nep-hea New Economics Papers
on Health Economics
Issue of 2016‒08‒07
twenty-two papers chosen by
Yong Yin
SUNY at Buffalo

  1. Including Relationship-Based Care Practices in Infant-Toddler Care: Implications for Practice and Policy By Laura Sosinsky; Karen Ruprecht; Diane Horm; Kerry Kriener-Althen; Cheri Vogel; Tamara Halle
  2. Measuring Adolescent Well-being: National Adolescent Assessment Cards (NAACs) By Judith Diers; Prerna Banati; UNICEF Office of Research - Innocenti
  3. Does Long-Term Care Subsidisation Reduce Unnecessary Hospitalisations? By Joan Costa-Font; Sergi Jiménez-Martín; Cristina Villaplana
  4. Model uncertainty approach in mortality projection with model assembling methodologies By Albarrán, Irene; Marín, J. Miguel; Alonso, Pablo J.; Benchimol, A.
  5. Temporary Jobs and the Severity of Workplace Accidents By Picchio, Matteo; van Ours, Jan
  6. The Effect of Medicare Eligibility on Spousal Insurance Coverage By Marcus Dillender; Karen Mulligan
  7. Spatial econometric approach to western diseases modelling By Alicja Olejnik; Agata Zoltaszek
  8. Maybe "honor thy father and thy mother": uncertainfamily aid and the design of social long term care insurance By Canta, Chiara; Cremer, Helmuth; Gahvari, Firouz
  9. THE 2016 CALIFORNIA MARIJUANA INITIATIVE AND YOUTH: Lessons from Alcohol Policy By Mosher, James F JD
  11. Assessing health facility performance in Indonesia using the Pabón Lasso Model and unit cost analysis of health services By Firdaus Hafidz; Tim Ensor; Sandy Tubeuf
  12. Parenting, Family Care and Adolescence in East and Southern Africa: An evidence-focused literature review By Rachel Bray; Andrew Dawes; UNICEF Office of Research - Innocenti
  13. What Explains the Difference in the Effect of Retirement on Health?: Evidence from Global Aging Data By Motegi, H.; Nishimura, Y.; Oikawa, M.
  14. Efficiency measurement in health facilities: Literature review in low- and middle-income countries By Firdaus Hafidz; Tim Ensor; Sandy Tubeuf
  15. Demand for prenatal care and its impact on neonatal, infant and child mortality in Zimbabwe: Evidence from the Demographic and Health Surveys By Makate, Marshall; Makate, Clifton
  16. What Factors Influence States’ Capacity to Report Children’s Health Care Quality Measures? A Multiple-Case Study By Anna L. Christensen; Dana M. Petersen; Rachel A. Burton; Vanessa C. Forsberg; Kelly J. Devers
  17. Long-term Consequences of Workplace Bullying on Sickness Absence By Eriksen, Tine Louise Mundbjerg; Hogh, Annie; Hansen, Åse Marie
  18. Worth the Wait? The Effect of Early Term Birth on Maternal and Infant Health By Buckles, Kasey; Guldi, Melanie
  19. Workplace Disability: Whose Wellbeing Does It Affect? By Haile, Getinet Astatike
  20. Impact of Caregiver Incentives on Child Health: Evidence from an Experiment with Anganwadi Workers in India By Singh, Prakarsh; Masters, William A.
  21. Ethnic Attrition and the Observed Health of Later-Generation Mexican Americans By Antman, Francisca M.; Duncan, Brian; Trejo, Stephen
  22. The Effect of Occupational Licensing on Consumer Welfare: Early Midwifery Laws and Maternal Mortality By Anderson, D. Mark; Brown, Ryan; Charles, Kerwin Kofi; Rees, Daniel I.

  1. By: Laura Sosinsky; Karen Ruprecht; Diane Horm; Kerry Kriener-Althen; Cheri Vogel; Tamara Halle
    Abstract: This review of research on relationship-based care practices outlines considerations for implementing these practices in Early Head Start and childcare centers serving infants and toddlers.
    Keywords: relationship-based, care, practice, infant, toddler, practice, policy, primary caregiving, federal, state, policies, early head start, licensing, QRIS, standards
    JEL: I
  2. By: Judith Diers; Prerna Banati; UNICEF Office of Research - Innocenti
    Abstract: Advocacy and action for adolescents have been hampered by the lack of a concrete results framework that can be used to describe the state of the world’s adolescents and serve as a basis for goals and targets. In order to fill this gap, UNICEF, in collaboration with key partners, is facilitating the development of an outcome-based framework that incorporates the key dimensions of an adolescent’s life and a proposed set of globally comparable indicators that will provide a common platform to track the progress of adolescent development and well-being. The domains that have been selected for measurement are: health and well-being, education and learning, safety and protection, participation, transition to work.
    Keywords: adolescents; employment policy; health programmes; research;
    Date: 2016
  3. By: Joan Costa-Font; Sergi Jiménez-Martín; Cristina Villaplana
    Abstract: The expansion of long-term care (LTC) coverage may improve health system efficiency by reducing hospitalisations (bed-blocking), and pave the way for the implementation of health and social care coordination plans. We draw upon the quasi- experimental evidence from the main expansion of long term care increase subsidisation in Spain in 2007 to examine the causal effect of the expansion of LTC subsidisation and coordination on hospitalisations (both on the internal and external margin) and the hospital length of stay. In addition, we examine the 2012 austerity budget cuts that reduced the subsidy. We find robust evidence of a reduction in hospitalisations and the length of stay after the expansion of LTC subsidisation. However, the reduction in hospitalisations is heterogeneous to the existence of health and social care coordination plans and type of subsidy. Overall, we estimate savings related to hospitalisations of up to 11% of total hospital costs. Consistently, subsidy reduction is found to attenuate bed-blocking gains.
    Date: 2016–07
  4. By: Albarrán, Irene; Marín, J. Miguel; Alonso, Pablo J.; Benchimol, A.
    Abstract: Forecasting mortality rates has become a key task for all who are concerned with payments for non-active people, such as Social Security or life insurance firms managers. The non-ending process of reduction in the mortality rates is forcing to continuously improve the models used to project these variables. Traditionally, actuaries have selected just one model, supposing that this model were able to generate the observed data. Most times the results have driven to a set of questionable decisions linked to those projections. This way to act does not consider the model uncertainty when selecting a specific one. This drawback can be reduced through model assembling. This technique is based on using the results of a set of models in order to get better results. In this paper we introduce two approaches to ensemble models: a classical one, based on the Akaike information criterion (AIC), and a Bayesian model averaging method. The data are referred to a Spanish male population and they have been obtained from the Human Mortality Database. We have used four of the most widespread models to forecast mortality rates (Lee-Carter, Renshaw-Haberman, Cairns-Blake-Dowd and its generalization for including cohort effects) together with their respective Bayesian specifications. The results suggest that using assembling models techniques gets more accurate predictions than those with the individual models.
    Keywords: Renshaw-Haberman model; projected life tables; longevity risk; Lee-Carter model; Cairns-Blake-Dowd model; bootstrap; Bayesian model averaging; AIC model averaging
    Date: 2016–07
  5. By: Picchio, Matteo (Tilburg University, Center For Economic Research); van Ours, Jan (Tilburg University, Center For Economic Research)
    Abstract: From the point of view of workplace safety, it is important to know whether having a temporary job has an effect on the severity of workplace accidents. We present an empirical analysis on the severity of workplace accidents by type of contract. Method: We used micro data collected by the Italian national institute managing the mandatory insurance against work related accidents. We estimated linear models for a measure of the severity of the workplace accident. We controlled for time-invariant fixed effects at worker and firm levels to disentangle the impact of the type of contract from the spurious one induced by unobservables at worker and firm levels. Results: Workers with a temporary contract, if subject to a workplace accident, were more likely to be confronted with severe injuries than permanent workers. When correcting the statistical analysis for injury underreporting of temporary workers, we found that most of, but not all, the effect is driven by the under-reporting bias. Conclusions: The effect of temporary contracts on the injury severity survived the inclusion of worker and firm fixed effects and the correction for temporary workers’ injury under-reporting. This however does not exclude the possibility that, within firms, the nature of the work may vary between different categories of workers. For example, temporary workers might be more likely to be assigned by the employer dangerous tasks because they might have less bargaining power. Practical implications: The findings will be of help in designing public policy effective in increasing temporary workers’ safety at work and limiting their injury under-reporting.
    Keywords: workplace accidents; injury severity; temporary jobs; contract type; injury under reporting
    JEL: J81
    Date: 2016
  6. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research); Karen Mulligan (Middle Tennessee State University)
    Keywords: health insurance, medicare, individual market, marriage, employer benefits, ACA
    JEL: H55 J32
  7. By: Alicja Olejnik (Faculty of Economics and Sociology, University of Lodz); Agata Zoltaszek (Faculty of Economics and Sociology, University of Lodz)
    Abstract: For years now, developed countries face an epidemic of high blood pressure, diabetes and high cholesterol, risk factors related to heart and circulatory disease, and a suite of psychological disorders ranging from depression, anxiety, to compulsive behaviours. These health risks have traditionally been associated with affluence however by 2008 there is no clear link between national income and these diseases. E.g. according to Danaei, there was no relationship between national income and blood pressure in men, and in women blood pressure was even higher in poorer countries. Therefore, this paper provides deepen analysis of this correlation applying spatial econometrics tools. The spatial aspect of the prevalence of western diseases does not seem to be obvious and, to our knowledge, is not widely explored in the literature. In particular, the paper investigates the spatial processes of selected diseases of affluence in regions of the European Union. The research covers 261 NUTS 2 regions for the period 2003-2010. This study provides the spatial analysis of Circulatory and Mental diseases. In our opinion, the presented spatial econometric approach may constitutes an important contribution to the field of epidemiology.
    Keywords: diseases of affluence, health, socioeconomic development, spatial analysis.
    JEL: I14 I15 O18 O57
    Date: 2016–06
  8. By: Canta, Chiara; Cremer, Helmuth; Gahvari, Firouz
    Abstract: We study the role and design of private and public insurance programs when informal care is uncertain. Children's degree of altruism is represented by a parameter which is randomly distributed over some interval. The level of informal care on which dependent elderly can count is therefore random. Social insurance helps parents who receive a low level of care, but it comes at the cost of crowding out informal care. Crowding out occurs both at the intensive and the extensive margins. We consider two types of LTC policies. A topping up (TU ) scheme provides a transfer which is non exclusive and can be supplemented. An opting out (OO) scheme is exclusive and cannot be topped up. TU will involve crowding out both at the intensive and the extensive margins, whereas OO will crowd out solely at the extensive margin. However, OO is not necessarily the dominant policy as it may exacerbate crowding out at the extensive margin. Finally, we show that the distortions of both policies can be mitigated by using an appropriately designed mixed policy.
    Keywords: Long term care, uncertain altruism, private insurance, public insurance, topping up, opting out.
    JEL: H2 H5
    Date: 2016–07
  9. By: Mosher, James F JD
    Keywords: Medicine and Health Sciences, Social and Behavioral Sciences
    Date: 2016–07–01
  10. By: Jayanti Rao; Kashinath G Metri; Amit Singh.
    Abstract: Constipation is most common GI problem which significantly affects health related quality of life, social functioning and compromises the ability to perform daily activities. Yoga is one of the alternative and complementary therapies known to have positive role in various GI related chronic problems. There is lack of evidences for role yoga in constipation. Thirty-seven participants suffering from chronic constipation, who attended one week of IAYT program consisting of asana (physical posture), pranayama, meditation, devotional sessions, diet modification and interactive sessions on philosophical concepts of yoga, at holistic health center S-VYASA, were enrolled in this study. The quality of life and the bowel habits were assessed before and after the intervention using Patient Assessment of Constipation- Quality of Life (PAC-QoL) questionnaire. There is a significant change in different domains of PAC-QoL such as reduction in the scores of physical discomfort (61.25%), psychological discomfort (59.21%), worries and concern (55.92%) and satisfaction (44%) were found after one week IAYT intervention. This pilot study indicated the potential role of IAYT role in management of chronic constipation. However further randomized control studies need to be performed in order to confirm the findings of present study Key words: Chronic constipation, PAC-QOL, IAYT
    Date: 2016–06
  11. By: Firdaus Hafidz (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Tim Ensor (Leeds Institute of Health Sciences, University of Leeds); Sandy Tubeuf (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds)
    Abstract: Total health care costs have dramatically increased in Indonesia and health facilities consume the largest share of health resources. This study aims to provide a better understanding of the characteristics of the best performing health facilities and identify potential drivers of service efficiency. We employ four cross-sectional national Indonesian datasets for 2011 and analysed 200 hospitals and 95 health centres. We first apply the Pabón Lasso Model to assess the relative performance of health facilities in terms of bed occupancy rate and the number of admission per bed; the model groups health facilities into four sectors representing different levels of productivity. We then use a step-down costing method to estimate the cost per outpatient visit, inpatient, and bed-days in hospitals and health centres. We also apply bivariate analyses, including difference and correlation tests to identify the internal and external factors affecting health facility performance. Forty percent of hospitals and 33 percent of health centres were located in the high performing sector of the Pabón Lasso model. A wide variation in unit costs across health facilities present a basis for benchmarking and identifying relatively efficient units. The major components of cost were human resources and materials such as pharmaceuticals and medical supplies. Combining the unit cost analysis and Pabón Lasso model, we find that health facility performance is likely affected by both internal (size and capacity, financing, ownership, accreditation status, and staff availability) and external factors (economic status, market competition, population education level, location, and insurance coverage). Our study demonstrates that it is feasible to identify the best performing health facilities and provide information about how to improve efficiency using simplistic methods.
    Keywords: Efficiency, performance, health facilities, costing study, Pabón Lasso model
    JEL: I10 D24
    Date: 2016
  12. By: Rachel Bray; Andrew Dawes; UNICEF Office of Research - Innocenti
    Abstract: Based on an evidence-focused literature review, this paper examines existing knowledge on raising adolescents in east and southern African countries, including Kenya, Malawi, Mozambique, South Africa, Tanzania and Zimbabwe. Country selection was based on the availability of relevant literature and data. The vast majority of studies on parenting and adolescent development is based on research from the global north. This research sought to deepen understandings of family life, care practices and support networks in the east and southern African region so as to inform policy and interventions that seek to improve adolescent-family relations and reduce risk behaviours. An evidence-informed model for understanding the ecology of adolescent-parent relationships in the cultural and economic contexts of the region is provided. In addition, a framework for exploring contextually-relevant dimensions of parenting through research and practice is offered.
    Keywords: adolescent health; adolescents; family environment; gender issues; HIV and AIDS; parent-child relationship; risk;
    Date: 2016
  13. By: Motegi, H.; Nishimura, Y.; Oikawa, M.
    Abstract: This paper analyzes the reasons for differences in the effect of retirement on health estimated results in previous studies. We investigate these differences by focusing on the analysis methods used by these studies. Using various health indexes, numerous researchers have examined the effects of retirement on health. However, there are no unifed views on the impact of retirement on various health indexes. Consequently, we show that the choice of analysis method is one of the key factors in explaining why the estimated results of the effect of retirement on health differ. Moreover, we re-estimate the effect of retirement on health by using a fixed analysis method controlling for individual heterogeneity and endogeneity of the retirement behavior. We analyze the effect of retirement on health parameters, such as cognitive function, self-report of health, activities of daily living (ADL), depression, and body mass index in eight countries. We find that the effects of retirement on self-report of health, depression, and ADL are positive in many of these countries.
    Keywords: aging; health; retirement; global aging data;
    JEL: I00 I10 I12 I19 J26
    Date: 2016–07
  14. By: Firdaus Hafidz (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Tim Ensor (Leeds Institute of Health Sciences, University of Leeds); Sandy Tubeuf (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds)
    Abstract: Limited health care resources and budget restrictions in low-and middle- income countries (LMICs) have led policy makers to improve efficiency. Therefore, it is essential to understand how efficiency has been measured in the LMICs setting. To date, no systematic review has been conducted to assess efficiency measurement in health facilities in LMICs. This paper synthesises studies of efficiency measurement in health facilities in LMICs. A systematic search of Embase, MEDLINE, Econlit and Global Health identified 4944 articles with a further 15 articles identified through manual searching. A total of 95 papers were eligible for inclusion. These covered a wide range type of health facilities with more than half of the studies (61%) were hospitals. Most studies (67%) employed Data Envelopment Analysis (DEA,) as efficiency measurement method. Studies usually included physical and financial inputs while they used the number of outpatients, inpatients, or bed-days as outputs. We identified main internal and external contextual factors applied to explore the determinant of health facility efficiency. Most studies suggested policies focused on input optimisation, rather than increasing production. The paper concludes by highlighting the need for routine benchmarking as a monitoring and evaluation tool to improve efficiency
    Keywords: efficiency, health facility, low- and middle-income countries
    JEL: I10 D24
    Date: 2016
  15. By: Makate, Marshall; Makate, Clifton
    Abstract: Abstract: The effect of the quality of prenatal care on child mortality outcomes has received less attention in sub-Saharan Africa. This study sought to explore the consequence of the quality of prenatal care and its individual components on neonatal, infant and under-five mortality using the three most recent rounds of the nationally representative Demographic and Health Survey data for Zimbabwe conducted in 1999, 2005/06 and 2010/11. The model for the demand for the quality of prenatal care is estimated using an OLS regression while the child mortality models are estimated using standard probit regressions. Since infant mortality rates and access to quality prenatal care might differ by rural and urban residence, we estimate separate models for the overall sample, urban and rural samples. The results indicate that a one-unit increase in the quality of prenatal care lowers the risks of neonatal, infant and under-five mortality by nearly 36%, 29.31%, and 27.53% respectively for the overall sample. The probability of neonatal, infant and under-five mortality is lowered by about 41.67%, 35.18%, and 30.77% respectively for urban-born children following a one-unit increase in the quality of prenatal care. For the rural sample, we found that a one-unit increase in the quality of prenatal care lowers the risks of neonatal, infant and under-five mortality by nearly 34.61%, 27.12%, and 25.35% respectively. These findings are all statistically significant at the 1% significance level. Examining the effect of individual prenatal care components on child mortality revealed that blood pressure checks, information on pregnancy complications, iron supplementations, and tetanus vaccinations are all important in lowering child deaths. Overall, our results suggest the need for public health policy makers in Zimbabwe to focus on ensuring high-quality prenatal care especially in low-income and rural segments of the population to save Zimbabwe’s children.
    Keywords: Key words: Quality of prenatal care; neonatal, infant and under-five mortality; rural and urban communities; sub-Saharan Africa; Zimbabwe
    JEL: I1 I12 I18
    Date: 2016–04–06
  16. By: Anna L. Christensen; Dana M. Petersen; Rachel A. Burton; Vanessa C. Forsberg; Kelly J. Devers
    Abstract: The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services’ (CMS) core set of children’s health care quality measures (Child Core Set).
    Keywords: Quality measures , Medicaid , CHIPRA , Case study , Multiple-case study
    JEL: I
  17. By: Eriksen, Tine Louise Mundbjerg (Aarhus University); Hogh, Annie (University of Copenhagen); Hansen, Åse Marie (University of Copenhagen)
    Abstract: Bullying in workplaces is a problem thought to harm individual productivity. This paper investigates whether being exposed to bullying in the workplace increases long-term sickness absence. We analyze employees from a selection of workplaces from The Bullying Cohort Study conducted in Denmark in 2006. The Negative Acts Questionnaire-Revised was used to avoid bias related to self-labeling as being bullied. We account for important confounders, such as historical information on sickness absence and mental health, obtained through rich registry data. Our results show that gender does not significantly explain exposure to bullying and that exposure to bullying is associated with negative immediate self-reported health for both genders. We also find, however, that only bullied females have higher, persistent increases in long-term sickness absence and adverse long-term health. This suggests that men and women have different coping strategies. We investigate plausible explanations for this and find that the differences cannot be explained by, for example, turnover or lack of employment. Although insignificant, our results nonetheless indicate that men are twice as likely to leave the labor force immediately after exposure to bullying.
    Keywords: working environment, harassment, absenteeism, health, gender
    JEL: J15 J24 J81
    Date: 2016–07
  18. By: Buckles, Kasey (University of Notre Dame); Guldi, Melanie (University of Central Florida)
    Abstract: Early term birth is defined as birth at 37 or 38 weeks gestation. While infants born early term are not considered premature, the medical literature suggests that they have an increased risk of serious adverse health outcomes compared to infants born at term (39 or 40 weeks). Despite these known harms, we document a rise in early term births in the United States from 1989 to the mid-2000's, followed by a decline in recent years. We posit that the recent decline in early term births has been driven by changes in medical practice advocated by American College of Obstetricians and Gynecologists recommendations and programs such as the March of Dimes' "Worth the Wait" campaign. We first show that this pattern cannot be attributed to changes in the demographic composition of mothers. We next exploit county-level variation in the timing of these changes in medical practice and show that early term inductions lead to an increased risk of precipitous labor, lower birth weights and an increased risk of birth injury and required ventilation. Our results suggest that reductions in early term inductions can explain about one-third of the overall increase in birth weights for term births between 2010 and 2013.
    Keywords: infant health, maternal health, birth weight, induction of labor, early elective delivery
    JEL: J13 I18
    Date: 2016–07
  19. By: Haile, Getinet Astatike (University of Nottingham)
    Abstract: The paper investigates if there is a link between workplace disability (WD) and job satisfaction (JS) in Britain using nationally representative linked data from WESR2011 and alternative empirical analyses. The results obtained indicate that in the private sector, workplaces with respondents with disabilities have significantly lower JS vis-à-vis workplaces without such respondents. JS is also found to decline with the percentage of respondents with disabilities in private sector workplaces with a mix of respondents with and without disabilities. Notably; the decline in JS found for private sector workplaces is specific to co-workers without disabilities therein. These, coupled with the significant positive (negative) relationship found between workplace JS and disability policies and practices for respondents with (without) disabilities in private sector workplaces, suggest that the sector may have to go some way towards dealing with issues of workplace disability more efficiently.
    Keywords: workplace disability, job satisfaction, linked data, Britain
    JEL: J14 J82 J7 I31
    Date: 2016–07
  20. By: Singh, Prakarsh (Amherst College); Masters, William A. (Tufts University)
    Abstract: This paper provides evidence of effectiveness for performance pay among government caregivers to improve child health in India. In a controlled study of 160 daycare centers serving over 4,000 children, we randomly assign individual workers to receive either fixed bonuses or incentive payments based on the weight‐for‐age nutritional status of children in their care, and also collect data from a control group receiving only their standard salary. Mothers of children in all three study arms receive nutrition information. We find that performance pay reduces the prevalence of underweight by about 5 percentage points over 3 months, and height improves by about one centimeter. Impacts are sustained in the medium term when incentives are renewed but fade when they are discontinued. Fixed bonuses lead to smaller effects. Both treatments appear to improve worker effort and communication with mothers, who in turn feed a more calorific diet to their children at home.
    Keywords: performance pay, incentives, malnutrition, undernutrition, underweight, child development, child health, Anganwadis, ICDS, nutrition
    JEL: O1 I1 M5
    Date: 2016–07
  21. By: Antman, Francisca M. (University of Colorado, Boulder); Duncan, Brian (University of Colorado Denver); Trejo, Stephen (University of Texas at Austin)
    Abstract: Numerous studies find that U.S.-born Hispanics differ significantly from non-Hispanic whites on important measures of human capital, including health. Nevertheless, almost all studies rely on subjective measures of ethnic self-identification to identify immigrants' U.S.-born descendants. This can lead to bias due to "ethnic attrition," which occurs whenever a U.S.-born descendant of a Hispanic immigrant fails to self-identify as Hispanic. This paper shows that Mexican American ethnic attritors are generally more likely to display health outcomes closer to those of non-Hispanic whites. This biases conventional estimates of Mexican American health away from suggesting patterns of assimilation and convergence with non-Hispanic whites.
    Keywords: assimilation, ethnic attrition, identity
    JEL: J15 J12 I14
    Date: 2016–07
  22. By: Anderson, D. Mark (Montana State University); Brown, Ryan (University of Colorado Denver); Charles, Kerwin Kofi (Harris School, University of Chicago); Rees, Daniel I. (University of Colorado Denver)
    Abstract: Occupational licensing is intended to protect consumers. Whether it does so is an important, but unanswered, question. Exploiting variation across states and municipalities in the timing and details of midwifery laws introduced during the period 1900-1940, and using a rich data set that we assembled from primary sources, we find that requiring midwives to be licensed reduced maternal mortality by 6 to 7 percent. In addition, we find that requiring midwives to be licensed may have had led to modest reductions in nonwhite infant mortality and mortality among children under the age of 2 from diarrhea. These estimates provide the first econometric evidence of which we are aware on the relationship between licensure and consumer safety, and are directly relevant to ongoing policy debates both in the United States and in the developing world surrounding the merits of licensing midwives.
    Keywords: occupational licensing, midwives, maternal mortality, infant mortality
    JEL: J08 I18
    Date: 2016–07

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.