nep-hea New Economics Papers
on Health Economics
Issue of 2015‒12‒28
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Cost per DALY averted thresholds for low- and middle-income countries: evidence from cross country data By Jessica Ochalek; James Lomas; Karl Claxton
  2. Modelling Eligibility for Medical Cards and GP Visit Cards: Methods and Baseline Results By Callan, Tim; Colgan, Brian; Keane, Claire; Walsh, John
  3. Income-Related Subsidies for Universal Health Insurance Premia: Exploring Alternatives Using the SWITCH Model By Callan, Tim; Colgan, Brian; John Walsh
  4. How Does Promotion to a Managerial Position Affect Mental Health? (Japanese) By SATO Kazuma
  5. Can Pay-for-Performance to Primary Care Providers Stimulate Appropriate Use of Antibiotics? By Anell, Anders; Dietrichson, Jens; Ellegård , Lina Maria
  6. Targets for maximum waiting times and patient prioritisaton: evidence from England By Arthur Sinko; Silviya Nikolova; Matt Sutton
  7. Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care By Andrea Wysocki; Mary Butler; Robert L. Kane; Rosalie A. Kane; Tetyana Shippee; François Sainfort
  8. Functional Improvement Among Short-Stay Nursing Home Residents in the MDS 3.0 By Andrea Wysocki; Kali S. Thomas; Vincent Mor
  9. Federal Financial Benefits and Health Care Coverage for Veterans with Disabilities By Lucy Miller; John Kregel
  10. Prescription Drug Advertising and Drug Utilization: The Role of Medicare Part D By Abby Alpert; Darius Lakdawalla; Neeraj Sood
  11. Impacts of Being Downwind of a Coal-Fired Power Plant on Infant Health at Birth: Evidence from the Precedent-Setting Portland Rule By Muzhe Yang; Shin-Yi Chou
  12. It’s About Time: Effects of the Affordable Care Act Dependent Coverage Mandate On Time Use By Gregory Colman; Dhaval Dave
  13. Identifying the Cost of a Public Health Success: Arsenic Well Water Contamination and Productivity in Bangladesh By Mark M. Pitt; Mark R. Rosenzweig; Nazmul Hassan
  14. Short-run Effects of Parental Job Loss on Child Health By Jessamyn Schaller; Mariana Zerpa
  15. Information Frictions and Adverse Selection: Policy Interventions in Health Insurance Markets By Benjamin R. Handel; Jonathan T. Kolstad; Johannes Spinnewijn
  16. Listen to your Doctor, or else!: Medication Under-use and Overuse and Long-term Health Outcomes of Danish Diabetes Patients By Gisela Hostenkamp; Frank R. Lichtenberg
  17. Internalizing Behavioral Externalities: Benefit Integration in Health Insurance By Amanda Starc; Robert J. Town
  18. Menthol Cigarette Advertising and Cigarette Demand By Donald Kenkel; Alan Mathios; Hua Wang
  19. Inferring Risk Perceptions and Preferences using Choice from Insurance Menus: Theory and Evidence By Keith Marzilli Ericson; Philipp Kircher; Johannes Spinnewijn; Amanda Starc
  20. Historical Origins of a Major Killer: Cardiovascular Disease in the American South By Richard H. Steckel; Garrett Senney
  21. The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured By Zack Cooper; Stuart V. Craig; Martin Gaynor; John Van Reenen
  22. Do Wealth Shocks Affect Health? New Evidence from the Housing Boom By Eleonora Fichera; John Gathergood
  23. Parental health and children’s cognitive and non-cognitive development: New evidence from the Longitudinal Survey of Australian Children By Huong Thu Le; Ha Trong Nguyen
  24. Intergenerational Transmission in Health: Causal estimates from fixed effects instrumental variables models for two cohorts of Australian children By Huong Thu Le; Ha Trong Nguyen
  25. Body Weight and Gender: Academic Choice and Performance By Barone, Adriana; Nese, Annamaria
  26. Feeling Useless: The Effect of Unemployment on Mental Health in the Great Recession By Lídia Farré; Francesco Fasani; Hannes Mueller
  27. International Trade and Determinants of Price Differentials of Insulin Medicine By Helble, Matthias; Aizawa, Toshiaki

  1. By: Jessica Ochalek (Centre for Health Economics, University of York, UK.); James Lomas (Centre for Health Economics, University of York, UK); Karl Claxton (Centre for Health Economics, University of York, UK.)
    Abstract: Low- and middle-income countries (LMICs) face difficult decisions about which health care interventions are worthwhile given existing constraints on health care expenditure. Decisions require some assessment of the health opportunity costs of proposed investments, i.e., a ‘supply side’ cost-effectiveness threshold (CET) that represents the likely health effects of changes in health care expenditure. This paper provides a framework for generating country-level CETs using existing published estimates of the mortality effect of health expenditure. Two different estimation strategies are used (Bokhari et al (2007) and Moreno-Serra and Smith (2015)) and, where possible, estimation is extended to include other measures of mortality, survival and disability outcomes, reflecting the demographic and other characteristics of each LMIC. The results suggest that CETs representing likely health opportunity costs tend to be below the lower bound suggested by WHO of 1x GDP per capita. Hence, many previous and existing recommendations about which interventions are cost-effective that are based on the WHO threshold are likely to do more harm than good.
    Date: 2015–12
  2. By: Callan, Tim; Colgan, Brian; Keane, Claire; Walsh, John
    Abstract: The Irish healthcare system includes a complex mix of entitlements – some are universal, others age-related, and some are income-related. In this report, we concentrate on the major income-related entitlements in the current system i.e., the Medical Card and the GP Visit Card. Most medical cards are provided on an income-tested basis, and provide free access to in-patient and out-patient care in public hospitals, to GP care, and to prescription drugs. We examine how the income test for such schemes can be modelled using the detailed income and demographic information in the Survey on Income and Living Conditions. The approach taken applies the rules for income-related cards to each family in this nationally representative sample, using the information they provide on incomes and family composition. This is essential groundwork for later studies which will examine how the pattern of entitlements might change under different rules, such as those introducing age-related entitlements to GP visit cards, or changes in income limits.
    Date: 2015–11
  3. By: Callan, Tim; Colgan, Brian; John Walsh
    Abstract: The Programme for Government indicated that under a Universal Health Insurance system, the State would “pay insurance premia for people on low incomes and subsidise premia for people on middle incomes”. This paper examines issues in the design of such a subsidy scheme, in the context of overall premium costs as estimated by Wren et al. (2015) and the KPMG (2015) study for the Health Insurance Authority. Subsidy design could involve a step-level system, similar to the medical card and GP visit card in the current system; or a smooth, tapered withdrawal of the subsidy, similar to what obtains for many cash benefits in the welfare system. The trade-offs between the income limit up to which a full subsidy would be payable, the rate of withdrawal of subsidy with respect to extra income and overall subsidy cost are explored.
    Date: 2015–11
  4. By: SATO Kazuma
    Abstract: This study examines the effect of a promotion to a managerial position on mental health by using the Survey on Human Capital Formation and Work-life Balance conducted by the Research Institute for Economy, Trade and Industry (RIETI). The analysis clarified the following three findings. First, although mental health deteriorates in the year of the promotion, it improves in the following year. This result indicates that supporting workers who have been promoted recently is effective in preventing mental health from deteriorating. Second, analysis by gender showed that promotions have a negative effect on the mental health of male workers. Third, a robustness check using the Keio Household Panel Survey (KHPS) showed that mental health deteriorates in the year of the promotion. However, mental health is not affected as observed in annual intervals up to three years post- promotion.
    Date: 2015–12
  5. By: Anell, Anders (Department of Business Administration, Lund University); Dietrichson, Jens (SFI - The Danish National Centre for Social Research); Ellegård , Lina Maria (Department of Economics, Lund University)
    Abstract: Resistance to antibiotics is a major threat to the effectiveness of modern health care. This study examines if pay-for-performance (P4P) to care providers stimulates the appropriate use of antibiotics; in particular, if P4P can induce a substitution away from broad-spectrum antibiotics, which contribute more to the development of resistance, to less resistance-driving types. In the context of Swedish primary care, we study the introduction of P4P indicators encouraging substitution of narrow-spectrum antibiotics for broad-spectrum antibiotics in the treatment of children with respiratory tract infections (RTI). During 2006-2013, 8 out of 21 county councils introduced such P4P indicators in their reimbursement schemes for primary care providers. We employ municipality-level register data covering all purchases of RTI related antibiotics and exploit the staggered introduction of pay-for-performance in a difference-in-differences analysis. Despite that the monetary incentives were small, we find that P4P significantly increased narrow-spectrum antibiotics' share of RTI antibiotics consumption. We further find larger effects in areas where there were many private providers, where the incentive was formulated as a penalty rather than a reward, and where all providers were close to a P4P target.
    Keywords: pay-for-performance; antibiotics resistance; primary care
    JEL: D23 H73 I11 I18 J33 J38
    Date: 2015–12–15
  6. By: Arthur Sinko (Economics, School of Social Sciences,University of Manchester, Manchester, U.K.); Silviya Nikolova (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Matt Sutton (Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, U.K.)
    Abstract: This paper develops a model for managing hospital waiting lists with two types of patients. The model focuses on answering how hospital priorities change following the introduction of targets for maximum waiting times and how uncertainty about future queue streams impact on this decision making. The paper shows that the main mechanism for meeting the target is reducing the waiting times for long-waiting patients at the expense of short-waiting patients. We test the model using administrative hospital data for the English NHS. We detect statistically significant changes in prioritisation between different groups of patients.
    Keywords: managing waiting times, maximum waiting time targets, conditional density estimation
    JEL: I18
    Date: 2015
  7. By: Andrea Wysocki; Mary Butler; Robert L. Kane; Rosalie A. Kane; Tetyana Shippee; François Sainfort
    Abstract: Despite a shift from institutional services toward more home and community-based services (HCBS) for older adults who need long-term services and supports (LTSS), the effects of HCBS have yet to be adequately synthesized in the literature.
    Keywords: comparative effectiveness review , home- and community-based services , nursing homes
    JEL: I
    Date: 2015–05–05
  8. By: Andrea Wysocki; Kali S. Thomas; Vincent Mor
    Abstract: This article examines the completeness of the activities of daily living (ADL) items on admission and discharge assessments and the improvement in ADL performance among short-stay residents in the newly adopted Minimum Data Set (MDS) 3.0.
    Keywords: Nursing home, Minimum Data Set (MDS), functional improvement
    JEL: I
    Date: 2015–06–01
  9. By: Lucy Miller; John Kregel
    Keywords: Veteran benefits, health care coverage, disability
    JEL: I J
    Date: 2015–12–04
  10. By: Abby Alpert; Darius Lakdawalla; Neeraj Sood
    Abstract: Pharmaceutical firms currently spend over $4 billion on direct-to-consumer advertising (DTCA) of prescription drugs, a nearly 30-fold increase since 1993 that has led to much debate about its value to patients. We examine how DTCA influences drug utilization along the extensive and intensive margins by exploiting a large and plausibly exogenous shock to DTCA driven by the introduction of Medicare Part D in 2006. Using data on advertising for local media markets from Nielsen, we show that Part D led to large relative increases in DTCA in geographic areas with a high concentration of Medicare beneficiaries compared to areas with a low concentration. We examine the effects of this sudden differential increase in advertising on non-elderly individuals to isolate the effects of advertising on drug utilization from the direct effects of Part D. Using data from pharmacy claims, we find substantial differential increases in drug utilization that mirror the increases in DTCA after Part D. These effects are driven both by increased take-up of treatment and improved drug adherence. Our results imply significant spillovers from Medicare Part D onto the under-65 population and an important role for non-price factors in influencing prescription drug utilization.
    JEL: H51 I10 I18
    Date: 2015–11
  11. By: Muzhe Yang; Shin-Yi Chou
    Abstract: We conduct the first study on the impacts of prenatal exposure to a uniquely identified large polluter, a coal-fired power plant located near the border of two states, on the birth outcomes of the downwind state. For mothers who live as far as 20 to 40 miles away but downwind of the power plant, being exposed to power plant emissions, in particular sulfur dioxide, during the first month of pregnancy could increase the likelihood of having full-term babies but with low birth weight, an indicator of slow fetal growth, by as much as 42 percent. This adverse impact could be driven by reactive sulfur species-induced intrauterine oxidative stress, arising from maternal exposure to emissions of sulfur dioxide, whose travelling from the emission source to the downwind region has been confirmed in the Portland Rule. In light of EPA’s continual efforts in regulating power plant emissions, our study is aimed at broadening the scope of cross-border pollution analysis by taking into account adverse infant heath impacts from upwind polluters, which can burden the downwind states disproportionately.
    JEL: H23 I1
    Date: 2015–11
  12. By: Gregory Colman; Dhaval Dave
    Abstract: One of the main purposes of the Patient Protection and Affordable Care Act (ACA) is to enable Americans to make more productive use of their time. This is apparent in the rationale given for the ACA’s extension of dependent care coverage, which requires employer-sponsored insurance plans that cover the children of insured workers to continue to cover these dependents until they turn 26. A number of studies have examined the effect of the dependent care coverage provision on insurance coverage, health, healthcare utilization, and labor supply among young adults. None that we are aware of has directly examined effects on time use. If, as suggested by prior work, the provision reduced the amount of time young adults work, the question arises, what have these adults done with the extra time? A related question is whether the change made them better off. We use the American Time Use Survey from 2003-2013 to answer these two main questions, providing several contributions to the literature on the ACA. Models are based on a difference-in-differences framework, and the results suggest that the ACA’s dependent coverage provision has reduced job-lock, as well as the duration of the average doctor’s visit, including time spent waiting for and receiving medical care, among persons ages 19-25. The latter effect is consistent with a substitution from hospital ER utilization to greater routine physician care. The extra time has gone into socializing, and to a lesser extent, into education and job search. Availability of insurance and change in work time appear to have increased young adults’ subjective well-being, enabling them to spend time on activities they view as more meaningful than those they did before insurance became available.
    JEL: H0 I1 J2
    Date: 2015–11
  13. By: Mark M. Pitt; Mark R. Rosenzweig; Nazmul Hassan
    Abstract: We exploit recent molecular genetics evidence on the genetic basis of arsenic excretion and unique information on family links among respondents living in different environments from a large panel survey within a theoretical framework incorporating optimizing behavior to uncover the hidden costs of arsenic poisoning in Bangladesh. We provide for the first time estimates of the effects of the ingestion and retention of inorganic arsenic on direct measures of cognitive and physical capabilities as well as on the schooling attainment, occupational structure, entrepreneurship and incomes of the rural Bangladesh population. We also provide new estimates of the effects of the consumption of foods grown and cooked in arsenic-contaminated water on individual arsenic concentrations. The estimates are based on arsenic biomarkers obtained from a sample of members of rural households in Bangladesh who are participants in a long-term panel survey following respondents and their coresident household members over a period of 26 years.
    JEL: I15
    Date: 2015–11
  14. By: Jessamyn Schaller; Mariana Zerpa
    Abstract: Recent research suggests that parental job loss has negative effects on children's outcomes, including their academic achievement and long-run educational and labor market outcomes. In this paper we turn our attention to the effects of parental job loss on children's health. We combine health data from 16 waves of the Medical Expenditure Panel Survey, which allows us to use a fixed effects specification and still have a large sample of parental job displacements. We find that paternal job loss is detrimental to the physical and mental health of children in low-socioeconomic status (SES) families, increasing their incidence of injuries and mental disorders. We separately find that maternal job loss leads to reductions in the incidence of infectious illness among children in high-SES families, possibly resulting from substitution of maternal care for market-based childcare services. Increases in public health insurance coverage compensate for a large share of the loss in private coverage that follows parental displacement, and we find no significant changes in routine or diagnostic medical care.
    JEL: I1 I12 I13 J0 J6
    Date: 2015–11
  15. By: Benjamin R. Handel; Jonathan T. Kolstad; Johannes Spinnewijn
    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.
    JEL: D8 D82 G22 I11 I13
    Date: 2015–11
  16. By: Gisela Hostenkamp; Frank R. Lichtenberg
    Abstract: We use Danish diabetes registry and health insurance data to analyze the extent, consequences, and determinants of under-use and overuse of oral anti-diabetic drugs. Less than half of patients consume the appropriate amount of medication--between 90% and 110% of the amount prescribed by their doctors. The life expectancy of patients consuming the appropriate amount is 2.5 years greater than that of patients consuming less than 70% of the prescribed amount, and 3.2 years greater than that of patients consuming more than 130% of the prescribed amount, controlling for time since diagnosis, insulin dependence, comorbidities, age, gender and education. Patients consuming the appropriate amount are also less likely to be hospitalized than under- or over-users. Pharmaceutical innovation appears to have reduced medication under-use and overuse: patients using newer drugs are significantly more likely to consume the appropriate amount, controlling for socioeconomic factors, average number of pills and average daily out-of-pocket costs. Defined Daily Doses published by the World Health Organization substantially overstate the appropriate level of consumption of these medications. Patients who don’t adhere to recommended medication regimens may also disregard other physician instructions. Medication under-use and overuse could easily be monitored to identify patients at risk and enact interventions.
    JEL: I1 O33
    Date: 2015–12
  17. By: Amanda Starc; Robert J. Town
    Abstract: We show that profit-maximizing firms alter product design in the market for Medicare prescription drug coverage to account for underutilization by consumers. Using plausibly exogenous variation in coverage, we examine prescription drug utilization under two different plan structures. We document that plans that cover all medical expenses spend more on drugs than plans that are only responsible for prescription drug spending, consistent with drug spending offsetting some medical costs. The effect is driven by drugs that are likely to generate substantial offsets. Our supply side model confirms that differential incentives across plans can explain this disparity. Counterfactuals show that the externality created by stand-alone drug plans is $405 million per year. Finally, we explore the extent to which subsidies and information provision can mitigate the externality generated by under-consumption.
    JEL: I13 L2
    Date: 2015–12
  18. By: Donald Kenkel; Alan Mathios; Hua Wang
    Abstract: The FDA is considering using its regulatory authority over the tobacco industry to promote public health by restricting the advertising of menthol cigarettes. In this paper we contribute new empirical evidence on the effects of magazine advertisements for menthol cigarettes on cigarette demand. Unlike previous research on cigarette advertising and demand, we use individual-level data and a measure of advertising exposure based on each consumer’s magazine-reading habits. These data allow us to control for individual heterogeneity that influences both advertising exposure and cigarette demand. We exploit quasi-experimental variation in advertising exposure in the 2000s created by sharply different supply-side variation in menthol and non-menthol advertising. We examine the importance of controlling for heterogeneity by estimating simple models relating advertising exposure to behavior and then adding specifications that take advantage of the richness of our individual-level data. We examine advertising effects on multiple margins of cigarette demand. Our empirical results do not provide any evidence that menthol advertising in magazines affects cigarette demand at various margins: the probability of menthol use; smoking participation; the number of cigarettes smoked per day; the probability of a past-year quit attempt; and anti-smoking attitudes among teens.
    JEL: I12
    Date: 2015–12
  19. By: Keith Marzilli Ericson; Philipp Kircher; Johannes Spinnewijn; Amanda Starc
    Abstract: Demand for insurance can be driven by high risk aversion or high risk. We show how to separately identify risk preferences and risk types using only choices from menus of insurance plans. Our revealed preference approach does not rely on rational expectations, nor does it require access to claims data. We show what can be learned non-parametrically from variation in insurance plans, offered separately to random cross-sections or offered as part of the same menu to one cross-section. We prove that our approach allows for full identification in the textbook model with binary risks and extend our results to continuous risks. We illustrate our approach using the Massachusetts Health Insurance Exchange, where choices provide informative bounds on the type distributions, especially for risks, but do not allow us to reject homogeneity in preferences.
    JEL: D8 I13
    Date: 2015–12
  20. By: Richard H. Steckel; Garrett Senney
    Abstract: When building major organs the fetus responds to signals via the placenta that forecast post-natal nutrition. A mismatch between expectations and reality creates physiological stress and elevates several noninfectious chronic diseases. Applying this concept, we investigate the historical origins of cardiovascular disease (CVD) in the American South using rapid income growth from 1950 to 1980 as a proxy for socioeconomic forces that created unbalanced physical growth among southern children born after WWII. Using state-level data on income growth, smoking, obesity and education, we explain over 70% of the variance in current CVD mortality rates across the country.
    JEL: I15 N32
    Date: 2015–12
  21. By: Zack Cooper; Stuart V. Craig; Martin Gaynor; John Van Reenen
    Abstract: We use insurance claims data for 27.6 percent of individuals with private employer-sponsored insurance in the US between 2007 and 2011 to examine the variation in health spending and in hospitals’ transaction prices. We document the variation in hospital prices within and across geographic areas, examine how hospital prices influence the variation in health spending on the privately insured, and analyze the factors associated with hospital price variation. Four key findings emerge. First, health care spending per privately insured beneficiary varies by a factor of three across the 306 Hospital Referral Regions (HRRs) in the US. Moreover, the correlation between total spending per privately insured beneficiary and total spending per Medicare beneficiary across HRRs is only 0.14. Second, variation in providers’ transaction prices across HRRs is the primary driver of spending variation for the privately insured, whereas variation in the quantity of care provided across HRRs is the primary driver of Medicare spending variation. Consequently, extrapolating lessons on health spending from Medicare to the privately insured must be done with caution. Third, we document large dispersion in overall inpatient hospital prices and in prices for seven relatively homogenous procedures. For example, hospital prices for lower-limb MRIs vary by a factor of twelve across the nation and, on average, two-fold within HRRs. Finally, hospital prices are positively associated with indicators of hospital market power. Even after conditioning on many demand and cost factors, hospital prices in monopoly markets are 15.3 percent higher than those in markets with four or more hospitals.
    JEL: I11 L10 L11
    Date: 2015–12
  22. By: Eleonora Fichera; John Gathergood
    Abstract: We exploit wealth shocks arising from housing wealth gains to examine the relationship between wealth and health. In UK household panel data positive housing wealth gains lower the likelihood of home owners exhibiting a range of non-chronic health conditions with no effect on renters. For owners housing wealth gains change health behaviours: increasing use of private health care, reducing hours of work (especially for women) and increasing time dedicated to exercise. Housing wealth gains, unlike income gains, do not increase risky health behaviours such as smoking and drinking. Furthermore, house prices highly pro-cyclical. The positive health effects of housing wealth gains on home owner health over the business cycle offset the negative health effects of labour market conditions and work intensity.
    Keywords: health, wealth, housing wealth, house prices
    Date: 2015
  23. By: Huong Thu Le (Queensland University of Technology); Ha Trong Nguyen (Bankwest Curtin Economics Centre, Curtin University)
    Abstract: This paper examines the effects of maternal and paternal health on cognitive and non-cognitive development in Australian children. The underlying nationally representative panel data and a child fixed effects estimator are used to overcome most of the previous cross-sectional study limitation in dealing with unobserved heterogeneity. While previous literature has found evidence supporting the adverse impact of poor parental health on child development our results found little evidence to support this. We also found little differential effect based on the gender of the child, the parent, or household income levels. However, we found a small amount of evidence suggesting that poor parental health may worsen some cognitive and non-cognitive skills of young children only. Our results demonstrate that either failing to account for parent-child fixed effects or using child non-cognitive skills reported by parents could over-estimate the harmful impact of poor parental health on child development.
    Keywords: Intergenerational transmission, health, education, panel data, Australia
    JEL: I14 J24
    Date: 2015–11
  24. By: Huong Thu Le (Queensland University of Technology); Ha Trong Nguyen (Bankwest Curtin Economics Centre, Curtin University)
    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: Anchoring vignettes, self-reports, reporting heterogeneity
    JEL: I1 C1 C3
    Date: 2015–12
  25. By: Barone, Adriana; Nese, Annamaria
    Abstract: This study examines the relationship between body weight and academic choice and performance, focusing on gender differences and using survey data from students at the University of Salerno in Italy.Our findings indicate a significant negative relationship between body weight and academic performance,particularly for female students.In our examination of BMI and field of study (i.e.,science vs.the humanities),our results indicate that overweight/obese females are less likely than those of average weight to pursue scientific studies, and hence, more remunerative careers.The asymmetry of the findings between males and females suggests that during late adolescence physicality plays different roles according to gender.
    Keywords: Human capital; Body weight; Educational economics; Microeconometrics
    JEL: C25 D01 I12 I21 J24
    Date: 2015–10
  26. By: Lídia Farré (Universitat de Barcelona, IAE (CSIC) and MOVE); Francesco Fasani (Queen Mary University of London, IAE (CSIC) and MOVE); Hannes Mueller (IAE (CSIC), Barcelona GSE and MOVE)
    Abstract: This article documents a strong connection between unemployment and mental disorders using data from the Spanish National Health Survey. We exploit the collapse of the construction sector to identify the causal effect of job loss. Our results suggest that an increase of the unemployment rate by 10 percent due to collapse of the sector raised mental disorders in the affected population by 3 percent. We argue that the large size of this effect responds to the fact that the construction sector was at the centre of the macroeconomic shock. As a result, workers exposed to the negative employment shock faced very low chances of re-entering employment. We show that this led to long unemployment spells, hopelessness and feelings of uselessness.
    Keywords: Mental health, Great recession, Unemployment, Spain
    JEL: I10 J60 C26
    Date: 2015–12
  27. By: Helble, Matthias (Asian Development Bank Institute); Aizawa, Toshiaki (Asian Development Bank Institute)
    Abstract: Empirical studies on pharmaceuticals pricing across countries have found evidence that prices vary according to per capita income. These studies are typically based on survey data from a subset of countries and cover only one year. In this paper, we study the international trade and price of insulin by using detailed trade data for 186 importing countries from 1995 to 2013. With almost 12,000 observations, our study constitutes the largest comparative study on pharmaceutical pricing conducted so far. The large dataset allows us to uncover new determinants of price differentials. Our analysis shows that the international trade of insulin increased substantially over this time period, clearly outpacing the increasing prevalence of diabetes. Using the unit values of imports, we also study the determinants of price differentials between countries. Running various panel regressions, we find that the differences in prices across countries can be explained by the following factors: First, corroborating earlier studies, we find that per capita GDP is positively correlated with the unit price of insulin. Second, the price of insulin drugs originating from Organisation for Economic Co-operation and Development countries tends to be substantially higher than for those imported from developing countries. Third, more intense competition among suppliers leads to lower insulin prices. Fourth, higher out-of-pocket payments for health care are associated with higher prices. Finally, higher volumes and tariffs seem to result in lower unit prices.
    Keywords: Insulin trade; price differentials; pharmaceuticals trade
    JEL: F14 I11
    Date: 2015–12–14

This nep-hea issue is ©2015 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.