field and the lab By Brañas-Garza, Pablo; Espín, Antonio M.; Lenkei, Balint
  40. Demand for Maternal health inputs in West Bengal-Inference from NFHS 3 By Mandal, Biswajit
  41. It’s No Spring Break in Cancun: The Effects of Exposure to Violence on Risk Preferences, Pro-Social Behavior, and Mental Health By Muhammad Nasir; Marc Rockmore; Chih Ming Tan
  42. Prenatal Incense Burning and Infant Health By Marie Christine Ho
  43. Explaining Variation in Medical Innovation: The Case of Vaccines, and the HIV AIDS effort By Ohid Yaqub
  44. Health Disparities by Income in Spain before and after the Economic Crisis By Max Coveney; Pilar Garcia Gomez; Eddy Van Doorslaer; Tom Van Ourti
  45. On Plague in a Time of Ebola By Cormac Ó Gráda
  46. Spillover effects of local human capital stock on adult obesity: Evidence from German neighborhoods By Dang, Rui

  1. By: Kamrul Islam (University of Chittagong); Sahadeb Chandra Majumder (University of Chittagong)
    Abstract: Noise is the silent killer which has the ability to deteriorate the normal health condition of a person. People working in heavy industries have a high risk of being affected by noise and this phenomenon is unequivocally true for a country like Bangladesh. This paper identified the status of noise levels, their ultimate impact on workers’ health, and noise reduction compliance in Kalurghat Heavy Industrial Area (KHIA) of Chittagong. Eleven companies gave access to collect data related to noise issues inside and outside of their factories. While the average inside and outside noise levels were within the limit of 75 decibels (dBA), excessive noise at 89 dBA from several sources like dryer machines and generators are a concern. A semi structured questionnaire was also used to collect data related to noise related compliance issue from the respective personnel of the factories. The study found that most of the factories hardly use physical mechanisms to control excessive noise.
    Keywords: Noise monitoring, compliance, Kalurghat Heavy Industrial Area, development, Bangladesh
    Date: 2015–12
  2. By: Michael Beckmann; Elena Shvartsman (University of Basel)
    Abstract: Work-related stress can lead to substantial health problems and thereby resultin immense costs for establishments. Therefore, the question as to what extentestablishments contribute to their employees’ stress levels is of great importance for firm performance. We investigate the relationship between personnel policies and work-related stress by considering a series of personnel policies that refer to a worker’s job reward, job demand, or job control situation. Using data from the German Socio-Economic Panel (SOEP) we find statistically significant associations of several policies and work-related stress. Most importantly, bad promotion opportunities and low working time control turn out to be associated with higher stress levels, while the opposite is true for an adequate salary.
    Keywords: job stress, personnel policy, working conditions
    JEL: I10 J81 M54
    Date: 2015
  3. By: Handel, Benjamin R.; Kolstad, Jonathan; Spinnewijn, Johannes
    Abstract: A large literature has analyzed pricing inefficiencies in health insurance markets due to adverse selection, typically assuming informed, active consumers on the demand side of the market. However, recent evidence suggests that many consumers have information frictions that lead to suboptimal health plan choices. As a result, policies such as information provision, plan recommendations, and smart defaults to improve consumer choices are being implemented in many applied contexts. In this paper we develop a general framework to study insurance market equilibrium and evaluate policy interventions in the presence of choice frictions. Friction-reducing policies can increase welfare by facilitating better matches between consumers and plans, but can decrease welfare by increasing the correlation between willingness-to-pay and costs, exacerbating adverse selection. We identify relationships between the underlying distributions of consumer (i) costs (ii) surplus from risk protection and (iii) choice frictions that determine whether friction-reducing policies will be on net welfare increasing or reducing. We extend the analysis to study how policies to improve consumer choices interact with the supply-side policy of risk-adjustment transfers and show that the effectiveness of the latter policy can have important implications for the effectiveness of the former. We implement the model empirically using proprietary data on insurance choices, utilization, and consumer information from a large firm. We leverage structural estimates from prior work with these data and highlight how the model's micro-foundations can be estimated in practice. In our specific setting, we find that friction-reducing policies exacerbate adverse selection, essentially leading to the market fully unraveling, and reduce welfare. Risk-adjustment transfers are complementary, substantially mitigating the negative impact of friction-reducing policies, but having little effect in their absence.
    Keywords: Adverse Selection; Information Frictions; Policy Interventions
    JEL: D80 I13
    Date: 2015–11
  4. By: Johannes Geyer; Peter Haan; Thorben Korfhage
    Abstract: Informal care by close family members is the main pillar of most longterm 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.
    Keywords: labor supply, long-term care, long-term care insurance, structural model
    JEL: J22 H31 I13
    Date: 2015
  5. By: Gani Aldashev; Jean-Marie Baland
    Abstract: At the height of HIV/AIDS epidemics, across African countries prevention policieswere unrelated to HIV/AIDS prevalence. Even when successful, they were often unsta-ble or reversed. To explain these puzzles, we propose a simple political economy modelthat examines joint determination of prevention policies and the epidemic dynamics.Prevention a¤ects both behavior and the perception of the role of policies in …ghtingAIDS. Behavioral changes induced by the policy, in turn, reduce the infection risk forsexually active agents, which creates political support for future policies. The two-wayrelationship between prevention policy and awareness generates two stable steady-stateequilibria. The low-prevalence equilibrium is fragile. Reduced transmission rates havean ambiguous impact on prevalence rates as they also imply less active preventionpolicies. An empirical analysis of the determinants of public support for HIV/AIDSpolicies using the 2005 Afrobarometer shows that high prevalence rates translate intopublic support for prevention policies only in countries which carried out active pre-vention campaigns in the past. Our framework extends to a large class of public healthpolicies under which awareness partly follows from the policies themselves.
    Keywords: HIV/AIDS; voting; public health; awareness
    JEL: I18 H51
    Date: 2015–10
  6. By: Kelley Lee; Tikki Pang
    Date: 2015–05–28
  7. By: Ningzhen Ruan; Thao Nguyen; Kellynn Khor
    Abstract: Vaccination is recognised as one of the most effective ways to combat seasonal influenza—a disease that exerts significant social and economic costs, yet is often neglected by policy-makers and the vaccine target population in developing countries. The situation in China is no exception with seasonal influenza vaccine remaining as a class II vaccine and being financed by citizens' out-of-pocket payments. The different cultural backgrounds, climate patterns and living standards across China further complicate the policymaking process of developing national level policy guidelines. Nevertheless, China's recent health care reform that focuses on preventive care, elderly care and equitable health care access has motivated policy-makers at the local level to formulate policies facilitating seasonal influenza vaccination provision. This article seeks to understand this process at the city level under China's current economic transition background, and aims to identify policy experiences that may be applicable for the larger Asia-Pacific region.
    Keywords: China;public health policy;health care reform;seasonal influenza;vaccination
    Date: 2015–05–28
  8. By: Aidan A. Cronin; Chander Badloe; Harriet Torlesse; Robin K. Nandy
    Abstract: Despite rapid economic growth in Asia, serious health, nutrition and development gaps persist, including inadequate services and inequitable access in the water, sanitation and hygiene (WASH) sector. We show that the WASH sector has ample justification for increased focus and investment to increase health and nutrition impact, but appropriate prioritisation and quality implementation of interventions are required to address these gaps. The Sustainable Development Goals present opportunities for an increased focus. We argue that the key components required to accelerate change include strengthened data availability, quality and use, institutional and policy reform for greater cross-sectoral integration and clear accountabilities at national and local level if countries are to achieve universal access with equity, sustainability and quality.
    Keywords: water;sanitation;hygiene;Sustainable Development Goals (SDGs)
    Date: 2015–05–28
  9. By: Marie Lamy; Marco Liverani
    Abstract: The wide circulation of substandard medicines in Southeast Asia is a serious public health concern. Substandard medicines may contain none, or inadequate quantities of the active ingredient, or may contain harmful ingredients. This poses a considerable threat to human lives and an obstacle to infectious disease control at the national, regional and global level, also due to the associated risk of antimicrobial resistance. As trade liberalisation in the region intensifies, moreover, there are concerns that reduced custom controls and higher mobility of people and goods may increase the illicit trade in falsified medicines. In this context, crucial is the ability of governments to develop adequate regulations and capacities as well as enforcement measures to tackle these issues. Given the transnational nature of the problem, the establishment of effective mechanisms for cross-country surveillance, information exchange and coordinated action is also necessary. In this article, we provide an overview of national responses, reflecting on strengths and limitations of past interventions. We then examine existing institutional frameworks for regional health cooperation, particularly the Association of Southeast Asian Nations, and their potential to support enhanced capacities and cooperation to address this challenge.
    Keywords: substandard medicines;falsified medicines;Southeast Asia;health policy;regional policy
    Date: 2015–05–19
  10. By: Xiaohui Hou; Xiaochen Xu; Ian Anderson
    Abstract: This article analyses smoking prevalence and smoking behaviours in Papua New Guinea (PNG). Using the 2009–2010 PNG Household Income and Expenditure Survey, the article analyses the determinants of tobacco use and tobacco choices in PNG. The results show adults (18 years and above) in the poorest quartile are more likely to smoke. Tobacco consumption imposes a large financial burden to poor households. Tobacco consumption accounts for about 23 per cent of total household food expenditure for households in the poorest quartile, as compared with 15 per cent for the entire sample. However, most of these households consume non-processed tobacco. The study reveals the urgency to control tobacco consumption in PNG and considers some practical challenges that the country may face.
    Keywords: tobacco consumption;behaviour change;Papua New Guinea;household survey;tobacco control
    Date: 2015–05–28
  11. By: Kelley Lee; Rebecca Zappelli; Elliot M. Goldner; Nguyen Cong Vu; Kitty K. Corbett; Jill Murphy
    Abstract: Among low- and middle-income countries, there is evidence that populations experiencing rapid political and economic transition have particularly high burdens of disease and disability from mental health conditions. This paper undertakes a political economy analysis of mental health in Vietnam to enhance knowledge translation, notably how both explicit and tacit knowledge can be used to promote evidence-based policy making. It argues that Vietnam's experience illustrates the need to better understand, not only how transition transforms societies, but how it impacts on the mental health needs and care of populations. The political economy of transition in Vietnam has so far given highest priority to economic growth through integration with the world economy and public sector reform. There is a need to recognise that transition in Vietnam poses both a potential threat to the care of people with mental health needs, and an opportunity to develop mental health services appropriate to local contexts.
    Keywords: Vietnam;mental health;globalisation;political economy;knowledge translation
    Date: 2015–03–28
  12. By: Fiona J. Charlson; Sandra Diminic; Harvey A. Whiteford
    Abstract: Despite progress, poor performance of Pacific Island health systems continues to be highlighted by treatment gaps. Projecting burden of disease and the human resource requirements for mental health services will help appropriately plan for mental health in the region. We drew upon burden of disease and population data to estimate disability-associated burden of disease from 2010 to 2050 for the Pacific region. Packages of care for low and middle income countries provided a method for estimating mental health staffing requirements. Gaps between estimated target and current staffing levels were estimated. Holding prevalence rates constant over time would see a 74 per cent increase in disability-related burden for mental disorders. Projected increases in workforce requirements over the 2010–2050 period are large. Preparation for the increasing burden of mental disorders into the future is essential. A sustained, collaborative approach must be secured to achieve improvements in mental health services and treatment coverage.
    Keywords: Pacific;policy;mental health;burden of disease
    Date: 2015–05–28
  13. By: Roger S. Magnusson; David Patterson
    Abstract: Pacific island countries and territories (PICTs) are some of the most geographically isolated in the world. Most have small populations and economies. In addition to the economic challenges that they face because of isolation and size are the risks of climate disaster and the challenge of non-communicable diseases (NCDs), including cardiovascular disease, cancer, diabetes and tobacco-related diseases. This article builds on knowledge about the key features that characterise effective national responses to NCDs, as embodied in the World Health Organization's Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. It seeks to identify some promising strategies for strengthening the governance and law reform processes that will be required to enhance the capacity of small island states to reduce NCD risks in their populations.
    Keywords: public health;regulation;non-communicable disease;Pacific islands;law
    Date: 2015–05–19
  14. By: Phillip Baker; Adrian Kay; Helen Walls
    Abstract: Trade liberalisation is a driver of the rising burden of non-communicable diseases in Asia through its role in facilitating the growth of the region's tobacco, alcohol and ultra-processed foods industries while simultaneously restricting the capacities of governments to enact public health regulations. This highlights the need for greater coherence between health and trade policy in the region. Yet there has been little analysis of these topics with regard to Asia. What are the barriers and opportunities for enhancing trade and health policy coherence and strengthening governance capacities? How can health, in particular the prevention of non-communicable diseases through curbing risk commodity markets, be positioned more centrally in trade policy? We draw upon a diversity of literature to outline seven key challenges to governing the health–trade nexus as it relates to risk commodities and non-communicable diseases in Asia, and offer suggestions for strengthening capacities.
    Keywords: non-communicable diseases;trade liberalisation;Asia;regulation;governance
    Date: 2015–05–28
  15. By: Sharon Friel1; Patrick Harris; Sarah Simpson; Anjana Bhushan; Britta Baer
    Abstract: Health in All Policies is an approach that seeks to strengthen public policy-making across health and other sectors in order to achieve the most favourable health impacts. There is currently interest in understanding how Health in All Policies is applied in different contexts; whether it makes a difference to policy practices, health outcomes and health equity; and what is required to equip the different sectors to work effectively to improve the health equity impacts of their policies. This article presents findings from a review of domestic policies and practices of Health in All Policies in countries across the World Health Organization Western Pacific Region. The findings illustrate that there is a strong foundation for action, particularly given prior intersectoral action and the important convening point that issues like non-communicable diseases and transport provide for Health in All Policies within the Western Pacific Region. However, the consideration of health equity in Health in All Policies needs more explicit attention. This knowledge can be used for building capacity within the health sector and other sectors to undertake sustainable and effective intersectoral collaboration for improved health equity.
    Keywords: health in all policies;health inequities;Western Pacific;social determinants of health
    Date: 2015–05–28
  16. By: Eun-mee Kim; Eun-hee Ha; Mi-jin Kwon
    Abstract: Although South Korea is one of the newest members to join the Organisation for Economic Co-operation and Development's Development Assistance Committee in 2010, it has a long history of official development assistance (ODA), first as a recipient of aid (1945–1995) and later as an emerging donor (with the establishment of aid-implementing agencies for concessional loans in 1987, and for grant aid in 1991, respectively). And, global public health has been one of the three largest outreach areas of South Korea's foreign aid programmes. This article examines the global public health outreach activities of South Korea's leading aid-implementing agencies, namely Korea International Cooperation Agency, Korea Foundation for International Healthcare and Economic Development and Cooperation Fund, using data for the latest period, 2008–2012. South Korea's innovative global public health ODA through the Global Poverty Eradication Contribution is also examined. The analysis of global public health outreach activities has shown that South Korea has concentrated its foreign aid to Asia and Africa, and that a large share of its aid has been focused on health care services; water, sanitation and hygiene (WASH); maternal and child health (MCH); and infectious diseases. A significant regional difference was found: South Korea's aid focused on health care services and MCH in Asia, while it focused on WASH and infectious diseases in Africa. Findings have also shown that South Korea's priority countries for development cooperation have received more aid compared with non-priority countries. In conclusion, we have found that South Korea's global health outreach activities were in line with the Millennium Development Goals (MDGs), but that they lack a clear focus and do not have globally recognised initiatives or projects compared with large and traditional donors such as the United States and Japan. Further research is needed to examine the impact of the rapidly rising aid activities of South Korea, especially in global public health.
    Keywords: South Korea, global public health;official development assistance;development cooperation;aid
    Date: 2015–05–28
  17. By: Amanda Smullen; Phua Kai Hong
    Abstract: The newly industrialised and high income economies of East Asia perform remarkably well on a range of health system indicators. We adopt an institutional lens to examine and compare the similarities and differences in health care financing and provision in the paired cases of Singapore, Malaysia, Taiwan and South Korea. This illuminates how, despite seemingly common global, regional and functional demands, reformers have responded through diverse means to different institutional constraints. Moreover, some of these cases illuminate the cognizance of reformers with respect to vulnerabilities in their own health care systems enabling effective, albeit ongoing, management.
    Keywords: institutions;health care;East Asia;policy reform;cognizance
    Date: 2015–03–28
  18. By: Pradeep Kumar Choudhury
    Abstract: Using data from the National Family Health Survey (2005–06), this study examines the effect of parental education and the related factors (mother's exposure to mass media and her socio-economic empowerment) in the regional variations in infant mortality in India. The study finds that parental education is significantly associated with reducing infant mortality to a varying degree at the regional level. It is also evident that children born to mothers having any kind of exposure to the mass media are less likely to die during infancy compared with children born to mothers having no mass media exposure. More importantly, parental education works better in regions that are socio-economically underdeveloped. The findings of the study place emphasis on imparting education to mothers along with mass media exposure and higher level of socio-economic empowerment to reduce infant deaths in India and also to minimise its glaring regional variations.
    Keywords: infant mortality;parental education;exposure to mass media;regional variation;India
    Date: 2015–09–09
  19. By: Ted Pinchbeck
    Abstract: In publicly funded health care systems policy-makers face a dilemma: placing low acuity emergency care services outside hospitals may widen access to care and divert patients from making costly hospital visits, but may also attract new patients that have little need for medical care. Using detailed information contained in hospital records, I evaluate the impacts of one type of low acuity service - Walk in Centres (WiCs) in the English National Health Service (NHS) - relying on timing differences in the deployment of a single wave of services and restricting attention to places where new facilities opened to mitigate endogeneity concerns. Results indicate that WiCs have significantly reduced attendances at hospital Emergency Departments in places close by, but suggest that only between 10-20% of patients seen at hospital-based WiCs and between 5-10% patients seen at other WiCs were diverted from the more costly high acuity facilities at hospitals.
    Keywords: emergency care; primary care; Walk in Centres
    JEL: C23 I11 R53
    Date: 2014–12
  20. By: Debebe, Z.Y.; O'Donnell, O.A.; Mebratie, A.D.; Alemu, G.; Bedi, A.S.
    Abstract: Little is known about perceptions of medical expenditure risks despite their presumed relevance to health insurance demand. This paper reports on a unique elicitation of subjective probabilities of medical expenditures from rural Ethiopians who are offered the opportunity to purchase health insurance. We find that expectations are positively correlated with past expenses to a degree that exceeds the serial correlation in realized expenditures, suggesting overestimation of persistence and underestimation of the potential gains from insurance. Despite the fact that forecast expenditures do predict realized expenditures to some extent, there is no evidence that expectations influence the decision to take out health insurance, although plans to insure are positively related to the perceived dispersion of medical expenses.
    Keywords: subjective probability, medical expenditure, out-of-pocket payments, adverse selection, health insurance, Ethiopia
    JEL: D82 D84 O12
    Date: 2015–11–26
  21. By: Nakajima, Makoto (Federal Reserve Bank of Philadelphia); Tuzemen, Didem (Federal Reserve Bank of Kansas City)
    Abstract: An equilibrium model with firm and worker heterogeneity is constructed to analyze labor market and welfare implications of the Patient Protection and Affordable Care Act, commonly called the Affordable Care Act (ACA). The authors’ model implies a significant reduction in the uninsured rate from 22.6 percent to 5.6 percent. The model predicts a moderate positive welfare gain from the ACA because of the redistribution of income through health insurance subsidies at the exchange as well as the Medicaid expansion. About 2.1 million more part-time jobs are created under the ACA at the expense of 1.6 million full-time jobs, mainly because the link between full-time employment and health insurance is weakened. The model predicts a small negative effect on total hours worked (0.36 percent), partly because of the general equilibrium effect.
    Keywords: Health insurance; Health-care reform; Affordable care act; Labor market; Heterogeneous agents
    JEL: D91 E24 E65 I10
    Date: 2015–09–16
  22. By: Laetitia Lebihan (Department of Economics, University of Quebec in Montreal); Catherine Haeck (Department of Economics, University of Quebec in Montreal); Pierre Lefebvre (Department of Economics, University of Quebec in Montreal); Philip Merrigan (Department of Economics, University of Quebec in Montreal)
    Abstract: In this paper, we study the long-run impact of a universal child care policy in Quebec on parental health and parenting practices. Using data from the National Longitudinal Survey of Child and Youth, we follow treated families for more than 9 years and investigate the impact well beyond the first few years of the policy. A non-experimental evaluation framework based on multiple pre- and post-treatment periods is used to estimate the policy effects. We show that the policy increased mothers' depression scores with preschool children as well as scores of inappropriate parenting behavior. The policy increased hostile and aversive parenting and reduced positive interaction and consistent parenting. However, negative effects of the program on parental behaviors vanish when the child is in school. Moreover, we find that this pattern persists even ten years after the implementation of the reform.
    Keywords: universal child care, parental health and behaviors, longer-run effects, child care policy, natural experiment
    JEL: I31 J18 J20
    Date: 2015–11
  23. By: Yukihiro Nishimura (Osaka University [Osaka]); Pierre Pestieau (CEPR - Center for Economic Policy Research - CEPR, CORE - Center of Operation Research and Econometrics [Louvain] - UCL - Université Catholique de Louvain, PSE - Paris-Jourdan Sciences Economiques - ENS Paris - École normale supérieure - Paris - EHESS - École des hautes études en sciences sociales - Institut national de la recherche agronomique (INRA) - École des Ponts ParisTech (ENPC) - CNRS - Centre National de la Recherche Scientifique, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics); Gregory Ponthiere (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 - ENS Paris - École normale supérieure - Paris - EHESS - École des hautes études en sciences sociales - Institut national de la recherche agronomique (INRA) - École des Ponts ParisTech (ENPC) - CNRS - Centre National de la Recherche Scientifique, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics)
    Abstract: We develop a 3-period overlapping generations (OLG) model where individuals borrow at the young age to finance their education. Education does not only increase future wages, but, also, raises the duration of life, which, in turn, affects education choices, in line with Ben Porath (1967). We first identify conditions that guarantee the existence of a stationary equilibrium with perfect foresight. Then, we reexamine the conditions under which the Ben-Porath effect prevails, and emphasize the impact of human capital decay and preferences. We compare the laissez-faire with the social optimum, and show that the latter can be decentralized provided the laissez-faire capital stock corresponds to the one satisfying the modified Golden Rule. Finally, we introduce intracohort heterogeneity in the learning ability, and we show that, under asymmetric information, the second-best optimal non-linear tax scheme involves a downward distortion in the level of education of less able types, which, quite paradoxically, would reinforce the longevity gap in comparison with the laissez-faire.
    Keywords: Education,Life expectancy,OLG models,Optimal policy
    Date: 2015–11
  24. By: Carole Treibich (AMSE - Aix-Marseille School of Economics - EHESS - École des hautes études en sciences sociales - AMU - Aix-Marseille Université - Centre national de la recherche scientifique (CNRS) - Ecole Centrale Marseille (ECM))
    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 fiinancial 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
    Date: 2015–11
  25. By: Bütikofer, Aline (Norwegian School of Economics); Løken, Katrine V. (Department of Economics, University of Bergen); Salvanes, Kjell G. (Norwegian School of Economics)
    Abstract: A growing literature documents the positive long-term effects of policy-induced improvements in early-life health and nutrition. However, there is still scarce evidence on early-life health programs targeting a large share of the population and the role of such programs in increasing intergenerational mobility. This paper uses the rollout of mother and child health care centers in Norway, which commenced in the 1930s, to study the long-term consequences of increasing access to well-child visits. These well-child visits included a physical examination and the provision of information about adequate infant nutrition. Our results indicate that access to mother and child health care centers had a positive effect on education and earnings: access in the first year of life increased the completed years of schooling by 0.15 years and earnings by two percent. The effects were stronger for children from a low socioeconomic background. In addition, we found that individuals suffer from fewer health risks at age 40 and positive effects on adult height, which support the fact that better nutrition within the first year of life is the likely mechanism behind our findings. While there is increasing knowledge on the benefits of various types of early childhood programs, the costs are often neglected, making it hard to compare different programs. We add to this by showing that investments in mother and child health care centers pass a simple cost-benefit analysis.
    Keywords: Well-child visits; early-life interventions; health and inequality
    JEL: I14 I15 I18 I20 J30
    Date: 2015–12–02
  26. By: Barbieri, Paolo Nicola (Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: This paper examines the influence of social norms on obesity. We develop a concept of social norm related to social distortion in weight perception developed through shared experiences in a common social environment with a high prevalence of obesity. The theoretical model show that when obesity is common it less likely to be recognized as a problem by mitigating individual's health concerns. We prove that our empirical measures of such a social component are significant in influencing individual weight using regional data from the Health Survey for England. We use the marked difference in obesity rates between 2002 and 2006 to undertake a Fairlie decomposition analysis. Our findings suggest that when we exclude social norms our estimates explain less than 50% of the obesity gap. When we include the social norms our estimates explain between 50% and 80% of the overall obesity gap. By stratifying the result by gender we are able to prove that men are more susceptible to social distortion, especially the low-skilled. Medium- and low-skilled women, similarly, are more susceptible to environmental pressure than highly-skilled women, who result as being completely unaffected by it. Men are also affected by a broader set of environmental pressures, with respect to women. Overall, these results suggest that an individual's concern over his or her body weight is closely related to the actual weight of his or her reference network.
    Keywords: Obesity; non-linear decomposition; social norm
    JEL: D91 I10 I12 I18 Z13
    Date: 2015–12
  27. By: Johansson, Per (Uppsala University); Laun, Lisa (Institute for Evaluation of Labor Market and Education Policy (IFAU)); Palme, Marten (Dept. of Economics, Stockholm University)
    Abstract: Following an era of a development towards earlier retirement, there has been a reversed trend to later exit from the labor market in Sweden since the late 1990s. We investigate whether or not there are potentials, with respect to health and work capacity of the population, for extending this trend further. We use two different methods. First, the Milligan and Wise (2012) method, which calculates how much people would participate in the labor force at a constant mortality rate. Second, the Cutler et al. (2012) method, which asks how much people would participate in the labor force if they would work as much as the age group 50-54 at a particular level of health. We also provide evidence on the development of self-assessed health and health inequality in the Swedish population.
    Keywords: SHARE; Health inequality
    JEL: I10 J26
    Date: 2015–11–15
  28. By: Fabienne Abadie (European Commission – JRC - IPTS); Wilhelmus Cornelis Graafmans (European Commission – JRC - IPTS); Francisco Lupianez Villanueva (European Commission – JRC - IPTS); Cristiano Codagnone (European Commission – JRC - IPTS)
    Abstract: This SIMPHS3 report on models of organisation aims to identify key elements of the integrated care and independent living models implemented in 23 initiatives (cases) identified across 18 regions in 14 countries - 12 EU Member States plus Israel and the US. These cases cover diverse institutional, organisational, human (in terms of people involved in launching the initiatives) and socio-economic settings which allowed us to gather evidence on a variety of contextual conditions. In spite of having looked for deployed services, and despite a very thorough approach to the selection of cases, a number of cases still have to prove their viability and full deployment is still to be realised. In addition, one case focused on pre-commercial procurement of innovation in healthcare, so as to gain understanding of this rather new approach. This case is out of the scope of the analysis presented here.
    Keywords: Europe 2020, Digital Agenda for Europe, Digital Living, Digital Society, Digital Economy, Information Society Technologies, Health, Emerging ICT technologies, Personal Health Systems, Remote Monitoring and Treatment, SIMPHS3, SIMPHS, ageing, integrated care, independent living, case studies, facilitators, governance, impact, drivers, barriers, integration, organisation
    Date: 2015–11
  29. By: Colin Peter Green; Bruce Philip Hollingsworth; Maria Navarro Paniagua
    Abstract: Two related issues in public policy with respect to alcohol are how increased availability influences consumption and what effect excess consumption has on individual health outcomes. This paper examines one particular source of variation in availability, bar opening hours, and how this influences alcohol consumption, physical and mental health. We focus on the extension of opening hours in England and Wales that occurred in 2005. We demonstrate a marked increase in consumption, which appears to be concentrated in heavy drinking. This increase in consumption is subsequently demonstrated to lead to deterioration in both individual physical and mental health outcomes. This has important policy implications for the regulation of alcohol availability.
    Keywords: Alcohol Availability, Health, Alcohol Consumption
    JEL: I12 I18
    Date: 2015
  30. By: Nan L. Maxwell; Nathan Wozny
    Abstract: Policymakers might draw incorrect conclusions about the risk of a workplace injury becoming a disability unless the research provides a joint assessment of incidence rates and disability probabilities and a comprehensive analysis of risk factors across worker groups.
    Keywords: Disability, work-related injuries
    JEL: I J
    Date: 2015–11–30
  31. By: Catherine M. DesRoches; Kirsten Barrett
    Keywords: national physician sampling frames
    JEL: I
    Date: 2015–10–30
  32. By: Galen Chin-Lun Hung; Stefanie A. Pietras; Hannah Carliner; Laurie Martin; Larry J. Seidman; Stephen L. Buka; Stephen E. Gilman
    Abstract: The authors conducted a cohort study using data from 633 participants in the New England Family Study with lifetime depression. Cognitive abilities at age 7 were measured using the Wechsler Intelligence Scale for Children. Depression outcomes were assessed using structured diagnostic interviews administered up to four times in adulthood between ages 17 and 49.
    Keywords: Depression, Cognitive Ability, Childhood
    JEL: I
    Date: 2015–11–19
  33. By: Marsha Gold; Mynti Hossain; Amy Mangum
    Abstract: Policymakers want health information technology (health IT) to support consumer engagement to help achieve national health goals. In this paper, we review the evidence to compare the rhetoric with the reality of current practice.
    Keywords: Health Information Technology, Patient Engagement, Health Delivery Reform, Patient Centered Health Care
    JEL: I
    Date: 2015–11–23
  34. By: Gina Livermore; Maura Bardos
    Abstract: In this brief, the authors document the characteristics and work-related experiences of beneficiaries who work and earn at relatively high levels, and compare them with other working and nonworking beneficiaries.
    Keywords: Disability, employment, Social Security Disability Insurance, Supplemental Security Income, National Beneficiary Survey
    JEL: I J
    Date: 2015–11–30
  35. By: Matthew Kehn; Rebecca Kleinman; Allison Wishon Siegwarth; Jonathan Brown
    Keywords: Mental health, substance abuse, state medicaid initiatives
    JEL: I
    Date: 2015–02–27
  36. By: Rebecca Kleinman; Matthew Kehn; Allison Wishon Siegwarth; Jonathan Brown
    Abstract: This Issue Brief describes the strategies used by four states—Louisiana, Massachusetts, Tennessee, and Illinois—to improve the link between Medicaid and housing services for adult Medicaid beneficiaries with behavioral health conditions.
    Keywords: Medicaid services, state strategies, housing, behavioral health
    JEL: I
    Date: 2015–04–30
  37. By: Helen Levy (University of Michigan); Thomas Buchmueller (University of Michigan); Sayeh Nikpay (University of Michigan)
    Abstract: Many studies have shown that the availability of health insurance is an important determinant of the retirement decision. Beginning in January 2014, the Affordable Care Act (ACA) made affordable alternatives to employer-sponsored health insurance much more widely available than they had been previously through the establishment of health insurance exchanges and, in some states, the expansion of Medicaid eligibility to low-income, childless adults. We analyze whether these new health insurance options led to an increase in retirement or part-time work among individuals ages 55 through 64 during the first 18 months after the policy took effect. Using data from the basic monthly Current Population Survey from January 2005 through June 2015, we find that there was no increase in retirement in 2014 either overall or in Medicare expansion states relative to nonexpansion states. We also find no change in the fraction of older workers who are working part-time.
    Date: 2015–09
  38. By: Le, Huong; Nguyen, Ha
    Abstract: This paper contributes to an emerging body of literature on intergenerational transmission in health by presenting the first causal estimates on the impact of maternal mental health on child health. The potential endogeneity of maternal mental health is dealt with by utilising nationally representative panel data from two cohorts and individual fixed effects instrumental variables models. While previous literature has found evidence supporting detrimental effects of poor maternal mental health on child health our results found no evidence to support this. Our results hold irrespective of whether we look at the contemporaneous or intertemporal effects. We also found little differential impact based on the gender or age of the child and the levels of maternal education or household income. These results demonstrate that failing to account for endogeneity of maternal mental health could over-estimate the harmful impact of poor maternal mental health on child health. Our findings are robust to a battery of sensitivity and specification tests.
    Keywords: Intergenerational transmission, health, instrumental variables, panel data, Australia
    JEL: C23 C26 I14 J13
    Date: 2015–12–02
  39. By: Brañas-Garza, Pablo; Espín, Antonio M.; Lenkei, Balint
    Abstract: Over the past few decades obesity has become one of the largest public policy concerns among the adult population in the developed world. Obesity and overweight are hypothesized to affect individuals’ sociability through a number of channels, including discrimination and low self-esteem. However, whether these effects translate into differential behavioural patterns in social interactions remains unknown. In two large-scale economic experiments, we explore the relationship between Body Mass Index (BMI) and social behaviour, using three paradigmatic economic games: the dictator, ultimatum, and trust games. Our first experiment employs a representative sample of a Spanish city's population (N=753), while the second employs a sample of university students from the same city (N=618). Measures of altruism, fairness/equality, trust and reciprocity are obtained from participants’ experimental decisions. Using a variety of regression specifications and control variables, our results suggest that BMI does not exert an effect on any of these social preferences. Some implications of these findings are discussed.
    Keywords: BMI; ultimatum game; dictator game; trust game; economic experiments; obesity; social preferences
    JEL: I12
    Date: 2015
  40. By: Mandal, Biswajit
    Abstract: Using data from National Family Health Survey-3 (NFHS-3) for India this paper attempts to look at various socioeconomic factors that account for the demand for maternal health inputs in an Indian state-West Bengal. Conditional Mixed Process estimation is used to estimate the demand functions for prenatal care and hospital delivery. We jointly estimate both these equations to control for selection bias in the use of health inputs. However, exogenous estimation results are also provided. It has been observed that the place of residence, standard of living, and educational level of women are those covariates that remarkably increase the demand for both the maternal health inputs. An impression we derive from the analysis is that the infrastructural facilities, supply of health professionals, workers, educational attainment of women have to be emphasized on to contain the undesired problems during pregnancy and child-birth. At the same time access to information and whether the women can keep some money for own use also raise the demand for quality care associated with pregnancy. This also indicates a linkage between mother’s autonomy and healthcare utilization behavior.
    Keywords: Health demand, Behavioral factors, Government policy
    JEL: D11 I12 I18
    Date: 2015–09
  41. By: Muhammad Nasir (Department of Economics, Clark University, USA); Marc Rockmore (Department of Economics, Clark University, USA); Chih Ming Tan (Department of Economics, University of North Dakota, USA; The Rimini Centre for Economic Analysis, Italy)
    Abstract: Exposure to violence has been found to affect behavioral parameters, mental health and social interactions. The literature focuses on large scale political violence. The effects of high levels of criminal violence – a common phenomenon in Latin America and the Caribbean – are largely unknown. We examine drug violence in Mexico and, I particular, the effects of exposure to high municipal levels of homicides on risk aversion, mental health and pro-social behavior. Using a nonlinear difference-in-differences (DID) model and data from the 2005-06 and 2009-12 waves of the Mexican Family Life Survey, we find that the surge in violence in Mexico after 2006 significantly increased risk aversion and reduced trust in civic institutions while simultaneously strengthening kinship relationships. Although the deterioration of mental health due to violence exposure has been hypothesized to explain changes in risk aversion, we find no such effect. This suggests that the literature may be potentially missing out on other relevant channels.
    Date: 2015–11
  42. By: Marie Christine Ho (Singapore Management University)
    Abstract: Incense burning for rituals or religious purposes is an important tradition in many countries. However, incense smoke contains particulate matter and gas products such as carbon monoxide, sulfur and nitrogen dioxide, which are potentially harmful to health. We analyzed the relationship between prenatal incense burning and birth weight and head circumference at birth using the Taiwan Birth Cohort Study. We performed multivariate regression analysis on a sample of 15,773 Taiwanese babies born in 2005 and controlled extensively for factors that may be correlated with incense burning and birth outcomes. Prenatal incense burning environment was associated with lower birth weight and smaller head circumference at birth, especially for boys and especially for the lower quantiles of the distributions of birth outcomes.
    Date: 2015–09
  43. By: Ohid Yaqub (SPRU — Science Policy Research Unit, University of Sussex, Brighton, UK)
    Abstract: This paper highlights two variables, neglected by economists, that I argue are important in explaining patterns of innovation seen in vaccines and perhaps in other parts of medicine too. They are: firstly, the extent to which it is safe to experiment on humans; and secondly, whether good animal models can be identified and used, with the latter especially important if there are strong constraints on experimenting with humans. To consider the argument, the paper discusses the case of vaccines, where the political economy of R&D appears to explain only part of the observed variation. I focus on HIV vaccine development and find that, together, these two variables not only make up a large part of how I would characterize ‘difficulty’ in the HIV R&D process, but they also seem to go a long way towards explaining why 31 other diseases have – or have not had vaccines developed for them. In characterizing these variables, I discuss what might happen if we choose to persist in difficult R&D domains, finding that development may be forced into trajectories that yield lower quality products. Counter intuitively, such lower quality products are typically more expensive because they are harder to pass through clinical trials. Implications for theory and policy are discussed, chief of which are that the technical difficulty of R&D is not fixed and can be shifted by policy, and that difficult R&D trajectories need not be pursued when alternative trajectories can be developed.
    Date: 2015–11
  44. By: Max Coveney (Erasmus University Rotterdam); Pilar Garcia Gomez (Erasmus University Rotterdam); Eddy Van Doorslaer (Erasmus University Rotterdam); Tom Van Ourti (Erasmus University Rotterdam, the Netherlands)
    Abstract: Little is known about what the economic crisis has done to health disparities by income. We apply a decomposition method to unravel the contributions of income growth, income inequality and differential income mobility across socio-demographic groups to changes in health disparities by income in Spain using longitudinal data from the Survey of Income and Living Conditions (SILC) for the period 2004-2012. We find a modest rise in health inequality by income in Spain in the five years of economic growth prior to the start of the crisis in 2008, but a sharp fall after 2008. The drop mainly derives from the fact that loss of employment and earnings has disproportionately affected the incomes of the younger and healthier groups rather than the (mainly stable pension) incomes of the over 65s. This suggests that unequal distribution of income protection by age may reduce health inequality in the short run after an economic recession.
    Keywords: economic crisis; health inequality; Spain
    JEL: D30 D63 I14 I15
    Date: 2015–12–03
  45. By: Cormac Ó Gráda
    Abstract: Ebola and plague share several characteristics, even though the second and third plague epidemics dwarfed the 2014-15 Ebola outbreak in terms of mortality. This essay reviews the mortality due to the two diseases and their lethality; the spatial and socioeconomic dimensions of plague mortality; the role of public action in containing the two diseases; and their economic impact.
    Keywords: Plague; Mortality; Health; Economic history
    JEL: I1 N
    Date: 2015–11
  46. By: Dang, Rui
    Abstract: This paper is the first to estimate the causal effect of local human capital stock on individual adiposity and adds to the existing literature on estimating human capital externalities at the neighborhood level. We explore the possible causal pathways that college-educated neighbors exert on individual body weight, with the results revealing small yet significant human capital spillover effects. Among all adults, a percentage point increase in the neighborhood college graduates share results in a decrease of individual body mass index by 0.0026 log points, as well as a decrease of the individual likelihood of being overweight by 0.77 percentage points. Among high school graduates and college graduates, a percentage point increase in the neighborhood college graduates share results in a decrease of individual likelihood of being overweight by approximately 0.83 percentage points.
    Abstract: Diese Studie bewertet zunächst die kausalen Auswirkungen von lokalem Bildungskapital auf individuelle Adipositas-Fälle und ergänzt die bestehende Literatur über die Auswirkungen des geschätzten Bildungskapitals auf Nachbarschaftsebene. Wir untersuchen die möglichen kausalen Zusammenhänge, dass Nachbarn mit Hochschulbildung Einfluss auf das individuelle Körpergewicht haben, mit dem Ergebnis kleiner, jedoch signifikanter Auswirkungen auf das Bildungskapital. Unter sämtlichen Erwachsenen teilt der Anstieg von einem Prozentpunkt unter Hochschulabsolventen in der Nachbarschaft die Ergebnisse mit der Abnahme des individuellen Body-Mass-Index in Höhe von 0.0026 Protokollpunkten, ebenso wie eine Abnahme der individuellen Wahrscheinlichkeit von Übergewicht in Höhe von 0.77 Prozentpunkten. Unter den Abiturienten und Hochschulabsolventen teilt der Anstieg von einem Prozentpunkt unter Hochschulabsolventen in der Nachbarschaft die Ergebnisse mit der individuellen Wahrscheinlichkeit zur Übergewichtigkeit in Höhe von 0.83 Prozentpunkten.
    Keywords: obesity,local human capital externalities,control function,non-random sorting
    JEL: I00 R23
    Date: 2015

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