nep-hea New Economics Papers
on Health Economics
Issue of 2016‒03‒29
23 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Ashes to ashes, time to time - Parental time discounting and its role in the intergenerational transmission of smoking By Philipp Huebler; Andreas Kucher
  2. Local variability in long-term care services: local autonomy, exogenous influences and policy spillovers By José-Luis Fernández; Julien Forder
  3. Examining the Effects of Five-minute, Internet-based Cognitive Behavioral Therapy and Simplified Emotion Focused Mindfulness on Depressive Symptoms: A randomized controlled trial (Japanese) By NOGUCHI Remi; SEKIZAWA Yoichi; SO Mirai; YAMAGUCHI Sosei; SHIMIZU Eiji
  4. Retirement Blues By Heller Sahlgren, Gabriel
  5. Does it really make a difference? Health care utilization with two high deductible health care plans By Stefan Pichler; Jan Ruffner
  6. The European Market for Healthcare Lighting By Aurelio Volpe
  7. Uncertainty, Tacit Knowledge, and Practice Variation: Evidence from Physicians in Training By David C. Chan, Jr
  8. Rich, Poor, Singles, and Couples. Who Receives Medicaid in Old Age and Why? By Margherita Borella; Mariacristina De Nardi; Eric French
  9. The Effect of Smoking on Obesity: Evidence from a Randomized Trial By Charles Courtemanche; Rusty Tchernis; Benjamin Ukert
  10. Social Security and Retirement Programs Around the World: The Capacity to Work at Older Ages – Introduction and Summary By Courtney Coile; Kevin S. Milligan; David A. Wise
  11. Health, Work Capacity and Retirement in Sweden By Per Johansson; Lisa Laun; Mårten Palme
  12. Health Capacity to Work at Older Ages: Evidence from Japan By Emiko Usui; Satoshi Shimizutani; Takashi Oshio
  13. Health Capacity to Work at Older Ages: Evidence from Spain By Pilar García-Gómez; Sergi Jimenez-Martin; Judit Vall Castelló
  14. Intergenerational Persistence of Health in the U.S.: Do Immigrants Get Healthier as they Assimilate? By Mevlude Akbulut-Yuksel; Adriana D. Kugler
  15. Using Preference Estimates to Customize Incentives: An Application to Polio Vaccination Drives in Pakistan By James Andreoni; Michael Callen; Yasir Khan; Karrar Jaffar; Charles Sprenger
  16. Public health expenditure in Spain: is there partisan behaviour? By Clemente, Jesús; Lazaro, Angelina; Montanes, Antonio
  17. Online Appendix to "Market Inefficiency, Insurance Mandate and Welfare: U.S. Health Care Reform 2010 By Juergen Jung; Chung Tran
  18. Peer Networks and Tobacco Consumption in South Africa By Alfred Kechia Mukong
  19. The Value of Cancer Prevention vs Treatment By Hammitt, James; Herrera, Daniel; Rheinberger, Christoph
  20. Early-life Exposure to Income Inequality and Adolescent Health and Well-being: Evidence from the Health Behaviour in School-aged Children Study By Candace Currie; Frank J. Elgar; UNICEF Office of Research - Innocenti
  21. The effect of health insurance on workers' compensation filing: Evidence from the Affordable Care Act's age-based threshold for dependent coverage By Marcus Dillender
  22. Financing the Frontline: An Analytical Review of Provincial Administrations' Rural Health Expenditure 2006-2012 By Alan Cairns; Xizohui Hou
  23. Should I stay or should I go? Hospital emergency department waiting times and demand. By Sivey, P,;

  1. By: Philipp Huebler (University of Augsburg, Department of Economics); Andreas Kucher (University of Augsburg, Department of Economics)
    Abstract: Intergenerational correlations of risky health behaviors such as tobacco consumption are well established. However, there is still limited empirical evidence about the underlying process through which the transmission is driven. This paper aims at analyzing parental time discounting and its role in the intergenerational transmission of smoking. The analysis is based on longitudinal data from the German Socio-Economic Panel (SOEP) for the years 2006, 2008 and 2010. We use a linear panel regression model to estimate the child’s likelihood of being a current smoker. The SOEP contains a great many of socio-economic characteristics and also meaningful measures of individual discounting behavior, namely, general patience and impulsivity. This enables us to distinguish between time preference and self-control, respectively. We ï¬ nd signiï¬ cant effects of time preference for both, mothers and fathers. That is, an increasing level of patience of parents is associated with a lower smoking probability of the child. Regarding self-control, only father’s impulsivity has a similar decreasing impact. Stratifying the sample by gender reveals substantial mother-daughter, mother-son and father-son effects. Additionally, we estimate the influence of health-related mediating factors such as parental smoking and alcohol consumption. It turns out that role modeling as well as time discounting of the parents are highly relevant in this transmission process.
    Keywords: family economics, intergenerational transmission, smoking, time discounting, time preference, patience, self-control, impulsivity
    JEL: D9 D10 I12 J13
    Date: 2016–03
  2. By: José-Luis Fernández; Julien Forder
    Abstract: In many countries, public responsibility over the funding and provision of long-term care services is held at the local level. In such systems, long-term care provision is often characterised by significant local variability. Using a panel dataset of local authorities over the period 2002 to 2012, the paper investigates the underlying causes of variation in gross social care expenditure for older people in England. The analysis distinguishes between factors outside the direct control of policy makers, local preferences, and local policy spillovers. The results indicate that local demand and supply factors, and to a much lesser extent local political preferences and spatial policy spillovers, explain a large majority of the observed variation in expenditure.
    Keywords: long-term care; spatial; variability; spillovers
    JEL: J50
    Date: 2015–03–11
  3. By: NOGUCHI Remi; SEKIZAWA Yoichi; SO Mirai; YAMAGUCHI Sosei; SHIMIZU Eiji
    Abstract: Objective and Methods: In order to find simple measures to reduce depressive symptoms, we examined the effects of simplified five-minute, internet-based cognitive behavioral therapy (iCBT) and simplified emotion focused mindfulness (sEFM) exercise. Nine hundred and seventy-four people were randomly assigned to the iCBT, sEFM, or waiting list control group. Those in intervention groups did each exercise for five weeks. The main outcome measure was the Center for Epidemiologic Studies Depression (CES-D) scale. The secondary outcome measures were PHQ-9 and GAD-7. Results: At post-intervention, there were no significant differences between the intervention groups and the control group in CES-D although the difference between the iCBT group and the control group was almost significant ( p =0.05) in favor of iCBT. In PHQ-9, there was a significant difference in favor of sEFM group compared with the control group. These results were not maintained at the six week follow-up. Conclusion: Both iCBT and sEFM have the potential to temporarily reduce depressive symptoms. In order to enhance the effects, some improvements are required such as extending the duration and combining several methodologies.
    Date: 2016–03
  4. By: Heller Sahlgren, Gabriel (London School of Economics)
    Abstract: This paper analyses the short- and long-term effects of retirement on mental health in ten European countries. It exploits thresholds created by regular state pension ages in a fuzzy regression-discontinuity design combined with individual-fixed effects to deal with endogeneity in retirement behaviour. The results display no short-term effects of retirement on mental health, but a large negative longer-term impact. This impact survives a battery of robustness tests, and applies to women and men as well as to people of different educational backgrounds equally. Differences compared to previous research are attributed to the study’s differentiation of short- and longer-term effects as well as its utilisation of a cleaner research design. Overall, the paper’s findings suggest that reforms inducing people to postpone retirement are not only important for making pension systems solvent, but with time could also pay a mental health dividend among the elderly and reduce public health care costs.
    Keywords: Mental Health; Retirement; SHARE; Regression-Discontinuity Design
    JEL: I10 J14 J26
    Date: 2016–03–09
  5. By: Stefan Pichler (KOF Swiss Economic Institute, ETH Zurich, Switzerland); Jan Ruffner (KOF Swiss Economic Institute, ETH Zurich, Switzerland)
    Abstract: Deductibles are commonly used to tame increasing health care costs. Numerous studies find that higher deductibles reduce health care utilization. In this paper we compare utilization in Switzerland between two health care plans with deductibles of 1,500 CHF and 2,500 CHF (1CHF =1$) per calendar year. While there is a minimum deductible level in Switzerland, individuals are free to increase their deductible and thereby reduce their insurance premium. In order to distinguish between selection and moral hazard we use regional variation in premiums as an instrument. Moreover, we take advantage of a policy change in 2005 that introduced the higher deductible for the first time. The results show that selection leads to considerable differences in utilization between the two groups, while we find no behavioral differences across both groups. If anything health care expenditures are higher for male individuals with the higher deductible, while for females there are no differences between the two deductible levels.
    Keywords: Moral hazard, Instrumental variables, Health insurance, Deductible, Advantageous Selection
    JEL: C23 C26 I12
    Date: 2016–03
  6. By: Aurelio Volpe (CSIL Centre for Industrial Studies)
    Abstract: This is the first edition of CSIL Report on the European market for healthcare lighting. The information provided in this report is based on desk analysis and field analysis for two healthcare macro segments and its main products such as hospitals and dental studies, the activity trend in Europe, the market drivers (such as demographic changes, healthcare expenditure, hospitals, nursing residential care facilities, dental practices and community pharmacies). It is provided also a market value by application and a list of the major players and weight on the overall lighting turnover. The desk analysis includes: i)statistical data collection from official sources (eg. Eurostat databases) and other sources (eg. associations, trade press..); ii)the review of other existing documentation (eg. press releases, web sources, studies relating to the lighting industry); iii) the analysis of companies databases (eg. balance sheets). The field analysis was carried on through 20 interviews with manufacturers and experts operating in the healthcare lighting industry. Analysis about LED share in the Healthcare lighting market and specific applications is given. Specific segments analyzed include surgery lighting, intensive care and examination rooms lighting, normal stay bedrooms, long-care bedrooms lighting, lighting for common areas, corridors and circulation areas lighting, stairwells lighting, lighting for laboratories and pharmacies, design tips.
    JEL: L11 L22 L68
    Date: 2015–04
  7. By: David C. Chan, Jr
    Abstract: Studying physicians in training, I investigate how uncertainty and tacit knowledge may give rise to significant practice variation. Consistent with tacit knowledge accruing only with experience, and empirically exploiting a discontinuity in the formation of teams, experience relative to a peer substantially increases the size of variation attributable to the physician trainees. Among the same physician trainees, convergence occurs for patients on services driven by specialists, where there is arguably more explicit knowledge, but not on the general medicine service. This difference is unexplained by formally coded patient information. In contrast, rich physician characteristics correlated with preferences and ability, and quasi-random assignments to high- or low-spending supervising physicians explain little if any variation.
    JEL: D20 D83 I10 L23 L84 M11 M53 M54
    Date: 2016–01
  8. By: Margherita Borella; Mariacristina De Nardi; Eric French
    Abstract: We use the Health and Retirement Survey (HRS) data set to study who receives Medicaid in old age and why. First, we conduct a descriptive analysis of Medicaid recipiency along a number of important observables. This analysis shows that, while fewer people with high permanent income receive Medicaid, a significant fraction of high permanent income people receive Medicaid at very old ages. It also shows that more single people receive Medicaid than people in couples, that people who just lost their spouse rapidly become very similar in their Medicaid recipiency and other important observable characteristics to people who have been single for much longer, and that bad health commoves with Medicaid recipiency. Finally, this analysis shows even people having long-term care insurance end up on Medicaid, but that the fraction of people in this group that is on Medicaid is one-third that of the entire population of the elderly. Second, multivariate regression analysis allows us to disentangle the effects of many observables on Medicaid recipiency while conditioning for others and reveals several interesting patterns. First, permanent income and other variables capturing economic background have a major role in determining individuals’ Medicaid coverage and explain much of the observed differences in Medicaid recipiency among singles, couples, and people who recently lost their spouse. Second, impairments in the activities of daily living and residency in a nursing home have a large effect on the probability of being on Medicaid, with the effect of nursing home residency being relatively large for those in the middle and upper income groups. Lastly, having long-term care insurance has no independent effect on the probability of ending up on Medicaid.
    JEL: D1 D31 E21 H2 H31 H4 H51
    Date: 2016–01
  9. By: Charles Courtemanche; Rusty Tchernis; Benjamin Ukert
    Abstract: This paper aims to identify the causal effect of smoking on body mass index (BMI) using data from the Lung Health Study, a randomized trial of smoking cessation treatments. Since nicotine is a metabolic stimulant and appetite suppressant, quitting or reducing smoking could lead to weight gain. Using randomized treatment assignment to instrument for smoking, we estimate that quitting smoking leads to an average long-run weight gain of 1.5-1.7 BMI units, or 11-12 pounds at the average height. These magnitudes are considerably larger than those typically estimated by studies that do not account for the endogeneity of smoking. Our results imply that the drop in smoking in recent decades explains 14% of the concurrent rise in obesity. Semi-parametric models provide evidence of a diminishing marginal effect of smoking on BMI, while subsample regressions show that the impact is largest for younger individuals, females, those with no college degree, and those with healthy baseline BMI levels.
    JEL: I12
    Date: 2016–01
  10. By: Courtney Coile; Kevin S. Milligan; David A. Wise
    Abstract: This is the introduction and summary to the seventh phase of an ongoing project on Social Security Programs and Retirement Around the World. The project compares the experiences of a dozen developed countries and uses differences in their retirement program provisions to explore the effect of SS on retirement and related questions. The first three phases of this project document that: 1) incentives for retirement from SS are strongly correlated with labor force participation rates across countries; 2) within countries, workers with stronger incentives to delay retirement are more likely to do so; and 3) changes to SS could have substantial effects on labor force participation and government finances. The fourth volume explores whether higher employment among older persons might increase youth unemployment and finds no link between the two. The fifth and sixth volumes focus on the disability insurance (DI) program, finding that changes in DI participation are more closely linked to DI reforms than to changes in health and that reducing access to DI would raise labor supply. This seventh phase of the project explores whether older people are healthy enough to work longer. We use two main methods to estimate the health capacity to work, asking how much older individuals today could work if they worked as much as those with the same mortality rate in the past or as younger individuals in similar health. Both methods suggest there is significant additional health capacity to work at older ages.
    JEL: H31 H55 I19 J14 J26
    Date: 2016–01
  11. By: Per Johansson; Lisa Laun; Mårten Palme
    Abstract: Following an era of a development towards earlier retirement, there has been a reversed trend to later exit from the labor market in Sweden since the late 1990s. We investigate whether or not there are potentials, with respect to health and work capacity of the population, for extending this trend further. We use two different methods. First, the Milligan and Wise (2012) method, which calculates how much people would participate in the labor force at a constant mortality rate. Second, the Cutler et al. (2012) method, which asks how much people would participate in the labor force if they would work as much as the age group 50-54 at a particular level of health. We also provide evidence on the development of self-assessed health and health inequality in the Swedish population.
    JEL: I10 I14 J14 J26
    Date: 2016–02
  12. By: Emiko Usui; Satoshi Shimizutani; Takashi Oshio
    Abstract: This paper explores the extent to which older Japanese can potentially expand the labor supply, based on two analytic approaches: the Milligan-Wise and Cutler et al. methods. First, we examine how much older individuals could work if they worked as much as those with the same mortality rate in the past (the Milligan-Wise method). Second, we estimate how much older individuals could work if they worked as much as younger ones in similar health (the Cutler et al. method). Results from both of these methods underscore a large work capacity in old age in Japan. We further investigate differences in health capacity across education groups and find that highly educated individuals tend to have more capacity to work after they are 65 years of age.
    JEL: H55 I12 J26
    Date: 2016–02
  13. By: Pilar García-Gómez; Sergi Jimenez-Martin; Judit Vall Castelló
    Abstract: In a world with limited PAYGO financing possibilities this paper explores whether older Spanish individuals have the health capacity to work longer. For that purpose we use Milligan-Wise and Cutler-Meara Cutler-Meara- Richards-Shubik simulation methods. Our results suggest that Spanish workers have significant additional capacities to extend their working careers.
    JEL: I1 J11 J14 J82
    Date: 2016–02
  14. By: Mevlude Akbulut-Yuksel; Adriana D. Kugler
    Abstract: It is well known that a substantial part of income and education is passed on from parents to children, generating substantial persistence in socio-economic status across generations. In this paper, we examine whether another form of human capital, health, is also largely transmitted from generation to generation, contributing to limited socio-economic mobility. Using data from the NLSY, we first present new evidence on intergenerational transmission of health outcomes in the U.S., including weight, height, the body mass index (BMI), asthma and depression for both natives and immigrants. We show that both native and immigrant children inherit a prominent fraction of their health status from their parents, and that, on average, immigrants experience higher persistence than natives in weight and BMI. We also find that mothers’ education decreases children’s weight and BMI for natives, while single motherhood increases weight and BMI for both native and immigrant children. Finally, we find that the longer immigrants remain in the U.S., the less intergenerational persistence there is and the more immigrants look like native children. Unfortunately, the more generations immigrant families remain in the U.S., the more children of immigrants resemble natives’ higher weights, higher BMI and increased propensity to suffer from asthma.
    JEL: I12 I14 J61 J62
    Date: 2016–02
  15. By: James Andreoni; Michael Callen; Yasir Khan; Karrar Jaffar; Charles Sprenger
    Abstract: We use structural estimates of time preferences to customize incentives for a sample of polio vaccinators during a series of door-to-door immunization drives in Pakistan. Our investigation proceeds in three stages. First, we measure time preferences using intertemporal allocations of vaccinations. Second, we derive the mapping between these structural estimates and individually optimal incentives given a specific policy objective. Third, we experimentally evaluate the effect of matching contract terms to individual discounting patterns in a subsequent experiment with the same vaccinators. This exercise provides a test of the specific point predictions given by structural estimates of time preference. We document present bias among vaccinators and find that tailored contracts achieve the intended policy objective of smoothing intertemporal allocations of effort. The benefits of customized incentives in terms of achieving the policy objective are largest for vaccinators allocating when present bias is relevant to the decision.
    JEL: D03 I1 O1
    Date: 2016–02
  16. By: Clemente, Jesús; Lazaro, Angelina; Montanes, Antonio
    Abstract: This study examines the disparities in the evolution of Spanish regional public health expenditures from 1991 to 2010. We find that the recent development of the Spanish regional public health system have led the regions to reflect a very heterogeneous pattern of behaviour. These differences depend on economic and demographic factors, but also on the ideology of the regional governments. The longer a region is governed by a right-wing party, the lower the public health expenditure. This result suggests the presence of clear partisan behaviour in the Spanish public health system.
    Keywords: Convergence analysis, Phillips-Sul; Health expenditure; Partisan behaviour.
    JEL: C22 I18 R10
    Date: 2016–02–29
  17. By: Juergen Jung (Towson University); Chung Tran (Australian National University)
    Abstract: Online appendix for the Review of Economic Dynamics article
    Date: 2016
  18. By: Alfred Kechia Mukong
    Abstract: This paper deepens the empirical analysis of peer networks by considering simultaneously their effects smoking participation and smoking intensity. Peer network is key in determining the smoking behaviour of youths, but the magnitude of the effects is still debated, questioned and inconclusive. I used a control function approach, a two-step least square and the fixed effect method to address the potential endogeneity of peer network. The results suggest positive and signicant peer effects on smoking participation and intensity. While the magnitude of the estimates of smoking participation varies across methodological approaches (ranging between 4 and 20 percent), that of smoking intensity ranges between 3 and 22 percent. Including older adults in the peer reference group increases the peer eects. The findings suggest that policies (excise tax) that directly aect the decision to smoke and the smoking intensity of the peer reference group are likely to aect own smoking behaviour.
    Keywords: Peer network, Smoking behavior, Control function, South Africa
    JEL: I10 I12 D12 C36
    Date: 2016
  19. By: Hammitt, James; Herrera, Daniel; Rheinberger, Christoph
    Abstract: We present an integrated valuation model for diseases that pose some chance of death. The model extends the standard one-period value-of-statistical-life model to three health prospects: healthy, ill, and dead. We derive willingness-to-pay values for preven- tion eorts that reduce a disease’s incidence rate as well as for treatments that lower the corresponding health deterioration and mortality rates. We find that the demand value of prevention always exceeds that of treatment. People often overweight small risks and underweight large ones. We use the rank dependent utility framework to explore how the demand for prevention and treatment alters when people evaluate probabilities in a non-linear manner. For incidence and mortality rates associated with common types of cancers, the inverse-S shaped probability weighting found in experimental studies leads to a significant increment in the demand values of both treatment and prevention.
    JEL: D11 D81 I10
    Date: 2016–02
  20. By: Candace Currie; Frank J. Elgar; UNICEF Office of Research - Innocenti
    Abstract: Children and adolescents living in relative poverty – regardless of overall material conditions – tend to experience more interpersonal violence, family turmoil, and environmental hazards that increase risk of injury, engage in more health compromising behaviours (e.g., physical inactivity, poor nutrition, smoking), report lower subjective well-being, and exhibit more social skills deficits and emotional and behavioural problems.
    Keywords: adolescents; children; health; health conditions; income distribution;
    JEL: C42 R2
    Date: 2016
  21. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research)
    Keywords: Workers' compensation, Moral hazard, Health insurance, Affordable Care Act
    JEL: I13 J32 J38
  22. By: Alan Cairns; Xizohui Hou
    Abstract: Financing the frontline updates the expenditure analysis carried out in below the glass floor (2013) and tests whether the spending patterns emerging in 2009 and 2010 in Papua New Guinea have been sustained or improved in 2011 and 2012. The review also supports a better understanding of the issues that confront frontline service delivery - such as the ambiguity of roles and responsibilities in some rural health functions - and presents next steps. Concurrently, the national department of health performance information on facilities (from the national health information system (NHIS)) has been reviewed. The integration of the expenditure analysis, the NHIS performance information, and the findings from the promoting effective public expenditure facility surveys will provide a rich source of information to help sharpen understanding and shape solutions.
    Keywords: sanitation, communities, spending levels, deficit, basic services, villages, accounting, financial management, operational expenditure, village, aggregate spending, provincial ... See More + support, provincial budget, local governments, community health, programs, services, policy recommendations, cost estimates, central budget, health care, revenues, health care facilities, provincial hospital, health, provincial levels, provinces, government accounting, health workers, projects, project, budget model, tax, environmental health, inflation, rural community, revenue sources, fiscal impact, cost of services, budget, fiscal capacity, health sector, knowledge, subnational, chart of accounts, budget allocations, district administration, district levels, outreach work, training, immunization, patient, patients, appropriation, operational costs, district, provincial government, health centers, ex ante controls, provincial ‘transfers, transfers, provincial spending, expenditure analysis, provincial administrators, auditor-general, cost of service, district health, accounting system, provincial level, service delivery, district level, expenditure data, national agency, public investment, health information, infrastructure, design, entitlements, health spending, expenditure, assignment of responsibilities, sub-national, equity, subnational expenditure, accountability, workers, appropriations, transparency, provincial expenditure, central administration, public expenditure, budget process, provision of water, province, distribution function, capacity constraints, national government, budgets, level of government, provincial performance, family planning, provincial administrations, medical supplies, performance information, fiscal year, provincial capital, performance analysis, provincial administration, nutrition, workshops, service delivery functions, personnel emoluments, primary health care, mobile clinics, internet, program structure, sanitation services, central coordination, district headquarters, clinics, annual budget, rural areas, birth attendants, health expenditure, allocation, provincial governments, cost estimate, revenue, facilities, national policy, community health worker, financial support, provincial treasury, community, strategy, public investment program, central agencies, hospitals, price index, provincial discretion, outcomes, government accounts, rural development, health services, implementation, service, districts, financing arrangements, service providers, provincial treasuries
    Date: 2015–09
  23. By: Sivey, P,;
    Abstract: In the absence of the price mechanism hospital emergency departments rely on waiting times, alongside prioritisation mechanisms, to restrain demand and clear the market. This paper aims to estimate the relationship between waiting times and demand: by how much is the number of treatments demanded reduced by a higher waiting time, other things equal? I use variation in waiting times for low-urgency patients caused by rare and resource-intensive high-urgency patients to estimate the relationship. I find that when waiting times are higher, more low-urgency patients are deterred from treatment and leave the hospital during the waiting period without being treated. The waiting time elasticity of demand for low-urgency patients is approximately -0.25, and is highest for the lowest-urgency patients and when more substitute forms of care are available. The results imply waiting times play a substantial role in reducing demand from low-urgency patients and large increases in hospital capacity will be necessary to reduce emergency department waiting times.
    Keywords: hospital emergency departments; waiting times; demand;
    JEL: I11
    Date: 2016–02

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