nep-hea New Economics Papers
on Health Economics
Issue of 2016‒08‒28
25 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Health Care Quality, Income Transfer and International Trade: A Theoretical Analysis By Chatterjee, Tonmoy; Gupta, Kausik
  2. Health Plan Type Variations in Spells of Health Care Treatment By Randall P. Ellis; Wenjia Zhu
  3. Provider Payment Methods and Incentives By Randall P. Ellis; Bruno Martins; Michelle McKinnon Miller
  4. Mispricing in Medicare Advantage Risk Adjustment By Jing Chen; Randall P. Ellis; Katherine H. Toro; Arlene S. Ash
  5. ‘Good-Enough’ Risk Adjustment Models for Physician Payment and Performance Assessment By Randall P. Ellis; Arlene S. Ash; Juan Gabriel Fernandez
  6. Assessing Incentives for Adverse Selection in Health Plan Payment Systems By Timothy J. Layton; Randall P. Ellis; Thomas G. McGuire
  7. Optimal health insurance for multiple goods and time periods By Randall P. Ellis; Shenyi Jian; Willard G. Manning
  8. Does My High Blood Pressure Improve Your Survival? Overall and Subgroup Learning Curves in Health By Gestel, R.V.; Müller, T.; Bosmans, J.
  9. Closing Down the Shop: Optimal Health and Wealth Dynamics near the End of Life By Hugonnier, J.; Pelgrin, F.; St-Amour, P.
  10. A Framework for Measurement Error in Self-Reported Health Conditions By Perry Singleton; Ling Li
  11. HIV Clinician Workforce Study By Boyd Gilman; Ellen Bouchery; Kirsten Barrett; Samantha Stalley; Margaret Hargreaves; Cicely Thomas; Dean Miller; John McCauley; Paul Hogan; Sebastian Negrusa; Thomas Arnold; Namrata Sen
  12. Lifestyle, Mental and Physical Stress and the Work Environment By Ai Nakano
  13. Characteristics of the Ryan White HIV/AIDS Program Provider Network: Implications for Access to Care Under the Affordable Care Act By Ellen Bouchery; Boyd Gilman; Sylvia Trent-Adams; Laura Cheever
  14. Impact of caregiver incentives on child health: evidence from an experiment with Anganwadi workers in India By Prakarsh Singh; William A. Masters
  15. The Impact of Women’s Health Clinic Closures on Fertility By Yao Lu; David J.G. Slusky
  16. Promotion of Medical R&D in Japan under Abenomics By Yuko Ito; Hiroshi Nagano
  17. Day-to-Day Living Expenses and Mental Health By Dackehag, Margareta; Ellegård, Lina Maria; Gerdtham, Ulf-G.; Nilsson, Therese
  18. Early Effects of the 2010 Affordable Care Act Medicaid Expansions on Federal Disability Program Participation By Pinka Chatterji; Yue Li
  19. The Pros and Cons of Sick Pay Schemes: Testing for Contagious Presenteeism and Noncontagious Absenteeism Behavior By Stefan Pichler; Nicolas R. Ziebarth
  20. Do Hospital-Owned Skilled Nursing Facilities Provide Better Post-Acute Care Quality? By Momotazur Rahman; Edward C. Norton; David C. Grabowski
  21. Are Publicly Insured Children Less Likely to be Admitted to Hospital than the Privately Insured (and Does it Matter)? By Diane Alexander; Janet Currie
  22. The Rise in Life Expectancy, Health Trends among the Elderly, and the Demand for Care - A Selected Literature Review By Bjorn Lindgren
  23. Employment Effects of the ACA Medicaid Expansions By Pauline Leung; Alexandre Mas
  24. Immunization and Moral Hazard: The HPV Vaccine and Uptake of Cancer Screening By Ali Moghtaderi; Avi Dor
  25. Life-Cycle Consumption Patterns at Older Ages in the US and the UK: Can Medical Expenditures Explain the Difference? By James Banks; Richard Blundell; Peter Levell; James P. Smith

  1. By: Chatterjee, Tonmoy; Gupta, Kausik
    Abstract: This paper deals with the aspect of trade in health services in the form of health care quality innovation from North to South in the presence of well established state interference in South. In accordance to the above mentioned scenario we have framed a theoretical structure where our health care is acting as a monopoly and the government has detected income transfer from richer people of South to the poorer section of South as an action to heal the welfare of the society. From such kind of set up we have discussed several possibilities through which a South based Multinational Health Service Provider (MNHSP) can export their health care quality innovation to the patients of North. Overall, we find price discrimination of the MNHSP between the Southern branches of MNHSP and the Northern branches of MNHSP with some standardisation is the main source of trade in health care innovation at least in our case.
    Keywords: Health quality innovation, International trade, Full information dynamic game and Income transfer
    JEL: C7 D4 F12 F23 I11
    Date: 2016–04–19
  2. By: Randall P. Ellis (Boston University); Wenjia Zhu (Boston University)
    Abstract: This paper analyzes 30-day “treatment spells†- fixed length periods that commence with a service after a gap in provider contact - to examine how health care utilization and spending of insured employees at large firms are influenced by health plan types. We focus on differences between preferred provider organizations (PPOs) and two recent innovations: plans that feature a narrow panel of providers, and plans that allow free choice of providers but increase demand-side cost sharing: consumer-driven/high-deductible health plans. Health plan effect estimates change dramatically after controlling for endogenous plan type choice, and individual fixed effects. With these controls, narrow panel plans reduce the probability of new treatment spells relative to PPOs by 34 percent with little effect on chronic, repeat visit spells. Visit reductions are more concentrated in less severe conditions in narrow network plans, hence diagnostic coding on the remaining patients increases. We find no evidence that either narrow panel or higher cost sharing plans pay lower prices per procedure or have less intensive treatment given initiation of treatment. With controls, consumer-driven/high-deductible health plans are associated with higher total spending on procedures than PPO plans.
    Keywords: health care spending, treatment spells, risk adjustment, exclusive provider organizations, consumer driven health plans
    JEL: I11 G22 I13
    Date: 2015–08–21
  3. By: Randall P. Ellis (Boston University); Bruno Martins (Boston University); Michelle McKinnon Miller (Loyola Marymount University)
    Abstract: Diverse provider payment systems create incentives that affect the quantity and quality of health care services provided. Payments can be based on provider characteristics, which tend to minimize incentives for quality and quantity. Or payments can be based on quantities of services provided and patient characteristics, which provide stronger incentives for quality and quantity. Payments methods using both broader bundles of services and larger numbers of payment categories are growing in prevalence. The recent innovation of performance-based payment attempts to target payments on key patient attributes so as to improve incentives, better manage patients, and control costs.
    Keywords: Provider payment, fees schedules, Diagnosis Related Groups (DRG), moral hazard, selection, capitation, incentives, risk adjustment
    Date: 2015–08–12
  4. By: Jing Chen (EMC Corporation); Randall P. Ellis (Boston University); Katherine H. Toro (University of Massachusetts Medical School); Arlene S. Ash (Verisk Health)
    Abstract: The Center for Medicare and Medicaid Services implemented hierarchical condition category (CMS-HCC) models in 2004 to adjust payments to Medicare Advantage (MA) plans to reflect enrollees’ expected health care costs. We use DxCG Medicare models, refined “descendants†of the same HCC framework with 189 comprehensive clinical categories available to CMS in 2004, to reveal two mispricing errors resulting from CMS’ implementation. One comes from ignoring all diagnostic information for “new enrollees†(those with less than 12 months of prior claims). Another comes from continuing to use the simplified models which were originally adopted in response to assertions from some capitated health plans that submitting the claims-like data that facilitate richer models was too burdensome. Even the main CMS model being used in 2014 recognizes only 79 condition categories, excluding many diagnoses and merging conditions with somewhat heterogeneous costs. Omitted conditions are typically lower cost or “vague†and not easily audited from simplified data submissions. In contrast, DxCG Medicare models use a comprehensive, 394-HCC classification system. Applying both models to Medicare’s 2010 - 2011 Fee-For-Service five-percent sample, we find mispricing and lower predictive accuracy for the CMS implementation. For example, in 2010, 13% of beneficiaries had at least one higher-cost DxCG- recognized condition, but no CMS-recognized, condition; their 2011 actual costs averaged $6,628, almost one-third more than the CMS model prediction. Since MA plans must now supply encounter data, CMS should consider using more refined and comprehensive (DxCG-like) models.
    Keywords: Medicare, CMS-HCC, DxCG, risk adjustment, payment models
    Date: 2015
  5. By: Randall P. Ellis (Boston University); Arlene S. Ash (Verisk Health); Juan Gabriel Fernandez (University of Massachusetts Medical School)
    Date: 2015–06–20
  6. By: Timothy J. Layton (Harvard Medical School); Randall P. Ellis (Boston University); Thomas G. McGuire (Harvard Medical School, NBER)
    Abstract: Health insurance markets face two forms of adverse selection problems. On the demand side, adverse selection leads to plan price distortions and inefficient sorting of consumers across health plans. On the supply side, adverse selection creates incentives for insurers to inefficiently distort benefits to attract profitable enrollees. These problems can be addressed by features of health plan payment systems such as reinsurance, risk adjustment, and premium categories. In this paper, we develop Harberger-type measures of the efficiency consequences of price and benefit distortions under a given payment system. Our measures are valid, that is, based on explicit economic models of adverse selection. Our measures are complete, in that they are able to incorporate multiple features of plan payment systems. Finally, they are practical, in that they are based on the ex-ante data available to regulators and researchers during the design phase of payment system development, prior to observing actual insurer and consumer behavior. After developing the measures, we compare the performance of the payment system planned for implementation in the ACA Marketplaces in 2017 to several policy alternatives. We show that, in protecting against both types of selection problems, a payment system that incorporates reinsurance and prospective risk adjustment out-performs the planned payment system which includes only concurrent risk adjustment.
    Date: 2015–07–12
  7. By: Randall P. Ellis (Boston University); Shenyi Jian (Renmin University of China); Willard G. Manning (Harris School of Public Policy Studies, The University of Chicago)
    Abstract: We examine the efficiency-based arguments for second-best optimal health insurance with multiple treatment goods and multiple time periods. Correlated shocks across health care goods and over time interact with complementarity and substitutability to affect optimal cost sharing. Health care goods that are substitutes or have positively correlated demand shocks should have lower optimal patient cost sharing. Positive serial correlations of demand shocks and uncompensated losses that are positively correlated with covered health services also reduce optimal cost sharing. Our results rationalize covering pharmaceuticals and outpatient spending more fully than is implied by static, one good, or one period models.
    Date: 2015
  8. By: Gestel, R.V.; Müller, T.; Bosmans, J.
    Abstract: Learning curves in health are of interest for a wide range of medical disciplines, for multiple types of healthcare providers and policy makers. In this paper, we distinguish between three types of learning when identifying overall learning curves: static learning, learning from cumulative experience and human capital depreciation. In addition, we approach the question of how treating more patients with specific characteristics improves provider performance. Information on the role of subgroups has the potential to better inform new or low outcome providers on how to improve. Statistically however, capturing all subgroup experiences in one analysis introduces strong collinearities among regressors. To soften collinearity problems, we explore the use of Lasso regression as a variable selection method and Theil-Goldberger mixed estimation to augment the available information. We use data from the Belgian Transcatheter Aorta Valve Implantation (TAVI) registry, containing information on the first 860 TAVI procedures in Belgium. Ultimately, we find evidence for both overall and subgroup learning effects: for 2-year survival, we find that the probability of survival is increased by about 0.16%-points for each additional patient treated. For adverse events like renal failure and stroke, we find that an extra day between procedures increases the probability for these events by 0.12%-points and 0.07%-points respectively. These overall effects are then split into subgroup effects where we find evidence for positive learning effects from physicians' experience with defibrillation, treating patients with hypertension and the use of certain types of replacement valves during the TAVI procedure.
    Keywords: Learning Curves; Lasso; Theil-Goldberger; TAVI;
    JEL: I10 C11 C18
    Date: 2016–08
  9. By: Hugonnier, J.; Pelgrin, F.; St-Amour, P.
    Abstract: The observed health decline near the end of life coincides with less curative (e.g. hospital stay, doctor visits), and more comfort (e.g. nursing home) care, which accelerate both the fall in wealth, and the timing of death. We investigate whether these dynamics jointly result from a closing down the shop decision i.e. a depletion of the health stock is optimally selected (and eventually accelerated), leading to states characterized by indifference between life, and death. Towards that aim, we expand, structurally estimate, and simulate a life cycle model of financial,and health expenses with endogenous mortality exposure (Hugonnier et al., 2013). Under economically plausible, and statistically verified conditions, we find that, unless sufficiently rich and healthy, agents will optimally select expected depletion of their health capital, and associated increase in death likelihood. Moreover, we identify a wealth and health locus below which agents accelerate their health depletion. Importantly, wealth is also expected to decline for all, such that all surviving agents eventually enter the closing down phase.
    Keywords: End of life; Life cycle; Dis-savings; Endogenous mortality risk; Unmet medical needs; Right to refuse treatment;
    JEL: D91 D14 I12
    Date: 2016–08
  10. By: Perry Singleton (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Ling Li (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244)
    Abstract: This study develops and estimates a model of measurement error in self-reported health conditions. The model allows self-reports of a health condition to differ from a contemporaneous medical examination, prior medical records, or both. The model is estimated using a two-sample strategy, which combines survey data linked medical examination results and survey data linked to prior medical records. The study finds substantial inconsistencies between self-reported health, the medical record, and prior medical records. The study proposes alternative estimators for the prevalence of diagnosed and undiagnosed conditions and estimates the bias that arises when using self-reported health conditions as explanatory variables.
    Keywords: Measurement Error, Disease Prevalence, Diabetes, Hypertension
    JEL: I12 J22
    Date: 2016–08
  11. By: Boyd Gilman; Ellen Bouchery; Kirsten Barrett; Samantha Stalley; Margaret Hargreaves; Cicely Thomas; Dean Miller; John McCauley; Paul Hogan; Sebastian Negrusa; Thomas Arnold; Namrata Sen
    Abstract: This study is the first large-scale effort to identify the number of HIV clinicians practicing in the United States, to characterize their workforce behavior, and to assess HIV workforce needs at the national and regional levels. It was designed to address concerns about a potential shortage of clinicians in the future.
    Keywords: Health care workforce, HIV care, health care practitioners, workforce projections
    JEL: I
  12. By: Ai Nakano (Graduate School of Economics, Kobe University)
    Date: 2016–08
  13. By: Ellen Bouchery; Boyd Gilman; Sylvia Trent-Adams; Laura Cheever
    Abstract: This study provides a baseline view of the HIV care system prior to implementation of the Patient Protection and Affordable Care Act (ACA).
    Keywords: Health care workforce, HIV care, health care practitioners, workforce projections
    JEL: I
  14. By: Prakarsh Singh; William A. Masters
    Abstract: This paper provides evidence for the effectiveness of performance pay among government caregivers to improve child health in India. In a controlled study of 160 daycare centers serving over 4000 children, we randomly assign workers to receive performance pay or fixed bonuses of roughly similar expected value, and test for differences in malnutrition among the children in their care. We find that performance pay reduces the prevalence of weight-for-age malnutrition by about 5 percentage points in 3 months. This effect is sustained in the medium term with a renewal of incentives but the differential growth rate fades away once the scheme is discontinued. Fixed bonuses lead to smaller-sized effects and only in the medium-term. 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; public health information; child malnutrition
    JEL: O1 I1 M5
    Date: 2016–05
  15. By: Yao Lu (Analysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA 02199); David J.G. Slusky (Department of Economics, The University of Kansas;)
    Abstract: The government of Texas recently enacted multiple restrictions and funding limitations on women’s health organizations that provide abortion services or are associated with those that do. These policies have caused numerous clinic closures throughout the state, drastically reducing access to care. We study the impact of these clinic closures on fertility by combining quarterly snapshots of health center addresses from a network of women's health centers with restricted geotagged data of all Texas birth certificates for 2007–2013. We calculate the driving distance to the nearest clinic for each ZIP code, and find that an increase of 100 miles to the nearest clinic results in a 1.2 percent increase in the birth rate. This increase is driven by fertility changes for unmarried women and those having their first or second child. It also reduces average maternal age.
    Keywords: Women’s Health; Family Planning; Abortion; Contraception; Birth Rate; Access; Restriction; Law; Texas
    JEL: H75 I18 J13
    Date: 2016–08
  16. By: Yuko Ito (National Graduate Institute for Policy Studies, and Japan Science and Technology Agency); Hiroshi Nagano (National Graduate Institute for Policy Studies, and Keio University)
    Abstract: Japan fs cabinet has been pushing forward with economic policy knowns as Abenomics since December 26 in 2012. Abenomics also includes the promotion of R&D in the medical field and related legislative reforms. The Headquarters for Healthcare and Medical Strategy Promotion was established in the cabinet in 2013. In 2014, gAct to Promote Healthcare and Medical Strategy h was promulgated and included for the formulation of the Health and Medical Strategy, the creation of the Plan for Promotion of medical R&D by the Headquarters, and the newly establishment for Japan Agency for Medical Research and Development. In 2014 the Pharmaceutical Affairs Law was revised and it newly contains the strengthening of safety measures for pharmaceuticals and medical devices, the construction of regulations taking into account the characteristics of medical devices, and a new definition for regenerative medicine along with approvals for manufacturing and sales in light of its special characteristics. Further, gSakigake Package Strategy h formulated in 2014, which included an gadvanced review designation system h as a fast-track- applications. With only three years having passed since the implementation of the policies related to Abenomics in 2013, it may be premature to judge their outcome, but several positive signs are appearing.
    Date: 2016–08
  17. By: Dackehag, Margareta (Department of Economics, Lund University); Ellegård, Lina Maria (Department of Economics, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University); Nilsson, Therese (Department of Economics, Lund University)
    Abstract: We use rich longitudinal survey and register data on Swedish individuals to examine the relationship between financial strain and mental health. Specifically, we consider the longitudinal relationships between payment difficulties and subjective (self-reported anxiety) as well as objective (psychiatric drug use) measures of mental ill-health. Among previously healthy individuals, payment difficulty experiences are strongly associated with self-reported mental ill-health. The association with later psychiatric drug use is weaker and differs by gender. Psychiatric drug users are on the other hand at high risk of later experiencing payment difficulties. This indicates that policy measures regarding the payment difficulties–health nexus ought to prioritize activities improving mental health.
    Keywords: financial strain; mental health; stress
    JEL: I12 I30 I31
    Date: 2016–08–19
  18. By: Pinka Chatterji; Yue Li
    Abstract: We test whether early Affordable Care Act (ACA) Medicaid expansions in Connecticut (CT), Minnesota (MN), California (CA), and the District of Columbia (DC) affected SSI applications, SSI and DI awards, and the number of SSI and DI beneficiaries. We use a difference-in-difference (DD) approach, comparing SSI/DI outcomes pre and post each early Medicaid expansion (“Early Expanders”) to SSI/DI outcomes in states that expanded Medicaid in January 2014 (“Later Expanders”). We also use a synthetic control approach, in which we examine SSI/DI outcomes before and after the Medicaid expansion in each Early Expander state, utilizing a weighted combination of Later Expanders as a comparison group. In CT, the Medicaid expansion is associated a statistically significant, 7 percent reduction in SSI beneficiaries; this finding is consistent across the DD and synthetic control methods. For DC, MN and CA, we do not find consistent evidence that the Medicaid expansions affected disability-related outcomes.
    JEL: I10 I13
    Date: 2016–08
  19. By: Stefan Pichler; Nicolas R. Ziebarth
    Abstract: This paper provides an analytical framework and uses data from the US and Germany to test for the existence of contagious presenteeism and negative externalities in sickness insurance schemes. The first part exploits high-frequency Google Flu data and the staggered implementation of U.S. sick leave reforms to show in a reduced-from framework that population-level influenza-like disease rates decrease after employees gain access to paid sick leave. Next, a simple theoretical framework provides evidence on the underlying behavioral mechanisms. The model theoretically decomposes overall behavioral labor supply adjustments ('moral hazard') into contagious presenteeism and noncontagious absenteeism behavior and derives testable conditions. The last part illustrates how to implement the model exploiting German sick pay reforms and administrative industry-level data on certified sick leave by diagnoses. It finds that the labor supply elasticity for contagious diseases is significantly smaller than for noncontagious diseases. Under the identifying assumptions of the model, in addition to the evidence from the U.S., this finding provides indirect evidence for the existence of contagious presenteeism.
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2016–08
  20. By: Momotazur Rahman; Edward C. Norton; David C. Grabowski
    Abstract: As hospitals are increasingly held accountable for patients' post-discharge outcomes under new payment models, hospitals may choose to acquire skilled nursing facilities (SNFs) to better manage these outcomes. This raises the question of whether patients discharged to hospital-based SNFs have better outcomes. In unadjusted comparisons, hospital-based SNF patients have much lower Medicare utilization in the 180 days following discharge relative to freestanding SNF patients. We solved the problem of differential selection into hospital-based and freestanding SNFs by using differential distance from home to the nearest hospital with a SNF relative to the distance from home to the nearest hospital without a SNF as an instrument. We found that hospital-based SNF patients spent roughly 5 more days in the community and 6 fewer days in the SNF in the 180 days following their original hospital discharge with no significant effect on mortality or hospital readmission.
    JEL: I11 I18
    Date: 2016–08
  21. By: Diane Alexander; Janet Currie
    Abstract: There is continuing controversy about the extent to which publicly insured children are treated differently than privately insured children, and whether differences in treatment matter. We show that on average, hospitals are less likely to admit publicly insured children than privately insured children who present at the ER and the gap grows during high flu weeks, when hospital beds are in high demand. This pattern is present even after controlling for detailed diagnostic categories and hospital fixed effects, but does not appear to have any effect on measurable health outcomes such as repeat ER visits and future hospitalizations. Hence, our results raise the possibility that instead of too few publicly insured children being admitted during high flu weeks, there are too many publicly and privately insured children being admitted most of the time.
    JEL: I13
    Date: 2016–08
  22. By: Bjorn Lindgren
    Abstract: The objective is to review the evidence on (a) ageing and health and (b) the demand for health- and social services among the elderly. Issues are: does health status of the elderly improve over time, and how do the trends in health status of the elderly affect the demand for health- and elderly care? It is not a complete review, but it covers most of recent empirical studies. The reviewed literature provides strong evidence that the prevalence of chronic disease among the elderly has increased over time. There is also fairly strong evidence that the consequences of disease have become less problematic due to medical progress: decreased mortality risk, milder and slower development over time, making the time with disease (and health-care treatment) longer but less troublesome than before. Evidence also suggests the postponement of functional limitations and disability. Some of the reduction in disability can be attributed to improvements in treatments of chronic diseases, but it is also due to the increased use of assistive technology, accessibility of buildings, etc. The results indicate that the ageing individual is expected to need health care for a longer period of time than previous generations but elderly care for a shorter.
    JEL: H51 I1 I38 J11 J14
    Date: 2016–08
  23. By: Pauline Leung; Alexandre Mas
    Abstract: We examine whether the recent expansions in Medicaid from the Affordable Care Act reduced “employment lock” among childless adults who were previously ineligible for public coverage. We compare employment in states that chose to expand Medicaid versus those that chose not to expand, before and after implementation. We find that although the expansion increased Medicaid coverage by 3.0 percentage points among childless adults, there was no significant impact on employment.
    JEL: H0 J0 J18
    Date: 2016–08
  24. By: Ali Moghtaderi; Avi Dor
    Abstract: Immunization can cause moral hazard by reducing the cost of risky behaviors. In this study, we examine the effect of HPV vaccination for cervical cancer on participation in the Pap test, which is a diagnostic screening test to detect potentially precancerous and cancerous process. It is strongly recommended for women between 21-65 years old even after taking the HPV vaccine. A reduction in willingness to have a Pap test as a result of HPV vaccination would signal the need for public health intervention. The HPV vaccination is recommended for women age eleven to twelve for regular vaccination or for women up to age 26 not vaccinated previously. We present evidence that probability of vaccination changes around this threshold. We identify the effect of vaccination using a fuzzy regression discontinuity design, centered on the recommended vaccination threshold age. The results show no evidence of ex ante moral hazard in the short-run. Sensitivity analyses using alternative specifications and subsamples are in general agreement. The estimates show that women who have been vaccinated are actually more likely to have a Pap test in the short-run, possibly due to increased awareness of its benefits.
    JEL: I10 I12
    Date: 2016–08
  25. By: James Banks; Richard Blundell; Peter Levell; James P. Smith
    Abstract: In this paper we document significantly steeper declines in nondurable expenditures in the UK compared to the US, in spite of income paths being similar. We explore several possible causes, including different employment paths, housing ownership and expenses, levels and paths of health status, number of household members, and out-of -pocket medical expenditures. Among all the potential explanations considered, we find that those to do with healthcare—differences in levels and age paths in medical expenses—can fully account for the steeper declines in nondurable consumption in the UK compared to the US.
    JEL: D10 D11 D12 D14 D91
    Date: 2016–08

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