nep-hea New Economics Papers
on Health Economics
Issue of 2016‒08‒21
23 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Incentives to Eat Healthy: Evidence from a Grocery Store Field Experiment By Anya Samek; John List; Terri Zhu
  2. Caring Alone? Social Capital and the Mental Health of Caregivers By Lars Thiel
  3. Increasing Ambient Temperature Reduces Emotional Well-Being By Clemens Noelke; Mark E. McGovern; Daniel J. Corsi; Marcia Pescador-Jimenez; Ari Stern; Ian Sue Wing; Lisa Berkman
  4. US Child Safety Seat Laws: Are they Effective, and Who Complies? By Lauren E. Jones; Nicolas Ziebarth
  5. Physician Group Practices and Technology Diffusion: Evidence from New Antidiabetic Drugs By Nosal, K.
  6. The impact of technology diffusion in health care markets: Evidence from heart attack treatment By Hentschker, Corinna; Wübker, Ansgar
  7. Can the use of Electronic Health Records in General Practice reduce hospitalizations for diabetes patients? Evidence from a natural experiment. By Kongstad, L.P.; Mellace, G.; Olsen, K.R.
  8. The gender gap in mortality: How much is explained by behavior? By Schünemann, Johannes; Strulik, Holger; Trimborn, Timo
  9. A New Econometric Method for Estimating Disease Prevalence: An Application to Multi-Drug Resistant Tuberculosis By McLaren, Z.; Burger, R.
  10. Marginal effects of physician coverage on infant and disease mortality By Liebert, H.; Mäder, B.
  11. Pay less, consume more? Estimating the price elasticity of demand for home care services of the disabled elderly By Roquebert, Q.; Tenand, M.
  12. Semiparametric Count Data Modeling with an Application to Health Service Demand By Bach, P.; Farbmacher, H.; Spindler, M.
  13. Globalisation and national trends in nutrition and health - a grouped fixed effects approach to inter-country heterogeneity By Oberländer, L.; Disdier, A-C.; Etilé, F.
  14. What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities and Spending Dynamics By Brot-Goldberg, Z.C.; Chandra, A.; Handel, B.; Kolstad, J.T.
  15. Temporary Jobs and the Severity of Workplace Accidents By Picchio, Matteo; van Ours, Jan C.
  16. Social Norms and Teenage Smoking: The Dark Side of Gender Equality By Rodríguez-Planas, Núria; Sanz-de-Galdeano, Anna
  17. The Impact of Diabetes on Labor Market Outcomes in Mexico: A Panel Data and Biomarker Analysis By Seuring, Till; Serneels, Pieter; Suhrcke, Marc
  18. To report or not to report: Applying game theory to nursing error reporting By Alex Barrachina; Víctor González-Chordá
  19. Health Insurance and Child Health: Evidence from Mexico By Conti, Gabriella; Ginja, Rita
  20. US Health and Aggregate Fluctuations By Vasilev, Aleksandar
  21. The Health Equivalent Adjusted Level (HEAL): Taking an Ordinal Approach to the Measurement of a Society's Health Achievements By SILBER, Jacques; XU, Yongsheng
  22. Taking the Measure of a Fatal Drug Epidemic By Christopher J. Ruhm
  23. A model of reporting and controlling outbreaks by public health agencies By Saak, Alexander E.; Hennessy, David A.

  1. By: Anya Samek; John List; Terri Zhu
    Abstract: We use a field experiment to investigate the effect of incentives on food purchase decisions at a grocery store. We recruit over 200 participants and track their purchases for a period of 6 months, permitting us a glimpse of more than 3,500 individual shopping trips. We randomize participants to one of several treatments, in which we incentivize fresh fruit and vegetable purchases, provide tips for fruit and vegetable preparation, or both. We report several key insights. First, our informational content treatment has little effect. Second, we find an important price effect: modest pecuniary incentives more than double the proportion of dollars spent on produce in the grocery store. Third, we find an interesting pattern of consumption after the experiment ends: even when incentives are removed, the treatment group has higher fruit and vegetable purchases compared to the control group. These long-term results are in stark contrast to either a standard price model or a behavioral model of 'crowd out.' Rather, our results are consonant with a habit formation model. This opens up the distinct possibility that short term incentives can be used as a key instrument to combat obesity.
    Date: 2015
  2. By: Lars Thiel
    Abstract: This study analyzes the role of social capital in buffering the negative relationship between informal-care provision and mental health. Using data from the German Socio-Economic Panel (SOEP) and fixed-effect regression models, we show that those individuals who socialize more frequently enjoy better mental health. We also find that stronger social ties moderate the negative association between caregiving and mental well-being. The protective role of social capital appears to be particularly strong for caregivers with high time commitments or those who regularly perform voluntary work. The moderating role of social activities can neither be explained by the caregiver's observed characteristics correlated with social capital, nor by features of the caregiving process. However, the results might be driven by insuficient overlap in covariates between carers and non-carers, and the simultaneity between caring decisions and social activities. We relate our results to recent policy initiatives that aim to improve the carer's well-being. Utilization of caregiver-support services is still rather low. Our findings suggest that caregivers may prefer informal support provided by family, friends, or neighbors to public caregiver benefits. To corroborate this hypothesis, further research regarding the (causal) buffering effects of social capital in the context of informal care is needed.
    Keywords: Informal care, social capital, mental health
    JEL: I10 J14 Z13
    Date: 2016
  3. By: Clemens Noelke; Mark E. McGovern; Daniel J. Corsi; Marcia Pescador-Jimenez; Ari Stern; Ian Sue Wing; Lisa Berkman
    Abstract: This study examines the impact of ambient temperature on emotional well-being in the U.S. population aged 18+. The U.S. is an interesting test case because of its resources, technology and variation in climate across different areas, which also allows us to examine whether adaptation to different climates could weaken or even eliminate the impact of heat on well-being. Using survey responses from 1.9 million Americans over the period from 2008 to 2013, we estimate the effect of temperature on well-being from exogenous day-to-day temperature variation within respondents' area of residence and test whether this effect varies across areas with different climates. We find that increasing temperatures significantly reduce well-being. Compared to average daily temperatures in the 50 to 60°F (10 to 16°C) range, temperatures above 70°F (21°C) reduce positive emotions (e.g. joy, happiness), increase negative emotions (e.g. stress, anger), and increase fatigue (feeling tired, low energy). These effects are particularly strong among less educated and older Americans. However, there is no consistent evidence that heat effects on well-being differ across areas with mild and hot summers, suggesting limited variation in heat adaptation.
    Keywords: Mental Health; Heat Exposure; Climate Impacts; Subjective Well-Being; Social Inequality
    JEL: I30 Q54
    Date: 2016–07
  4. By: Lauren E. Jones (Ohio State University, Department of Human Sciences); Nicolas Ziebarth (Cornell University)
    Abstract: This paper assesses the effectiveness of child safety seat laws. These laws progressively increased the mandatory age up to which children must be restrained in safety seats in cars. We use US Fatality Analysis Reporting System (FARS) data from 1978 to 2011 and rich state- time level variation in the implementation of these child safety seat laws for children of different ages. Increasing legal age thresholds is effective in increasing the actual age of child safety seat use. Across the child age distribution, restraint rates increase by about 30ppt in the long-run when the legal minimum age increases. However, we cannot reject the null hypothesis that restraining older children in safety seats does not reduce their likelihood to die in fatal accidents. We estimate that parents of 8.6M young children are “legal compliers.†They compose an important target group for policymakers because these parents alter their parenting behavior when laws change.
    Keywords: Child safety seats, age requirements, fatalities, FARS
    JEL: I18 K32 R41
    Date: 2016–03
  5. By: Nosal, K.
    Abstract: One way that physicians learn about new treatments and technologies is through interactions with other physicians. Such interactions are shaped, in part, by the structure of group medical practices: physicians who work in the same practice have more opportunities to exchange ideas. To quantify the importance of physician practices in technology adoption, I analyze physicians' adoption of three new anti-diabetic drugs introduced between 2009 and 2011 using data on the universe of Medicare Part D prescriptions. I construct the network of colleague relationships through practice memberships, and test whether physicians are more likely to adopt the new drugs if they have colleagues who do so. To distinguish the causal effect of interest from other sources of correlated decisions within practices, I use instrumental variables and also a panel data approach with physician and drug fixed effects. The instruments exploit the network structure, using characteristics of second degree connections (colleagues of colleagues) as a source of exogenous variation. The results indicate that having a colleague who prescribes the drug is associated with a 21 percentage point increase in a physician's probability of adopting the drug, compared to a 2 to 5 percent baseline adoption probability.
    Date: 2016–08
  6. By: Hentschker, Corinna; Wübker, Ansgar
    Abstract: Medical technological progress has been shown to be the main driver of health care costs. A key policy question is whether new treatment options are worth the additional costs. In this paper we assess the causal effect of percutaneous transluminal coronary angioplasty (PTCA), a major new heart attack treatment, on mortality. We use a full sample of administrative hospital data from Germany for the years 2005 to 2007. To account for non-random treatment assignment of PTCA, instrumental variable approaches are implemented that aim to randomize patients to different likelihoods of getting PTCA independent of heart attack severity. Instruments include differential distances to PTCA hospitals and regional PTCA rates. Our results suggest a 4.5 percentage point mortality reduction for patients who have access to this new treatment compared to patients receiving only conservative treatment. We relate mortality reduction to the additional costs for this treatment and conclude that this new treatment option is cost-effective in lowering mortality for AMI patients at reasonable cost-effectiveness thresholds.
    Abstract: Medizinisch-technischer Fortschritt ist einer der Hauptgründe für die steigenden Ausgaben im Gesundheitswesen. Daher ist es eine grundlegende Frage, ob neue und teurere Behandlungsmethoden auch den entsprechenden Zusatznutzen erbringen. In dem vorliegenden Artikel bestimmen wir den kausalen Effekt der perkutanen transluminalen Koronarangioplastie (PTCA) auf die Mortalität für Herzinfarktbehandlungen. Wir nutzen administrative Krankenhausdaten aus Deutschland für die Jahre 2005 bis 2007. Da häufig jüngere und gesündere Herzinfarktpatienten die PTCA-Behandlung erhalten und wir nicht für alle Patientencharakteristika kontrollieren können, führen wir eine Instrumentenvariablenschätzung durch, um den kausalen Effekt der PTCA auf die Mortalität zu erhalten. Als Instrument nutzen wir die Zeitdifferenz zu den nächstgelegenen Krankenhäusern. Die Ergebnisse zeigen, dass Patienten, die eine PTCA erhalten eine um 4,5 Prozentpunkte verringerte Mortalität aufweisen als Patienten mit einer konservativen Behandlung. Die zusätzlichen Behandlungskosten der PTCA im Vergleich zum Nutzen der Behandlung lässt die Schlussfolgerung zu, dass PTCA auch eine kosteneffektive Behandlung darstellt.
    Keywords: acute myocardial infarction,instrumental variables,mortality
    JEL: I11 I12 I18
    Date: 2016
  7. By: Kongstad, L.P.; Mellace, G.; Olsen, K.R.
    Abstract: Disease management programmes (DMP) in the general practice sector are increasingly used to improve health of chronically ill patients, reduce hospitalizations and thereby costs. The aim of this paper is to estimate the causal effects of the enrolment of general practices (GP) in a DMP based on Electronic Health Records (EHR) on diabetes patients total hospitalizations, diabetes related hospitalizations and hospitalizations with diabetes and cardiovascular related Ambulatory Care Sentive Conditions (ACSC). We use a rich nationwide panel dataset (2004-2013) with information of stepwise enrolment of GPs in the EHR program. As a control group we use GPs who never enrolled. Following the recent literature on causal inference with panel data, we use a standard propensity score matching estimator where we also match on pre-treatment outcomes. This allows controlling for all the unobservable confounders which were already present in the pre-treatment outcomes. Alternative, we use a difference in difference as well as a parametric model with a continuous treatment specification and find similar results. Our results show that enrolment in EHR reduced diabetes patients’ risk of hospitalizations by more than 10%. The results are comparable with studies on EHR programs from California and the magnitudes of the effects are comparable to DMPs including both EHR and financial incentives.
    Keywords: Disease management; General Practice; Ambulatory Care Sensitive Conditions (ACSC); propensity score matching;
    JEL: I12 I18
    Date: 2016–08
  8. By: Schünemann, Johannes; Strulik, Holger; Trimborn, Timo
    Abstract: In developed countries, women are expected to live about 4-5 years longer than men. In this paper we develop a novel approach in order to gauge to what extent gender differences in longevity can be attributed to gender-specific preferences and health behavior. For that purpose we set up a physiologically founded model of health deficit accumulation and calibrate it using recent insights from gerontology. From fitting life cycle health expenditure and life expectancy we obtain estimates of the gender-specific preference parameters. We then perform the counterfactual experiment of endowing women with the preferences of men. In our benchmark scenario this reduces the gender gap in life expectancy from 4.6 to 1.4 years. When we add gender-specific preferences for unhealthy consumption, the model can motivate up to 88 percent of the gender gap. Our theory offers also an economic explanation for why the gender gap declines with rising income.
    Keywords: health,aging,longevity,gender-specific preferences,unhealthy behavior
    JEL: D91 J17 J26 I12
    Date: 2016
  9. By: McLaren, Z.; Burger, R.
    Abstract: Accurate information on disease prevalence is needed to target limited health resources in order to maximize overall population health. Applying rigorous econometric methods to routinely collected data can produce accurate estimates of disease prevalence and under-detection rates at a fraction of the cost of alternatives such as prevalence surveys or universal diagnostic testing. Such estimates are valuable in developing countries to inform evidence-based health policy. We develop a simple framework with minimal assumptions to capture key features of clinical decision making surrounding diagnostic testing in resource limited settings. When it is infeasible to test every at-risk patient, clinicians must triage available resources to test those deemed most likely to have the disease. We use standard econometric estimation methods and iterative numerical optimization techniques to estimate (a) disease prevalence and (b) the accuracy with which clinicians triage patients for testing. We implement an instrumental variables approach using national and local policy changes that exogenously shift the available resources for diagnostic testing as instruments. We apply this method to tuberculosis (TB), which recently surpassed HIV as the leading infectious disease cause of death in the world. We use a national database of TB test data from South Africa, which includes over 11 million patients, to examine diagnostic testing for multi-drug resistant TB (MDR-TB). The predictions from our model closely match observed patterns in the data. We find that at least one-quarter of MDR-TB cases were undiagnosed between 2004-2011. Our estimates show that the official World Health Organization estimate of 2.5% based on notification rates is too low, and MDR-TB prevalence in South Africa could be as high as 3.29 - 3.37%. Noise-to-signal ratios in MDR-TB detection estimated in our model enable the identification of areas where clinicians do a poor job of sorting patients by MDR-TB risk prior to testing. In the case of MDR-TB there is a need for greater investment in early detection and more effective treatment. Our method of identifying areas with high MDR-TB under-detection rates, which was heretofore unmeasured and contributes to high transmission rates, provides clinicians and policy makers with a formidable new tool for targeting efforts to control TB. This method should be deployed in countries such as India, China and Russia, which together account for over 50% of MDR-TB cases worldwide, as well as applied to other infectious and non-infectious diseases where prevalence data is lacking.
    Date: 2016–08
  10. By: Liebert, H.; Mäder, B.
    Abstract: This paper investigates the effect of changes in the physician coverage ratio on infant mortality, perinatal mortality and the incidence of common childhood diseases. We utilize historical data and variation in the regional physician density provided by discriminatory policies in Germany in 1933, when Jewish physicians were expulsed from health insurance schemes and subsequently emigrated in large numbers. The results indicate substantial health effects. One additional physician per 1,000 of population reduces infant mortality by 23% and perinatal mortality by 16%. We find similar negative effects for gastrointestinal diseases, stillbirths and the incidence of measles, influenza and bronchitis. Using a semiparametric control function approach, we demonstrate that the marginal returns to coverage are nonlinear and decreasing. A coverage ratio of two physicians per 1,000 of population is sufficient to prevent mortality effects in the population.
    Keywords: infant mortality; physician coverage; health care supply; childhood diseases;
    JEL: I10 I18 N34
    Date: 2016–08
  11. By: Roquebert, Q.; Tenand, M.
    Abstract: Although the consumption of home care is increasing with population ageing, little is known about its price sensitivity. This paper estimates the price elasticity of the demand for home care of the disabled elderly, using the French home care subsidy program ("APA"). We use an original dataset collected from a French District Council with administrative records of APA out-of-pocket payments and home care consumption. Identification primarily relies on inter-individual variations in producer prices. We use the unequal spatial distribution of producers to address the potential price endogeneity arising from non-random selection into a producer. Our results point to a price elasticity around -0.4: a 10% increase in the out-of-pocket price is predicted to lower consumption by 4%, or 37 minutes per month for the median consumer. Copayment rates thus matter for allocative and dynamic efficiencies, while the generosity of home care subsidies also entails redistributive effects.
    Keywords: long-term care; price elasticity; public policy;
    JEL: C24 D12 I18 J14
    Date: 2016–08
  12. By: Bach, P.; Farbmacher, H.; Spindler, M.
    Abstract: Heterogeneous effects are prevalent in many economic settings. As the functional form between outcomes and regressors is often unknown apriori, we propose a semiparametric negative binomial count data model based on the local likelihood approach and generalized product kernels, and apply the estimator to model demand for health care. The local likelihood framework allows us to leave the functional form of the conditional mean unspecified while still exploiting basic assumptions in the count data literature (e.g., non-negativity). The generalized product kernels allow us to simultaneously model discrete and continuous regressors, which reduces the curse of dimensionality and increases its applicability as many regressors in the demand model for health care are discrete.
    Keywords: semiparametric; nonparametric; count data; health care demand;
    JEL: I10 C14 C25
    Date: 2016–08
  13. By: Oberländer, L.; Disdier, A-C.; Etilé, F.
    Abstract: This paper estimates the effect of globalisation on nutritional composition of the diet and health outcomes using a panel dataset of 70 countries spanning 42 years (1970-2011). Our key methodological contribution is the application of the grouped fixed effects estimator developed by Bonhomme and Manresa (2015), which enables us to better control for unobserved time-varying heterogeneity. Our results indicate that a one standard deviation increase in the index of social globalisation is associated with an increase in the share of animal protein of about 12%. In contrast, economic globalisation has no effect on the composition of the diet. Moreover, we do not find significant effects on diabetes prevalence or mean Body Mass Index. Our findings indicate that social aspects of globalisation, such as food advertising, deserve greater attention in the nutrition transition discourse.
    Keywords: nutrition transition; globalisation; overweight; grouped fixed effects;
    Date: 2016–08
  14. By: Brot-Goldberg, Z.C.; Chandra, A.; Handel, B.; Kolstad, J.T.
    Abstract: Measuring consumer responsiveness to medical care prices is a central issue in health economics and a key ingredient in the optimal design and regulation of health insurance markets. We study consumer responsiveness to medical care prices, leveraging a natural experiment that occurred at a large self-insured firm which required all of its employees to switch from an insurance plan that provided free health care to a non-linear, high deductible plan. The switch caused a spending reduction between 11.79%-13.80% of total firm-wide health spending. We decompose this spending reduction into the components of (i) consumer price shopping (ii) quantity reductions and (iii) quantity substitutions, finding that spending reductions are entirely due to outright reductions in quantity. We find no evidence of consumers learning to price shop after two years in high-deductible coverage. Consumers reduce quantities across the spectrum of health care services, including potentially valuable care (e.g. preventive services) and potentially wasteful care (e.g. imaging services). We then leverage the unique data environment to study how consumers respond to the complex structure of the high-deductible contract. We find that consumers respond heavily to spot prices at the time of care, and reduce their spending by 42% when under the deductible, conditional on their true expected end-of-year shadow price and their prior year end-of-year marginal price. In the first-year post plan change, 90% of all spending reductions occur in months that consumers began under the deductible, with 49% of all reductions coming for the ex ante sickest half of consumers under the deductible, despite the fact that these consumers have quite low shadow prices. There is no evidence of learning to respond to the true shadow price in the second year post-switch.
    Date: 2016–08
  15. By: Picchio, Matteo (Università Politecnica delle Marche, Ancona); van Ours, Jan C. (Tilburg University)
    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. 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. We found that 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 under-reporting of temporary workers, we found that most of, but not all, the effect is driven by the under-reporting bias. 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. 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: C23 J41 J81
    Date: 2016–08
  16. By: Rodríguez-Planas, Núria (Queens College, CUNY); Sanz-de-Galdeano, Anna (Universidad de Alicante)
    Abstract: This paper is the first to provide evidence that cultural attitudes towards gender equality affect behaviors with potentially devastating health consequences, and that they do so differently for male and female teenagers. In particular, we show that descending from more gender-equal societies makes girls relatively more prone to smoke than boys. Using data from over 6,000 second-generation immigrant teenagers coming from 45 different countries of ancestry and living in Spain, we find that the higher the degree of gender equality in the country of ancestry, the higher the likelihood that immigrant girls smoke relative to boys, even after we control for parental, sibling, and peer smoking. Importantly, we uncover similar patterns when analyzing other risky behaviors such as drinking or smoking marijuana. This reinforces the idea that more gender-equal social norms may come at an extra cost to women's health, as they increasingly engage in risky behaviors (beyond smoking) traditionally more prevalent among men.
    Keywords: culture and institutions, smoking, risky behaviors, gender equality, gender gap index
    JEL: I10 I12 J15 J16 Z13
    Date: 2016–08
  17. By: Seuring, Till (University of East Anglia); Serneels, Pieter (University of East Anglia); Suhrcke, Marc (University of York)
    Abstract: There is limited evidence on the labor market impact of diabetes, and existing evidence tends to be weakly identified. Making use of Mexican panel data to estimate individual fixed effects models, we find evidence for adverse effects of self-reported diabetes on employment probabilities, but not on wages or hours worked. Complementary biomarker information for a cross section indicates a large diabetes population unaware of the disease. When accounting for this, the negative relationship of self-reported diabetes with employment remains, but does not extend to those unaware. This difference cannot be explained by more severe diabetes among the self-reports, but rather worse general health.
    Keywords: diabetes, labor market, Mexico, biomarker, panel data
    JEL: J22 I15 D83
    Date: 2016–08
  18. By: Alex Barrachina (LEE and Department of Economics, Universitat Jaume I, Castellón, Spain); Víctor González-Chordá (Nursing Department, Universitat Jaume I, Castellón, Spain)
    Abstract: The interaction between nurses and their managers is a very important factor in nurses’ error reporting behaviour, which is crucial to improve patient safety in health care organisations. However, little theoretical work has been undertaken to analyse this interaction. This paper attempts to take a modest step forward in closing this gap in the health economics literature by considering a principal-agent model in which the principal (the nurse manager) asks the agent (the nurse) to perform a task with a certain patient. If the nurse makes a mistake while treating the patient, she has to decide whether to report it to the manager, taking into account that the manager can observe whether the patient suffered an accident. Considering four leadership styles for the manager and four styles of error reporting for the nurse, the paper concludes that a leadership style very close to the transformational one is, in general, the best one for receiving error notifications from nurses, which is coherent with the evidence provided by the nursing management literature.
    Keywords: Nurse error reporting – Patient safety – Asymmetric information – Nurse-manager interaction– Nurse leadership style
    JEL: C72 D82 I12 M12
    Date: 2016
  19. By: Conti, Gabriella (University College London); Ginja, Rita (Uppsala University)
    Abstract: We present evidence on the health impacts and mechanisms of a large expansion in non-contributory health insurance in Mexico. The Seguro Popular (SP) was rolled out in 2002-2010 across municipalities, providing exogenous variation in access to health services without co-pays. Our intent-to-treat estimates show that SP reduced child mortality by 7% in poor municipalities, saving 861 children/year. The decline is driven mainly by deaths due to preventable causes, such as diarrhea and respiratory infections. We also document an increase in hospital care for children with the same conditions. Our findings have important implications for the ongoing health insurance expansions.
    Keywords: health insurance, child mortality, health care utilization, Mexico
    JEL: H10 I12 I13 J13 O18
    Date: 2016–08
  20. By: Vasilev, Aleksandar
    Abstract: This paper aims to shed light on the importance of health considerations for business cycle fluctuations and the effect of health status on labor productivity and availability of labor input for productive use. To this end, Grossman's (2000) partial-equilibrium framework with endogenous health is incorporated in an otherwise standard Real- Business-Cycle (RBC) model. Health status in this setup is modelled as a utility-enhancing, intangible, and non-transferrable capital stock, which depreciates over time. The household can improve their health ("produce health") through investment using a health-recovery technology. The main results are: (i) overall, the model compares well vis-a-vis data; (ii) the behavior of the price of healthcare is adequately approximated by the shadow price of health in the model; (iii) the model-generated health variable exhibits moderate- to high correlation with a large number of empirical health indicators.
    Keywords: real business cycles,health status,health investment
    JEL: E32 E37
    Date: 2016
  21. By: SILBER, Jacques; XU, Yongsheng
    Abstract: This paper, following earlier work on the cardinal measurement of ordinal health inequality, proposes an axiomatic derivation of the health achievement in a population when only ordinal information on health is available. An empirical illustration based on EU data for 27 countries during the period 2005-2012 is then presented which confirms the usefulness of the new measure of health achievement that has been introduced.
    Keywords: axiomatic approach, European Union, health achievement, ordinal information
    JEL: I14 I31
    Date: 2016–08
  22. By: Christopher J. Ruhm
    Abstract: This analysis utilizes death certificate data from the Multiple Cause of Death (MCOD) files to better measure the specific drugs involved in drug poisoning fatalities. Statistical adjustment procedures are used to provide more accurate estimates, accounting for the understatement in death certificate reports resulting because no drug is specified in between one-fifth and one-quarter of cases. The adjustment procedures typically raise the estimates of specific types of drug involvement by 30% to 50% and emphasize the importance of the simultaneous use of multiple categories of drugs. Using these adjusted estimates, an analysis is next provided of drugs accounting for the rapid increase over time in fatal overdoses. The frequency of combination drug use introduces uncertainty into these estimates and so a distinction is made between any versus exclusive involvement of specific drug types. Many of the results are sensitive to the starting and ending years chosen for examination, with a key role of prescription opioids for analysis windows starting in 1999 but with other drugs, particularly heroin deaths, becoming more significant in more recent years and, again, with confirmatory evidence of the importance of simultaneous drug use.
    JEL: I10 I12 I18
    Date: 2016–08
  23. By: Saak, Alexander E.; Hennessy, David A.
    Abstract: When an outbreak of an infectious disease is suspected, a local health agency may notify a state or federal agency and request additional resources to investigate and, if necessary, contain it. However, due to capacity constraints, state and federal health agencies may not be able to grant all such requests, which may give an incentive to local agencies to request help strategically. We study a model of detection and control of an infectious disease by local health agencies in the presence of imperfect information about the likelihood of an outbreak and limited diagnostic capacity. When diagnostic capacity is rationed based on reports of symptoms, the decision to report symptoms or not creates a trade-off. On the one hand, rigorous testing allows one to make an informed disease control decision. On the other hand, it also increases the probability that the disease will spread from an untested area where fewer precautionary measures are taken. Symptoms are overreported (respectively, reported truthfully, or underreported) when the cost of disease control is sufficiently small (respectively, in some intermediate range, or sufficiently large). If the disease incidence decreases or infectiousness increases, symptoms are reported less frequently. If the precision of private signals increases, the extent of overreporting of symptoms may increase. For different values of the parameters it can be socially optimal to subsidize or tax requests for additional investigations and confirmatory testing.
    Keywords: infectious diseases, public health, epidemiology, cheap talk, private information, D82 Asymmetric and Private Information, Mechanism Design, D83 Search, Learning, Information and Knowledge, Communication, Belief, D62 Externalities, I18 Health: Government Policy, Regulation, Public Health,
    Date: 2016

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