nep-hea New Economics Papers
on Health Economics
Issue of 2016‒03‒17
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Understanding the Drivers of Overweight and Obesity in Developing Countries: The Case of South Africa By Butzlaf, Iris; Minos, Dimitrios
  2. The Value of A Statistical Life in Absence of Panel Data: What can we do? By Andr\'es Riquelme; Marcela Parada
  3. Smoke-free Policies in China:Â Evidence of Effectiveness and Implications for Action By World Health Organization
  4. Misery and mental health By Sarah Flèche; Richard Layard
  5. Use of Medical Services in Chile: How Sensitive are The Results to Different Econometric Specifications? By Alejandra Chovar; Felipe Vásquez; Guillermo Paraje
  6. Long-Term Care and Births Timing By Pestieau, P.; Ponthiere, G.
  7. Social long-term care insurance with two-sided altruism By CREMER, B.; PESTIEAU, P.; ROEDER, K.
  8. A Decomposition Analysis of Cigarette Consumption Differences between Male Turkish Immigrants and Germans in West Germany 2002-2012 By Rui Dang
  9. Medical savings accounts: assessing their impact on efficiency, equity, and financial protection in health care By Olivier J. Wouters; Jonathan Cylus; Wei Yang; Sarah Thomson; Martin McKee
  10. ‘Recessions, healthy no more?’: A note on Recessions, Gender and Mortality in France By Josselin Thuilliez
  11. Malaria and Education: Evidence from Mali By Josselin Thuilliez; Hippolyte D'Albis; Hamidou Niangaly; Ogobara Doumbo
  12. Migrants, Health, and Happiness: Evidence that Health Assessments Travel with Migrants and Predict Well-Being By Ljunge, Martin
  13. The Rise in Life Expectancy, Health Trends among the Elderly, and the Demand for Health and Social Care By Lindgren, Björn
  14. Health and Safety Risks in Britain's Workplaces: Where are They and Who Controls Them? By Bryson, Alex
  15. Cost-Sharing and Use of Health Services in Italy: Evidence from a Fuzzy Regression Discontinuity Design By Ponzo, Michela; Scoppa, Vincenzo
  16. Will a Universal Health Coverage Policy be fiscally sustainable for India? New evidence and implications By Muttur Ranganathan, Narayana
  17. Paid Sick Leave and Absenteeism: The First Evidence from the U.S. By Ahn, Thomas; Yelowitz, Aaron

  1. By: Butzlaf, Iris; Minos, Dimitrios
    Abstract: The beginning rise in obesity prevalence rates in South Africa was first noticed already in the early 1990s. Since then, several articles have discussed how the nutrition transition has affected people’s body weights in the country. This article is the first one that uses longitudinal data from South Africa to reveal the short- and long-term effects that socio-economic and cultural factors have on the probability of becoming obese. The concept of “benign” obesity seems to influence people’s perceptions of an ideal body shape and thus model the preference for a higher body weight. Women are more affected by increasing body weights than men. We find that time invariant characteristics and long-term effects have the largest influence on the probability of becoming obese. To address the problems of obesity, we suggest implementing programs that Change people’s attitudes and behavior regarding food intake and physical activity. If people change their perception of what kind of body weight can be considered as being healthy, then a combination of different health programs can be successful.
    Keywords: obesity, nutrition transition, developing country, South Africa, Food Consumption/Nutrition/Food Safety, Health Economics and Policy, I12, I18, P46,
    Date: 2016–01
  2. By: Andr\'es Riquelme; Marcela Parada
    Abstract: In this paper I show how reliable estimates of the Value of a Statistical Life (VSL) can be obtained using cross sectional data using Garen's instrumental variable (IV) approach. The increase in the range confidence intervals due to the IV setup can be reduced by a factor of 3 by using a proxy to risk attitude. In order state the "precision" of the cross sectional VSL estimates I estimate the VSL using Chilean panel data and use them as benchmark for different cross sectional specifications. The use of the proxy eliminates need for using hard-to-find instruments for the job risk level and narrows the confidence intervals for the workers in the Chilean labor market for the year 2009.
    Date: 2016–03
  3. By: World Health Organization
    Keywords: Medicine and Health Sciences, Social and Behavioral Sciences
    Date: 2015–10–01
  4. By: Sarah Flèche; Richard Layard
    Abstract: Mental illness is a far bigger source of human misery than poverty or unemployment, according to research by Sarah Flèche and Richard Layard. They argue that we need to move beyond a purely materialistic conception of misery - and call for increased public spending on mental health. Their study finds that dissatisfaction with life can have many causes - but mental illness is the most important. If people cannot enjoy life, they are just as deprived whether the cause is outside themselves or within.
    Keywords: Mental health, life-satisfaction, wellbeing, poverty, unemployment
    JEL: I1 I3 I31 I32
    Date: 2016–02
  5. By: Alejandra Chovar; Felipe Vásquez; Guillermo Paraje
    Abstract: We compared different econometric specifications to model the use of medical services in Chile focusing on visits to both a general practitioner and a specialist physician. We found the best-fitting model and discussed the determinant factors for the use of medical services. Our results indicate that the model with the best goodness of fit is the Latent Class Model. Furthermore, the econometric estimations consistently show that living outside the capital of the country, especially in rural areas, having some sort of physical or age-related limitation, are the main determinants of the use of medical services; additionally in average the model gives higher predictions of utilization of medical services for women. This research provides evidence, with policy implications, on how people's characteristics, such as place of residence or age, influence the use of medical services in different way depending on the type of medical service to be used.
    Date: 2016–02
  6. By: Pestieau, P. (Université catholique de Louvain, CORE, Belgium); Ponthiere, G. (University Paris East)
    Abstract: Due to the ageing process, the provision of long-term care (LTC) to the dependent elderly has become a major challenge of our epoch. But our societies are also characterized, since the 1970s, by a postponement of births, which, by raising the intergenerational age gap, can affect the provision of LTC by children. In order to examine the impact of those demographic trends on the optimal policy, we develop a four-period OLG model where individuals, who receive children is informal LTC at the old age, must choose, when being young, how to allocate births along their life cycle. It is shown that, in line with empirical evidence, early children provide more LTC to their elderly parents than late children, because of the lower opportunity cost of providing LTC when being retired. When comparing the laissez-faire with the long-run social optimum, it appears that individuals have, at the laissez-faire, too few early births, and too many late births. We then study, in first-best and second-best settings, how the social optimum can be decentralized by encourageing early births, in such a way as to reduce the social burden of LTC provision.
    Keywords: Long term care, birth timing, childbearing age, family policy, OLG models
    JEL: E13 J13 J14
    Date: 2015–06–17
  7. By: CREMER, B. (Toulouse School of Ecoomics); PESTIEAU, P. (3CREPP, Université de Liège; CORE, Université catholique de Louvain, and Toulouse School of Ecoomics); ROEDER, K. (University of Augsburg)
    Abstract: This paper studies the design of a social long-term care (LTC) insurance when altruism is two-sided. The laissez-faire solution is not efficient, unless there is perfect altruism. Under full information, the first-best can be decentralized by a linear subsidy on informal aid, a linear tax on bequests when the parent is dependent and state specific lump-sum transfers which provide insurance. We also study a second-best scheme comprising a LTC benefit, a payroll tax on children’s earnings and an inheritance tax. This scheme redistributes resources across individuals and between the states of nature and the tax on children’s labor enhances informal care to compensate for the children’s possible less than full altruism.
    Keywords: long-term care, social insurance, two-sided altruism
    JEL: H2 H5
    Date: 2015–10–21
  8. By: Rui Dang
    Abstract: In this article, we investigate the differences in smoking behavior between male Turkish immigrants and male Germans, using data from the German Socio-Economic Panel (SOEP). More specifically, we use a Blinder-Oaxaca decomposition method for count data models, and isolate differences in the number of cigarettes consumed daily between Turkish immigrants and Germans into a component reflecting differences in observed socio-economic characteristics and a component reflecting unobserved smoking behavior. Our results reveal that more than 50% of the differences in cigarette consumption between male Turkish immigrants and male Germans is attributable to observable characteristics.
    Keywords: integration, migration, and transnationalization; health and care; demography and population
    JEL: J15 I14 C21
    Date: 2016
  9. By: Olivier J. Wouters; Jonathan Cylus; Wei Yang; Sarah Thomson; Martin McKee
    Abstract: Medical savings accounts (MSAs) allow enrolees to withdraw money from earmarked funds to pay for health care. The accounts are usually accompanied by out-of-pocket payments and a high-deductible insurance plan. This article reviews the association of MSAs with efficiency, equity, and financial protection. We draw on evidence from four countries where MSAs play a significant role in the financing of health care: China, Singapore, South Africa, and the United States of America. The available evidence suggests that MSA schemes have generally been inefficient and inequitable and have not provided adequate financial protection. The impact of these schemes on long-term health-care costs is unclear. Policymakers and others proposing the expansion of MSAs should make explicit what they seek to achieve given the shortcomings of the accounts.
    JEL: J1
    Date: 2016–02–17
  10. By: Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: This study uses aggregate panel data on 96 French départements from 1982 to 2012 to investigate the relationship between macroeconomic conditions, gender and mortality. I use previously employed panel data methods, based on mortality variation across French départements and years. The novelty is to analyze the effect of gender-specific unemployment on gender-specific mortality. Within this “area-gender approach”, I give a particular attention to gender-cause-specific mortality such as prostate cancer, maternal mortality, female breast cancer, cervical cancer and ovarian cancer in addition to other cause-specific mortality. The analysis is undertaken for several age-groups, several time windows and different geographical aggregates of unemployment. The results reveal that the relationship between unemployment and mortality in France is weak and confirm recent conclusions from U.S. state-level analysis by Rhum [Ruhm, C.J., 2015. Recessions, Healthy no more?. Journal of Health Economics 42, 17-28].
    Keywords: Health,Mortality,Recessions,Gender,Macroeconomic conditions
    Date: 2016–01
  11. By: Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique); Hippolyte D'Albis (EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics, CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique); Hamidou Niangaly (MRTC - Malaria Research and Training Center - Faculté de Médecine de Bamako); Ogobara Doumbo (MRTC - Malaria Research and Training Center - Faculté de Médecine de Bamako)
    Abstract: This article examines the influence of malaria on human capital accumulation in the village of Diankabou in Mali. To account for malaria endogeneity and its interaction with unobservable risk factors, we exploit natural variations in malaria immunity across individuals of several sympatric ethnic groups – the Fulani and the non-Fulani – who differ in their susceptibility to malaria. The Fulani are known to be less susceptible to malaria infections, despite living with a similar malaria transmission intensity to those seen among other ethnic groups. We also use natural variation of malaria intensity in the area (during and after the malaria transmission season) and utilize this seasonal change as a treatment. We find that malaria has an impact on cognitive and educational outcomes in this village. We discuss the implications of this result for human capital investments and fertility decisions with the help of a quantity-quality model.
    Keywords: Immunity,Malaria,Education,Cognition,Fertility
    Date: 2016–01
  12. By: Ljunge, Martin (Research Institute of Industrial Economics (IFN))
    Abstract: Health assessments correlate with health outcomes and subjective well-being. Immigrants offer an opportunity to study persistent social influences on health where the social conditions are not endogenous to individual outcomes. This approach provides a clear direction of causality from social conditions to health, and in a second stage to well-being. Natives and immigrants from across the world residing in 30 European countries are studied using survey data. The paper applies within country analysis using both linear regressions and two stage least squares. Natives’ and immigrants’ individual characteristics have similar predictive power for health, except Muslim immigrants who experience a sizeable health penalty. Average health reports in the immigrant’s birth country have a significant association with the immigrant’s current health. Almost a quarter of the birth country health variation is brought by the immigrants, while conditioning on socioeconomic characteristics. There is no evidence of the birth country predictive power declining neither as the immigrant spends more time in the residence country nor over the life course. The second stage estimates indicate that a one standard deviation improvement in health predicts higher happiness by 1.72 point or 0.82 of a standard deviation, more than four times the happiness difference of changing employment status from unemployed to employed. Studying life satisfaction yields similar results. Health improvements predict substantial increases in individual happiness.
    Keywords: Health status; Self-reported health; Subjective well-being (SWB); Happiness; Life satisfaction; Immigrant health
    JEL: F22 I12 I31 J15
    Date: 2016–02–25
  13. By: Lindgren, Björn (Lund University, Lund, Sweden and National Bureau of Economic Research, Cambridge, MA, United States.)
    Abstract: The objective of this report is to review the evidence on (a) ageing and health and (b) the demand for health and social care among the elderly. The issues discussed are: does health status of the elderly improve over time, and how do the trends in health status of the elderly affect the demand for health and social care? The review is based on some 100 published scientific papers. While it is not a complete review, it covers most recent empirical studies of health trends and the changing pattern of demand for health and social care. Health is a multidimensional concept. It includes self-assessed health, presence of disease, functional status, and disability, usually expressed as capacity to perform activities of daily living (ADL). There are certainly elderly who have no problems in any of these dimensions. But health among elderly varies, and to a much larger extent than among younger people. Many elderly have one or more chronic diseases; if the disease is well controlled, there may be no problems in other dimensions of health. If not, other health problems may follow, lowering self-assessed health, creating ADL limitations etc. When analyzing health trends, it is important to cover all four dimensions of health, since the impact on health care and social care differ, depending on which dimension shows improved health. The reviewed literature provides strong evidence that the prevalence of chronic disease among the elderly has increased over time. There is also fairly strong evidence that the consequences of disease have become less problematic due to medical progress: decreased mortality risk, milder and slower development over time, making the time with disease (and health care treatment) longer but less troublesome than before. Evidence also suggests the postponement of functional limitations and disability. Some of the reduction in disability may certainly be attributed to improvements in treatments of chronic diseases. But they are apparently also due to the increased use of assistive technology, public transport, accessibility of buildings, etc. The results, hence, indicate that the ageing individual is expected to need health care for a longer (and not necessarily postponed) period of time than previous generations but elderly care for a shorter (and certainly postponed) period of time. Thus, one might say that the development overall has been in accordance with the “dynamic equilibrium” scenario. A general conclusion of the empirical literature seems to be that expenditures will not be lower over remaining life years but they will be distributed over a longer period of time. Several authors warn against the potential negative impact of an increasing prevalence of obesity on life expectancy, health, and health and social care. The role of technological advances within medicine is highlighted by many authors and its consequences for the elderly analyzed.
    JEL: H51 I10 I38 J11 J14
    Date: 2016–03–01
  14. By: Bryson, Alex (University College London)
    Abstract: This is the first paper to identify the correlates of workplace managers' perceptions of the health and safety risks faced by workers and the degree to which workers have control over those risks. The risks workers face and the control they have over those risks are weakly negatively correlated. Managerial risk ratings are positively associated with both injury and illness rates, but not with absence rates. The control rating is also positively associated with injury and illness rates, but it is negatively correlated with absence rates. Workers are more likely to be exposed to health and safety risks when their workplace is performing poorly and where it has been adversely affected by the recession. Union density is positively associated with risks but is not associated with worker control over risks. Having on-site worker representatives dealing with health and safety is linked to lower risks than direct consultation between management and employees over health and safety. However, there is no evidence that particular types of health and safety arrangement are related to worker control over health and safety risks.
    Keywords: workplace safety, working conditions, unions
    JEL: J81
    Date: 2016–02
  15. By: Ponzo, Michela (University of Naples Federico II); Scoppa, Vincenzo (University of Calabria)
    Abstract: We use a Regression Discontinuity Design (RDD) to evaluate the impact of cost-sharing on the use of health services. In the Italian health system, individuals reaching age 65 and earning low incomes are given total exemption from cost-sharing for health services consumption. Since the probability of exemption changes discontinuously at age 65, we use a Fuzzy RDD in which the age threshold is used as an instrument for exemption. We find that prescription drug consumption, specialist visits and diagnostic checks remarkably increase with exemption. However, using several measures of health outcomes we do not find any change in individual health.
    Keywords: health insurance, healthcare demand, cost-sharing, moral hazard, health outcomes, fuzzy regression discontinuity design, instrumental variables
    JEL: I10 I13 I11 I18 C26
    Date: 2016–02
  16. By: Muttur Ranganathan, Narayana
    Abstract: This paper analyses the fiscal sustainability of India’s recently proposed Universal Health Coverage Policy (UHCP) over the period 2005-2100. Public expenditure on UHCP is calculated by combining the age profiles of public and private health consumption expenditure in the framework of National Transfer Accounts. Fiscal sustainability of UHCP is determined by using the concept and measure of Generational Imbalance in Generational Accounting. In general, the results show that India’s current fiscal policies are not sustainable in both the Baseline and UHCP expenditure scenarios. However, other things being the same, fiscal sustainability of public expenditure on the UHCP is attainable in both the policy scenarios if the income elasticity of public expenditure on social welfare and health expenditure is less than unity. These new results offer evidence and strengthen the arguments for implementation of proposed UHCP by justifying its fiscal sustainability.
    Keywords: Universal Health Coverage, Public health expenditure, Fiscal sustainability, National Transfer Account, Generational imbalance, Generational Accounting, India
    JEL: H51 I18 J11
    Date: 2016–02–22
  17. By: Ahn, Thomas; Yelowitz, Aaron
    Abstract: Using a balanced sample of workers from the NHIS, we estimate of the impact of paid sick leave (PSL) insurance on absenteeism in the United States. PSL increases absenteeism by 1.2 days per year, a large effect given the typical benefit duration. Consistent with moral hazard, the effects are concentrated in moderate sick days, not severe ones. In addition, we merge the NHIS with Google Flu Trends. Severe influenza outbreaks lead workers to exhaust sick days, consequently leading to a replacement rate of zero for additional absences. Consistent with a lower replacement rate, worker absenteeism is reduced on the margin.
    Keywords: Paid Sick Leave, Absenteeism, Presenteeism, Moral Hazard, Google Flu Trends
    JEL: H51 I18 J22
    Date: 2016–03–01

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