nep-hea New Economics Papers
on Health Economics
Issue of 2016‒07‒16
24 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Years of good life based on income and health: Re-engineering cost-benefit analysis to examine policy impacts on wellbeing and distributive justice By Richard Cookson; Owen Cotton-Barrett; Matthew Adler; Miqdad Asaria; Toby Ord
  2. Delayed discharges and hospital type: Evidence from the English NHS By James Gaughan; Hugh Gravelle; Luigi Siciliani
  3. Bayesian Expectancy Invalidates Double-Blind Randomized Controlled Medical Trials By Chemla, Gilles; Hennessy, Christopher
  4. Long-Term Care and Births Timing By Pestieau, Pierre; Ponthiere, Gregory
  5. The Financialisation of Health in England and Wales; Lessons from the Water Sector By Kate Bayliss
  6. Health Care Reform or More Affordable Health Care? By Ferreira, Pedro Cavalcanti; Gomes, Diego B. P.
  7. Local Institutions and Resistance to test for HIV/AIDS. Some lessons of a survey in the city of Fortaleza, Brazil By Yves-André FAURE
  8. Unfair Pay and Health By Armin Falk; Fabian Kosse; Ingo Menrath; Pablo Emilio Verde; Johannes Siegrist
  9. Does Money Relieve Depression? Evidence from Social Pension Eligibility By Chen, Xi; Wang, Tianyu
  10. Effects of the Minimum Wage on Infant Health By Wehby, George; Dave, Dhaval M.; Kaestner, Robert
  11. Causes and Consequences of Teen Childbearing: Evidence from a Reproductive Health Intervention in South Africa By Nicola Branson; Tanya Byker
  12. Lifetime Consequences of Early and Midlife Access to Health Insurance: A Review By Étienne Gaudette; Gwyn C. Pauley; Gwyn C. Pauley
  13. Health insurance coverage and firm performance: Evidence using firm level data from Vietnam By Hiroyuki Yamada; Tien Manh Vu
  14. Volunteering and perceived health. A European cross-countries investigation By Fiorillo, Damiano; Nappo, Nunzia
  15. Work Incentives of Medicaid Beneficiaries and The Role of Asset Testing By Pashchenko, Svetlana; Porapakkarm, Ponpoje
  16. Medical Care Spending and Labor Market Outcomes: Evidence from Workers' Compensation Reforms By Powell, David; Seabury, Seth A.
  18. Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction? By Joan Costa-Font; Gilberto Turati
  19. Arsenic contamination of drinking water and mental health By Chowdhury, Shyamal; Krause, Annabelle; Zimmermann, Klaus F.
  20. Do healthcare tax credits help poor healthy individuals on low incomes? By Cinzia Di Novi; Anna Marenzi; Dino Rizzi
  21. Like Mother, Like Father? Gender Assortative Transmission of Child Overweight By Costa-Font, J.; Jofre-Bonet, M.
  22. 'Cultural Persistence' of Health Capital: Evidence from European Migrants By Costa-Font, J.; Sato, A.
  23. Fuel for life: Domestic cooking fuels and women's health in rural China? By Nie, Peng; Sousa-Poza, Alfonso; Xue, Jianhong
  24. Medical insurance and free choice of physician shape patient overtreatment: A laboratory experiment By Huck, Steffen; Lünser, Gabriele; Spitzer, Florian; Tyran, Jean-Robert

  1. By: Richard Cookson (Centre for Health Economics, University of York, York, UK); Owen Cotton-Barrett (University of Oxford, Oxford, UK); Matthew Adler (Duke University, North Carolina, USA); Miqdad Asaria (Centre for Health Economics, University of York, York, UK); Toby Ord (Duke University, North Carolina, USA)
    Abstract: In this paper, we propose a practical measure of individual wellbeing to facilitate the economic evaluation of public policies. We propose to evaluate policies in terms of years of good life gained, in a way that complements and generalises conventional cost-benefit analysis in terms of money. We aim to show how years of good life could be measured in practice by harnessing readily available data on three important elements of individual wellbeing: income, health-related quality of life, and longevity. We also aim to identify the main ethical assumptions needed to use this measure.
    Date: 2016–07
  2. By: James Gaughan (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, UK); Hugh Gravelle (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, UK); Luigi Siciliani (Department of Economics and Related Studies, University of York, York, UK)
    Abstract: Delayed discharges of patients from hospital, commonly known as bed-blocking, is a long standing policy concern. Delays can increase the overall cost of treatment and may worsen patient outcomes. We investigate how delayed discharges vary by hospital type (Acute, Specialist, Mental Health, Teaching), and the extent to which such differences can be explained by demography, casemix, the availability of long-term care and hospital governance as reflected in whether the hospital has Foundation Trust status, which gives greater financial autonomy and flexibility in staffing and pay. We use a new panel database of delays in all English NHS hospital Trusts from 2011/12 to 2013/14. Employing count data models, we find that a greater local supply of long-term care (care home beds) is associated with fewer delays. Hospitals which are Foundation Trusts have fewer delayed discharges and might therefore be used as exemplars of good practice in managing delays. Mental Health Trusts have more delayed discharges than Acute Trusts but a smaller proportion of them are attributed to the NHS, possibly indicating a relatively greater lack of adequate community care for mental health patients.
    Date: 2016–07
  3. By: Chemla, Gilles; Hennessy, Christopher
    Abstract: Double-blind RCTs are viewed as the gold standard in eliminating placebo effects and identifying non-placebo physiological effects. Expectancy theory posits that subjects have better present health in response to better expected future health. We show that if subjects Bayesian update about efficacy based upon physiological responses during a single-stage RCT, expected placebo effects are generally unequal across treatment and control groups. Thus, the difference between mean health across treatment and control groups is a biased estimator of the mean non-placebo physiological effect. RCTs featuring low treatment probabilities are robust: Bias approaches zero as the treated group measure approaches zero.
    Keywords: Bayesian updating; bias; control; double-blind RCTs; drug; placebo; treatment
    Date: 2016–06
  4. By: Pestieau, Pierre; Ponthiere, Gregory
    Abstract: Due to the ageing process, the provision of long-term care (LTC) to the dependent elderly has become a major challenge of our epoch. But our societies are also characterized, since the 1970s, by a postponement of births, which, by raising the intergenerational age gap, can a¤ect the provision of LTC by children. In order to examine the impact of those demographic trends on the optimal policy, we develop a four-period OLG model where individuals, who receive children’s informal LTC at the old age, must choose, when being young, how to allocate births along their life cycle. It is shown that, in line with empirical evidence, early children provide more LTC to their elderly parents than late children, because of the lower opportunity cost of providing LTC when being retired. When comparing the laissez-faire with the long-run social optimum, it appears that individuals have, at the laissez-faire, too few early births, and too many late births. We then study, in …rst-best and second-best settings, how the social optimum can be decentralized by encourageing early births, in such a way as to reduce the social burden of LTC provision.
    Keywords: birth timing; childbearing age; family pol- icy; long term care; OLG models.
    JEL: E13 J13 J14
    Date: 2016–07
  5. By: Kate Bayliss (School of Oriental and African Studies)
    Abstract: This is a Foresight paper prepared for the EU-funded research project, Financialisation, Economy, Society and Sustainable Development, FESSUD. Drawing on lessons from the provision of water in England, the paper anticipates future developments in the provision of health, exploring the increasing role of finance and financial cultures. This is captured in the term “financialisation” which has recently emerged in academic literature to account for the rapid expansion of financial assets and financial activity in the economy, and the expanding reach of the financial sector into traditionally non-financial areas of economic and social life. The paper starts with an overview of the context in which financialisation has evolved within, and impacted upon, the National Health Service (NHS). Two contextual elements stand out. First, since the 1980s, the NHS has been subject to incremental reforms to introduce market-mimetic structures. These reforms accelerated with the introduction of the 2012 Health and Social Care Act (HSCA). This legislation has only just begun to have an impact at the time of writing (December 2015), but the extent of private sector involvement in health provision is likely to increase rapidly as a result of the Act. The second significant aspect of the context for financialisation is the growing financial deficit in the NHS which creates an important backdrop to the HSCA reforms. Irrespective of the proximate as well as the deeper reasons for this, it provides for a narrative of “unaffordability” and “inefficiency”, itself taken as a rationale both for greater private sector intervention and as justification for NHS trusts to increase revenue from private sources. However, the paper shows that this narrative thread does not fit with global data which indicate that the NHS is broadly in line with OECD averages for spending on GDP, and health outcomes. The paper considers four mechanisms by which financialisation is affecting the health service in England. First, financing in the sector is allocated on the basis of internal “markets” which mimic financialised structures (regardless of ownership or provision). An institutional division between the “purchaser” and “provider” of health services within the NHS has been refined over the years since it was first introduced in the early 1990s. Health providers are remunerated via a complex “pricing” system known as Payment by Results (PBR) so that transactions between state agencies are delineated in financial terms. Second, financial processes have become embedded in the sector via the process of tendering to both NHS and private service providers. A growing proportion of services has been contracted to private companies, particularly in the wake of the 2012 HSCA. Aside from creeping privatization, this process brings financial practices into the provision of health services, with, for example, health commissioners required to observe competition law even where contracts are awarded to state organisations. Third, under the 2012 HSCA, the cap on the proportion of income that NHS providers can raise from private patients has increased from 2% to 49%, leading to an increase in private patient income within some NHS hospitals. Global finance is becoming more closely integrated with health provision as a result with new partnerships developing between NHS providers and private investors. Finally, since the early 1990s most new capital investment in the NHS has been undertaken through the Private Finance Initiative (PFI) where the private sector finances the design, build and operation of hospitals and these are then leased back to the NHS Trust over a period of decades. These contracts have proven to be costly for NHS hospitals but highly lucrative for (often institutional financial sector) investors in PFI contracts. The paper then considers the nature of the private companies that are involved in healthcare. Health providers are often owned by larger conglomerates for which health is one of many assets in a diverse investment portfolio. The paper compares the changes taking place in health with developments in the water sector in England which has been privatized since 1989 and where financial structures, processes motives and investors have long been established. In both sectors, processes associated with financialisation mean that services are increasingly distanced from the materiality of provision and instead are interpreted in terms of the revenue stream that they can provide to investors. Innovative financial practices have been adopted to boost shareholder returns. In terms of Foresight, health provision is in the process of a fundamental transition from a public service to a financial asset, as has happened in the provision of water in England. The result is expected to be a considerable deepening in the cultures of individualisation and commodification of the health system. This is likely to be associated with a fragmented service and greater inequality in a number of respects: government spending on health will be transferred ultimately to global private finance, boosting the earnings of financial investors; the state will be left with the most difficult (and expensive) to treat as these are of least interest to the private sector; a two-tier system will emerge, with the poorest left with a severely weakened second-rate health system; labour rights are expected to be weakened as employment structures become fragmented across different health providers. Such developments threaten to undermine the core principles on which the NHS was founded. Furthermore, these changes will be difficult to reverse as the ability of the public sector to pose an effective alternative to private and financialised provision of health will be considerably debilitated.
    Keywords: Health privatisation, NHS, financialisation
    JEL: B50 I18 I38 P16 L33
    Date: 2016–02–28
  6. By: Ferreira, Pedro Cavalcanti; Gomes, Diego B. P.
    Abstract: This article investigates the impact on the U.S. economy of making health care more affordable. We compare health care cost reductions with the Patient Protection and Affordable Care Act (PPACA) using a rich life cycle general equilibrium model with heterogeneous agents. We found that all policies were able to reduce uninsured population, but the PPACA was the most effective: in the long run, less than 5% of Americans would remain uninsured. Cost reductions alleviated the government budget, while tax hikes were needed to finance the reform. Feasible cost reductions are less welfare improving than the PPACA.
    Date: 2016–06–17
  7. By: Yves-André FAURE
    Abstract: In the field of the fight against the HIV / AIDS substantial resources have been used regularly both in all of Brazil to Fortaleza. All these means affected populations more numerous and demographic cohorts constantly renewed and sexually active. One would therefore expect that all of these initiatives have had the effect of making effective incentives for voluntary practice test. However quantitative and qualitative researches shows that if the number of tests performed has steadily increased over time, they raise the reluctance persists continuously as in the general population as well as than in the social categories considered vulnerable because most exposed than others to the risk of being affected by HIV / AIDS.The question suggested by this situation is to try to identify and characterize the factors that make intelligible the persistence of resistance to the voluntary practice test or, equivalently, to understand the limitations of the effectiveness of incentives to take the test. We question here especially the world of local institutions, public ones and those within the third sector, involved in the fight against HIV / AIDS. This institutional landscape, despite or because of its thickness and its complexity, presents a number of shortcomings, limitations, dysfunctions that tend to weaken the expected efficacy of the structures, reduce the universalizing objective of test campaigns, hinders the understanding of the information generated around this struggle by the people.\r\n\r\nThe survey results suggest that, in a context of individual and collective factors, maintaining these complex relationships, the local institutional apparatus, despite efforts to raise the level of participation in HIV testing, contributes to a climate of uncertainty and lack of knowledge about the existence and importance of the test. The overall incentive system in practice has not achieved the desired effectiveness. And the persistence of vulnerabilities and the survival of reluctance and resistance to HIV meet involuntary allies in the actual functioning of local institutions.
    Keywords: HIV / AIDS, resistance to HIV / AIDS tests, vulnerable groups, Brazil, Fortaleza, local public institutions, local civil organizations.
    JEL: D64 D73 H51 H75 I18
    Date: 2016
  8. By: Armin Falk (Universität Bonn); Fabian Kosse (University of Bonn); Ingo Menrath (Heinrich Heine University, Department of Medical Sociology); Pablo Emilio Verde (Heinrich Heine University, Department of Medical Sociology); Johannes Siegrist (Heinrich Heine University, Department of Medical Sociology)
    Abstract: This paper investigates physiological responses to perceptions of unfair pay. We use an integrated approach exploiting complementarities between controlled lab and representative panel data. In a simple principal-agent experiment agents produce revenue by working on a tedious task. Principals decide how this revenue is allocated between themselves and their agents. Throughout the experiment we record agents’ heart rate variability, which is an indicator of stress-related impaired cardiac autonomic control, and which has been shown to predict coronary heart disease in the long-run. Our findings establish a link between unfair payment and heart rate variability. Building on these findings, we further test for potential adverse health effects of unfair pay using observational data from a large representative panel data set. Complementary to our experimental findings we show a strong and significant negative association between unfair pay and health outcomes, in particular cardiovascular health.
    Keywords: fairness, social preferences, Inequality, heart rate variability, Health, experiment, SOEP
    JEL: C91 D03 D63 I14
    Date: 2016–06
  9. By: Chen, Xi (Yale University); Wang, Tianyu (Beijing Academy of Social Sciences)
    Abstract: We estimate the impact of receiving pension benefits on mental well-being using China's New Rural Pension Scheme launched in 2010, the largest pension program in the world. More than four hundred million Chinese have enrolled in the program, and the program on average amounts to one fifth of pensioners' earned income. We find a salient increase in pension benefits and poverty alleviation around the pension eligibility age cut-off. Employing an instrumental variable approach to a national sample of the China Family Panel Studies, our empirical strategy overcomes the endogeneity of pension receipt that prevents us from identifying the causal effect of income change on mental health as measured by the full version of CES-D and depressive symptoms. Results reveal a sizeable reduction in depression susceptibility due to pension income. The improvement in mental health is larger for vulnerable populations with financial and health constraints. We further discuss potential pathways through which pension may affect mental health.
    Keywords: pension income, depression, mental health, older populations
    JEL: H55 I18 I38 J14
    Date: 2016–07
  10. By: Wehby, George (University of Iowa, NBER); Dave, Dhaval M. (Bentley University); Kaestner, Robert (University of Illinois at Chicago)
    Abstract: The minimum wage has increased in multiple states over the past three decades. Research has focused on effects on labor supply, but very little is known about how the minimum wage affects health, including children's health. We address this knowledge gap and provide an investigation focused on examining the impact of the effective state minimum wage rate on infant health. Using data on the entire universe of births in the US over 25 years, we find that an increase in the minimum wage is associated with an increase in birth weight driven by increased gestational length and fetal growth rate. The effect size is meaningful and plausible. We also find evidence of an increase in prenatal care use and a decline in smoking during pregnancy, which are some channels through which minimum wage can affect infant health. Labor market policies that enhance wages can thus affect wellbeing in broader ways, and such health effects should enter into any cost‐benefit calculus of such policies.
    Keywords: minimum wage, health, infant, prenatal care, smoking, income, pregnant women
    JEL: I1 I3 J2 J3
    Date: 2016–07
  11. By: Nicola Branson (SALDRU, School of Economics, University of Cape Town); Tanya Byker (Department of Economics, Middlebury College)
    Abstract: The rollout of the National Adolescent Friendly Clinic Initiative (NAFCI) serves as a natural experiment to study the causes and consequences of early teen child bearing. Geolinking residence histories to the rollout, we estimate that living near a NAFCI clinic during adolescence delayed early childbearing by 1.2 years on average. Adolescents who had access to NAFCI completed more years of schooling and, consistent with increased human capital investments, earn substantially higher wages as young adults. Children born to women who had access to youth-friendly services as teens show substantial health advantages, indicating a strong intergenerational benefit of delayed childbearing.
    Keywords: teenage childbearing, maternal and child outcomes, youth friendly reproductive health services
    Date: 2016
  12. By: Étienne Gaudette (University of Southern California); Gwyn C. Pauley (University of Southern California); Gwyn C. Pauley (University of Southern California)
    Abstract: This article reviews the literature on how health insurance affects health and economic outcomes in the United States prior to automatic Medicare eligibility at age 65, with the aim of providing a snapshot of the breadth of the existing evidence. A targeted approach was used to identify and review experimental or quasi-experimental articles deemed most likely to identify the causal impact of health insurance. Results were systematically reviewed by outcome category–ranging from mental health to education—and population of interest—ranging from prenatal to preretired. The effects of health insurance on economic outcomes remain inconclusive despite being well-studied, while evidence on the relationship between health insurance and several aspects of health has strengthened over the last decade.
    Date: 2016–03
  13. By: Hiroyuki Yamada (Faculty of Economics, Keio University); Tien Manh Vu (International Research Fellow of the Japan Society for the Promotion of Science, Osaka School of International Public Policy, Osaka University)
    Abstract: In literature, there is limited direct evidence regarding the effect of health insurance coverage on firm performance and worker productivity. In this paper, we study the impacts of health insurance on medium and large-scale domestic private firms' performance and productivity in Vietnam, using a large firm level census dataset. We deploy propensity-score matching methods, and find statistically positive health insurance effects on both aggregate profit and profit per worker for both complying and non-complying medium and large-scale firms. Given the full sample results, we recommend an improvement in government monitoring as one of the important policy options to induce medium and large-scale firms to contribute to health insurance premiums for their employees.
    Keywords: Health insurance, Medium and large-scale firms, Propensity-score matching, Vietnam
    JEL: D22 I13 I15 I18 O25
    Date: 2016–07
  14. By: Fiorillo, Damiano; Nappo, Nunzia
    Abstract: In this paper, we study the effect of formal and informal volunteering on self-perceived health across 9 European countries after controlling, amongst other things, for socio-economic characteristics, social and cultural participation. We employ the 2006 wave of EU-SILC for estimating recursive trivariate probit models with instrumental variables. Our results show that although formal and informal volunteering are correlated with each other, they have a different impact on health. Formal volunteering has a significant positive effect on self-perceived health in the Netherlands, but none in other countries. By contrast, informal volunteering has a significant negative effect on self-perceived health in Austria, Finland, France, the Netherlands, Spain, and Italy.
    Keywords: Self-perceived health, formal and informal volunteering, social and cultural participation, recursive trivariate probit model, European countries
    JEL: C3 D64 I1 P5 Z10
    Date: 2014
  15. By: Pashchenko, Svetlana; Porapakkarm, Ponpoje
    Abstract: Should asset testing be used in means-tested programs? These programs target low-income people, but low income can result not only from low productivity but also from low labor supply. We aim to show that in the asymmetric information environment, there is a positive role for asset testing. We focus on Medicaid, one of the largest means-tested programs in the US, and we ask two questions: 1) Does Medicaid distort work incentives? 2) Can asset testing improve the insurance-incentives trade-off of Medicaid? Our tool is a general equilibrium model with heterogeneous agents that matches many important features of the data. We find that 23% of Medicaid enrollees do not work in order to be eligible. These distortions are costly: if individuals' productivity was observable and could be used to determine Medicaid eligibility, this results in substantial ex-ante welfare gains. When productivity is unobservable, asset testing is effective in eliminating labor supply distortions, but to minimize saving distortions, asset limits should be different for workers and non-workers. This work-dependent asset testing can produce welfare gains close to the case of observable productivity.
    Keywords: health insurance, Medicaid, labor supply, asset testing, general equilibrium, life-cycle models
    JEL: D52 D91 E21 H53 I13 I18
    Date: 2016–07–07
  16. By: Powell, David; Seabury, Seth A.
    Abstract: Injuries sustained at work represent large income and welfare losses to households and there is a significant policy interest in reducing these burdens. Workers' compensation program is a large government program which provides monetary and medical benefits to injured workers. Despite the potential importance of medical care in improving the health and labor productivity of injured workers, little research has addressed the relationship between medical care provided through workers' compensation and post-injury labor outcomes. This paper exploits the 2003-2004 California workers' compensation reforms which reduced medical care spending for injured workers with a disproportionate effect on workers suffering low back injuries. We study the differential impact of this reduction in medical care generosity on post-injury outcomes, using administrative data which includes claim-level medical costs, pre- and post-injury labor earnings, and earnings information for matched (uninjured) workers at the same preinjury firm. Our focus on labor outcomes is motivated by the importance of understanding the relationship between health and labor productivity more broadly and by the policy interest in mechanisms to improve the labor outcomes of injured workers. Adjusting for injury severity and selection into workers' compensation, we find that workers with lower back injuries experienced a 7.3% greater decline in medical care after the reforms, and that this led to an 8.3% reduction in post-injury earnings relative to other injured workers. We estimate that this earnings decline is due both to an increase in injury duration and to lower earnings conditional on working.
    Keywords: effectiveness of medical care, health, labor productivity, workers' compensation
    JEL: I12 I13 J24 J28 J38
    Date: 2014–10
  17. By: Tuncer Bulutay (Turkish Economic Association); Deniz Karaoğlan (Middle East Technical University, Ankara, Turkey (Visiting Scholar))
    Abstract: This study provides causal effect of education on health behaviors in Turkey which is a middle income developing country. Health Survey of the Turkish Statistical Institute for the years 2008, 2010 and 2012 are used. The health behaviors considered are smoking, alcohol consumption, fruit and vegetable consumption, exercising and one health outcome namely, the body mass index (BMI). We examine the causal effect of education on these health behaviors and the BMI Instrumental variable approach is used in order to address the endogeneity of education to health behaviors. Educational expansion of the early 1960s is used as the source of exogenous variation in years of schooling. Our main findings are as follows. Education does not significantly affect the probability of smoking or exercising. The higher the education level the higher the probability of alcohol consumption and the probability of fruit and vegetable consumption. Higher levels of education lead to higher BMI levels. This study provides a baseline for further research on the various aspects of health behaviors in Turkey.
    Date: 2016
  18. By: Joan Costa-Font (Department of Social Policy, London School of Economics and Political Science (LSE), UK); Gilberto Turati (Department of Economics and Statistics (Dipartimento di Scienze Economico-Sociali e Matematico-Statistiche), University of Torino, Italy)
    Abstract: Does regional decentralization threaten the commitment to regional equality in government outcomes? We attempt to shed light on this question by drawing on unique evidence from the largest European unitary states to have engaged in countrywide health system decentralization: Italy and Spain. We estimate, decompose, and run counterfactual analysis of regional inequality in government output (health expenditure per capita) and outcome (health system satisfaction) during expansion of health care decentralization in both countries. We find no evidence of increase in regional inequalities in outcomes and outputs in the examined period. Inequalities are accounted for by differences in health system design.
    Keywords: Health Care Decentralization, Regional Inequality, Health Care, Oaxaca Decomposition
    JEL: H7 I18 I3
    Date: 2016–06
  19. By: Chowdhury, Shyamal (School of Economics, University of Sydney); Krause, Annabelle (IZA, Bonn); Zimmermann, Klaus F. (UNU-MERIT, Maastricht University, and Harvard University)
    Abstract: This paper investigates the effect of drinking arsenic contaminated water on mental health. Drinking water with an unsafe arsenic level for a prolonged period can lead to arsenicosis and associated illness. Based on rich and newly collected household survey data from Bangladesh, we construct several measures for arsenic contamination that include the actual arsenic level in the respondent's tube well (TW), and past institutional arsenic test results as well as their physical and mental health. To account for potential endogeneity of water source, we take advantage of the quasi-randomness of arsenic distribution and employ the pre-1999 use of TW as an instrument and structural modelling as alternatives for robustness checks. We find that suffering from an arsenicosis symptom is strongly negatively related to mental health, even more so than from other illnesses. Calculations of the costs of arsenic contamination reveal that the average individual would need to be compensated for suffering from an arsenicosis symptom by an amount of money over 10 percent of annual household income.
    Keywords: Arsenic, Water Pollution, Mental Health, Subjective Well-Being, Environment, Bangladesh
    JEL: Q53 I10 I31
    Date: 2016–06–28
  20. By: Cinzia Di Novi; Anna Marenzi; Dino Rizzi
    Abstract: In several countries, personal income tax permits tax credits for out-of-pocket healthcare expenditures. Tax credits produce two effects on taxpayers’ disposable income. On the one hand, they benefit taxpayers at all income levels by reducing their net tax liability; on the other hand, they modify the price of out-of-pocket expenditure and, to the extent that consumer demand is price elastic, they may influence the amount of eligible healthcare expenditure for which taxpayers may claim a credit. These two effects influence, in turn, income redistribution and may affect taxpayers’ health status and therefore income-related inequality in health. Redistributive consequences of tax credits have been widely investigated; however, little is known about the ability of tax credits to ensure a more equitable distribution of healthcare expenditure and, consequently, to alleviate health inequality. In this paper, we study the potential effects that tax credits for health expenses may have on health-related inequality with reference to the Italian institutional setting. The analysis is performed using a tax-benefit microsimulation model which reproduces the personal income tax and incorporates taxpayers’ behavioural responses to changes in tax credit rate. Our results suggest that a healthcare tax credit design that does not rely on income, like the one implemented in the Italian personal income tax, is not effective in improving equity in health and tends to favour the richest part of the population.
    Keywords: personal income tax, health-related tax credit, health inequality
    JEL: I10 I14 H24
    Date: 2016
  21. By: Costa-Font, J.; Jofre-Bonet, M.
    Abstract: Parental influences on children health related behaviours are argued to be gender assortative (e.g., that maternal behaviour is more important for daughters), but research devoted to disentangling such effects is still at its infancy. We take advantage of a unique dataset (Health Survey for England) containing records of clinically measured weight and height for a representative sample of English children and their parents for the period 1996-2009. We examine the magnitude and change of the association between maternal and paternal overweight and that of their offspring by gender, alongside the combined parental effect. We aim at identifying the existence and the magnitude of a gender-assortative transmission of overweight after controlling for a long list of covariates, including time and survey-wave fixed effects. Our findings point out that the intergenerational transmission is most significant when both parents are obese or overweight, and the effects size increases with child age 0.7 percentage point among infants to 1.3-1.4 percentage points among schooled children and teenagers. However, we find weak evidence of a specific maternal effect on girls’ overweight, and more generally gender assortative intergenerational transmission of overweight and obesity.
    Keywords: Gender Assortative Parental Transmission; child obesity; child overweight; role models; inter-generational transmission;
    Date: 2016–06
  22. By: Costa-Font, J.; Sato, A.
    Abstract: Culture is an under-studied determinant of health production and seldom measured. This paper empirically examines the persistence and association of health capital assessments of first and second-generation migrants with that of their ancestral countries. We draw on European data from 30 countries, including over 90 countries of birth and control for timing of migration, selective migration and other controls including citizenship and cultural proxies. Our results show robust evidence of cultural persistence of health assessments. Culture persists, rather than fades, and further, appears to strengthen over generations. We estimate a one standard deviation increase in ancestral health assessment increases first generation migrant’s health assessments by an average of 16%, and that of second generation migrants between 11% and 25%. Estimates are heterogeneous by gender (larger for males) and lineage (larger for paternal lineage).
    Keywords: assimilation; health; health assessments; cultural persistence; first generation migrant; second generation migrant;
    JEL: I18 H23 Z13
    Date: 2016–06
  23. By: Nie, Peng; Sousa-Poza, Alfonso; Xue, Jianhong
    Abstract: Using longitudinal and biomarker data from the China Family Panel Studies and the China Health and Nutrition Survey, this study examines the association between the type of domestic cooking fuel and the health of women aged Ï16 in rural China. Regarding three major domestic cooking fuels (wood/straw, coal and liquefied natural gas (LNG)), we find that, compared to women whose households cook with dirty fuels like wood/straw, women whose households cook with cleaner fuels like LNG have a significantly lower probability of chronic or acute diseases and are more likely to report better health. Even after controlling for unobserved individual heterogeneity, we find some evidence that women in households cooking with LNG are less likely to suffer from chronic/acute diseases. Cooking with domestic coal instead of wood or straw is also associated with elevated levels of having certain risks (such as systolic and diastolic blood pressure) related to cardiovascular diseases.
    Keywords: household cooking fuels,health,women,rural China
    JEL: I10 D10 J10 Q53
    Date: 2016
  24. By: Huck, Steffen; Lünser, Gabriele; Spitzer, Florian; Tyran, Jean-Robert
    Abstract: In a laboratory experiment designed to capture key aspects of the interaction between physicians and patients, we study the effects of medical insurance and competition in the guise of free choice of physician, including observability of physicians' market shares. Medical treatment is an example of a credence good: only the physician knows the appropriate treatment, the patient does not. Even after a consultation, the patient is not sure whether he received the right treatment or whether he was perhaps overtreated. We find that with insurance, moral hazard looms on both sides of the market: patients consult more often and physicians overtreat more often than in the baseline condition. Competition decreases overtreatment compared to the baseline and patients therefore consult more often. When the two institutions are combined, competition is found to partially offset the adverse effects of insurance: most patients seek treatment, but overtreatment is moderated.
    Keywords: Credence good,Physician,Overtreatment,Competition,Insurance
    JEL: C91 I11 I13
    Date: 2016

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.