nep-hea New Economics Papers
on Health Economics
Issue of 2016‒06‒09
thirteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Is the Distribution of Cardiovascular Risks Really Improving? A Robust Analysis for France. By Fatiha Bennia; Nicolas Gravel
  3. A unified approach to mortality modelling using state-space framework: characterisation, identification, estimation and forecasting By Man Chung Fung; Gareth W. Peters; Pavel V. Shevchenko
  4. Introduction of a national minimum wage reduced depressive symptoms in low-wage workers: a quasi-natural experiment in the UK By Aaron Reeves; Martin McKee; Johan Mackenbach; Margaret Whitehead; David Stuckler
  5. Age or time-to-death – what drives health care expenditures? Panel data evidence from the OECD countries By Maciej Lis
  6. Impacts of an HIV counseling and testing initiative -- results from an experimental intervention in a large firm in South Africa By Arimoto, Yutaka; Hori, Narumi; Ito, Seiro; Kudo, Yuya; Tsukada, Kazunari
  7. Access to Health Care and the Out-of-Pocket Burden of the European Elderly By Veronika Krutilova
  8. Case Study of Kentucky: Exploring Links Between Policy, Practice and the Trends in New Medicaid/SCHIP Enrollments By Christopher Trenholm; Bridget Lavin
  9. The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the 2014 ACA Medicaid Expansions By Kosali Simon; Aparna Soni; John Cawley
  10. Suffer for the Faith? Parental Religiosity and Children’s Health By Olga Popova
  11. Telework and health effects review, anda a research framework proposal By Tavares, Aida Isabel
  12. Dimension of the Country of Origin Effect in the Perception of Medical Services in EU Countries– an International Comparison By Ewa Magier-Šakomy; Monika Boguszewicz-Kreft; Brigita Janiūnaitė
  13. The Triangular Causality among Education, Health and Economic Growth: A Time Series Analysis of Nepal By Gangadhar Dahal

  1. By: Fatiha Bennia (Aix-Marseille University, Laboratoire de Santé Publique, Faculté de Médecine); Nicolas Gravel (Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS)
    Abstract: In this paper, we appraise the recent evolution of the distribution of individuals’ risk of cardiovascular diseases (CVD) in France among both men and women using new normative criteria. An individual risk of CVD is described by a probability of getting such a disease. Building on the framework of Gravel and Tarroux (2015), we assume that individuals, who differ by their income, have Von Neuman-Morgenstern (VNM) preferences over such risks. We appeal to Harsanyi’s aggregation theorem to provide empirically implementable dominance criteria that coincide with the unanimity, taken over a large class of such individual preferences, of anonymous and Pareto-inclusive VNM social rankings of distributions of individuals’ risk of CVD. The implementable criteria that we obtain are Sequential headcount poverty dominance and Sequential headcount affluence dominance. We apply these criteria to the distribution of cardiovascular risks among French men and women on the 2006-2010 period. Probabilities of CVD are assigned to individuals on the basis of a logit model estimated on both the men and the women samples for each of the two years. Our main empirical result is that men and women were differently affected by evolution in the distribution of CVD risks between 2006 and 2010. Specifically, the distribution improved for women but did not improve for men.
    Keywords: Risk, Dominance, ex ante Social Welfare, State-Dependent Expected Utility, Poverty, Health, Cardiovascular diseases
    JEL: C81 D3 D63 D81 I32 J63 J64
    Date: 2016–05–16
    Date: 2016
  3. By: Man Chung Fung; Gareth W. Peters; Pavel V. Shevchenko
    Abstract: This paper explores and develops alternative statistical representations and estimation approaches for dynamic mortality models. The framework we adopt is to reinterpret popular mortality models such as the Lee-Carter class of models in a general state-space modelling methodology, which allows modelling, estimation and forecasting of mortality under a unified framework. Furthermore, we propose an alternative class of model identification constraints which is more suited to statistical inference in filtering and parameter estimation settings based on maximization of the marginalized likelihood or in Bayesian inference. We then develop a novel class of Bayesian state-space models which incorporate apriori beliefs about the mortality model characteristics as well as for more flexible and appropriate assumptions relating to heteroscedasticity that present in observed mortality data. We show that multiple period and cohort effect can be cast under a state-space structure. To study long term mortality dynamics, we introduce stochastic volatility to the period effect. The estimation of the resulting stochastic volatility model of mortality is performed using a recent class of Monte Carlo procedure specifically designed for state and parameter estimation in Bayesian state-space models, known as the class of particle Markov chain Monte Carlo methods. We illustrate the framework we have developed using Danish male mortality data, and show that incorporating heteroscedasticity and stochastic volatility markedly improves model fit despite an increase of model complexity. Forecasting properties of the enhanced models are examined with long term and short term calibration periods on the reconstruction of life tables.
    Date: 2016–05
  4. By: Aaron Reeves; Martin McKee; Johan Mackenbach; Margaret Whitehead; David Stuckler
    Abstract: Does increasing incomes improve health? In 1999, the UK government implemented minimum wage legislation, increasing hourly wages to at least £3.60. This policy experiment created intervention and control groups that can be used to assess the effects of increasing wages on health. Longitudinal data were taken from the British Household Panel Survey. We compared the health effects of higher wages on recipients of the minimum wage with otherwise similar persons who were likely unaffected because (1) their wages were between 100 and 110% of the eligibility threshold or (2) their firms did not increase wages to meet the threshold. We assessed the probability of mental ill health using the 12-item General Health Questionnaire. We also assessed changes in smoking, blood pressure, as well as hearing ability (control condition). The intervention group, whose wages rose above the minimum wage, experienced lower probability of mental ill health compared with both control group 1 and control group 2. This improvement represents 0.37 of a standard deviation, comparable with the effect of antidepressants (0.39 of a standard deviation) on depressive symptoms. The intervention group experienced no change in blood pressure, hearing ability, or smoking. Increasing wages significantly improves mental health by reducing financial strain in low-wage workers. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.
    Keywords: minimum wage; natural experiments; health policy; GHQ caseness
    JEL: R14 J01
    Date: 2016–04–04
  5. By: Maciej Lis
    Abstract: The most important engines for the growth of aggregate health care expenditures (HCE) in last 50 years in OECD have been growth of income, technological progress in medicine and their interaction with institutional setting. The accelerating ageing is expected to additionally fuel the growth of HCE. The interaction between the growth factors with age is crucial for understanding the impact of ageing on health care expenditures. We propose a non-linear framework for testing the dynamics of the interaction of the growth of HCE with age structure. This framework utilizes the micro and cohort evidence from other studies on the shape of HCE and time-to-death. We have found that the growth of health care expenditure in recent decades in 26 OECD was concentrated on the close-to-death expenditures. Close-to-death HCE demonstrated twice higher growth rates than expenditures more distant from death. No clear dynamics of age pattern has been however identified.
    Keywords: health, modelling
    JEL: H51 I12 I18 J14
    Date: 2016–04
  6. By: Arimoto, Yutaka; Hori, Narumi; Ito, Seiro; Kudo, Yuya; Tsukada, Kazunari
    Abstract: We have run experimental interventions to promote HIV tests in a large firm in South Africa. We combined HIV tests with existing medical check programs to increase the uptake. In the foregoing survey we undertook previously, it was suggested that fears and stigma of HIV/AIDS were the primary reasons given by the employees for not taking the test. To counter these, we implemented randomized interventions. We find substantial heterogeneity in responses by ethnicity. Africans and Colored rejected the tests most often. Supportive information increased the uptake by 6 to 16% points. A tradeoff in targeting resulting in stigmatizing the targeted and a reduction of exclusion error is discussed.
    Keywords: Diseases, Public health, Labor conditions, HIV, Stigma, RCT, Testing, Corporate setting
    JEL: I19 J16
    Date: 2016–04
  7. By: Veronika Krutilova (Research Centre, Faculty of Business and Economics, Mendel University in Brno, Zemedelska 1, 61300 Brno)
    Abstract: Provision of access to health care is a desirable feature of health care systems. Access to health care is caused to be restricted whether out-of-pocket burden is too high. The paper focuses on the European elderly with restricted access to health care and evaluates their health care burden and determines factors affecting the burden. The data from the Survey of Health, Ageing and Retirement in Europe from the fifth wave is used. The methods of descriptive and multivariate analysis are applied. A linear regression model with a bootstrapped method is used. The results showed that inequalities in access to health care exist. Unmet need is a critical issue in Estonia and Italy. The highest burden is found in Estonia, Italy and Belgium. Chronic diseases and limitation in activities significantly contributes to health care burden. Expenditure on drugs, outpatient and nursing care have a significant effect on the burden. The effect is found to be insignificant for inpatient care. Income and the employment status is a preventing factor.
    Keywords: elderly, unmet need, health care, out-of-pocket payments, access to health care, health care burden, SHARE.
    JEL: I14 I18 J14
    Date: 2016–05
  8. By: Christopher Trenholm; Bridget Lavin
    Abstract: This case study discusses the trends in new enrollment of children in Kentucky’s Medicaid and SCHIP from 1999 to 2005.
    Keywords: Covering Kids & Families Evaluation, Kentucky, Medicaid, SCHIP, health
    JEL: I
  9. By: Kosali Simon; Aparna Soni; John Cawley
    Abstract: The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA’s state-level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference-in-differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g. dental visits, immunizations, mammograms, cancer screenings) and risky health behaviors (e.g. smoking, heavy drinking, lack of exercise, obesity). We find evidence consistent with increased use of certain forms of preventive care such as dental visits and cancer screenings but little evidence of changes in health behaviors and in particular no evidence of ex ante moral hazard (i.e., no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also resulted in modest improvements in self-assessed health and decreases in the number of work days missed due to poor health.
    JEL: I12 I13 I28
    Date: 2016–05
  10. By: Olga Popova
    Abstract: Abstract This paper provides novel evidence on differences in health outcomes of children in religious and non-religious families in Russia. The health indicators analyzed include the subjective health status and anthropometric outcomes. The endogeneity of religiosity is accounted for. The empirical findings suggest that if both parents are religious, their religiosity does not affect children’s height-for-age, but increases children’s body mass index and subjective health. Father’s religiosity has a stronger salutary effect than mother’s religiosity. In fatherless families, children’s health is more strongly affected by mother’s education and employment status than in two-parent families. All findings are stronger for older children. These results underscore the importance of considering both maternal and paternal characteristics for family-oriented policies that target the protection of children’s health. Also, policies protecting children’s health should target single mothers as a particularly vulnerable social group.
    Keywords: children, health, religiosity, parental beliefs, Russia
    JEL: I15 J13 O12 P36 Z12
    Date: 2016–04
  11. By: Tavares, Aida Isabel
    Abstract: Telework is an increasingly popular flexible working arrangement. The features that characterize telework are presented in this work. The advantages and disadvantages of teleworking are described, as well as its effect on the health of the worker. In general, empirical evidence seems to show a positive association between telework and worker health. However, it can also have negative impacts on health such as stress and depression. We propose a framework of analysis of the effect of telework on health that draws on contributions from health economics and from occupational psychology.
    Keywords: telecommuting, teleworking, workers, health
    JEL: I12
    Date: 2015
  12. By: Ewa Magier-Šakomy (WSB University in Gdańsk); Monika Boguszewicz-Kreft (WSB University in Gdańsk); Brigita Janiūnaitė (Kaunas University of Technology)
    Abstract: The influence of the country’s images on consumer attitudes has been defined as the country of origin (COO) effect. So far, the research in that field in services has been relatively scarce, and the analysis of expert literature indicated that the question of the COO effect in medical services has been discussed only in one article.The aim of the paper is to provide the answers to the following questions: 1) do the COO dimensions apply to the assessment of medical services?; 2) what is the significance of the particular dimensions in these services?; 3) does the significance of the particular dimensions depend on consumers’ origin?Four dimensions have been introduced: innovativeness, diversity, quality, prestige. Study has been carried out in three European countries (Germany, Lithuania and Poland) and the survey sample consists of 264 respondents. The data have been collected with the use of a questionnaire form developed by the authors. Their statistical processing has been provided with the use of a t test and the analysis of variance with repeated measurement.The analysis confirms very high significance of the COO dimensions in medical services, and the fact that the significance is of differentiated nature. The research indicates that Quality and Innovativeness are the most important dimensions as regards medical services. Diversity and Prestige are significantly less important. The differentiation pertaining to the significance of dimensions indirectly indicates that medical services are affected by the COO effect. The analysis indicates that the COO dimensions as well as consumers’ origin affect the assessment of the importance pertaining to a particular dimension, however the pattern of dimension preference is similar in all three countries. The results of the research may be applied in economic practice: in marketing operations of service providers and in operations of institutions which deal with shaping the image of their country and its positioning in the international environment.
    Keywords: country-of-origin (COO) effect, the dimensions of the COO effect, medical services, services marketing
    JEL: M31 L84 L83
  13. By: Gangadhar Dahal (University of Warsaw)
    Abstract: he study scrutinizes the existence of the long run association and triangular causality among real GDP per capita, per capita education expenditures and per capita health expenditures in Nepal. The present study applies ARDL bounds testing approach to examine the existence of long-run relationship and Granger Causality test for estimating short run, long run and combined short run and long run triangular causality among the variables for the time series data of Nepal from 1995-2014. The present study exposes that there exists long run relationship among real GDP per capita, per capita education expenditures and per capita health expenditures in Nepal. There exist two-way relationships between per capita real GDP and per capita education expenditures in the short run, whereas per capita health expenditures and real GDP per capita do not granger cause each other in short run in Nepal. Also, there is two-way granger causality among real GDP per capita, per capita education expenditures and per capita health expenditures in a long run in Nepal. The present study also confirms the existence of joint causality among real GDP per capita, per capita education expenditures and per capita health expenditures in both short runs and long run in Nepal.
    Keywords: Real GDP per capita; Per capita education expenditures; Per capita Health Expenditures of Nepal
    JEL: O10 I21 I15

This nep-hea issue is ©2016 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.