nep-hea New Economics Papers
on Health Economics
Issue of 2016‒10‒02
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Supporting the development of an essential health package: principles and initial assessment for Malawi By Jessica Ochalek; Karl Claxton; Paul Revill; Mark Sculpher; Alexandra Rollinger
  2. Working Paper 234 - The Unintended Consequences of Agricultural Input Intensification: Human Health Implications of Agro-chemical use in Sub-Saharan Africa By Megan Sheahan; Christopher Barrett; Casey Goldvale
  3. Healthcare Spending Decelerating? Not so Fast! By William B.P. Robson
  4. What Explains the Difference in the Effect of Retirement on Health?: Evidence from Global Aging Data By Motegi, Hiroyuki; Nishimura, Yoshinori; Oikawa, Masato
  5. Improving Patient’s Satisfaction at Urgent Care Clinics by Using Simulation-based Risk Analysis and Quality Improvement By Sajadnia, Sahar; Heidarzadeh, Elham
  6. Healthcare Exceptionalism? Performance and Allocation in the U.S. Healthcare Sector By Chandra, Amitabh; Finkelstein, Amy; Sacarny, Adam; Syverson, Chad
  7. What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics By Brot-Goldberg, Zarek C.; Chandra, Amitabh; Handel, Benjamin R.; Kolstad, Jonathan T.
  8. Measuring the End of Life Premium in Cancer using Individual ex ante Willingness to Pay By Olofsson , Sara; Gerdtham, Ulf-G.; Hultkrantz, Lars; Persson, Ulf
  9. Dread and Risk Elimination Premium for the Value of a Statistical Life By Olofsson , Sara; Gerdtham, Ulf-G.; Hultkrantz, Lars; Persson, Ulf
  10. How the New International Goal for Child Mortality is Unfair to Sub-Saharan Africa (Again) By Simon Lange; Stephan Klasen
  11. The organisation of out-of-hours primary care in OECD countries By Caroline Berchet; Carol Nader
  12. ‘Recessions, healthy no more?’: A note on Recessions, Gender and Mortality in France By Josselin Thuilliez
  13. Medical Representative in Bangladesh: a Job with Different Pattern By S.M.Yasir Arafat; Zuhayer Ahmed
  14. What future for the health system? By André Grimaldi
  15. Malaria and Education: Evidence from Mali By Josselin Thuilliez; Hippolyte D'Albis; Hamidou Niangaly; Ogobara Doumbo
  16. Outpatient Chemotherapy Planning: a Literature Review with Insights from a Case Study By Guillaume Lamé; Oualid Jouini; Julie Stal-Le Cardinal
  17. The dynamics of health and labour market transitions at older ages: evidence from a multi-state model By Harris, M.N.; Zhao, X.; Zucchelli, E.
  18. Education, lifetime labor supply, and longevity improvements By Sanchez-Romero, Miguel; d'Albis, Hippolyte; Fürnkranz-Prskawetz, Alexia
  19. Effect of a micro entrepreneur-based community health delivery program on under-five mortality in Uganda: a cluster-randomized controlled trial By Björkman Nyqvist, Martina; Guariso, Andrea; Svensson, Jakob; Yanagizawa-Drott, David
  20. Fertility and health insurance types in Germany By Robert Stelter
  21. What is the relationship between education, literacy and self-reported health? By OECD
  22. Prescription Drug Expenditure and 'Universal' Coverage: the Quebec Experience in Canada By Rose Anne Devlin; Yiwen Wang
  23. Access to and Disparities in Care among Migrant and Seasonal Farm Workers (MSFWs) at U.S. Health Centers By Ruwei Hu; Leiyu Shi; De-Chih Lee; Geraldine Pierre Haile
  24. Effects of the Affordable Care Act on Part-Time Employment: Early Evidence By Marcus Dillender; Carolyn Heinrich; Susan Houseman
  25. A Doctor Will See You Now: Physician-Patient Relationships and Clinical Decisions By Erin Johnson; M. Marit Rehavi; David C. Chan, Jr; Daniela Carusi
  26. Measuring Effects of SNAP on Obesity at the Intensive Margin By Lorenzo N. Almada; Rusty Tchernis
  27. Inequality of opportunity for healthy aging in Europe By Bora Kim

  1. By: Jessica Ochalek (Centre for Health Economics, University of York, York, UK.); Karl Claxton (Centre for Health Economics, University of York, York, UK.); Paul Revill (Centre for Health Economics, University of York, York, UK.); Mark Sculpher (Centre for Health Economics, University of York, York, UK.); Alexandra Rollinger (Centre for Health Economics, University of York, York, UK.)
    Abstract: Many health care systems in low income settings define essential health packages (EHP) to concentrate scarce resources on key health interventions to which their populations can have free access at the point of delivery. Malawi has used EHPs since 2004 but they have generally included unaffordable interventions that have not been fully delivered. To guide decisions about the 2016 EHP in Malawi, an analytical framework is proposed that identifies interventions which, based on currently available evidence, offer the most gains in population health. The framework uses existing estimates of what the Malawian health care system is currently able to afford to generate gains in health – a measure of health opportunity costs. This facilitates an initial quantification of an appropriate budget for the EHP, and of the interventions that might be included which can then be prioritised on the basis of their expected impact on population health assuming 100% implementation. In practice, lower levels of implementation will be achieved by interventions due to various constraints operating on the demand or supply side, and which apply to specific interventions or the system more generally. The framework provides an analytical basis to consider the implications for population health of these different types of constraints. It uses this as a basis of assessing how the underspend on the EHP due to the ‘implementation gap’ can be used. The framework estimates the potential impacts on health outcomes of intervention-specific implementation activities and system strengthening. These potential impacts are compared with the health outcomes offered by extending the package to include additional interventions. The analytical framework can also assess the implications for population health of the types of constraints that donors may impose on their funding schemes in health care. These constraints can include requiring that particular interventions are included in the EHP when the funding could have a bigger impact on health if spent elsewhere; offers to expand the package but restricted to particular interventions and forgoing greater health outcomes elsewhere; and offers to provide additional funding as long as these are matched by government. In negotiating with donors and communicating with relevant stakeholders, policy makers will benefit from understanding the implications for population health of such constraints.
    Date: 2016–09
  2. By: Megan Sheahan; Christopher Barrett; Casey Goldvale
    Abstract: While agro-chemicals such as pesticides, fungicides, and herbicides are often promoted as inputs that increase agricultural productivity by limiting a range of pre-harvest losses, their use may have negative human health and labor productivity implications. We explore the relationship between agro-chemical use and the value of crop output at the plot level and a range of human health outcomes at the household level using nationally representative panel survey data from four Sub-Saharan African countries where more than ten percent of main season cultivators use agro-chemicals. We find that agro-chemicals use is associated with increased value of harvest, with similar magnitudes across three of the four countries under study, but is also associated with increases in costs associated with human illness, including increased health expenditures related to illness and time lost from work due to sickness in recent past. We motivate our empirical work with a simple dynamic optimization model that clearly shows the role that farmer understanding of these feedbacks can play in optimizing the use of agro-chemicals. The central role of information in determining that optimum underscores the role of agricultural and public health extension as modern input intensification proceeds in the region.
    Date: 2016–04–18
  3. By: William B.P. Robson
    Keywords: Health Policy
    JEL: I10 H51
  4. By: Motegi, Hiroyuki; Nishimura, Yoshinori; Oikawa, Masato
    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 unified 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: I1 I12 I18 J26
    Date: 2016–09–23
  5. By: Sajadnia, Sahar; Heidarzadeh, Elham
    Abstract: Several factors are expected to significantly increase stakeholders’ interest in healthcare simulation studies in the foreseeable future, e.g., the use of metrics for performance measurement, and increasing patients’ expectations. Total time spent by a patient as an important issue leads to patients’ dissatisfaction which should be improved in any healthcare facility. We reported on the use of discrete event simulation modeling, quality function deployment (QFD) and failure mode effects analysis (FMEA) to support process improvements at urgent care clinics. The modeling helped identify improvement alternatives such as optimized healthcare facility staff numbers. It also showed that lack of identified role for all team members and inconsistent process of ordering and receiving blood products and lab results are crucial failures that may occur. Moreover, using experienced staff and forcing staff to follow correct procedures are important technical aspects of improving the urgent care clinics in order to increase patient’s satisfaction. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that total time spent by a patient was significantly improved and the after result of waiting time is also decreased.
    Keywords: Urgent care, discrete event simulation, quality function deployment (QFD), failure mode effects analysis (FMEA), process improvement.
    JEL: I1 I11 I15
    Date: 2016–09–05
  6. By: Chandra, Amitabh (Harvard University); Finkelstein, Amy (MIT); Sacarny, Adam (MIT); Syverson, Chad (University of Chicago)
    Abstract: The conventional wisdom in health economics is that idiosyncratic features of the healthcare sector leave little scope for market forces to allocate consumers to higher performance producers. However, we find robust evidence across a variety of conditions and performance measures that higher quality hospitals tend to have higher market shares at a point in time and expand more over time. Moreover, we find that the relationship between performance and allocation is stronger among patients who have greater scope for hospital choice, suggesting a role for patient demand in allocation in the hospital sector. Our findings suggest that the healthcare sector may have more in common with "traditional" sectors subject to standard market forces than is often assumed.
    Date: 2015–10
  7. By: Brot-Goldberg, Zarek C. (University of CA, Berkeley); Chandra, Amitabh (Harvard University); Handel, Benjamin R. (University of CA, Berkeley); Kolstad, Jonathan T. (University of CA, Berkeley)
    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 forced 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 ($100 million lower spending per year). We decompose this spending reduction into the components of (i) consumer price shopping (ii) quantity reductions (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: 2015–10
  8. By: Olofsson , Sara (The Swedish Institute for Health Economics (IHE)); Gerdtham, Ulf-G. (Department of Economics, Lund University); Hultkrantz, Lars (Örebro University, School of Business); Persson, Ulf (The Swedish Institute for Health Economics (IHE))
    Abstract: For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per Quality-Adjusted Life-Years (QALY) gained. Some HTAs accept a higher cost per QALY gained when treatment is aimed at prolonging survival for patients with a short expected remaining lifetime, a so called End-Of-Life (EoL) premium. The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population 20-80 years old using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias. The value of a QALY at EoL in cancer was between €275,000 and €440,000, which is higher than the thresholds applied by HTAs. When expected remaining life expectancy was 6 months, the value of a QALY was 10-20 % higher compared to when remaining life expectancy was 24 months. Order of scenarios did not have a significant impact on the result and the result showed scale sensitivity. Thus this study supports an EoL premium in cancer when expected remaining lifetime is short.
    Keywords: willingness to pay; value of a QALY; cancer; contingent valuation; order bias
    JEL: D61 D80 I18 J17
    Date: 2016–09–23
  9. By: Olofsson , Sara (The Swedish Institute for Health Economics (IHE)); Gerdtham, Ulf-G. (Department of Economics, Lund University); Hultkrantz, Lars (Örebro University, School of Business); Persson, Ulf (The Swedish Institute for Health Economics (IHE))
    Abstract: The Value of a Statistical Life (VSL) is a widely used measure of the value of mortality risk reduction. Since VSL should reflect preferences and attitudes to risk, there are reasons to believe that it varies depending on the type of risk involved. It has been argued that cancer should be considered a “dread disease”, which supports the use of a “cancer premium”. The objective of this study is to elicit the existence and size of a cancer premium (for pancreatic cancer and multiple myeloma) in relation to road traffic accidents, sudden cardiac arrest and Amyotrophic Lateral Sclerosis (ALS). Data was collected from 500 individuals in the Swedish general population 50 -74 years old using a web-based questionnaire. Preferences were elicited using the Contingent Valuation method, and a split-sample design was applied to test for scale sensitivity. VSL differs significantly between contexts, being highest for ALS and lowest for road traffic accident. A premium (26-76 %) for cancer was found in relation to road traffic accidents, but not in relation to ALS and sudden cardiac arrest. The premium was higher for cancer with a shorter time from diagnosis to death. Eliminating risk was associated with a premium of around 17 %. Evidence of scale sensitivity was found when comparing WTP for all risks simultaneously. This study shows that there exist a dread premium and risk elimination premium. These factors should be considered when searching for an appropriate value for economic evaluation and health technology assessment.
    Keywords: willingness to pay; value of a statistical life; cancer; contingent valuation; risk elimination
    JEL: D61 D80 I18 J17
    Date: 2016–09–23
  10. By: Simon Lange (Georg-August University Göttingen); Stephan Klasen (University of Göttingen)
    Abstract: The post-2015 development includes level-end goals for both under-five and neonatal mortality to be obtained by 2030: no more than 25 and 12 deaths per 1,000 births, respectively. Recent accelerations in the rate of reduction in under-five mortality have been cited as a cause for optimism. In this paper, we show that changes in mortality rates are subject to mean reversion. Hence, high rates observed recently for Sub-Saharan Africa make for an overly optimistic estimate of future reductions. Taking this into account in projecting mortality rates until 2030, we find that only very few countries in Sub-Saharan Africa are likely to attain the new targets while a majority of countries elsewhere are likely to attain the target or have done so already. We also show that while MDG4 has been rightly criticized as `unfair' to Sub-Saharan Africa in the past, a relative target may have been more appropriate today and would be relevant for all countries. We also offer a discussion of likely challenges the region faces in making further inroads against preventable deaths.
    Keywords: MDGs; SDGs; under-five mortality; Sub-Saharan Africa
    JEL: I15 I18 J11 J18 O21
    Date: 2016–09–28
  11. By: Caroline Berchet; Carol Nader
    Abstract: Out-of-hours (OOH) services provide urgent primary care when primary care physician (PCP) offices are closed, most often from 5pm on weekdays and all day on weekends and holidays. Based on a policy survey (covering 27 OECD countries) and the existing literature, the working paper describes the current challenges associated with the organisation of OOH primary care and reviews the existing models of delivering OOH primary care. The paper pays particular attention to policies which have been pursued to improve access and quality of OOH primary care. Findings of the paper show that most OECD health systems report key challenges to provide OOH primary care in an accessible and safe way. These challenges relate to (i) PCPs’ reluctance to practise due to high workload and insufficient remuneration; and (ii) geographical variations in access to OOH primary care within each health system. Together these challenges are leading sources of inappropriate hospital emergency department (ED) visits. Results also indicate that several models of OOH primary care exist alongside each other in the 27 OECD countries participating in the policy survey. Hospital EDs, rota groups and practice-based services remain the most common OOH arrangements, but there is a tendency to shift OOH primary care towards primary care centres and large-scale organisations known as general practice cooperatives (GPCs). A range of solutions have been implemented to improve access and quality of OOH primary care across OECD countries. These include providing organisational and financial support to PCPs; using other health care professionals (such as nurse practitioners), making OOH care participation compulsory, setting up a telephone triage system, using new technologies, and developing rich information systems.
    JEL: I18
    Date: 2016–09–21
  12. By: Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: This study uses aggregate panel data on 96 French départements from 1982 to 2012 to investigate the relationship between macroeconomic conditions, gender and mortality. I use previously employed panel data methods, based on mortality variation across French départements and years. The novelty is to analyze the effect of gender-specific unemployment on gender-specific mortality. Within this “area-gender approach”, I give a particular attention to gender-cause-specific mortality such as prostate cancer, maternal mortality, female breast cancer, cervical cancer and ovarian cancer in addition to other cause-specific mortality. The analysis is undertaken for several age-groups, several time windows and different geographical aggregates of unemployment. The results reveal that the relationship between unemployment and mortality in France is weak and confirm recent conclusions from U.S. state-level analysis by Rhum [Ruhm, C.J., 2015. Recessions, Healthy no more?. Journal of Health Economics 42, 17-28].
    Keywords: Health,Mortality,Recessions,Gender,Macroeconomic conditions
    Date: 2016–01
  13. By: S.M.Yasir Arafat (Bangabandhu Sheikh Mujib Medical University); Zuhayer Ahmed (Global Alliance for Vaccines and Immunization (GAVI), Bangladesh)
    Abstract: Pharmaceutical industry is one of the progressive sectors in Bangladesh economy and medical representatives play important role in achieving the company sales target. There is paucity of literatures in this field. Therefore, it was aimed to describe the daily job life of a medical representative based on close observations. Authors gained insights from unstructured interview of medical representatives, marketing personnel, training department personnel of the representative and top executives of pharmaceutical companies. Medical representatives are working with intense sales pressure, very little holiday, huge job insecurity and very little time to be with family in a biphasic job schedule. This article will provide a glimpse to the job seekers to compare their options and hope to draw attention of the policy makers to make the job more attractive.
    Keywords: Reps,Bangladesh,Pharma marketing,Medical Representatives
    Date: 2016
  14. By: André Grimaldi (UPMC - Université Pierre et Marie Curie - Paris 6, CHU Pitié-Salpêtrière [APHP])
    Abstract: The French health system is facing a double challenge: epidemic of chronic diseases, and financial sustainability of the social security established in 1945. Our system is very good for caring acute illness, but is inadequate for the management of chronic diseases. And this, on four areas: prevention, medical model, organization, and ways of funding. The second challenge is the increase health spending reaching 11.6 % of GDP in 2013. Beyond the cost of new drugs, there is a problem of dual ways of refunding for each care: social security, and private health insurance. This duality is responsible for a very high cost of health management, up to 16 billion euros. The inevitable increase in health care spending, due to aging and medical progress, within a restricted budget, will lead to choose between two solutions: increase in privatization of routine care funding, social security refocusing on the poorest people and on the patients with the more severe and costly diseases, or separate the care supported by the community and the care relating to personal choice supported by private insurance. An intermediate solution would be to allow those who wish, to choose the social security as additional insurance, for an additional fee.
    Abstract: Le système de santé français est confronté à un double défi : l’augmentation épidémique du nombre de patients atteints de maladies chroniques, et la soutenabilité financière du système solidaire fondé en 1945. Or, notre système de santé, très bon pour les soins aigus, est mal adapté à la prise en charge des affections chroniques sur quatre plans : la prévention, le modèle médical, l’organisation, et le financement. Le 2e défi est celui de l’accroissement des dépenses de santé, représentant 11,6 % du Produit intérieur brut (PIB) en 2013. Au-delà de l’augmentation du coût des médicaments et des dispositifs médicaux innovants, se pose le problème de la dualité du mode de financement reposant, pour chaque acte, à la fois sur l’assurance maladie obligatoire et sur des assurances privées dites complémentaires. D’où un coût de gestion globalement très élevé, atteignant 16 milliards d’euros. L’augmentation des dépenses de santé, en raison du vieillissement de la population et des progrès médicaux, dans un contexte de budget contraint, va conduire, soit à une privatisation croissante du financement des soins courants, l’assurance maladie obligatoire prenant en charge les personnes les plus pauvres et les malades les plus graves, soit à la définition d’un panier de soins solidaire pris en charge par la Sécurité sociale, les soins hors panier de soins solidaire étant pris en charge par les assurances privées, non plus complémentaires, mais supplémentaires. Une proposition intermédiaire consisterait à permettre aux assurés qui le souhaitent de choisir, moyennant une cotisation supplémentaire, la Sécurité sociale comme assurance maladie complémentaire, en plus de son rôle d’assurance maladie obligatoire.
    Keywords: Chronic disease,integrated medicine,long term affections,health insurance,health expenditure,affections de longue durée,médecine intégrée,Maladies chroniques,assurances maladie,dépenses de santé
    Date: 2016
  15. By: Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique); Hippolyte D'Albis (PSE - Paris School of Economics, CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique); Hamidou Niangaly (MRTC - Malaria Research and Training Center - Faculté de Médecine de Bamako); Ogobara Doumbo (MRTC - Malaria Research and Training Center - Faculté de Médecine de Bamako)
    Abstract: This article examines the influence of malaria on human capital accumulation in the village of Diankabou in Mali. To account for malaria endogeneity and its interaction with unobservable risk factors, we exploit natural variations in malaria immunity across individuals of several sympatric ethnic groups – the Fulani and the non-Fulani – who differ in their susceptibility to malaria. The Fulani are known to be less susceptible to malaria infections, despite living with a similar malaria transmission intensity to those seen among other ethnic groups. We also use natural variation of malaria intensity in the area (during and after the malaria transmission season) and utilize this seasonal change as a treatment. We find that malaria has an impact on cognitive and educational outcomes in this village. We discuss the implications of this result for human capital investments and fertility decisions with the help of a quantity-quality model.
    Keywords: Immunity,Malaria,Education,Cognition,Fertility
    Date: 2016–01
  16. By: Guillaume Lamé (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec); Oualid Jouini (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec); Julie Stal-Le Cardinal (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec)
    Abstract: With an ageing population and more efficient treatments, demand for cancer care is increasing. Therefore, hospitals need to find ways to improve their operational efficiency for cancer care. In this article, we review the contributions in the operations management and operations research (OM/OR) literature that address the planning of outpatient chemotherapy, one of the main treatments for cancer. The distinctive characteristics of outpatient chemotherapy are highlighted. In particular, the interdependence between the administration of chemotherapy drugs in the outpatient clinic and drug preparation in the pharmacy is pointed out. This makes outpatient chemotherapy planning a multiple department challenge where coordination is essential to the global performance of the system. The modeling challenges induced by this interdependence and by the clinical dimension of chemotherapy are presented. Finally, a case study is performed to confront the literature with the reality of a hospital. Important gaps in the literature are outlined, such as the lack of studies taking an integrated, systemic perspective on this multi-department issue.
    Keywords: pharmacy,outpatient clinics,healthcare management,multi-department,Chemotherapy
    Date: 2016
  17. By: Harris, M.N.; Zhao, X.; Zucchelli, E.
    Abstract: Despite its clear relevance and policy significance, there is still sparse evidence on the effects of ill-health on the dynamics of labour state transitions among older individuals. We provide novel evidence by considering retirement as mobility among full-time work, part-time work, self-employment and inactivity, using a dynamic multinomial choice model that simultaneously accounts for state dependence, individual-level and state-specific unobserved heterogeneity, captivity and correlations between labour market states. We also simulate the dynamic paths for the four labour states from both transitory and permanent health shocks. We find strong state dependence for all four labour states even after accounting for individual effects. Both ill-health and health shocks are found to greatly increase the probability of leaving full-time employment into inactivity, and we find some evidence of part-time and self-employment paths. Significant evidence is found for “captivity†effects for the “inactive†state, and correlations across labour states. We also show that the degree of state dependence is over-estimated and, for men, the effects of ill health under-estimated, if unobserved individual effects are not controlled for in dynamic models.
    Keywords: health; dynamic labour transitions; captivity; unobserved heterogeneity;
    JEL: C23 I10 J24 J2
    Date: 2016–09
  18. By: Sanchez-Romero, Miguel; d'Albis, Hippolyte; Fürnkranz-Prskawetz, Alexia
    Abstract: This paper presents an analysis of the differential role of mortality for the optimal schooling and retirement age when the accumulation of human capital follows the so-called "Ben-Porath mechanism". We set up a life-cycle model of consumption and labor supply at the extensive margin that allows for endogenous human capital formation. This paper makes two important contributions. First, we provide the conditions under which a decrease in mortality leads to a longer education period and an earlier retirement age. Second, those conditions are decomposed into a Ben-Porath mechanism and a lifetime-human wealth effect vs. the years-to-consume effect. Finally, using US and Swedish data for cohorts born between 1890 and 2000, we show that our model can match the empirical evidence.
    JEL: I25 J10 J24 J26
    Date: 2016
  19. By: Björkman Nyqvist, Martina; Guariso, Andrea; Svensson, Jakob; Yanagizawa-Drott, David
    Abstract: Systematic reviews of existing evidence show promising effects of community health worker (CHW) programs as a strategy to improve child survival, but also highlight challenges faced by CHW programs, including insufficient incentives to deliver timely and appropriate services. We assessed the effect of an incentivized community health delivery program in Uganda on all-cause under-five mortality. A cluster-randomized controlled trial, embedded within the scale-up of a new community health delivery program, was undertaken in 214 clusters in 10 districts in Uganda. In the intervention clusters micro entrepreneur-based community health promoters (CHPs) were deployed over a three-year period (2011-2013). On average 38 households were surveyed in each cluster at the end of 2013, for a total sample size of 8,119 households. The primary study outcome was all-cause under-five mortality (U5MR). U5MR was reduced by 27% (adjusted RR 0.73, 95% CI 0.58-0.93).
    Keywords: child mortality; infant mortality; social entrepreneurship; Living Goods; community health worker
    Date: 2016–09
  20. By: Robert Stelter (Max Planck Institute for Demographic Research, UNIVERSITE CATHOLIQUE DE LOUVAIN, Institut de Recherches Economiques et Sociales (IRES) and University of Rostock)
    Abstract: In this paper I study how different health insurance types in Germany alter the incentives to give birth. A stylized model illustrates that both the private and statutory health insurance can imply a higher number of births. While the family insurance in the latter clearly reduces the costs per child, income effects due to varying parental premia might operate in the opposite direction. If they are higher in the statutory health insurance, for instance, due to a selection of healthy individuals in the private health insurance, the latter might induce a higher number of births. Relying on data of the German Socio Economic Panel, I apply endogenous treatment effects models for count data to control for selection effects. Estimation results indicate that the private health insurance positively affects the number of births. The positive impact is robust across several alternative specifications.
    Keywords: Dual health insurance system; Fertility; Health insurance choice
    JEL: I13 J13
    Date: 2016–09–21
  21. By: OECD
    Abstract: Highly-educated and highly-skilled individuals are more likely to report better health than the less-educated and less-skilled, even when comparing individuals with similar background characteristics. The difference in self-reported health that is associated with schooling is largest in Norway and the United States and smallest in France, Italy and Sweden. The association between self-reported health and literacy is highest in Austria and the United States. Cross-country differences in the association between schooling and self-reported health and between literacy proficiency and self-reported health suggest that healthcare and social welfare systems play an important role in shaping the association between schooling, literacy and health.
    Date: 2016–09–30
  22. By: Rose Anne Devlin (Department of Economics, University of Ottawa, Ottawa, ON); Yiwen Wang
    Abstract: This paper examines the relationship between public expenditures on prescription drugs and public-insurance coverage in Canada over the period 1985 to 2012 using data from the Canadian Institute for Health Information and Statistics Canada. We pay particular attention to the introduction of universal prescription drug coverage in Quebec in 1997. Employing an OLS procedure with panel-corrected standard errors (PCSE) and correcting for AR(1) disturbances, we find that universal coverage in Quebec led to an increase in per capita public expenditures on prescription drugs. It also led to a reduction in spending for over-the-counter medications, suggesting some substitutability between prescription and non-prescription drugs.
    Keywords: prescription drug expenditures, catastrophic drug plans, non-spherical disturbances, panel-corrected standard errors, universal prescription drug coverage, Quebec
    JEL: I11
    Date: 2016
  23. By: Ruwei Hu; Leiyu Shi; De-Chih Lee; Geraldine Pierre Haile
    Abstract: This study describes the characteristics of migrant and seasonal farm workers (MSFWs) served by federally-funded health centers and examines disparities in access to primary and preventive care between migrant health center (MHC) and community health center (CHC) program patients.
    Keywords: Access to and Disparities in Care , Migrant and Seasonal Farm Workers (MSFWs) , U.S. Health Centers
    JEL: I
  24. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research); Carolyn Heinrich (Vanderbilt University); Susan Houseman (W.E. Upjohn Institute for Employment Research)
    Abstract: The Affordable Care Act (ACA) requires employers with at least 50 full-time-equivalent employees to offer “affordable” health insurance to employees working 30 or more hours per week. If employers do not comply with the mandate, they may face substantial financial penalties. Employers can potentially circumvent the mandate by reducing weekly hours below the 30-hour threshold or by using other nonstandard employment arrangements (direct-hire temporaries, agency temporaries, small contractors, and independent contractors). We examine the effects of the ACA on short-hours, part-time employment. Using monthly CPS data, we estimate that the ACA resulted in an increase in low-hours, involuntary part-time employment of a half-million to a million workers in retail, accommodations, and food services, the sectors in which employers are most likely to reduce hours if they choose to circumvent the mandate, and also the sectors in which low-wage workers are most likely to be affected. Our empirical strategy uses as a control group Hawaii, which has had a more stringent employer health insurance mandate than that of the ACA for several decades. The findings are robust to placebo tests and alternative specifications.
    Keywords: Affordable Care Act, employer-sponsored health insurance, employer mandate, part-time employment, involuntary part-time employment
    JEL: I13 J23 J3
    Date: 2016–06
  25. By: Erin Johnson; M. Marit Rehavi; David C. Chan, Jr; Daniela Carusi
    Abstract: We estimate the effect of physician-patient relationships on clinical decisions in a setting where the treating physician is as good as randomly assigned. OBs are 25% (4 percentage points) more likely to perform a C-section when delivering patients with whom they have a pre-existing clinical relationship (their “own patients”) than when delivering patients with whom they had no prior relationship. OBs’ decisions are consistent with receiving greater disutility from their own patients’ difficult labors. After a string of difficult labors, OBs are more likely to perform C-sections on their own patients, and this can explain the entire own patient effect.
    JEL: I11 J44
    Date: 2016–09
  26. By: Lorenzo N. Almada; Rusty Tchernis
    Abstract: The effects of the Supplemental Nutrition Assistance Program (SNAP) on obesity have been the focus of much debate. However, causal interpretation of estimates from previous studies, comparing participants to non-participants, is complicated by endogeneity and possible misreporting of participation in SNAP. In this paper, we take a novel approach to examine quasi-experimental variation in SNAP benefit amount on adult obesity. Children of SNAP households qualify for free in-school meals, thus freeing some additional benefits for the household. A greater proportion of school-age children eligible for free in-school meals proxies for an exogenous increase in the amount of SNAP benefits available per adult. Using data from the National Longitudinal Survey of Youth-1979 we show that school meals represent a non-trivial part of the food budget for SNAP households. We find that increases in SNAP benefits have no effect on obesity levels for the full sample of those who report SNAP participation. To better isolate the effects of additional benefits from other potential changes we restrict our analysis to adults living in households with at least one child under 5 years of age. In this setting, we find that additional SNAP benefits reduce BMI and the probability of being obese for SNAP adults.
    JEL: H51 H53 I1 I38
    Date: 2016–09
  27. By: Bora Kim
    Abstract: This study quantifies the inequality of opportunity (IOp) for healthy aging in Europe. Unlike earlier studies, an objective health indicator, grip strength, is used as an outcome. Using the longitudinal data from the Survey of Health, Aging and Retirement in Europe (Wave 1-5), I introduce a general model where explanatory variables portray individual lifetime trajectory. All predictors are disentangled into illegitimate and legitimate components. The Hausman-Taylor (1981) estimator is employed to deal with the presence of unobserved heterogeneity and endogeneity of time-variant lifestyle. Both upper and lower bounds of IOp are considered by incorporating different sets of illegitimate factors under six scenarios. Parallel results based on self-reported health are provided. We find that IOp in a subjective measure is less sensitive to age, but more to unobserved factors. Finally, the magnitude of IOp is compared between men and women as well as across ten states Denmark, Sweden, Switzerland, Austria, Germany, France, the Netherlands, Belgium, Spain and Italy. Overall, the results are sensitive to the choice in health indicator.
    Date: 2016–09

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