nep-hea New Economics Papers
on Health Economics
Issue of 2016‒11‒06
fifteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. How OECD health systems define the range of good and services to be financed collectively By Ane Auraaen; Rie Fujisawa; Grégoire de Lagasnerie; Valérie Paris
  2. The Effect of Early ACA Medicaid Expansion on Mental Health By Hoke, Omer; Dunn, Richard
  3. Care choices in Europe: To each according to his needs? By Heger, Dörte; Korfhage, Thorben
  4. Informal care and long-term labor market outcomes By Schmitz, Hendrik; Westphal, Matthias
  5. The effects of competition on medical service provision By Brosig-Koch, Jeannette; Hehenkamp, Burkhard; Kokot, Johanna
  6. Taking Stock of New Supermarkets in Food Deserts: Patterns in Development, Financing, and Health Promotion By Chrisinger, Benjamin W.
  7. What makes Vietnamese (not) attend periodic general health examinations? A cross-sectional study By Quan-Hoang Vuong; Quang-Hoi Vu; Thu Trang Vuong
  8. The Effects of False Identification Laws with a Scanner Provision on Underage Alcohol-Related Traffic Fatalities By Erik Nesson; Vinish Shrestha
  9. The Interaction between Consumption and Health in Retirement By John Karl Scholz; Ananth Seshadri
  10. A Two-parameter Family of Socio-economic Health Inequality Indices: Accounting for Risk and Inequality Aversions By MUSSARD Stéphane; PI ALPERIN Maria Noel
  11. The Effect of Income on Health: Using the Coal Boom as a Natural Experiment By Sunghoon Lim; Beomsoo Kim
  12. Immigration and the Reallocation of Work Health Risks By Giuntella, Osea; Mazzonna, Fabrizio; Nicodemo, Catia; Vargas-Silva, Carlos
  13. Health, Consumption and Inequality By Jose-Victor Rios-Rull; Josep Pijoan-Mas
  14. Effects of Adult Health Interventions at Scale on Children's Schooling: Evidence from Antiretroviral Therapy in Zambia By Adrienne M. Lucas; Margaret Chidothe; Nicholas L. Wilson
  15. Competitive Effects of Scope of Practice Restrictions: Public Health or Public Harm? By Sara Markowitz; E. Kathleen Adams; Mary Jane Lewitt, PhD,CNM; Anne Dunlop, MD

  1. By: Ane Auraaen; Rie Fujisawa; Grégoire de Lagasnerie; Valérie Paris
    Abstract: Universal health coverage has been achieved in nearly all OECD countries, providing the population with access to a defined range of goods and services. This paper provides detailed descriptions of how countries delineate the range of benefits covered, including the role of health technology assessment and specific criteria to inform the decision-making process. Further, the paper examines the composition of assessment/appraisal and decision-making bodies across the different OECD health systems, highlighting the role of patients and public as well as transparency of decision-making processes. While the process of including new technologies to the range of benefits covered is structured and relies on a well-defined set of criteria, dynamic adjustments of the range of benefits covered are less structured. The paper then looks at the boundaries of health care coverage and presents a set of services for which coverage varies greatly across the OECD countries. La quasi-totalité des pays de l’OCDE offrent à présent une couverture maladie universelle, donnant accès à leur population à un panier défini de biens et services de santé. Ce document décrit en détail la manière dont les pays définissent les contours de ce panier de soins, notamment le rôle de l’évaluation des technologies et des critères utilisés pour éclairer la prise de décision. Ce document examine également la composition des instances responsables d’évaluer les technologies et de prendre les décisions en matière de couverture, mettant en évidence le rôle des patients ou du public en général et la transparence du processus de décision. Alors que le processus visant à inclure de nouvelles technologies dans le panier de soins est en général très structuré, les processus d’ajustements dynamiques du panier de soins sont moins bien définis. Ce document analyse enfin les contours du panier de biens et services couverts dans les pays de l’OCDE en analysant un ensemble de biens et services de santé, dont la couverture varie largement d’un pays à l’autre.
    JEL: I11 I18
    Date: 2016–11–03
  2. By: Hoke, Omer (University of Connecticut); Dunn, Richard
    Abstract: This article examines the effect of insurance coverage on mental health outcomes by exploiting variation in the timing of Medicaid expansion under the Affordable Care Act (ACA). Using BRFSS data from 2007 to 2013, we compare self-reported mental and physical health between individuals in seven states that enacted more generous Medicaid eligibility guidelines before the federal deadline set in the ACA with individuals in variously defined control groups. Results show that while Medicaid expansion improves mental health, it does not have a statistically significant effect on physical health in the short-run. Furthermore, the benefits of Medicaid expansion on mental health status are evident between the passage of ACA in 2010 and the actual implementation of Medicaid expansion. This suggests that insurance coverage may improve mental health status by relieving the stress associated with being uncovered.
    Date: 2016–06
  3. By: Heger, Dörte; Korfhage, Thorben
    Abstract: Growing long-term care (LTC) needs represent a major challenge for our ageing societies. Understanding how utilization patterns of different types of care are influenced by LTC policies or changes in the population composition such as age patterns or health can provide helpful insight on how to adequately prepare for this situation. To this aim, this paper explores how individuals choose between different forms of LTC. We exploit variation between countries as well as between individuals within countries using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). Using nonlinear decomposition techniques, we break down the difference in utilization rates between countries into differences based on observed sociodemographic and need related characteristics and differences in the impacts of these characteristics, which allows us to identify the drivers behind differences in the formal-informal care mix. Our results show that a substantial fraction of the observed country differences can be explained by the different features of the LTC systems.
    Abstract: Der zunehmende Bedarf an Langzeitpflege stellt eine große Herausforderung für unsere alternden Gesellschaften dar. Ein besseres Verständnis darüber, wie die Inanspruchnahme der verschiedenen Pflegearten durch das Pflegesystem oder Veränderungen der Bevölkerungsstruktur, wie z.B. der Altersstrukturen oder dem Gesundheitszustand, beeinflusst wird, ermöglicht es sich auf diese Situation besser vorzubereiten. Um diese Fragen zu beantworten, untersuchen wir wie Individuen zwischen den verschiedenen Formen von Langzeitpflege wählen. Wir analysieren Unterschiede zwischen den Ländern sowie zwischen Individuen innerhalb einzelner Länder anhand Daten des Survey of Health, Ageing, and Retirement (SHARE). Mit Hilfe nicht-linearer Dekompositionstechniken untergliedern wir die Unterschiede in Nutzungsraten zwischen den Ländern in Unterschiede aufgrund von beobachtbaren soziodemografischen und bedarfsbezogenen Charakteristiken und in Unterschiede in den Auswirkungen dieser Charakteristiken auf die Wahl der Pflegeart. Diese Methodik ermöglicht es die Treiber hinter den Differenzen in dem formellen-informellen Pflegemix zu identifizieren. Unsere Ergebnisse zeigen, dass ein wesentlicher Anteil der beobachteten Unterschiede in Pflegequoten durch die verschiedenen Eigenschaften der Pflegesysteme zu erklären ist.
    Keywords: Long-term care,informal care,international comparison,decomposition
    JEL: I11 J14 J18
    Date: 2016
  4. By: Schmitz, Hendrik; Westphal, Matthias
    Abstract: In this paper we estimate the long-run effects of informal care provision on female caregivers' labor market outcomes up to eight years after care provision. We compare a static version, where the average effects of care provision in a certain year on later labor market outcomes are estimated, to a partly dynamic version where the effects of up to three consecutive years of care provision are analyzed. Our results suggest that there are significant initial negative effects of informal care provision on the probability to work full time. The reduction in the probability to work full time by 4 percentage points (or 2.4 to 5.0 if we move from point to partial identification) is persistent over time. Effects on the probability of being in the labor force are quite small, however high care intensity strongly reduces the probability to be in the labor force eight years after the start of the episode. Short-run effects on hourly wages are zero but we find considerable long-run wage penalties.
    Abstract: In diesem Papier wird der langfristige Einfluss von häuslicher Pflege auf das Arbeitsangebot von Frauen (bis zu acht Jahre nach Aufnahme der Pflegetätigkeit) untersucht. Wir vergleichen statische Ergebnisse, die Aufschluss darüber geben, wie sich der Effekt einer Pflegeaufnahme durchschnittlich über die Zeit entwickelt, mit einem teilweise dynamisch geschätzten Ansatz, in dem die Effekte von drei aufeinanderfolgenden Pflegejahren analysiert werden. Unsere Ergebnisse legen nahe, dass Pflege mit einem negativen Effekt auf die Wahrscheinlichkeit, einer Vollzeitbeschäftigung nachzugehen, einhergeht. Der Effekt beträgt anfänglich 4 Prozentpunkte (oder 2,4 bis 5,0 Prozentpunkte bei partieller Identifikation anstelle von Punktidentifikation) und ist über die Zeit persistent. Der Effekt auf die Wahrscheinlichkeit im Arbeitsmarkt zu verbleiben ist relativ gering. Allerdings reduziert eine hohe Pflegeintensität substanziell die Wahrscheinlichkeit nach acht Jahren im Arbeitsmarkt verblieben zu sein. Kurzfristige Effekte auf den Stundenlohn werden nicht gefunden, jedoch gibt es beträchtliche Lohneffekte, die nach ein paar Jahren zu Tage treten.
    Keywords: informal care,labor supply,inverse probability weighting,dynamic sequential models
    JEL: I10 I18 C21 J14 J22
    Date: 2016
  5. By: Brosig-Koch, Jeannette; Hehenkamp, Burkhard; Kokot, Johanna
    Abstract: We explore how competition between physicians affects medical service provision. Previous research has shown that, without competition, physicians deviate from patient-optimal treatment under payment systems like capitation and fee-for-service. While competition might reduce these distortions, physicians usually interact with each other repeatedly over time and only a fraction of patients switches providers at all. Both patterns might prevent competition to work in the desired direction. To analyze the behavioral effects of competition, we develop a theoretical benchmark which is then tested in a controlled laboratory experiment. Experimental conditions vary physician payment and patient characteristics. Real patients benefit from treatment decisions made in the experiment. Our results reveal that, in line with the theoretical prediction, introducing competition can reduce overprovision and underprovision, respectively. The observed effects depend on patient characteristics and the payment system, though. Tacit collusion is observed and particularly pronounced with fee-for-service payment, but it appears to be less frequent than in related experimental research on price competition.
    Abstract: In der vorliegenden Studie untersuchen wir, wie sich Wettbewerb zwischen Ärzten auf deren Behandlungsentscheidungen auswirkt. Bisherige Forschungsergebnisse zeigen, dass ohne Wettbewerb die Behandlungsentscheidungen von Ärzten bei klassischen Vergütungssystemen wie der Einzelleistungsvergütung oder der Kopfpauschale von den patientenoptimalen Entscheidungen abweichen. Während diese Abweichungen grundsätzlich durch Wettbewerb reduziert werden könnten, ist davon auszugehen, dass Ärzte typischerweise wiederholt miteinander interagieren und dass nur ein Teil der Patienten den Arzt wechselt. Beides könnte die positiven Effekte des Wettbewerbs verringern. Um die Verhaltenswirkungen von Wettbewerb zu analysieren, entwickeln wir ein spieltheoretisches Modell, das wir mit Hilfe kontrollierter Laborexperimente testen. Die experimentellen Anordnungen variieren bezüglich der Arztvergütung und der Charakteristika der Patienten. Reale Patienten profitieren von den im Experiment getroffenen Behandlungsentscheidungen. Unsere Ergebnisse zeigen, dass Wettbewerb im Einklang mit der theoretischen Prognose Überbehandlung und Unterbehandlung reduzieren kann. Die beobachteten Effekte hängen jedoch von den Charakteristika der Patienten und der Arztvergütung ab. Wir finden auch stillschweigende Kollusion, insbesondere bei der Einzelleistungsvergütung. Diese tritt jedoch in geringerem Ausmaß auf als in vergleichbaren experimentellen Studien zum Preiswettbewerb.
    Keywords: physician competition,fee-for-service,capitation,laboratory experiment
    JEL: I11 D43 C91 C72
    Date: 2016
  6. By: Chrisinger, Benjamin W. (Stanford Prevention Research Center, Stanford University School of Medicine)
    Abstract: Across the U.S., neighborhoods face disparate healthy food access, which has motivated federal, state, and local initiatives to develop supermarkets in “food deserts.” Differences in the implementation of these initiatives are evident, including the presence of health programming, yet no comprehensive inventory of projects exists to assess their impact. Using a variety of data sources, this paper provides details on all supermarket developments under “fresh food financing” regimes in the U.S. from 2004-2015, including information such as project location, financing, development, and the presence of health promotion efforts. The analysis identifies 126 projects, which have been developed in a majority of states, with concentrations in the mid-Atlantic and Southern California regions. Average store size was approximately 28,100 square feet, and those receiving financial assistance from local sources and New Markets Tax Credits were significantly larger, while those receiving assistance from other federal sources were significantly smaller. About 24 percent included health-oriented features; of these, over 80 percent received federal financing. If new supermarkets alone are insufficient for health behavior change, greater attention to these nuances is needed from program designers, policymakers, and advocates who seek to continue fresh food financing programs. Efforts to reduce rates of diet-related disease by expanding food access can be improved by taking stock of existing efforts.
    Date: 2016–07–01
  7. By: Quan-Hoang Vuong; Quang-Hoi Vu; Thu Trang Vuong
    Abstract: Background: General health examinations (GHE) have become an increasingly common measure for preventive medicine in Vietnam. However there has still been a lack of understanding about what make Vietnamese (not)attend GHE. The effects of budget or time constraints remain to evaluated. Better-informed policy making needs these inputs. Aim & Objectives: This study aims to investigate factors that may affect Vietnamese behaviors with respect to periodic GHE. Main objectives are to: i) explore empirical relationships between influencing factors and periodic GHE frequencies; and, ii) predict the probabilities of attending GHE and associated conditions.Materials and Methods: The study uses a 2,068-observation categorical dataset obtained from a Vietnamese survey in 2016Q4. The analysis is then performed using the methods of baseline-category logits for establishing relationships between predictor and response variables. Results: There exist relationships among: (i) GHE expenditure and time consumption; (ii) health priority and sensitivity to health data; (iii) insurance status, and (iv) the frequency of GHE, with most p’s
    Keywords: General health examination; Health insurance; Medical costs; Health service consumers; Vietnam
    JEL: I18 P20 I10
    Date: 2016–10–26
  8. By: Erik Nesson (Department of Economics, Ball State University); Vinish Shrestha (Department of Economics, Towson University)
    Abstract: We examine the effects of false identification laws with a scanner provision (FSP laws) on alcohol-related fatal accidents involving underage drivers using data on traffic fatalities from the National Highway Traffic Administration from 1998 to 2014 and information on alcohol control policies from the Alcohol Policy Information System. We find that the implementation of FSP laws reduced alcohol-related traffic fatalities among 16-18 year olds without a statistically significant change in non alcohol-related fatalities among 16-18 year olds or in alcohol-related fatalities among 21-24 year olds. Our results are stable across a number of different specifications. A back-of-the-envelope calculation suggests that if all remaining states passed FSP laws, the reduction in underage alcohol-related traffic fatalities among 16-18 year olds would generate nearly $250 million in annual economic benefits.
    Keywords: Underage alcohol consumption, Drunk driving, DWI, False ID laws, Scanner provision.
    JEL: I12 I18
    Date: 2016–10
  9. By: John Karl Scholz (University of Wisconsin-Madison); Ananth Seshadri (University of Wisconsin-Madison)
    Abstract: We study the interaction between consumption and health in retirement. Our main contribution is the estimation of a consumption Euler equation taking health into consideration. The Euler equation is derived from a model of consumption in retirement with three important building blocks of health: health shocks, health as an investment and health as a provider of utility. We estimate the Euler equation using data from the Health and Retirement Study (HRS) and Consumption and Activities Mail Survey (CAMS). The estimates suggest that health is an important determinant of utility. We use the estimated model to study the empirical significance of the three building blocks of health. We find that health shocks play an important role in slowing down the decline of consumption with age in retirement. We also find that including health into the utility function could help explain the heterogeneous consumption-age profiles related to health. Finally, we find that health investments, such as physical exercise, have a significant effect on the evolutions of both health and consumption in retirement.
    Date: 2016–09
  10. By: MUSSARD Stéphane; PI ALPERIN Maria Noel
    Abstract: This paper proposes a two-parameter family of socio-economic health inequality indices. First, these indices allow a Boolean risk factor to be associated to other health dimensions. Second, multidimensional health distributions can be compared thanks to a stochastic dominance rule, which includes the attitude of the social planner with respect to the risk factor (risk neutrality, risk aversion and extreme risk aversion). Third, each order of stochastic dominance is also associated to the intensity of possible health transfers occurring between individuals, that is, the degree of inequality aversion of the social planner. This approach is a multidimensional extension of Yitzhaki's Gini indices accounting simultaneously for risk and redistribution.
    Keywords: Counting; Dominance; Health; Inequality; Risk
    JEL: D60 I10
    Date: 2016–10
  11. By: Sunghoon Lim (Department of Economics, The Pennsylvania State University State College, United States); Beomsoo Kim (Department of Economics, Korea University, Seoul, Republic of Korea)
    Abstract: This study estimates the effect of positive income shocks on health conditions. We analyze the birth weight and mortalities of babies born in the US states of Kentucky, Ohio, and West Virginia during the early 1970s. Babies who were born in a coal-mining county benefited from the boom of the coal mining industry, whereas other babies did not. During the period, there was a sudden increase in the price of coal, resulting from an increase in the price of oil, which, in turn, resulted from an oil price embargo by the Organization of the Petroleum Exporting Countries. We use per capita personal income, which is the average income of people living in a county, as a measure for income. However, it is well known that there is an endogeneity issue when estimating the effect of income on health. To overcome the problem, we adopted the instrumental variable approach and use coal price as an instrument for income. We find that an exogenous $1,000 (in 1984 dollars) increase in income increases birth weight by 56 g. In addition, low birth weight would decrease by 0.9% point, which is 12% of the sample mean (7.6%). Our study avoids possible bias from compositional change by focusing on the period directly before and after the economic shock.
    Keywords: Health Outcome, Birth Weight, Low Birth Weight, Infant Mortality, Income Shock, Endogeneity, Two-stage Least Squares
    JEL: I10 I18 I12
    Date: 2016
  12. By: Giuntella, Osea (University of Oxford); Mazzonna, Fabrizio (USI Università della Svizzera Italiana); Nicodemo, Catia (University of Oxford); Vargas-Silva, Carlos (University of Oxford)
    Abstract: This paper studies the effects of immigration on the allocation of occupational physical burden and work health risks. Using data for England and Wales from the Labour Force Survey, we find that, on average, immigration leads to a reallocation of UK-born workers towards jobs characterized by lower physical intensity and injury risk. The results also show important differences across skill groups. Immigration reduces the average physical burden of UK-born workers with medium levels of education, but has no significant effect on those with low levels.
    Keywords: immigration, labor-market, physical burden, work-related injuries, health
    JEL: J61 I10
    Date: 2016–10
  13. By: Jose-Victor Rios-Rull (University of Pennsylvania); Josep Pijoan-Mas (CEMFI)
    Abstract: We use a stylized model of endogenous health choices to construct compensated variation measures of inequality between individuals in different education and wealth groups at age 50, taking into account differences in consumption, differences in health, and differences in mortality between types. In doing so, we allow for the more disadvantaged types to take actions to improve their health when given some extra income. We use a simple revealed preference argument to measure the health-improving technology with information on consumption, medical expenditure, and health transitions by different types. We find that inequality in education is much more damaging in welfare terms than education in wealth due to the larger differences in life expectancy by education groups than by wealth groups. Our estimates of health technology show that only a small fraction of life expectancy differences between individuals of different education can be imputed to differential medical expenditure after age 50.
    Date: 2016
  14. By: Adrienne M. Lucas; Margaret Chidothe; Nicholas L. Wilson
    Abstract: In 2007, approximately one in five children in Zambia lived with an HIV positive adult. We identify the effect of adult antiretroviral therapy (ART) availability at scale on children's educational outcomes by combining data on the expansion of ART availability with two national household surveys that include HIV testing. Through a triple difference specification, we find that the availability of ART increased the likelihood that children in households with HIV positive household heads started school on time and were the appropriate grade-for-age. The mechanisms were likely decreased opportunistic infections in the household and related care giving duties.
    JEL: I15 I18 J13 O15 O18
    Date: 2016–10
  15. By: Sara Markowitz; E. Kathleen Adams; Mary Jane Lewitt, PhD,CNM; Anne Dunlop, MD
    Abstract: The demand for health care and healthcare professionals is predicted to grow significantly over the next decade. Securing an adequate health care workforce is of primary importance to ensure the health and wellbeing of the population in an efficient manner. Occupational licensing laws and related restrictions on scope of practice (SOP) are features of the market for healthcare professionals and are also controversial. At issue is a balance between protecting the public health and removing anticompetitive barriers to entry and practice. In this paper, we examine the controversy surrounding SOP restrictions for certified nurse midwives (CNMs). We use the variation in SOP laws governing CNM practice that has occurred over time in a quasi-experimental design to evaluate the effect of the laws on the markets for CNMs and their services, and on related maternal and infant outcomes. We focus on SOP laws that pertain to physician oversight requirements and prescribing rules, and examine the effects of SOP laws in geographic areas designated as medically underserved. Our findings indicate that SOP laws are neither helpful nor harmful in regards to maternal behaviors and infant health outcomes, but states that allow CNMs to practice with no SOP-based barriers to care have lower rates of induced labor and Cesarean section births. We discuss the implications of these findings for the policy debate surrounding SOP restrictions and for health care costs.
    JEL: I1 J44 K2
    Date: 2016–10

This nep-hea issue is ©2016 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.