nep-hea New Economics Papers
on Health Economics
Issue of 2016‒05‒08
nineteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. The construction of the network of public hospitals and outpatient clinics in Spain, 1880-1960. By Margarita Vilar-Rodríguez; Jerònia Pons-Pons
  2. Factor Models for Cancer Signatures By Zura Kakushadze; Willie Yu
  3. Are Banks Bad for Boys? Estimating the Effect of Banks on Child Mortality, Education, and Fertility in Rural India By Daniel Rosenblum
  4. Can Iron-Fortified Salt Control Anemia? Evidence from Two Experiments in Rural Bihar By Banerjee, Abhijit; Barnhardt, Sharon; Duflo, Esther
  5. The consequences of sibling rivalry on survival and reproductive success across different ecological contexts: a comparison of the historical Krummhörn and Quebec populations By Jonathan F. Fox; Kai P. Willführ; Alain Gagnon; Lisa Dillon; Eckart Voland
  6. In sickness but not in wealth: field evidence on patients’ risk preferences in the financial and health domain By Matteo M. Galizzi; Marisa Miraldo; Charitini Stavropoulou
  7. A critical analysis of the review on antimicrobial resistance report and the infectious disease financing facility By David M. Brogan; Elias Mossialos
  8. Workers' Mental Health, Long Work Hours, and Workplace Management: Evidence from workers' longitudinal data in Japan By KURODA Sachiko; YAMAMOTO Isamu
  9. Labor Market Effects of US Sick Pay Mandates By Pichler, Stefan; Ziebarth, Nicolas R.
  10. High Times: The Effect of Medical Marijuana Laws on Student Time Use By Chu, Yu-Wei Luke; Gershenson, Seth
  11. Research Parasites Are Beneficial for the Organism as a Whole: Competition between Researchers Creates a Symbiotic Relationship By Fecher, Benedikt; Wagner, Gert G.
  12. Nutrient Intake: A Cross-National Analysis of Trends and Economic Correlates By Dhaval M. Dave; Nadia Doytch; Inas Rashad Kelly
  13. Mortality Inequality: The Good News from a County-Level Approach By Janet Currie; Hannes Schwandt
  14. Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act By Molly Frean; Jonathan Gruber; Benjamin D. Sommers
  15. Regional Disparities In Access To Health Care: A Multilevel Analysis In Selected OECD Countries By Monica Brezzi; Patrizia Luongo
  16. Your Retirement and My Health Behaviour: Evidence on Retirement Externalities from a Fuzzy Regression Discontinuity Design By Müller, Tobias; Shaikh, Mujaheed
  17. Political Economy of Healthcare Provision: Evidence from India By Subham Kailthya; Uma Kambhampati
  18. Cost-Sharing and Use of Health Services in Italy: Evidence from a Fuzzy Regression Discontinuity Design By Michela Ponzo; Vincenzo Scoppa
  19. Use of Decision Support Systems in Nursing Field: Turkey Profile By Selma İNFAL; Esra USLU; Menekşe Nazlı Aker

  1. By: Margarita Vilar-Rodríguez (Universidad de A Coruña, Spain); Jerònia Pons-Pons (Universidad de Sevilla, Spain)
    Abstract: This paper aims to analyze the historical construction of the network of health infrastructures in Spain from very different areas both public and private. The first part provides a first statistical progress of the major infrastructure before approving the compulsory insurance. The second part of the paper analyzes the implementation of compulsory insurance in a context where the state lacked a basic network of public health infrastructure. Within this context, concerts with the private sector were essential. Later, the Plan Nacional de Instalaciones Sanitarias was approved. It was an ambitious and expensive project launched in a country with serious economic problems. From here, several questions arise: How did the dictatorship manage to fund and build the plan?; What role did private health infrastructure play after the approval of this plan?; Did this plan achieve convergence between Spain and Europe in provision of health infrastructure? The paper ends with some conclusions and a future research agenda.
    Keywords: Health Insurance, Health Infrastructures, Hospitals, Spain, XIXth-XXth centuries
    JEL: I18 I38
    Date: 2016–04
  2. By: Zura Kakushadze; Willie Yu
    Abstract: We present a novel method for extracting cancer signatures by applying statistical risk models ( from quantitative finance to cancer genome data. Using 1389 whole genome sequenced samples from 14 cancers, we identify an "overall" mode of somatic mutational noise. We give a prescription for factoring out this noise and source code for fixing the number of signatures. We apply nonnegative matrix factorization (NMF) to genome data aggregated by cancer subtype and filtered using our method. The resultant signatures have substantially lower variability than those from unfiltered data. Also, the computational cost of signature extraction is cut by about a factor of 10. We find 3 novel cancer signatures, including a liver cancer dominant signature (96% contribution) and a renal cell carcinoma signature (70% contribution). Our method accelerates finding new cancer signatures and improves their overall stability. Reciprocally, the methods for extracting cancer signatures could have interesting applications in quantitative finance.
    Date: 2016–04
  3. By: Daniel Rosenblum
    Abstract: I investigate whether a large-scale bank expansion program affected parents' decisions to invest in the health and education of their children. From 1977 to 1990, the Indian government implemented a new licensing program to encourage the construction of banks in underserved rural communities. The timing of the bank expansion program is used as an instrument to account for the possible reverse causality of child mortality or education rates affecting bank expansion. An empirical analysis using large-scale Indian surveys finds that states with a more rapid expansion of rural banks did not have significantly lower child mortality overall. However, in households with a first-born daughter, in which discrimination against daughters and in favor of sons is exacerbated, excess female mortality declines with an increase in banks. This occurs through higher male mortality rather than lower female mortality. Similarly, an increase in banks has no effect on daughters' education, but it reduces sons' years of education. Both of these effects occur in a context of more banks causing lower fertility and a reduction in poverty rates, which if anything should lead to reduced child mortality and higher education levels.
    Keywords: gender discrimination, child mortality, education, credit constraints, rural banking, India
    JEL: J13 K11 O12
    Date: 2016–04
  4. By: Banerjee, Abhijit; Barnhardt, Sharon; Duflo, Esther
    Abstract: Iron deficiency anemia is frequent among the poor worldwide. While it can be prevented with the appropriate supplement or food fortification, these programs often do not consistently reach the poorest. This paper reports on the impact of a potential strategy to address iron deficiency anemia in rural areas: double fortified salt (DFS) - salt fortified with iron and iodine. We conducted a large-scale experiment in rural Bihar. In 200 villages, randomly selected out of 400, DFS was introduced at a price that was half the regular retail price for DFS. After two years, we find no evidence that either selling DFS in villages or providing it for free directly to households has an economically meaningful or statistically significant impact on hemoglobin, anemia, physical health, cognition or mental health. For the sales experiment, we can reject at the 95% level a reduction of 2.5 percentage points in the fraction anemic in the entire sample, and 3.7 percentage points among those who were previously anemic. Using an IV strategy, we find a statistically significant, though relatively small, increase in hemoglobin and reduction in the fraction anemic for adolescents, a subgroup that has responded well to supplements and fortification in earlier studies. These disappointing results are explained both by relatively low take up and by low impact of DFS even when consumed more regularly for the majority of the population.
    Keywords: anemia; iron supplementation
    JEL: I00 I10 O11
    Date: 2016–03
  5. By: Jonathan F. Fox (Max Planck Institute for Demographic Research, Rostock, Germany); Kai P. Willführ (Max Planck Institute for Demographic Research, Rostock, Germany); Alain Gagnon (Max Planck Institute for Demographic Research, Rostock, Germany); Lisa Dillon; Eckart Voland
    Abstract: This article investigates the relationship between large families and the probability of offspring survival, marriage, and fertility across the historical populations of the Quebec (1670-1799) and Krummhörn regions (1720-1874). Both populations exist in agriculturally based economies, but differ in important ways. The Krummhörn population faced a fixed supply of land, which was concentrated amongst a small number of farmers. Most individuals were landless agricultural workers who formed a relatively competitive labor supply for the large farmers. In contrast, individuals in Quebec had access to a large supply of land, but with far fewer available agricultural workers, had to rely on their family to develop and farm that land. Results indicate that more siblings of the same gender were generally associated with increases in mortality during infancy and childhood, later ages of first marriage, and fewer numbers of children ever born. For mortality and age at first marriage, the effects of sibling formation appear strongest in the Krummhörn region. This indicates that although sibship effects appear in both ecological contexts, that the context of the region mattered in determining their magnitude.
    Keywords: Canada, Germany, child mortality, historical demography, reproduction, siblings
    JEL: J1 Z0
    Date: 2016–01
  6. By: Matteo M. Galizzi; Marisa Miraldo; Charitini Stavropoulou
    Abstract: We present results from a hypothetical framed field experiment assessing whether risk preferences significantly differ across the health and financial domains when they are elicited through the same multiple price list paired-lottery method. We consider a sample of 300 patients attending outpatient clinics in a university hospital in Athens, during the Greek financial crisis. Risk preferences in finance are elicited using paired-lottery questions with hypothetical payments. The questions are adapted to the health domain by framing the lotteries as risky treatments in hypothetical healthcare scenarios. Using Maximum Likelihood methods, we estimate the degree of risk aversion, allowing for the estimates to be dependent on domain and individual characteristics. The subjects in our sample, who were exposed to both health and financial distress, tend to be less risk averse in the financial than in the health domain.
    Keywords: Behavioral experiments in health; Field experiments; Risk aversion
    JEL: G32
    Date: 2016
  7. By: David M. Brogan; Elias Mossialos
    Abstract: Over the past year, two major policy initiatives have been introduced focusing on stimulating antibiotic development for human consumption. The European Investment Bank has announced the development of the Infectious Disease Financing Facility (IDFF) and the British government commissioned the Review on Antimicrobial Resistance, led by Jim O’Neill. Each constitutes a major effort by the European community to address the evolving crisis of antimicrobial resistance. Though both have similar goals, the approaches are unique and worthy of consideration. This manuscript utilizes a previously published framework for evaluation of antibiotic incentive plans to clearly identify the strengths and weaknesses of each proposal. The merits of each proposal are evaluated in how they satisfy four key objectives: 1) Improve the overall net present value (NPV) for new antibiotic projects; 2) Enable greater participation of Small to Medium Sized Enterprises (SME); 3) Encourage participation by large pharmaceutical companies; 4) Facilitate cooperation and synergy across the antibiotic market. The IDFF seeks to make forgivable loans to corporations with promising compounds, while the O’Neill group proposes a more comprehensive framework of early stage funding, along with the creation of a stable global market. Ultimately, the proposals may prove complementary and if implemented together may form a more comprehensive plan to address an impending global crisis. Substantial progress will only be made on these efforts if action is taken at an international level, therefore we recommend consideration of these efforts at the upcoming G20 summit.
    Keywords: International Disease Financing Facility; review of antimicrobial resistance; antibiotic development
    JEL: F3 G3
    Date: 2016–03–22
  8. By: KURODA Sachiko; YAMAMOTO Isamu
    Abstract: Overwork is widely acknowledged as the main culprit behind mental health issues, but research in social science and epidemiology seldomly considers an adequate range of factors when investigating that connection. Using longitudinal data of Japanese workers over four consecutive years, this study investigates how the number of hours worked, job characteristics, and workplace circumstances affect workers' mental health. Using widely used scores in epidemiology to measure the degrees of mental health (General Health Questionnaire), our main findings are as follows. First, long work hours contribute significantly to deteriorations in respondents' mental health, even after controlling for individual fixed effects and other characteristics. Second, the relationship between work hours and mental health is not linear. Working more than 50 hours per week notably erodes the mental health of workers. Third, clear job descriptions, ability to exercise discretion in performing tasks, and workplace atmosphere significantly influence respondents' mental health after controlling for hours worked. Fourth, if a coworker is suffering from mental illness at the workplace, the mental health of other workers are also likely to be poor. These findings suggest that proper workplace practices, including management of work hours, would affirmatively improve workers' mental health.
    Date: 2016–03
  9. By: Pichler, Stefan (ETH Zurich); Ziebarth, Nicolas R. (Cornell University)
    Abstract: This paper exploits temporal and spatial variation in the implementation of US sick pay mandates to assess their labor market consequences. We use the Synthetic Control Group Method (SCGM) and the Quarterly Census of Employment and Wages (QCEW) to estimate the causal effect of mandated sick leave on employment and wages. Our findings do not provide much evidence that employment or wages were significantly affected by the mandates which typically allow employees to earn one hour of paid sick leave per work week, up to seven days per year. Joint tests for all treatment regions let us exclude, with 90% statistical probability, that wages decreased by more than 1% as a result of the mandates. With 92% probability, we can exclude that employment decreased by more than 1%.
    Keywords: sick pay mandates, sick leave, medical leave, employer mandates, employment, wages, synthetic control group, United States, Quarterly Census of Employment and Wages (QCEW)
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2016–04
  10. By: Chu, Yu-Wei Luke (Victoria University of Wellington); Gershenson, Seth (American University)
    Abstract: Twenty-three states and the District of Columbia have passed medical marijuana laws. Previous research shows that these laws increase marijuana use among adults. In this paper, we estimate the effects of medical marijuana laws (MML) on secondary and post-secondary students' time use using time diaries from the American Time Use Survey. We apply a difference-in-differences research design and estimate flexible fixed effects models that condition on state fixed effects and state-specific time trends. We find that on average, part-time college students in MML states spend 42 fewer minutes on homework, 37 fewer minutes attending class, and 60 more minutes watching television than their counterparts in non-MML states. However, we find no effects of MMLs on secondary or full-time college students. These results provide evidence on the mechanisms through which marijuana use affects educational outcomes, young peoples' behavioral responses to MMLs (and reduced costs of obtaining marijuana), and that the impact of MMLs on student outcomes are heterogeneous and stronger among disadvantaged students.
    Keywords: time use, medical marijuana, unintended consequences
    JEL: I18 K32 K42
    Date: 2016–04
  11. By: Fecher, Benedikt (DIW Berlin); Wagner, Gert G. (DIW Berlin)
    Abstract: In the New England Journal of Medicine, Longo and Drazen critically assessed the concept of data sharing. Their main concern is that a "new class of research person will emerge" that uses data, which were gathered by other researchers, for their own original research questions. The authors referred to this class of researcher as "research parasites". Longo and Drazen are right when they note that scientific data sharing deserves more recognition. However, they indicate that the most adequate form of recognition for data sharing is coauthorship. They suggest to work "symbiotically, rather than parasitically, with the investigators holding the data, moving the field forward in a way that neither group could have done on its own." Although this is true in particular cases, co-authorship as the sole instrument of credit will unnecessarily restrict the potential of data sharing. More suitable instruments for giving credit where credit is due would be a much greater appreciation of data sharing by research communities by introducing citations of data sets, bestowing awards for good datasets, and considering data "production" when assessing scientists' career prospects, funding applications, and research outputs.
    Keywords: data sharing, incentives, rewards, organism, culture
    JEL: B40 C80 Z11
    Date: 2016–04
  12. By: Dhaval M. Dave; Nadia Doytch; Inas Rashad Kelly
    Abstract: Nutrition is a key input in the health production function, and a better understanding of how we eat can aid in guiding effective policy change towards better population health. This study documents prevalence rates, trends in, and potential correlates of nutrient intake for panels of countries, categorized by geographical regions and levels of development. We assemble data from 209 countries, spanning 51 years (1961-2011), based on original data compilations using 960 country-years for BMI, 370 country-years for glucose, and 321 country-years for cholesterol. Our estimates inform the nature and scope of nutrient intake on a global scale, and contribute towards an understanding of the drivers of the general upward trend in food intake and obesity. The cross-national trends, across countries spanning the spectrum of economic development and geographic regions, suggest that simply analyzing aggregate caloric intake masks the heterogeneity in trends for the various food groups. Food groups analyzed include cereals, sugars and sweeteners, vegetable oils, meat, starch, milk, fruits, animal fats, alcoholic beverages, oil crops, pulses, vegetables, fish, and eggs. Fixed effects regression analyses reveal that caloric intake is strongly associated with hunger depth, body mass index, cholesterol levels, and glucose levels. Moreover, changes in real GDP per capita, labor force participation, and health care measures in a nation can partly explain the increase in caloric intake. We note that substantial heterogeneity remains. While these associations should not be interpreted as causal, they provide a first step towards understanding shifts in aggregate eating patterns across the globe and levels of economic activity.
    JEL: I1
    Date: 2016–04
  13. By: Janet Currie; Hannes Schwandt
    Abstract: Analysts who have concluded that inequality in life expectancy is increasing have generally focused on life expectancy at age 40 to 50. However, we show that among infants, children, and young adults, mortality has been falling more quickly in poorer areas with the result that inequality in mortality has fallen substantially over time. This is an important result given the growing literature showing that good health in childhood predicts better health in adulthood and suggests that today’s children are likely to face considerably less inequality in mortality as they age than current adults. We also show that there have been stunning declines in mortality rates for African-Americans between 1990 and 2010, especially for black men. The fact that inequality in mortality has been moving in opposite directions for the young and the old, as well as for some segments of the African-American and non-African-American populations argues against a single driver of trends in mortality inequality, such as rising income inequality. Rather, there are likely to be multiple specific causes affecting different segments of the population.
    JEL: J11
    Date: 2016–04
  14. By: Molly Frean; Jonathan Gruber; Benjamin D. Sommers
    Abstract: Using a combination of subsidized premiums for Marketplace coverage, an individual mandate, and expanded Medicaid eligibility, the Affordable Care Act (ACA) has significantly increased insurance coverage rates. We assessed the relative contributions to insurance changes of these different ACA provisions in the law’s first full year, using rating-area level premium data for all 50 states and microdata from the 2012-2014 American Community Survey. We employ a difference-in-difference-in-difference estimation strategy that relies on variation across income groups, areas, and years to causally identify the role of the ACA policy levers. We have four key findings. First, insurance coverage was only moderately responsive to price subsidies, but the subsidies were still large enough to raise coverage by almost one percent of the population; the coverage gains were larger in states that operated their own health insurance exchanges (as opposed to using the federal exchange). Second, the exemptions and tax penalty structure of the individual mandate had little impact on coverage decisions. Third, the law increased Medicaid coverage both among newly eligible populations and those who were previously eligible for Medicaid (the “woodwork” effect), with the latter driven predominantly by states that expanded their programs prior to 2014. Finally, there was no “crowdout” effect of expanded Medicaid on private insurance. Overall, we conclude that exchange premium subsidies produced roughly 40% of the ACA’s 2014 coverage gains, and Medicaid the other 60%, of which 2/3 occurred among previously-eligible individuals.
    JEL: H2 I13
    Date: 2016–04
  15. By: Monica Brezzi; Patrizia Luongo
    Abstract: This paper investigates regional disparities in access to healthcare, measured by self-reported unmet medical needs. It looks at disparities across 86 regions in 5 European countries: Czech Republic, France, Italy, Spain and the United Kingdom. The results show that in addition to individual factors, such as age, gender, health status, or education, the characteristics of the region where people live, such as the average skill endowment or employment rate, have a significant impact on the probability of unmet medical needs. Individual and regional determinants play different roles across regions in these five countries. Moreover, in three of these countries (Czech Republic, Italy and Spain), age and chronic illness have different impacts on unmet medical needs depending on the region of residence, when all the other conditions are kept the same. The result calls for further investigation on regionalspecific factors that could be modified with targeted policies in order to reduce the probability of foregone health care.
    Keywords: health, access to health care, regional inequality, multilevel logistic analysis
    JEL: C14 I14 R11 R12
    Date: 2016–04–14
  16. By: Müller, Tobias; Shaikh, Mujaheed
    Abstract: This paper presents evidence on intra-household retirement externalities by assessing the causal effect of partner's retirement on own health behaviour in Europe. We identify partner's retirement effects by applying a fuzzy regression discontinuity (RD) framework using retirement eligibility as an exogenous instrument for partner's retirement status. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) we find that while partner's retirement increases own physical activity, it also increases smoking by up to 7 cigarettes a day and increases alcohol intake by 1-2 drinks per day. Furthermore, we find that physical activity increases only for individuals that are themselves retired pointing toward compensated effects that arise due to husband's and wife's retirement being complements. Similarly, an increase in alcohol intake is observed only if the individuals are themselves retired and an increase in smoking is only observed if the partner is a smoker suggesting mutual positive externalities and leisure complementarities.
    Keywords: Retirement Externalities, Health Behaviour, Fuzzy Regression Discontinuity Design
    JEL: C26 I12 J26
    Date: 2016
  17. By: Subham Kailthya (Department of Economics, University of Reading); Uma Kambhampati (Department of Economics, University of Reading)
    Abstract: The public provision of healthcare is common in democracies. Yet very little is known as to how political-economic factors are related to healthcare service delivery. In this paper, we examine the role of electoral participation and political competition in affecting healthcare service delivery at the sub-national level in India. However, examining this issue is less than straightforward for many reasons: first, systematic biases in health perceptions and priming of the electorate to ambient health means that existing health conditions affect expectations of the electorate from the government regarding healthcare provision; secondly, elected leaders favor providing more visible public goods vis-a-vis less visible ones to increase their chances of electoral success. And third, weak enforcement mechanisms perpetuate conditions conducive to rent-seeking. All these factors, create conditions for the presence of multiple equilibria in public provision. A least squares approach that focuses on the conditional mean alone misses this important point. We therefore employ a quantile regression method that examines the impact of political-economic factors at different points along the conditional distribution to yield a more comprehensive picture. We find signiffcant differences in the impact of political-economic variables along the conditional distributions of healthcare access and system capacity variables. Our results are also consistent with the 'visibility-effect' hypothesis in public provision: elected leaders respond differently to political-market characteristics when the public good is more, rather than less, visible. We find that health care access improves with greater electoral participation and diminishes with political competition whereas, it is the opposite for system capacity. The combined effect however limits access and increases provision of system capacity.
    Keywords: local government spending, healthcare, quantile regressions, India
    Date: 2016–04–21
  18. By: Michela Ponzo (University of Naples and CSEF); Vincenzo Scoppa (University of Calabria and IZA)
    Abstract: We use a Regression Discontinuity Design (RDD) to evaluate the impact of cost-sharing on the use of health services. In the Italian health system, individuals reaching age 65 and earning low incomes are given total exemption from cost-sharing for health services consumption. Since the probability of exemption changes discontinuously at age 65, we use a Fuzzy RDD in which the age threshold is used as an instrument for exemption. We find that prescription drug consumption, specialist visits and diagnostic checks remarkably increase with exemption. However, using several measures of health outcomes we do not find any change in individual health.
    Keywords: Health Insurance; Healthcare Demand; Cost-Sharing; Moral Hazard; Health Outcomes; Fuzzy Regression Discontinuity Design; Instrumental Variables.
    JEL: I10 I13 I11 I18 C26
    Date: 2016–04–23
  19. By: Selma İNFAL (Selcuk University); Esra USLU (Selcuk University); Menekşe Nazlı Aker (Selcuk University)
    Abstract: This systematic review assesses decision support systems used in nursing area in Turkey and effect of these systems on nursing care. This study was conducted using scientific search engines such as Ulakbim Medical Data Base, Turkish Medline Data Base, National Thesis Center, Turkish Citation Index, Turkish Psychiatry Index, Academic Index. As determined, keywords were searched in several combinations. A total of two theses that met the inclusion criteria were involved in the evaluation. This systematic review shows that the studies on this issue are very limited in terms of quantitative perspective but the results are positive. In this context, it is suggested that the number studies which are evaluating the effectiveness of the nursing care with clinical decision support systems are increased and similar studies are planned with various nursing practices.
    Keywords: Decision support systems, nursing, care, Turkey

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