nep-hea New Economics Papers
on Health Economics
Issue of 2016‒03‒23
forty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Dust and Death: Evidence from the West African Harmattan By Achyuta Adhvaryu; Prashant Bharadwaj; James Fenske; Anant Nyshadham; Richard Stanley
  2. Transitioning between ‘the old’ and ‘the new’ long-term care systems By Joan Costa-Font; José-Luis Fernández; Katherine Swartz
  3. Entangled stakeholder roles and perceptions in health information systems: a longitudinal study of the UK NHS N3 network By Nancy Pouloudi; Wendy Currie; Edgar A. Whitley
  4. Bayesian regression discontinuity designs: incorporating clinical knowledge in the causal analysis of primary care data By Sara Geneletti; Aidan G. O'Keeffe; Linda D. Sharples; Sylvia Richardson; Gianluca Baio
  5. Reproductive history and post-reproductive mortality: a sibling comparison analysis using Swedish register data By Kieron Barclay; Katherine Keenan; Emily Grundy; Martin Kolk; Mikko Myrskylä
  6. The most efficient critical vaccination coverage and its equivalence with maximizing the herd effect By Duijzer, E.; van Jaarsveld, W.L.; Wallinga, J.; Dekker, R.
  7. The Incidence of Health Insurance Costs: Empirical evidence from Japan By HAMAAKI Junya
  8. Health-care reform or labor market reform? a quantitative analysis of the Affordable Care Act By Nakajima, Makoto; Tuzemen, Didem
  9. Maternal Employment Trajectories and Caring for an Infant or Toddler with a Disability By Anna Zhu
  10. Parallel Trade of Pharmaceuticals: The Danish Market for Statins By Susan J. Méndez
  11. Working-Time Mismatch and Mental Health By Steffen Otterbach; Mark Wooden; Yin King Fok
  12. Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply By Robert Kaestner; Bowen Garrett; Anuj Gangopadhyaya; Caitlyn Fleming
  13. The Incidence of Mandated Health Insurance: Evidence from the Affordable Care Act Dependent Care Mandate By Gopi Shah Goda; Monica Farid; Jay Bhattacharya
  14. Disentangling Moral Hazard and Adverse Selection in Private Health Insurance By David Powell; Dana Goldman
  15. Forecasting Trends in Disability in a Super-Aging Society: Adapting the Future Elderly Model to Japan By Brian K. Chen; Hawre Jalal; Hideki Hashimoto; Sze-Chuan Suen; Karen Eggleston; Michael Hurley; Lena Schoemaker; Jay Bhattacharya
  16. Out of Africa: Human Capital Consequences of In Utero Conditions By Victor Lavy; Analia Schlosser; Adi Shany
  17. Saving Lives or Saving Money? Understanding the Dual Nature of Physician Preferences By Alice Chen; Darius N. Lakdawalla
  18. Health Capacity to Work at Older Ages: Evidence from the U.S. By Courtney Coile; Kevin S. Milligan; David A. Wise
  19. Parental Influences on Health and Longevity: Lessons from a Large Sample of Adoptees By Mikael Lindahl; Evelina Lundberg; Mårten Palme; Emilia Simeonova
  20. Work Capacity and Longer Working Lives in Belgium By Alain Jousten; Mathieu Lefebvre
  21. Healthy, Happy and Idle: Estimating the Health Capacity to Work at Older Ages in Germany By Hendrik Jürges; Lars Thiel; Axel Börsch-Supan
  22. Work Capacity at Older Ages in the Netherlands By Adriaan Kalwij; Arie Kapteyn; Klaas de Vos
  23. Health Capacity to Work at Older Ages: Evidence from the United Kingdom By James Banks; Carl Emmerson; Gemma Tetlow
  24. Including Health Insurance in Poverty Measurement: The Impact of Massachusetts Health Reform on Poverty By Sanders Korenman; Dahlia K. Remler
  25. Who Benefits from Calorie Labeling? An Analysis of its Effects on Body Mass By Partha Deb; Carmen Vargas
  26. Health Capacity to Work at Older Ages in Denmark By Paul Bingley; Nabanita Datta Gupta; Peder Pedersen
  27. Health Capacity to Work at Older Ages in France By Didier Blanchet; Eve Caroli; Corinne Prost; Muriel Roger
  28. How Does Access to Health Care Affect Teen Fertility and High School Dropout Rates? Evidence from School-based Health Centers By Michael F. Lovenheim; Randall Reback; Leigh Wedenoja
  29. Subsidies and Structure: The Lasting Impact of the Hill-Burton Program on the Hospital Industry By Andrea Park Chung; Martin Gaynor; Seth Richards-Shubik
  30. Transparency and Negotiated Prices: The Value of Information in Hospital-Supplier Bargaining By Matthew Grennan; Ashley Swanson
  31. Economic Conditions, Illicit Drug Use, and Substance Use Disorders in the United States By Christopher S. Carpenter; Chandler B. McClellan; Daniel I. Rees
  32. "Peer Effects on Vaccination: Experimental Evidence from Rural Nigeria" By RyokoSato; Yoshito Takasaki
  33. Aging and Health Financing in the US: A General Equilibrium Analysis By Juergen Jung; Chung Tran; Matthew Chambers
  34. Health Insurance and Labor Force Participation: What Legal Recognition Does for Same-Sex Couples By Marcus Dillender
  35. The Effect of Medicare Eligibility on Spousal Insurance Coverage By Marcus Dillender; Karen Mulligan
  36. Larger is Better: the Scale Effects of the Italian Local Healthcare Authorities Amalgamation Program By Cinzia Di Novi; Dino Rizzi; Michele Zanette
  37. Adolescent Fertility and Sexual Health in Nigeria By Rafael Cortez; Seemeen Saadat; Edmore Marinda; Oluwole Odutolu
  38. When the affordable has no value, and the valuable is unaffordable: The U.S. market for long-term care insurance and the role of Medicaid By Fels, Markus
  39. Decomposing differences in health and inequality using quasi-objective health indices By Heger, Dörte
  40. Medical care within an OLG economy with realistic demography By Frankovic, Ivan; Kuhn, Michael; Wrzaczek, Stefan

  1. By: Achyuta Adhvaryu; Prashant Bharadwaj; James Fenske; Anant Nyshadham; Richard Stanley
    Abstract: Dust pollution in West Africa increases infant and child mortality. Employing differences in differences, we make three contributions. First, using data from 12 poor countries, we highlight the vulnerability of people with few resources, fragile health, and limited capacity to adopt avoidance behavior. Second, we examine prenatal and post-natal parental investment responses, and show evidence consistent with compensating behaviors. However, despite these efforts, the health of surviving children is still adversely affected. Third, we investigate differential impacts over time and across countries. We find declining effects over time, implying in the absence of reductions in dust itself that societies are adapting in some way. Using national-level measures of macroeconomic conditions and public health resources, we find suggestive evidence that both economic development and public health improvements have contributed to this adaptation, with health improvements seemingly playing a stronger role.
    Keywords: Dust; Infant Mortality; West Africa; Adaptation
    Date: 2016
  2. By: Joan Costa-Font; José-Luis Fernández; Katherine Swartz
    Keywords: long-term care; long term care insurance; long term care systems
    JEL: J50
    Date: 2015–03
  3. By: Nancy Pouloudi; Wendy Currie; Edgar A. Whitley
    Abstract: The combination of pervasive and complex technology and an increasingly challenging healthcare environment is the setting for this research study. As a longitudinal case study, the research tracks the development and implementation of a large private information systems network in the UK National Health Service (NHS). Using stakeholder theory, we unpack the story of a complex network of stakeholder roles and perceptions and how these change over time. Our findings show that favorable and unfavorable positions held by multiple stakeholder groups become entangled, where even the same focal group may adopt competing positions which undermine the adoption of the health network. As this situation develops, the policy and implementation of the broader health IT program becomes confused and destabilized. This study makes three contributions. It expands the literature on stakeholder theory within the IS domain; it extends the managerial focus of stakeholder approaches to include policy-making in the diverse multi-stakeholder setting of healthcare; it demonstrates how stakeholder analysis can be employed in IS research by adopting a broader, dynamic approach to identifying and including different stakeholder groups focusing on their varied roles and views during the course of a large scale health IT program.
    Keywords: entangled information systems; interpretive stakeholder analysis; healthcare; NHS; N3 infrastructure
    JEL: J50
    Date: 2016
  4. By: Sara Geneletti; Aidan G. O'Keeffe; Linda D. Sharples; Sylvia Richardson; Gianluca Baio
    Abstract: The regression discontinuity (RD) design is a quasi-experimental design that estimates the causal effects of a treatment by exploiting naturally occurring treatment rules. It can be applied in any context where a particular treatment or intervention is administered according to a pre-specified rule linked to a continuous variable. Such thresholds are common in primary care drug prescription where the RD design can be used to estimate the causal effect of medication in the general population. Such results can then be contrasted to those obtained from randomised controlled trials (RCTs) and inform prescription policy and guidelines based on a more realistic and less expensive context. In this paper, we focus on statins, a class of cholesterol-lowering drugs, however, the methodology can be applied to many other drugs provided these are prescribed in accordance to pre-determined guidelines. Current guidelines in the UK state that statins should be prescribed to patients with 10-year cardiovascular disease risk scores in excess of 20%. If we consider patients whose risk scores are close to the 20% risk score threshold, we find that there is an element of random variation in both the risk score itself and its measurement. We can therefore consider the threshold as a randomising device that assigns statin prescription to individuals just above the threshold and withholds it from those just below. Thus, we are effectively replicating the conditions of an RCT in the area around the threshold, removing or at least mitigating confounding. We frame the RD design in the language of conditional independence, which clarifies the assumptions necessary to apply an RD design to data, and which makes the links with instrumental variables clear. We also have context-specific knowledge about the expected sizes of the effects of statin prescription and are thus able to incorporate this into Bayesian models by formulating informative priors on our causal parameters. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.
    Keywords: regression discontinuity design; causal inference; local average treatment effect; informative priors
    JEL: C1
    Date: 2015
  5. By: Kieron Barclay; Katherine Keenan; Emily Grundy; Martin Kolk; Mikko Myrskylä
    Abstract: A growing body of evidence suggests that reproductive history influences post-reproductive mortality. A potential explanation for this association is confounding by socioeconomic status in the family of origin, as socioeconomic status is related to both fertility behaviours and to long-term health. We examine the relationship between age at first birth, completed parity, and post-reproductive mortality and address the potential confounding role of family of origin. We use Swedish population register data for men and women born 1932-1960, and examine both all-cause and cause-specific mortality. The contributions of our study are the use of a sibling comparison design that minimizes residual confounding from shared family background characteristics and assessment of cause-specific mortality that can shed light on the mechanisms linking reproductive history to mortality. Our results were entirely consistent with previous research on this topic, with teenage first time parents having higher mortality, and the relationship between parity and mortality following a U-shaped pattern where childless men and women and those with five or more children had the highest mortality. These results indicate that selection into specific fertility behaviours based upon socioeconomic status and experiences within the family of origin does not explain the relationship between reproductive history and post-reproductive mortality. Additional analyses where we adjust for other lifecourse factors such as educational attainment, attained socioeconomic status, and post-reproductive marital history do not change the results. Our results add an important new level of robustness to the findings on reproductive history and mortality by showing that the association is robust to confounding by factors shared by siblings. However it is still uncertain whether reproductive history causally influences health, or whether other confounding factors such as childhood health or risk-taking propensity could explain the association.
    Keywords: Age at first birth; parity; reproductive history; mortality; sibling fixed effects; Sweden
    JEL: C1
    Date: 2016
  6. By: Duijzer, E.; van Jaarsveld, W.L.; Wallinga, J.; Dekker, R.
    Abstract: ‘Critical vaccination coverages’ are vaccination allocations that result in an effective reproduction ratio of one. In a population with interacting subpopulations there are many different critical vaccination coverages. To find the most efficient critical vaccination coverage, we define the following optimization problem: minimize the required amount of vaccines to obtain an effective reproduction ratio of exactly one. We prove that this optimization problem is equivalent to the problem of maximizing the proportion of susceptibles that escape infection during an epidemic (i.e., maximizing the herd effect). We propose an efficient general algorithm to solve these optimization problems based on Perron- Frobenius theory. We study two special cases that provide further insight into these optimization problems. First, we derive an explicit analytic solution for the case of two interacting populations. Second, we derive an efficient algorithm for the case of multiple populations that interact according to separable mixing. In this algorithm the subpopulations are ordered by their ratio of population size to reproduction ratio. Allocating vaccines based on this priority order results in an optimal allocation. We apply our solutions in a case study for pre-pandemic vaccination in the initial phase of an influenza pandemic where the entire population is susceptible to the new influenza virus. The results show that for the optimal allocation the critical vaccination coverage is achieved for a much smaller amount of vaccines as compared to allocations proposed previously.
    Keywords: infectious diseases, vaccination, reproduction number, heterogeneous mixing, optimization, mathematical model
    Date: 2016–02–18
  7. By: HAMAAKI Junya
    Abstract: Empirical studies on the incidence of social security contributions in Japan have produced conflicting results. Against this background, the present study, using new panel data, examines the extent to which employers' health insurance contributions have been shifted to employees through the adjustment of wages following a major reform of the way insurance contributions are calculated. The results indicate that a large part of employers' contribution burden was shifted to employees, and that this tendency was particularly pronounced for health insurers with a large number of insurees. This finding is consistent with the view that the labour supply in Japan is inelastic with regard to changes in wages. Furthermore, the empirical results suggest that the increase in employers' insurance burden following the reform was not passed on to employees immediately but rather over time through the gradual adjustment of wages.
    Date: 2016–03
  8. By: Nakajima, Makoto; 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 (ACA). Our model implies a significant reduction in the uninsured rate from 22.6 percent to 5.6 percent. {{p}} The model predicts a moderate positive welfare gain from the ACA, due to redistribution of income through Health Insurance Subsidies at the Exchange as well as Medicaid expansion. About 2.1 million more part-time jobs are created under the ACA, in 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%), partly because of the general equilibrium effect.
    Keywords: Health insurance; Affordable Care Act; Labor market;
    JEL: D91 E24 E65 I10
    Date: 2015–09–01
  9. By: Anna Zhu (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    Abstract: Mothers caring for an infant or toddler continue to face barriers in returning to work after child birth. Mothers caring for an infant or toddler with a disability, however, may face even greater barriers. This paper contributes to the literature by exploring the employment costs for this group of mothers using a novel Australian administrative data set. The employment patterns of mothers with and without a disabled infant or toddler are compared both before and after child birth. The data follow 7,600 mothers on a bi-weekly basis for the entire period 12 months before and the 24 months after child birth and contain information on the disability status of the child, measures of employment and the intensity of employment. I find that mothers of disabled toddlers and infants suffer employment disadvantages relative to mothers of non-disabled children. The employment gaps grow from approximately six percentage points shortly after their children are born to 14-17 percentage points when their children are 12 to 24 months old. The employment gaps exist for full-time employment as well as for short part-time employment. Classification- I12, J13, J22
    Keywords: Disability, infants or toddlers, mothers’ employment
    Date: 2016–02
  10. By: Susan J. Méndez (Melbourne Institute of Applied Economics and Social Research, The University of Melbourne)
    Abstract: The goal of this paper is to investigate and quantify the impact of parallel trade in markets for pharmaceuticals. The paper develops a structural model of demand and supply using data on prices, sales and characteristics of statins, medicines used in the treatment for high cholesterol, in Denmark. The model provides a framework to simulate outcomes under a complete ban of parallel imports, keeping other regulatory schemes unchanged. There are two sets of key results from prohibiting parallel imports. The first set focuses on price effects, which differ substantially along two dimensions: the patent protection status of the molecule and the type of the firm. On average, prices increase more in markets where the molecule has lost patent protection. On the other dimension, both generic firms and original producers increase their pharmacy purchase prices when competition from parallel importers is removed. Given the prevailing reimbursement rules, most changes in pharmacy purchase prices are absorbed by the government. The final price paid by consumers after reimbursement increases more for original firms than for generic producers. The second set of empirical results reports the effects on market participants. My model takes into consideration consumers’ preferences allowing them to substitute between products. Prohibiting parallel imports induces consumers to substitute towards original products for which they have stronger preferences. In sum, banning parallel imports leads to (i) an increase in variable profits for original producers and a decrease for generic firms, (ii) an increase in governmental health care expenditures, and (iii) a decrease in consumers’ welfare. Classification- I18, H51
    Keywords: Pharmaceutical markets, parallel trade, regulation, welfare analysis
    Date: 2016–02
  11. By: Steffen Otterbach (Institute for Health Care & Public Management, University of Hoehenheim); Mark Wooden (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Yin King Fok (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    Abstract: Nationally representative panel survey data for Australia and Germany are used to investigate the impact of working-time mismatches (i.e., differences between actual and desired work hours) on mental health, as measured by the Mental Component Summary Score from the SF-12. Fixed effects and dynamic linear models are estimated, which, together with the longitudinal nature of the data, enable person-specific traits that are time invariant to be controlled for. The incorporation of dynamics also reduces concerns about the potential effects of reverse causation. The results suggest that overemployment (working more hours than desired) has adverse consequences for the mental health of workers in both countries, though the magnitude of such effects are larger in Germany. Underemployment (working fewer hours than desired), however, seems to only be of significance in Australia. Classification-I12, J22
    Keywords: Australia, Germany, mental health, Mental Component Summary Score (SF-12), longitudinal data, work hours, working-time mismatch
    Date: 2016–03
  12. By: Robert Kaestner; Bowen Garrett; Anuj Gangopadhyaya; Caitlyn Fleming
    Abstract: We examined the effect of the expansion of Medicaid eligibility under the Affordable Care Act on health insurance coverage and labor supply of adults with a high school education or less. We found that the Medicaid expansions increased Medicaid coverage by approximately 4 percentage points, decreased the proportion uninsured by approximately 3 percentage points, and decreased private health insurance coverage by 1 percentage point. The Medicaid expansions had little effect on labor supply as measured by employment, usual hours worked per week and the probability of working 30 or more hours per week. Most estimates suggested that the expansions increased employment slightly, although not significantly.
    JEL: H42 I13 J22
    Date: 2015–12
  13. By: Gopi Shah Goda; Monica Farid; Jay Bhattacharya
    Abstract: The dependent care mandate is one of the most popular provisions of the 2010 Affordable Care Act (ACA). This provision requires that employer-based insurance plans cover health care expenditures for workers with children 26 years old or younger. While there has been considerable scholarly and policy interest in the effects of this mandate on health insurance coverage among young adults, there has been little scholarly work measuring the costs and incidence of this mandate and who pays the costs of it. In our empirical work, we exploit the fact that some states had dependent care mandates in years prior to the passage of the ACA. Using data from the Survey of Income and Program Participation (SIPP), we find that workers at firms with employer-based coverage – whether or not they have dependent children – experience an annual reduction in wages of approximately $1,200. Our results imply that the marginal costs of mandated employer-based coverage expansions are not entirely borne only by the people whose coverage is expanded by the mandate.
    JEL: I1 I13 J3
    Date: 2016–01
  14. By: David Powell; Dana Goldman
    Abstract: Moral hazard and adverse selection create inefficiencies in private health insurance markets and understanding the relative importance of each factor is critical for policy. We use claims data from a large firm to isolate moral hazard from plan selection. Previous studies have attempted to estimate moral hazard in private health insurance by assuming that individuals respond only to the spot price, end-of-year price, expected price, or a related metric. The nonlinear budget constraints generated by health insurance plans make these assumptions especially poor and we statistically reject their appropriateness. We study the differential impact of the health insurance plans offered by the firm on the entire distribution of medical expenditures without assuming that individuals only respond to a parameterized price. Our empirical strategy exploits the introduction of new plans during the sample period as a shock to plan generosity, and we account for sample attrition over time. We use an instrumental variable quantile estimation technique that provides quantile treatment effects for each plan, while conditioning on a set of covariates for identification purposes. This technique allows us to map the resulting estimated medical expenditure distributions to the nonlinear budget sets generated by each plan. We estimate that 53% of the additional medical spending observed in the most generous plan in our data relative to the least generous is due to moral hazard. The remainder can be attributed to adverse selection. A policy which resulted in each person enrolling in the least generous plan would cause the annual premium of that plan to rise by $1,000.
    JEL: I1 I10 I11 I12 I13
    Date: 2016–01
  15. By: Brian K. Chen; Hawre Jalal; Hideki Hashimoto; Sze-Chuan Suen; Karen Eggleston; Michael Hurley; Lena Schoemaker; Jay Bhattacharya
    Abstract: Japan has experienced pronounced population aging, and now has the highest proportion of elderly adults in the world. Yet few projections of Japan’s future demography go beyond estimating population by age and sex to forecast the complex evolution of the health and functioning of the future elderly. This study adapts to the Japanese population the Future Elderly Model (FEM), a demographic and economic state-transition microsimulation model that projects the health conditions and functional status of Japan’s elderly population in order to estimate disability, health, and need for long term care. Our FEM simulation suggests that by 2040, over 27 percent of Japan’s elderly will exhibit 3 or more limitations in IADLs and social functioning; almost one in 4 will experience difficulties with 3 or more ADLs; and approximately one in 5 will suffer limitations in cognitive or intellectual functioning. Since the majority of the increase in disability arises from the aging of the Japanese population, prevention efforts that reduce age-specific disability (or future compression of morbidity among middle-aged Japanese) may have only a limited impact on reducing the overall prevalence of disability among Japanese elderly.
    JEL: I1 J1 J11 J14
    Date: 2016–01
  16. By: Victor Lavy; Analia Schlosser; Adi Shany
    Abstract: This paper investigates the effects of environmental conditions during pregnancy on later life outcomes using quasi-experimental variation created by the immigration of Ethiopian Jews to Israel in May 24th 1991. Children in utero prior to immigration faced dramatic differences in medical care technologies, prenatal conditions, and prenatal care at the move from Ethiopia to Israel. One of the major differences was adequacy of micronutrient supplements, particularly iodine, iron and folic acid. We find that children exposed in an earlier stage of the pregnancy to better environmental conditions in utero have two decades later higher educational attainment (lower repetition and dropout rates and higher Baccalaureate rate) and higher education quality (achieve a higher proficiency level in their Baccalaureate diploma). The average treatment effect we estimate is driven mainly by a strong effect on girls. We find however, no effect on birth weight or mortality for girls.
    JEL: I1 I2 J13 O15
    Date: 2016–01
  17. By: Alice Chen; Darius N. Lakdawalla
    Abstract: A longstanding literature has highlighted the tension between the altruism of physicians and their desire for profit. This paper develops new implications for how these competing forces drive pricing and utilization in healthcare markets. Altruism dictates that providers reduce utilization in response to higher prices, but profit-maximization does the opposite. Rational physicians will behave more altruistically when treating poorer patients or those that face higher medical cost burdens, and when foregone profits are lower. These insights help explain the observed heterogeneity in pricing dynamics across different healthcare markets. We empirically test the implications of our model by utilizing two exogenous shocks in Medicare price setting policies. Our results indicate that patient income, out-of-pocket costs, and profitability alone explain up to one-quarter of the variation in price elasticities. Finally, we demonstrate that uniform policy changes in reimbursement or patient cost-sharing may lead to unintended consequences.
    JEL: I11 I12 I18
    Date: 2016–01
  18. By: Courtney Coile; Kevin S. Milligan; David A. Wise
    Abstract: Public programs that benefit older individuals, such as Social Security and Medicare, may be changed in the future in ways that reflect an expectation of longer work lives. But do older Americans have the health capacity to work longer? This paper explores this question by asking how much older individuals could work if they worked as much as those with the same mortality rate in the past or as much as their younger counterparts in similar health. Using both methods, we estimate that there is significant additional capacity to work at older ages. We also explore whether there are differences in health capacity across education groups and whether health has improved more over time for the highly educated, using education quartiles to surmount the challenge of changing levels of education over time.
    JEL: I19 J14 J26
    Date: 2016–01
  19. By: Mikael Lindahl; Evelina Lundberg; Mårten Palme; Emilia Simeonova
    Abstract: To what extent is the length of our lives determined by pre-birth factors? And to what extent is it affected by parental resources during our upbringing that can be influenced by public policy? We study the formation of adult health and mortality using data on about 21,000 adoptees born between 1940 and 1967. The data include detailed information on both biological and adopting parents. We find that the health of the biological parents affects the health of their adopted children. Thus, we confirm that genes and conditions in utero are important intergenerational transmission channels for long-term health. However, we also find strong evidence that the educational attainment of the adopting mother has a significant impact on the health of her adoptive children, suggesting that family environment and resources in the post-birth years have long-term consequences for children’s health.
    JEL: I0 I12 I18 J13
    Date: 2016–01
  20. By: Alain Jousten; Mathieu Lefebvre
    Abstract: We explore the link between health indicators and employment rates of the population aged 55 or more. Our focus lies on work capacity as a key determinant of employment. Using cohort mortality information as a proxy for overall health outcomes, we establish a substantial untapped work capacity in the population 55+. Even stronger results are obtained when relying on individual-level objective and subjective health and socioeconomic parameters as predictors.
    JEL: J14 J21 J26
    Date: 2016–02
  21. By: Hendrik Jürges; Lars Thiel; Axel Börsch-Supan
    Abstract: After two decades of reforms that have tightened eligibility for early retirement and the generosity of social security payments, the German government has begun to turn back time and re-introduce more generous disability and early retirement benefits. Often, poor health is cited as the main reason why workers cannot work until the regular retirement age. In this chapter, we try to answer a seemingly simple question: what is the proportion of older individuals who could work in the labor market if they wanted to and if they were not limited by poor health? To answer this question, we follow two different empirical approaches with a similar logic: we estimate the link between health and labor force participation in a population whose employment patterns are or were hardly affected by the current (early) retirement incentives. Using these “pure health effects” on labor force participation to extrapolate to a population that is currently strongly affected by legislation informs us how many could not work for health reasons and how many could work. We find substantial capacity to work among the older population. We estimate that two thirds of the population would be capable of working in the labor market until they turn 70 if they wanted to.
    JEL: H31 H55 I19 J14 J26
    Date: 2016–02
  22. By: Adriaan Kalwij; Arie Kapteyn; Klaas de Vos
    Abstract: Over the last two decades policy reforms in the Netherlands have increased work incentives, resulting in rising employment rates at older ages. Over the same period health of the population has increased as well. A natural question is how much people could work taking into account their health status. As the other chapters in this volume, we use two approaches to answering this question. The first approach takes the relation between mortality and employment in 1981 as a base and then estimates what employment rates could be in 2010 if the relation between mortality and employment were the same in 1981 and 2010. The estimated additional work capacity based on this approach is about 50 percentage points for males at age 65. A second approach estimates the relation between health and employment in the age interval 50-54 and then predicts employment at later ages using health at these later ages. This leads to an estimated additional work capacity in 2010 of more than 75 percentage points for males aged 65-74. When including mortality as an additional health indicator to control for unobserved health differences in the latter approach, the estimated work capacities are more in line with those from the former approach: about 53 percentage points for males aged 65-69 and 44 percentage points for males aged 70-74.
    JEL: H55 I1 J26
    Date: 2016–02
  23. By: James Banks; Carl Emmerson; Gemma Tetlow
    Abstract: This paper estimates how much additional work capacity there might be among men and women aged between 55 and 74 in the United Kingdom, given their health, and how this has evolved over the last decade. The objective is not to suggest how much older people should work but rather to shed light on how much ill-health (as opposed to other constraints and preferences) constrains older individuals’ ability to work. We present two alternative methods, both of which rely on constructing a ‘counterfactual’ employment rate for older people based on the behaviour of other similarly healthy individuals. Both methods suggest that there is significant additional capacity to work among older men and women, but that this has been declining over recent years for women (and possibly also for men). This latter finding suggests that the increase in employment rates among older people seen over the last decade are more rapid than would have been expected based on the improvements seen in health alone.
    JEL: I14 J21 J22 J26
    Date: 2016–02
  24. By: Sanders Korenman; Dahlia K. Remler
    Abstract: We develop and implement what we believe is the first conceptually valid health-inclusive poverty measure (HIPM)—a measure that includes health care or insurance in the poverty needs threshold and health insurance benefits in family resources—and we discuss its limitations. Building on the Census Bureau’s Supplemental Poverty Measure, we construct a pilot HIPM for the under-65 population under ACA-like health reform in Massachusetts. This pilot is intended to demonstrate the practicality, face validity and value of a HIPM. Results suggest that public health insurance benefits and premium subsidies accounted for a substantial, one-third reduction in the poverty rate. Among low-income families who purchased individual insurance, premium subsidies reduced poverty by 9.4 percentage points.
    JEL: I13 I32
    Date: 2016–02
  25. By: Partha Deb; Carmen Vargas
    Abstract: This study uses county-level variation in implementation of calorie labeling laws in the US to identify the effects of such laws on body mass. Using the 2003 to 2012 waves of the Behavioral Risk Factor Surveillance System, we find a statistically insignificant average treatment effect for women and a small, statistically significant and negative average treatment effect for men, indicating a decrease in BMI after implementation of calorie-labeling laws. We estimate finite mixture models and discover that the average treatment effects mask substantial heterogeneity in the effects across three classes of women and men. For both women and men, the three classes, determined within the model, can be described as a subpopulation with normal weight, a second one that is overweight on average and a third one that is obese on average. Estimates from finite mixture models show that the effect is largely concentrated among a class of women with BMI distributions centered on overweight. The effects for men are statistically significant for each of the three classes and large for men in the overweight and obese classes. These results suggest that overweight and obese individuals are especially sensitive to relevant information.
    JEL: I12 I18
    Date: 2016–02
  26. By: Paul Bingley; Nabanita Datta Gupta; Peder Pedersen
    Abstract: Longevity is increasing and many people are spending a greater proportion of their lives reliant on pensions to support consumption. In response to this, several countries have mandated delays to age of first entitlement to pension benefits in order to reduce incentives to retire early. However, it is unknown to what extent older individuals have the health capacity to sustain the longer working lives that delayed pension benefits may encourage. We estimate the health capacity to work longer in Denmark by comparing how much older individuals work today with how much those with similar mortality rates worked in the past, and how much younger individuals today with similar self-assessed health work. We find substantial health capacity for longer working lives among those currently aged 55 and above. We also find significant heterogeneity by education and gender. Those with a high school degree have the greatest additional work capacity, women have more additional capacity than men, especially women with a college degree.
    JEL: I14 J26
    Date: 2016–02
  27. By: Didier Blanchet; Eve Caroli; Corinne Prost; Muriel Roger
    Abstract: France stands out as a country with a low labor force attachment of older workers. A reversal in the trend of French labor participation rates over 50 is under way, partly due to the pension reforms that took place since 1993. The French ageing process is driven by large gains in life expectancy and Pension reforms allocate part of these gains to work rather than to retirement. The implicit assumptions guiding the reforms have been that additional years of life are years with a health status that can be considered reasonably compatible with work. If this is not the case, the idea of sharing these additional years of life between work and retirement is questionable. Considering mortality and health status, we question the fact that the reforms may have gone too far in increasing the retirement age. To tackle these issues, we rely on two different methodological approaches developed in the economic literature: one based on the gap in employment rates across time for given mortality rates; the other using the work/health relationship measured at certain ages to predict the health-related work capacity of older age groups at the same period of time. Both methods aim at providing measures of additional work capacity. This capacity may be defined as a measure of the distance between current retirement ages and what we call the “health barrier”, i.e. the age at which health prevents people from working longer. Both methods predict high average levels of additional work capacity. However, the picture becomes somewhat different when disaggregating the results by social groups or education. Our results emphasize the idea that policies aiming at activating any estimated additional work capacity should take into account, when possible, the heterogeneity of health conditions in the population. Moreover, additional work capacity cannot be a general indicator of how much seniors should work. The methods used here indeed leave aside many factors that determine the employment rate of older workers.
    JEL: I10 J14 J21 J26
    Date: 2016–02
  28. By: Michael F. Lovenheim; Randall Reback; Leigh Wedenoja
    Abstract: Children from low-income families face persistent barriers to accessing high-quality health care services. Previous research studies have examined the importance of expanding children's health insurance coverage, but there is little prior evidence concerning the impacts of directly expanding primary health care access to this population. We address this gap in the literature by exploring whether teenagers' access to primary health care influences their fertility and educational attainment. We study how the significant expansion of school-based health centers (SBHCs) in the United States since the early 1990's has affected teen fertility and high school dropout rates. Our results indicate that school-based health centers have a negative effect on teen birth rates: adding services equivalent to the average SBHC reduces the 15-18 year old birth rate by 5%. The effects are largest among younger teens and among African Americans and Hispanics. However, primary care health services do not reduce high school dropout rates by very much despite the sizable reductions in teen birth rates
    JEL: H75 I14 I21 J13
    Date: 2016–02
  29. By: Andrea Park Chung; Martin Gaynor; Seth Richards-Shubik
    Abstract: The hospital industry is one of the most important industries in the U.S., and industry structure can have profound effects on the functioning of markets. Using county-level panel data, we study the effect of public subsidies from the Hospital Survey and Construction Act of 1946, known as the Hill-Burton program, on hospital capacity, organization of the hospital industry, and utilization. We find that the program generated substantial increases in capacity and these changes were highly persistent, lasting well beyond twenty years. However the increases in capacity at non-profit and public hospitals were partially offset by reductions in capacity at for-profit hospitals. Nonetheless, we estimate that the Hill-Burton program accounted for a net increase of over 70,000 beds nationwide, which is roughly 17 percent of the total growth in hospital beds in the U.S. from 1948 to 1975. We also show that differences across counties in the number of hospital beds per capita were greatly reduced over this period. Differences between high and low income counties, rural and urban counties, and the South and the rest of the country fell substantially. We conclude that the program largely achieved its goals, and had substantial and long lasting effects on the hospital industry in the U.S..
    JEL: H25 H32 H54 I11 I18
    Date: 2016–02
  30. By: Matthew Grennan; Ashley Swanson
    Abstract: We empirically examine the role of information in business-to-business bargaining between hospitals and suppliers of medical technologies. Using a new data set including all purchase orders issued by over sixteen percent of US hospitals 2009-14, and differences-in-differences identification strategies based on both timing of hospitals’ joining a benchmarking database and on new products entering the market, we find that access to information on purchasing by peer hospitals leads to reductions in prices. These reductions are concentrated among hospitals previously paying high prices relative to other hospitals and for products purchased in relatively large volumes, and we demonstrate that they are consistent with hospitals resolving asymmetric information problems between themselves and their suppliers. We estimate that the achieved savings due to information provision amount to 26 percent of the savings we would observe if all hospitals paying above average prices for a given product at a point in time were to instead pay the average price. These results have implications for understanding the economic effects of introducing more information into relatively opaque business-to-business markets, including the emerging role of intermediaries offering benchmarking data and policymakers’ calls for transparency in medical device pricing.
    JEL: D40 D82 D83 I11 L14
    Date: 2016–02
  31. By: Christopher S. Carpenter; Chandler B. McClellan; Daniel I. Rees
    Abstract: We provide the first analysis of the relationship between economic conditions and the use of illicit drugs other than marijuana. Drawing on US data from 2002-2013, we find mixed evidence with regard to the cyclicality of illicit drug use. However, there is strong evidence that economic downturns lead to increases in substance use disorders involving hallucinogens and prescription pain relievers. These effects are robust to a variety of specification choices and are concentrated among prime-age white males with low educational attainment. We conclude that the returns to spending on the treatment of substance use disorders are particularly high during economic downturns.
    JEL: E32 I12
    Date: 2016–02
  32. By: RyokoSato (Global Asia Institute, National University of Singapore); Yoshito Takasaki (Faculty of Economics, The University of Tokyo)
    Abstract: Understanding how and why social interactions matter for people's vaccination behavior is important for disease control. This paper conducts the first causal analysis of peer effects on vaccination in developing countries. We created exogenous variations in peers' vaccination behaviors by randomizing cash incentives for tetanus vaccine take-up among Nigerian women. Vaccine take-up among friends strongly increased women's take-up; having a friend getting vaccinated increases the likelihood that one receives a vaccination by 18.9 percentage points. The peer effects among friends are heterogeneous by one's belief about vaccine safety and access to health clinics in a way that is consistent with whether or not a woman visits a clinic with her friend. This provides evidence for collective action as a mechanism underlying the positive peer effect.
  33. By: Juergen Jung (Department of Economics, Towson University); Chung Tran (Research School of Economics, The Australian National University); Matthew Chambers (Department of Economics, Towson University)
    Abstract: We quantify the effects of population aging on the US healthcare system. Our analysis is based on a stochastic general equilibrium overlapping generations model of endogenous health accumulation calibrated to match pre-2010 U.S. data. We find that population aging not only leads to large increases in medical spending but also a large shift in the relative size of public vs. private insurance. Without the Affordable Care Act (ACA), aging itself leads to a 36.6 percent increase in health expenditures by 2060. The group based health insurance (GHI) market shrinks, while the individual based health insurance (IHI) market and Medicaid expand significantly. Additional funds equivalent to roughly 4 percent of GDP are required to finance Medicare in 2060 as the elderly dependency ratio increases. The introduction of the ACA increases the fraction of insured workers to 99 percent by 2060, compared to 81 percent without the ACA. This additional increase is mainly driven by the further expansion of Medicaid and the IHI market. Interestingly, the ACA reduces aggregate health care spending by enrolling uninsured workers into Medicaid which pays lower prices for medical services. Overall, the ACA adds to the fiscal cost of population aging mainly via the Medicare and Medicaid expansion.
    Keywords: Population aging, health expenditures, Medicare/Mediaid, Affordable Care Act 2010, Grossman model of health capital, endogenous health spending and financing, general equilibrium.
    JEL: H51 I13 J11 E21 H62
    Date: 2016–03
  34. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research)
    Keywords: health insurance, ACA, same-sex couples
    JEL: I13 J32 J38
  35. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research); Karen Mulligan (Middle Tennessee State University)
    Keywords: Health Insurance, Medicare, Individual Market, Marriage, Employer Benefits, ACA
    JEL: I13 J3
  36. By: Cinzia Di Novi (Department of Economics, University Of Venice Cà Foscari); Dino Rizzi (Department of Economics, University Of Venice Cà Foscari); Michele Zanette (Department of Economics, University Of Venice Cà Foscari)
    Abstract: Consolidation is often considered as a means to lower service delivery costs and enhance accountability. This paper uses a prospective evaluation design to derive estimates of the potential cost savings that may arise from Local Healthcare Authorities (LHAs) amalgamation process, which is concerning the Italian National Health System. We focus specifically on cost savings due to scale economies with reference to a particular subset of the production costs of the LHAs, i.e. the administrative costs together with the purchasing costs of both goods as well as non-healthcare related services. Our results demonstrate the existence of economies of scale linked to the size of the LHA population. Hence, the decision to reduce the number of LHAs may result in larger local health authorities that are more cost efficient, especially when the consolidation process concerns merging a large number of LHA.
    Keywords: Italian Health Care System, Local Health Authority, Consolidation
    JEL: H59 I18
    Date: 2016
  37. By: Rafael Cortez; Seemeen Saadat; Edmore Marinda; Oluwole Odutolu
    Abstract: This study examines the determinants of adolescent sexual behavior and fertility in Nigeria, with a special focus on knowledge, attitudes and behaviors of adolescents aged 10-19 years old in Karu Local Government Authority (LGA), a peri-urban area near the capital city of Abuja. Using the last three waves of Demographic and Health Surveys (2003, 2008, 2013), focus group discussions, stakeholder interviews, and a specialized survey of 643 girls and boys aged 10-19 years old in Karu LGA, the study narrows in on key challenges to and opportunities for improving adolescent sexual and reproductive health outcomes. The national median age at sexual debut for adolescent girls and boys is between 15 and 16 years of age. This is closely emulated in Karu LGA with a median age of 14.8 years for girls and 15.3 years for boys. While data on pregnancies was limited in the Karu sample, DHS data show that for girls, sexual debut is closely associated with marriage or cohabitation, which in turn is a strong predictor of adolescent fertility. Poverty is another strong predictor, with the odds of becoming pregnant being twice as high for adolescents in the lower wealth quintiles compared to their counterparts in the richest quintile in the country. While adolescents’ knowledge of contraception has increased from under 10 percent to over 30 percent, use of health services among adolescents for SRH (and contraception) is limited due to factors such as fear of stigma, embarrassment, and poor access to services, something also emphasized in focus group discussions. Challenges for improving adolescent SRH outcomes relate to: (i) the paucity of data, especially on the 10-14 year olds; (ii) availability and access to youth-friendly services and the Family Life and HIV Education (FLHE); (iii) reaching out-of-school adolescents with SRH information; and (iv) addressing ambiguities and gaps in Federal law and customs on age at marriage, and generating support for the legal age at marriage of at least 18 years old. Addressing these barriers at the State and sub-regional levels is going to be critical in improving adolescent well-being
    Keywords: use of contraception, sex education, religious differences, child health, risks, social norms, reproductive health, contraception, peer education, people, vaccination ... See More + midwifery, school enrolment, antenatal care, family support, prevention, sexual behaviour, youth-friendly services, morbidity, sexually transmitted diseases, health education, sexual health, community health, social work, ethnic groups, reproductive health policy, health care, infertility, school health, sexually transmitted infections, legal status, focus group discussions, puberty, health, capacity building, holistic approach, emergency contraception, number of people, information systems, social studies, public health, life expectancy, knowledge, pregnancies, patient, smoking, intervention, population growth, secondary schools, health indicators, family health, sexuality, rape, secondary school, nurses, stis, violence, gender norms, child abuse, dissemination, service provider, service provision, marriage, sexual intercourse, basic human rights, gynecology, adolescent fertility, service delivery, quality improvement, social development, interview, secondary school enrolment, age at marriage, mortality, sexual practices, health care system, risk groups, risky sexual behavior, unions, unemployment, human capital, teenage pregnancy, sexual abuse, migrant, older people, young adults, workers, iuds, policies, aged, population studies, adolescent girls, hiv, health policy, ministry of education, health outcomes, universal access, sexual activity, family formation, urban areas, family planning, unwanted pregnancy, decision making, population council, nutrition, workshops, adolescents, quality control, policy, quality of life, primary health care, health policies, contraceptive use, internet, risk factors, sexual behavior, government policies, legal age at marriage, weight, communicable diseases, human rights, pregnant women, economic opportunities, populous country, sexual harassment, children, clinics, working conditions, lack of knowledge, youth- friendly services, young women, single parents, policy implications, young people, national policy, population, inequitable gender norms, unfpa, strategy, fertility, siblings, families, child health services, women, sexual violence, adolescent health, hospitals, social issues, health interventions, aids, early marriage, birth attendant, health services, implementation, alcohol consumption, abortion, pregnancy, condoms, political instability, parental consent, service providers, alcoholism
    Date: 2016–01
  38. By: Fels, Markus
    Abstract: I consider the popular argument of Medicaid crowding out demand for private long-term care insurance. I show that this argument rests on a wrong counterfactual comparison. Furthermore, I question the welfare-decreasing impact of Medicaid as it neglects a large value of the program in providing access to care. I show that private insurance is unable to offer a similar value. I posit that the low take-up of private insurance is due to a dilemma prevalent in - but not exclusive to - the market for long term care insurance: a dilemma between access and affordability. Several empirical patterns in insurance uptake and lapsing behavior can be explained by considering the issue of limited affordability.
    Keywords: Aging,Insurance,Long term Care,Medicaid
    JEL: G22 I11 I38
    Date: 2016
  39. By: Heger, Dörte
    Abstract: People in Canada and the U.S. often make claims regarding whose country has a better health system. Several researchers have attempted to address this question by analysing subjective health in the two countries, thus assuming a common definition of 'good' health. Using data from the Joint Canada/U.S. Survey of Health, I generate quasi-objective health indices and show that Canadians and Americans define 'good' health differently. After controlling for reporting heterogeneity, health differences between Americans and Canadians are eliminated for intermediate health statuses, while health differences at the tails of the health distribution lead to slightly better average population health in Canada. In both countries, income and education gradients increase steeply with poor health.
    Abstract: Es wird häufig debattiert, ob das kanadische oder das amerikanische Gesundheitssystem vorzuziehen ist. Um diese Frage zu beantworten, haben Forscher die subjektive Gesundheit in Kanada und den USA verglichen, was eine Übereinstimmung in der Definition von "guter Gesundheit' in beiden Ländern voraussetzt. Anhand von Daten des Joint Canada/U.S. Survey of Health konstruiere ich zwei quasi-objektive Gesundheitsindizes und zeige, dass diese Bedingung für Kanadier und Amerikaner nicht erfüllt ist. Berücksichtigt man die Heterogenität im Antwortverhalten, verschwinden Unterschiede im Gesundheitszustand zwischen Amerikanern und Kanadiern weitgehend. Verbleibende Unterschiede am unteren und oberen Rand der Gesundheitsverteilung führen zu einem leicht besseren durchschnittlichen Gesundheitszustand in Kanada. In beiden Ländern steigt der Einkommens- und Bildungsgradient mit schlechtem Gesundheitszustand deutlich.
    Keywords: Public health,inequality,Oaxaca-Blinder decomposition
    JEL: C43 I13 I14 I18
    Date: 2016
  40. By: Frankovic, Ivan; Kuhn, Michael; Wrzaczek, Stefan
    Abstract: We study the role of health care within a continuous time economy of overlapping generations subject to endogenous mortality. The economy consists of two sectors: final goods production and a health care sector, selling medical services to individuals. Individuals demand health care with a view to lowering mortality over their life-cycle. We derive the age-specific individual demand for health care based on the value of life as well as the resulting aggregate demand for health care across the population. We then characterize the general equilibrium allocation of this economy, providing both an analytical and a numerical representation. We study the allocational impact of a medical innovation both in the presence and absence of anticipation; and a temporary baby boom. We place particular emphasis on disentangling general equilibrium from partial equilibrium impacts and identifying the relevant transmission channels.
    Keywords: demographic change,life-cycle model,health care,health policy,medical change,overlapping generations,value of life
    JEL: D91 I11 I12 I18 J11 J17 O31 O41
    Date: 2016

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