nep-hea New Economics Papers
on Health Economics
Issue of 2016‒04‒04
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. BMI Growth Rates and the Nutrition Transition: The Role of Income, Inequality and Income Growth in Russia By Butzlaff, Iris
  2. Medical spending and hospital inpatient care in England: An analysis over time By Maria Jose Aragon; Martin Chalkley; Nigel Rice
  3. The Effect of Non-Work Related Health Events on Career Outcomes: An Evaluation in the French Labor Market By Emmanuel Duguet; Christine Le Clainche
  4. Maternal Employment Trajectories and Caring for an Infant or Toddler with a Disability By Anna Zhu
  5. Heterogeneous Effects of Medical Interventions on the Health of Low-Risk Newborns By Daysal, N. Meltem; Trandafir, Mircea; van Ewijk, Reyn
  6. Working-Time Mismatch and Mental Health By Otterbach, Steffen; Wooden, Mark; Fok, Yin King
  7. Vaccination policy of Japanese municipalities By Shun-ichiro Bessho; Yoko Ibuka
  8. Riverside/San Bernardino: Despite Large Medi-Cal Expansion, Many Uninsured Remain By Laurie Felland; Cannon Warren; Dori Cross
  9. To ‘Vape’ or Smoke? A Discrete Choice Experiment Among U.S. Adult Smokers By Joachim Marti; John Buckell; Johanna Catherine Maclean; Jody L. Sindelar
  10. The Price Effects of Cross-Market Hospital Mergers By Leemore Dafny; Kate Ho; Robin S. Lee
  11. The drivers of public health spending: Integrating policies and institutions By Christine de la Maisonneuve; Rodrigo Moreno-Serra; Fabrice Murtin; Joaquim Oliveira Martins
  12. Having an Older Brother Is Good or Bad for Your Education And Health? Evidence from Vietnam By Tran, Dong Quang; Nguyen, Viet Cuong
  13. An Analysis of the Relationship between U.S. State Level Carbon Dioxide Emissions and Health Care Expenditure By Nicholas Apergis; Rangan Gupta; Chi Keung Marco Lau; Zinnia Mukherjee
  14. Early treatment in HCV: is it a cost-effective option from the Italian perspective? By Andrea Marcellusi; Raffaella Viti; Francesco Damele; Calogero Cammà; Gloria Taliani; Francesco Saverio Mennini
  15. Use it or lost it: Irish evidence By Irene Mosca; Robert E Wright
  16. Progressive Universalism? The Impact of Targeted Coverage on Healthcare Access and Expenditures in Peru By Sven Neelsen; Owen O’Donnell
  17. Inequality of opportunity in health: a decomposition-based approach By Carrieri, V.;; Jones, M.A,;

  1. By: Butzlaff, Iris
    Abstract: This study analyzes the extent to which nutritional status in terms of weight change has been affected by the income distribution as the economy has grown. Is BMI growth different at different tails of the income distribution? Health and nutritional outcomes are not normally expected to be uniform across the income distribution and over time. Using recent individual level data from the Russia Longitudinal Monitoring Survey (RLMS) from 1994 to 2012, we scrutinize the influence of transitional processes, particularly economic transitions on nutritional and health outcomes. We test the hypothesis that the income gradient of individual body weight growth (i.e. the relationship between income and BMI growth) follows an inverted U-shape and thus changes its sign from positive to negative in the process of economic development. For the case of Russia, we could not find clear evidence that the income-BMI-growth gradient has already shifted. Turning points have not yet been reached. Expenditure increases have significant positive effects on BMI levels and on BMI growth rates. Better educated women have lower BMI levels than women with less than secondary education whereas men who completed tertiary education have higher BMI levels than men with less than secondary education.
    Keywords: Overweight, obesity, health, transition economy, Russia, Food Consumption/Nutrition/Food Safety, Health Economics and Policy, H51, I15, O15, P36,
    Date: 2016–03
  2. By: Maria Jose Aragon (Centre for Health Economics, University of York, UK.); Martin Chalkley (Centre for Health Economics, University of York, UK.); Nigel Rice (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK.)
    Abstract: Health care in England is predominantly provided free at the point of service through the publicly funded National Health Service (NHS). Total NHS expenditure, which has risen in real terms by an average of 3.7% per annum since the inception of the NHS in 1948, constituted 7.9% of GDP in 2012. This paper presents a summary of the trends in medical expenditure in England and then using detailed administrative data presents analysis of the growth over 15 years of expenditure and activity in hospital inpatient health care, which represents around 20-25% of all NHS expenditure. We document the coincidence of observed trends in expenditure with reported activity, morbidity and the proximity of individuals to death. We find that; (i) expenditure for both elective and emergency inpatient care broadly follows activity so expenditure is mostly driven by activity rather than unit costs; (ii) expenditure is concentrated in individuals with multiple diseases so that the prevalence and identification of complex medical conditions are important drivers of expenditure and (iii) health care activity rises substantially for individuals in the period before death so that expenditure is driven substantially by mortality in the population. Taken together these findings indicate that this element of health care expenditure in England has been substantially driven by the underlying morbidity and age of the population in conjunction with improving health care technology
    Keywords: English National Health Service, health care expenditure, health care activity, end of life expenditures
    JEL: H51 J11 I19
    Date: 2016–03
  3. By: Emmanuel Duguet (TEPP - Travail, Emploi et Politiques Publiques - UPEM - Université Paris-Est Marne-la-Vallée - CNRS - Centre National de la Recherche Scientifique, ERUDITE - Equipe de Recherche sur l’Utilisation des Données Individuelles en lien avec la Théorie Economique - UPEM - Université Paris-Est Marne-la-Vallée - UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12); Christine Le Clainche (CEE - Centre d'études de l'emploi - M.E.N.E.S.R. - Ministère de l'Éducation nationale, de l’Enseignement supérieur et de la Recherche - Ministère du Travail, de l'Emploi et de la Santé, LEM - Lille - Economie et Management - Université Lille 1 - Sciences et technologies - Fédération Universitaire et Polytechnique de Lille - CNRS - Centre National de la Recherche Scientifique)
    Abstract: This paper investigates whether chronic illnesses and injuries have a significant impact on individual performance in the labor market. We use the “Santé et Itinéraires Professionnels” (SIP, “Health and Labor Market Histories”) survey, conducted in France in the period 2006-2007. We evaluate the impact of chronic illnesses and accidents using propensity score matching. We find that chronic illness and injuries have negative effects on career outcomes and that women are more likely to claim minimum assistance revenue when such events occur. Moreover, while the initial health shock generally has long-lasting effects, it differs across genders and according to the nature of the health event: the results for men reveal a prevalence of short-run effects following accidents and a prevalence of long-run effects following chronic illnesses. We do not observe similar results for women: both chronic illnesses and accidents have long-run effects.
    Keywords: accident, chronic illness, labor, revenue.
    Date: 2014–04
  4. 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
  5. By: Daysal, N. Meltem (University of Southern Denmark); Trandafir, Mircea (University of Southern Denmark); van Ewijk, Reyn (University of Mainz)
    Abstract: We investigate the impact of early-life medical interventions on low-risk newborn health. A policy rule in The Netherlands creates large discontinuities in medical treatments at gestational week 37. Using a regression discontinuity design, we find no health benefits from additional treatments for average newborns. However, there is substantial heterogeneity in returns to treatments with significant health benefits for newborns in the lowest income quartile and no benefits in higher income quartiles. This seems due to increased maternal stress from referral to an obstetrician among higher-income mothers, heterogeneous effects of home births, and potential difficulties in risk screening among low-income women.
    Keywords: medical interventions, birth, heterogeneity, mortality
    JEL: I11 I12 I18 J13
    Date: 2016–03
  6. By: Otterbach, Steffen (University of Hohenheim); Wooden, Mark (Melbourne Institute of Applied Economic and Social Research); Fok, Yin King (Melbourne Institute of Applied Economic and Social Research)
    Abstract: Nationally representative panel survey data for Germany and Australia 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. Underemployment (working fewer hours than desired), however, seems to only be of significance in Australia.
    Keywords: Australia, Germany, mental health, Mental Component Summary Score (SF-12), longitudinal data, work hours, working-time mismatch
    JEL: I12 J22
    Date: 2016–03
  7. By: Shun-ichiro Bessho (Faculty of Economics, Keio University); Yoko Ibuka (Tohoku University)
    Abstract: Japan's immunization policy is often perceived as lagging behind those of other developed nations because of the delay in vaccine licensing and exclusion from the national program of some vaccines widely used elsewhere. In Japan, municipal authorities provide financial support for voluntary vaccinations, which are not included in the national program. This study examines the process of vaccination policymaking by municipal governments, focusing on the interdependency of such policy and using the spatial lag model and data from 2010. We make the following three findings. First, there are no systematic priorities on vaccines across municipalities. Second, vaccination subsidy policy is statistically significantly correlated with neighboring municipalities in the same prefecture, but not outside, indicating that Japanese municipalities engage in "yardstick competition" in the same prefecture. Third, no strong correlations between the other socio-economic or fiscal characteristics of municipalities and vaccination subsidy policy are detected.
    Keywords: vaccine policy, spatial lag model, yardstick competition
    JEL: I18 H75 H77
    Date: 2016–03–07
  8. By: Laurie Felland; Cannon Warren; Dori Cross
    Abstract: Riverside and San Bernardino Counties continue to recover from the devastating economic effects of the 2008 recession. Income levels in the region remain relatively low, and employment growth is characterized by lower-wage jobs with fewer health insurance benefits.
    Keywords: Medi-Cal, Riverside, San Bernardino, California, Uninsured
    JEL: I
    Date: 2016–03–18
  9. By: Joachim Marti; John Buckell; Johanna Catherine Maclean; Jody L. Sindelar
    Abstract: A small but rapidly growing percentage of the U.S. population uses e-cigarettes. Policymakers, especially the FDA, are concerned about their public health impact and thus are contemplating regulations. We provide empirical evidence to inform such policy choices. Specifically, we examine how the demand for e-cigarettes would vary across policy-relevant attributes: 1) health impact, 2) effectiveness in helping smokers quit, 3) bans in public places, and 4) price. We conduct an online discrete choice experiment of 1,669 adult smokers who select among combustible cigarettes and two types of e-cigarettes as attributes are varied. Using a conditional logit model we estimate smokers’ preferences across attributes. Then, using a latent class model, we identify types of smokers and conduct policy simulations separately by these types and for the full sample. In general, smokers value the attributes in the predicted directions and the demand for e-cigarettes tends to be motivated more by smokers’ health concerns than by price or smoking bans. The latent class model identifies three types of smokers, those who prefer combustible cigarettes (‘smokers’), e-cigarettes (‘vapers’), and using both (‘dual users’). We conclude that varying these policy-relevant attributes will have small, significant impacts on average, but with substantial heterogeneity by smoker type.
    JEL: C35 I12 I18
    Date: 2016–03
  10. By: Leemore Dafny; Kate Ho; Robin S. Lee
    Abstract: So-called "horizontal mergers" of hospitals in the same geographic market have garnered significant attention from researchers and regulators alike. However, much of the recent hospital industry consolidation spans multiple markets serving distinct patient populations. We show that such combinations can reduce competition among the merging providers for inclusion in insurers' networks of providers, leading to higher prices. The result derives from the presence of "common customers” (i.e. purchasers of insurance plans) who value both providers, as well as (one or more) "common insurers" with which price and network status is negotiated. We test our theoretical predictions using two samples of cross-market hospital mergers, focusing exclusively on hospitals that are bystanders rather than the likely drivers of the transactions in order to address concerns about the endogeneity of merger activity. We find that hospitals gaining system members in-state (but not in the same geographic market) experience price increases of 6-10 percent relative to control hospitals, while hospitals gaining system members out-of-state exhibit no statistically significant changes in price. The former group are likelier to share common customers and insurers. This effect remains sizeable even when the merging parties are located further than 90 minutes apart. The results suggest that cross-market, within-state hospital mergers appear to increase hospital systems' leverage when bargaining with insurers.
    JEL: I11 L10
    Date: 2016–03
  11. By: Christine de la Maisonneuve; Rodrigo Moreno-Serra; Fabrice Murtin; Joaquim Oliveira Martins
    Abstract: This paper investigates the impact of policies and institutions on health expenditures for a large panel of OECD countries for the period 2000-10. We use a set of 20 policy and institutional indicators developed by the OECD characterising the main supply-side, demand-side, and public management, coordination and financing features of health systems. The impact of these indicators is tested alongside control variables related to demographic (dependency ratio) and non-demographic (income, prices and technology) drivers of health expenditures per capita. Overall, there is a reasonably good fit between the expected signs of the coefficients for the institutional indicators and the actual estimates. By integrating the role of policies and institutions, together with the other primary determinants, our analysis is able to explain most of the cross-country variation in public health expenditures. Les déterminants des dépenses publiques de santé : Le rôle des politiques et des institutions Ce papier analyse l’impact des politiques et des institutions sur les dépenses de santé pour un large ensemble de pays de l’OCDE durant la période 2000-10. Nous utilisons un groupe de 20 indicateurs politiques et institutionnels développés par l’OCDE et qui caractérisent principalement l’offre, la demande, la gestion publique, la coordination et le financement des systèmes de santé. L’incidence de ces indicateurs est évaluée conjointement avec des variables de contrôle en lien avec les déterminants démographiques (taux de dépendance) et non démographiques (revenu, prix et technologie) des dépenses de santé par tête. Globalement, il existe une adéquation satisfaisante entre les signes attendus des coefficients des indicateurs institutionnels et les estimations. En intégrant le rôle des politiques et des institutions avec les autres déterminants principaux, notre analyse réussit à expliquer la majorité de la variation entre pays des dépenses publiques de santé.
    Keywords: public health expenditures, demographic and non-demographic effects, health policies and institutions, linear and non-linear estimates, cross-country variation, estimations linéaires et non linéaires, effets démographiques et non démographiques, dépenses publiques de santé, variation entre pays
    JEL: C1 H51 I12 I18 J11
    Date: 2016–03–09
  12. By: Tran, Dong Quang; Nguyen, Viet Cuong
    Abstract: This study examines the sex of the first-born children on education and health outcome of later born children. We do not find a significant effect of the sex of the first-born children on health utilization of later born children. However, we find some small effects of education. Once controlled for the number of sibling, having a firstborn brother reduces the probability of school enrolment and the probability of having good academic performance. Although the education outcomes of girls are higher than boys, this evidence still indicates gender bias in education investment of parents in their children in Vietnam.
    Keywords: Gender, birth order, education, household surveys, Vietnam.
    JEL: I1 I2
    Date: 2014–06–20
  13. By: Nicholas Apergis (Department of Banking and Financial Management, University of Piraeus, Greece); Rangan Gupta (Department of Economics, University of Pretoria); Chi Keung Marco Lau (Newcastle Business School, Northumbria University, UK); Zinnia Mukherjee (Department of Economics, Simmons College, USA)
    Abstract: This paper is the first to provide an empirical analysis of the short run and long run effects of carbon dioxide emissions on health care spending across U.S. states. Accounting for the possibility of non-linearity in the data of the individual variables as well as in the relationship amongst the variables, the analysis estimated various statistical models to show that CO2 emissions increased health care expenditures. Using quantile regressions, the analysis displayed that the effect of CO2 emissions was stronger at the upper-end of the conditional distribution of health care expenditures. The results indicate the effect of CO2 emissions on health care was relatively stronger for states that spend higher amounts in health care expenditures. A key policy message that stems out of the empirical findings is that the health benefits associated with policies implemented to reduce CO2 emissions can more than pay for the costs of implementing these policies.
    Keywords: health care expenditure, carbon dioxide emissions, panel cointegration, panel quantile regression
    JEL: I18 C31 C33
    Date: 2016–03
  14. By: Andrea Marcellusi (CEIS University of Rome "Tor Vergata"); Raffaella Viti (CEIS University of Rome "Tor Vergata"); Francesco Damele (Health Economics & Outcomes Research Manager HEMAR Manager Infectious Diseases Janssen-Cilag SpA Italia); Calogero Cammà (Sezione di Gastroenterologia, Di.Bi.M.I.S, Università di Palermo, Italia); Gloria Taliani (Infectious and Tropical Diseases Unit, Department of Clinical Medicine, Sapienza University of Rome, Italy); Francesco Saverio Mennini (CEIS-EEHTA and DEF University of Rome "Tor Vergata")
    Abstract: Background: The aim of this study is to perform an economic analysis to estimate the cost-utility of the early innovative therapy in Italy for managing HCV-infected patients. Methods: The incremental cost-utility analysis was carried out to quantify the benefits of the early treatment approach in HCV subjects. A Markov simulation model including direct and indirect costs and health outcomes was developed from Italian National Healthcare Service and societal perspective. 5,000 Monte Carlo simulations were performed on two distinct scenarios: Standard of Care (SoC) which includes 14.000 Genotype 1 patients in Italy treated with innovative interferon-free in the Fibrosis stage 3 and 4 (F3-F4) vs Early-treatment Scenario (ETS) where 2.000 patients were additionally treated with simeprevir plus peginterferon and ribavirin in the Fibrosis stage 2 (F2) (based on AIFA reimbursement criteria). A systematic literature review was carried out to identify epidemiological and economic data, which were subsequently used to inform the model. Furthermore, a one-way probabilistic sensitivity was performed in order to measure the relationship between the main parameters of the model and the cost-utility results. Results: The model shows that, in terms of Incremental Cost Effectiveness Ratio (ICER) per QALY gained, ETS appeared to be the most cost-effective option compared from both perspective Societal (ICER = €11.396) and NHS (ICER = €14.733) over a time horizon of 10 years. The cost-effectiveness of ETS is more sustainable as it extends the time horizon analysis (ICER = € 6.778 per QALY to 20 years and € 4,474 per QALY to 30 years). From the societal perspective the ETS represents the dominant option at a time horizon of 30 years. If we consider the sub-group population of treated patients (16.000 patients of which 2.000 not treated in the SoC), the ETS scenario was dominant after only 5 years horizon and cost-effective at 2 years of simulation. The one-way sensitivity analysis on the main variables confirmed the robustness of the model for the early-treatment approach. Conclusions: In conclusion, our model represents a tool for policy makers and health care professionals provide information on the cost-effectiveness of early-treatment approach in patients HCV-infected in Italy. Starting innovative treatment earlier regimens keeps HCV-infected patients in better health and reduces the incidence of HCV related events; this generating a gain both in terms of health of the patients and correct resource allocation.
    Keywords: cost-utility, early treatment, HCV management
    JEL: I19
    Date: 2016–03–23
  15. By: Irene Mosca (The Irish Longitudinal Study of Ageing, Trinity College Dublin); Robert E Wright (Department of Economics, University of Strathclyde)
    Abstract: A small but growing body of research suggests that retirement and cognitive decline are related. In fact, some have argued that retirement causes cognitive decline. The aim of this paper is to add to this literature using data of older women from The Irish Longitudinal Study on Ageing (TILDA). Ordinary least square (OLS) regressions show a significant negative association between retirement and cognitive functioning. These estimates are based on the assumption that retirement is exogenous. As retirement is potentially endogenous with respect to cognition, instrumental variable (IV) methods are also used. The instrument employed is the abolition of the so-called “Marriage Bar”. In simple terms, the Marriage Bar was the requirement that women leave paid employment on getting married. It was established in the 1930s and removed in the 1970s. When IV estimations are used, the effect of retirement on cognition is negative but statistically insignificant. Differences between OLS and IV estimates are compared with a standard test. OLS estimates are preferred as the null hypothesis of exogeneity of retirement cannot be rejected at conventional statistical levels.
    Keywords: cognition, ageing, retirement
    JEL: J14 J26
    Date: 2016–02
  16. By: Sven Neelsen (Erasmus University Rotterdam, the Netherlands); Owen O’Donnell (Erasmus University Rotterdam, the Netherlands; University of Lausanne, Switzerland; University of Macedonia, Greece)
    Abstract: Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to healthcare by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target population’s change in healthcare utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal healthcare when sick is increased by almost two fifths, while the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow cover offered, there is no impact on use of inpatient care. Mean out-of-pocket (OOP) expenditure on healthcare is unaffected but spending is reduced by up to one quarter at some points of the distribution. Among healthcare users, medical spending is reduced across much of the distribution and in relative terms falls most at lower quantiles, which is consistent with limited nominal and effective coverage of expensive treatments.
    Keywords: Health insurance; health financing; healthcare; Universal Coverage; Peru
    JEL: H42 H51 I18
    Date: 2016–03–16
  17. By: Carrieri, V.;; Jones, M.A,;
    Abstract: This paper presents a decomposition-based approach to measure inequality in health that captures Roemer’s distinction between circumstances and effort. Our approach builds on a decomposition of the Gini index with heterogeneous responses and is extended to decompose an inequality of opportunity Gini index inspired by the “fairness gap†principle. An original feature of our empirical analysis is the use of objectively measured biomarker as health outcomes and as proxies for relevant effort variables. Using data from the Health Survey for England from 2003 to 2012, we find that circumstances are the leading determinant of inequality in cholesterol, glycated haemoglobin, fibrinogen and mean arterial pressure. Moreover, we find a strong interaction between circumstances and effort leading to a smaller effect of effort on health for individuals in worse circumstances. Among the effort factors, we find that healthy diet and physical activity play the largest role in shaping objective health.
    Keywords: biomarkers; decomposition analysis; health inequalities; inequality of opportunity;
    JEL: C1 C5 D63 I14
    Date: 2016–03

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