nep-hea New Economics Papers
on Health Economics
Issue of 2016‒11‒13
24 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Literature review on integrated hospital scheduling problems By Joren Marynissen; Erik Demeulemeester
  2. Producing the Dutch and Belgian mortality projections: A stochastic multi-population standard By Katrien Antonio; Sander Devriendt; Wouter de Boer; Robert de Vries; Anja De Waegenaere; Hok-Kwan Kan; Egbert Kromme; Wilbert Ouburg; Tim Schulteis; Erica Slagter; Michel Vellekoop; Marco van der Winden; Corné van Iersel
  3. Supplementary health insurance in the Colombian managed care system: Adverse or advantageous selection? By Bardey, David; Buitrago, Giancarlo
  4. Effects of Weather on Diarrheal Disease in Peruvian Children: A Geospatial Investigation By James Manley
  5. Does Debt Relief Improve Child Health? Evidence from Cross-Country Micro Data By Welander, Anna
  6. Effect of Type 1 Diabetes on School Performance in a Dynamic World: New Analysis Exploring Swedish Register Data By Persson, Emma; Persson, Sofie; Gerdtham, Ulf-G.; Steen Carlsson, Katarina
  7. Was Civil War Surgery Effective? By Matthew J. Baker
  8. The return to education in terms of wealth and health By Strulik, Holger
  9. Social participation and self-rated psychological health By Fiorillo, D.; Lavadera, G.L.; Nappo, N.
  10. Child Health, Human Capital and Adult Financial Behavior By Luik, Marc-André
  11. Effects of pregnancy and birth on smoking and drinking behaviors: a comparative study between men and women By Eiji Yamamura; Yoshiro Tsutsui
  12. The Mortality and Medical Costs of Air Pollution: Evidence from Changes in Wind Direction By Tatyana Deryugina; Garth Heutel; Nolan H. Miller; David Molitor; Julian Reif
  13. How Increasing Medical Access to Opioids Contributes to the Opioid Epidemic: Evidence from Medicare Part D By Powell, David; Pacula, Rosalie Liccardo; Taylor, Erin Audrey
  14. Incentivizing Healthy Eating in Children: An Investigation of the “Ripple” and “Temporal” Effects of Reward-Based Interventions By Saied Toossi
  15. Trade, Pollution and Mortality in China By Matilde Bombardini; Bingjing Li
  16. Long-run Consequences of Exposure to Natural Disasters By KARBOWNIK, Krzysztof; WRAY, Anthony
  17. Analysing the links between child health and education outcomes: Evidence from NIDS Waves 1 – 4 By Daniela Casale
  18. Testing the Replicability of a Successful Care Management Program: Results from a Randomized Trial and Likely Explanations for Why Impacts Did Not Replicate By G. Greg Peterson; Jelena Zurovac; Randall S. Brown; Kenneth D. Coburn; Patricia A. Markovich; Sherry A. Marcantonio; William D. Clark; Anne Mutti; Cara Stepanczuk
  19. The Impact of Maternal Death on Children's Health and Education Outcomes By Cally Ardington; Megan Little
  20. Stepping Up to the Plate: Federally Qualified Health Centers Address Growing Demand for Care By Laurie Felland
  21. Physician EHR Adoption and Potentially Preventable Hospital Admissions Among Medicare Beneficiaries: Panel Data Evidence, 2010 – 2013 By Eric J. Lammers; Catherine G. McLaughlin; Michael Barna
  22. The Effect of E-Cigarette Minimum Legal Sale Age Laws on Traditional Cigarette Use and Birth Outcomes among Pregnant Teenagers By Michael F. Pesko; Janet M. Currie
  23. Intertemporal Substitution in Health Care Demand: Evidence from the RAND Health Insurance Experiment By Haizhen Lin; Daniel W. Sacks
  24. Socio-economic correlates with the prevalence and onset of diabetes in South Africa: Evidence from the first four waves of the National Income Dynamics Study By Velenkosini Matsebula; Vimal Ranchhod

  1. By: Joren Marynissen; Erik Demeulemeester
    Abstract: This paper presents a review of the literature on integrated hospital scheduling problems. In these problems, patients need to sequentially visit multiple resource types in a hospital setting in order to receive full treatment. Therefore, each patient is assigned a specific path over a subset of the resources and each step of the path needs to be scheduled. The main aim of these problems is to have each patient complete all stages of his or her path within the required due date, such that all patients receive timely care. This is important as a delayed diagnosis or treatment may result in adverse health effects. Also, with integrated scheduling, hospitals have the opportunity to augment patient satisfaction by creating a smooth patient flow, even if the patient needs to visit multiple hospital departments. In order to structure the growing body of literature in this field, a classification scheme is proposed and used to classify all scientific work on integrated hospital scheduling published between 1995 and 2016. The results are surprising as, although pathway concepts such as clinical pathways or diagnosis related groups have been around for several decades, the classification scheme indicates that the majority of relevant work is only quite recent. In fact, integrated hospital scheduling is currently gaining progressively more momentum in practice as well as in the academic literature. Both seem to have realized that eliminating the silos of information in hospitals is no longer optional but a true necessity if overall performance needs to be maximized.
    Keywords: OR in health service, Integrated scheduling, Combination appointments, Appointment series, Integrated healthcare
    Date: 2016–10
  2. By: Katrien Antonio; Sander Devriendt; Wouter de Boer; Robert de Vries; Anja De Waegenaere; Hok-Kwan Kan; Egbert Kromme; Wilbert Ouburg; Tim Schulteis; Erica Slagter; Michel Vellekoop; Marco van der Winden; Corné van Iersel
    Abstract: The quantification of longevity risk in a systematic way requires statistically sound forecasts of mortality rates and their corresponding uncertainty. Actuarial associations have a long history and continue to play an important role in the development, application and dispersion of mortality projections for the countries they represent. This paper gives an in depth presentation and discussion of the mortality projections as published by the Dutch (in 2014) and Belgian (in 2015) actuarial associations. The goal of these institutions was to publish a stochastic mortality projection model in line with both rigorous standards of state-of-the art academic work as well as the requirements of practical work such as robustness and transparency. Constructed by a team of authors from both academia and practice, the developed mortality projection standard is a Li & Lee type multi-population model. To project mortality, a global Western European trend and a country-specific deviation from this trend are jointly modelled with a bivariate time series model. We motivate and document all choices made in the model specification, calibration and forecasting process as well as the model selection strategy. We show the model fit and mortality projections and illustrate the use of the model in several pension-related applications.
    Keywords: stochastic mortality models, projected mortality, stochastic multi-population mortality, Li & Lee model, Lee & Carter model, Poisson regression, pension calculations, longevity risk, professional actuarial associations
    Date: 2016
  3. By: Bardey, David; Buitrago, Giancarlo
    Abstract: The aim of this article is to estimate the type of selection that exists in the voluntary health insurance market in Colombia where the compulsory coverage is implemented through a managed care competition. We build a panel database that combines individuals’ information from the Ministry of Health and a database provided by two private health insurers. We perform the correlation test for health expenditure and coverage. Following Fang et al. (2008), we condition the estimation on health controls that are available to the econometrician but not to insurers. In both cases we obtain a positive correlation, suggesting that adverse selection predominates. In order to rule out some moral hazard effects, we estimate the correlation between previous health service consumption and insurance purchase. The positive correlation obtained is robust to the inclusion of controls for diagnosis, suggesting that despite some risk selection strategies, health insurers are not protected from adverse selection.
    Keywords: Information asymmetry, Health insurance, Adverse Selection, Correlation test.
    JEL: D82 G22 I13
    Date: 2016–10
  4. By: James Manley (Department of Economics, Towson University)
    Abstract: Combining information on household characteristics with data from nearby weather stations, I investigate the effect of fluctuations in temperature and rainfall from longer-term averages on the incidence of diarrheal disease among Peruvian children under age 5. Low level variation in temperature and precipitation have little effect except in one case: incidence increases by about 7-12% when low temperatures stay above freezing. This set of circumstances is a concern in the central, mountainous "sierra" region during the dry season. The analysis also affirms previously established findings such as the importance of improved water access and sanitation.
    Keywords: Weather, climate, freezing, diarrhea, child health, Peru.
    JEL: O12 O15 I15 I18
    Date: 2016
  5. By: Welander, Anna (Department of Economics, Lund University)
    Abstract: This paper analyzes the effects of a multilateral debt relief program on child health. The International Monetary Fund and the World Bank launched the Heavily Indebted Poor Countries Initiative in the late 1990s to reduce the debt burdens of poor countries, and explicitly linked the initiative to the aim of poverty reduction and social targets. As a result, debt-servicing costs have gone down by an average 1.8 percentage points of gross domestic product in Heavily Indebted Poor Countries. However, the social effects of debt relief are not well known. The paper employs micro data on infant mortality from 56 country-specific Demographic and Health Surveys to investigate the effects of the Heavily Indebted Poor Countries Initiative on child health. The retrospective fertility structure of the data allows for analysis using the within-mother variation in the probability of survival of babies before and after different stages of the initiative. The results suggest that after a debt-ridden country enters the program, which is conditional on reform and pro-development policies, and receives interim debt relief, the probability of infant mortality goes down by about 0.5 percentage point. This translates into about 3,000 fewer infant deaths in an average Heavily Indebted Poor Country. The findings are particularly strong for infants born to poor mothers and mothers living in rural areas, and are driven by access to vaccines early in life and during pregnancy. There are no child health effects from graduating from the program and receiving full debt relief.
    Keywords: Debt Relief; Heavily Indebted Poor Countries Initiative; Child Health; Demographic and Health Surveys
    JEL: F34 I15 I18
    Date: 2016–10–25
  6. By: Persson, Emma (Department of Statistics, Umeå University); Persson, Sofie (Department of Clinical Sciences, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University); Steen Carlsson, Katarina (Department of Clinical Sciences, Lund University)
    Abstract: This paper investigates if the effect of type 1 diabetes mellitus (T1DM) on school performance has changed over time using national Swedish population register data. The issue is of interest because management and treatment of the disease have improved over the last decades and, furthermore, because of changes in the educational grading system. Despite these changes, data indicate a persistent negative effect of T1DM on compulsory and upper secondary school grades and the results appears similar to earlier findings on cohorts completing school under the previous grading system. Moreover, the results are robust to alternative model specifications and econometric estimation strategies. Whereas access to new treatment technologies and improved diabetes management strategies has reduced the burden of diabetes in daily life, the results from this study indicate that other trends have not implied a reduction, over time, in the impact of T1DM on school performance. This finding indicates that continued efforts are needed to improve the situation in school for children with T1DM to prevent potential long-term socioeconomic consequences.
    Keywords: type 1 diabetes; education; school performance; register data
    JEL: I00 I10 I21 J24
    Date: 2016–10–24
  7. By: Matthew J. Baker (Hunter College and the Graduate Center, CUNY)
    Abstract: During the U. S. Civil War (1861-65) surgeons performed a vast number of surgical procedures such as amputations, resections, excisions, and bullet extractions. The efficacy of wartime surgery has been the subject of continuing debate since the start of the war. One reason debate continues is the dearth of empirical evidence on the (in)effectiveness of surgery. To shed light on the subject, I analyze a data set created by Dr. Edmund Andrews, a Civil war surgeon with the 1st Illinois Light Artillery. Dr. Andrews’s data can be rendered into an observational data set on surgical intervention and recovery, with controls for wound location and severity. The data also admits instruments for the surgical decision. My analysis suggests that Civil War surgery was effective, and increased the probability of survival of the typical wounded soldier, with average treatment effect of 0.25-0.28.
    Keywords: civil war, surgery, treatment effect
    JEL: N31 N41 C21
    Date: 2016–11–02
  8. By: Strulik, Holger
    Abstract: This study presents a new view on the association between education and longevity. In contrast to the earlier literature, which focused on inefficient health behavior of the less educated, we investigate the extent to which the education gradient can be explained by fully rational and efficient behavior of all social strata. Specifically, we consider a life-cycle model in which the loss of body functionality, which eventually leads to death, can be accelerated by unhealthy behavior and delayed through health expenditure. Individuals are heterogeneous with respect to their return to education. The proposed theory rationalizes why individuals equipped with a higher return to education chose more education as well as a healthier lifestyle. When calibrated for the average male US citizen, the model motivates about 50% percent of the observable education gradient by idiosyncratic returns to education, with causality running from education to longevity. The theory also explains why compulsory schooling has comparatively small effects on longevity and why the gradient gets larger over time through improvements in medical technology.
    Keywords: health inequality,schooling,aging,longevity,health expenditure,unhealthy behavior,smoking,value of life
    JEL: D91 I10 I20 J24
    Date: 2016
  9. By: Fiorillo, D.; Lavadera, G.L.; Nappo, N.
    Abstract: Although social capital have been hypothesized to have positive influence on psychological health, few papers found a relationship between social capital dimensions and psychological wellbeing. This study investigates the longitudinal relationship between social participation in associations and self-rated psychological health. The paper uses five waves of the British Household Panel Survey (BHPS) that follows the same individuals between 1991 and 1995. Ordered logit fixed effect methods have been used to study the longitudinal link between structural social capital (being member, active, and both member and active in associations) and self-rated psychological health assessed by single items of the General Health Questionnaire (GHQ-12) controlling for age, marital status, household size, number of children, education, income, economic status, number of visit to GP or family doctor. The paper shows that being both member and active in associations is linked to all “positive†items of self-rated psychological health and to two main “negative†items of psychological wellbeing. Instead, being only member or only active in associations have no statistical effect on single items of the GHQ-12, with few exceptions. Findings highlight the protective role of being both member and active in associations against poor psychological health outcomes.
    Keywords: social capital; social participation; psychological health; ordered logit fixed effect; British Household Panel Survey;
    JEL: C23 D71 I10 I31 Z1
    Date: 2016–11
  10. By: Luik, Marc-André (Helmut Schmidt University, Hamburg)
    Abstract: In this work, utilizing yearly variation between biological siblings, we test for a correlation between poor child health and adult household financial behavior, i.e. risky asset market participation. Using regression and decomposition techniques, we test if this long reach of child health operates through cognitive and non-cognitive skills. Our results indicate a negative correlation of roughly -4.1 percentage points conditional on demographics and family background. Slightly more than half of this correlation can be explained by differences in cognitive and non-cognitive skills. This work highlights the importance of good child health for adult financial behavior.
    Keywords: Portfolio choice; human capital; child health
    JEL: D14 G11 J24
    Date: 2016–11–07
  11. By: Eiji Yamamura (Department of Economics, Seinan Gakuin University); Yoshiro Tsutsui (Faculty of Economics, Konan University)
    Abstract: Using panel data obtained from monthly surveys for 3 years, we examined how the effects of life events such as marriage, pregnancy, and birth on smoking and drinking behaviors differ between men and women. Key findings were: (1) marriage did not reduce s moking for men or women. (2) Both men and women fs consumption of alcohol and cigarettes were lower during pregnancy and after childbirth than before pregnancy. The degree of the effects of pregnancy for women was approximately 5- 7 times larger than that fo r men. (3) Giving birth reduced consumption by roughly 11 cigarettes per day for women and two cigarettes per day for men compared with before pregnancy. These results indicate that a predicted negative externality to infants from their parents f drinking a nd smoking behaviors gives parents an incentive to avoid consuming alcohol and tobacco.
    Keywords: Externality, Passive smoking, Pregnancy
    JEL: I12 D03
    Date: 2016–11
  12. By: Tatyana Deryugina; Garth Heutel; Nolan H. Miller; David Molitor; Julian Reif
    Abstract: We estimate the effect of acute air pollution exposure on mortality, life-years lost, and health care utilization among the US elderly. We address endogeneity and measurement error using a novel instrument for air pollution that strongly predicts changes in fine particulate matter (PM 2.5) concentrations: changes in the local wind direction. Using detailed administrative data on the universe of Medicare beneficiaries, we find that an increase in daily PM 2.5 concentrations increases three-day county-level mortality, hospitalizations, and inpatient spending, and that these effects are not explained by co-transported pollutants like ozone and carbon monoxide. We then develop a new methodology to estimate the number of life-years lost due to PM 2.5. Our estimate is much smaller than one calculated using traditional methods, which do not adequately account for the relatively low life expectancy of those killed by pollution. Heterogeneity analysis reveals that life-years lost due to PM 2.5 varies inversely with individual life expectancy, indicating that unhealthy individuals are disproportionately vulnerable to air pollution. However, the largest aggregate burden is borne by those with medium life expectancy, who are both vulnerable and comprise a large share of the elderly population.
    JEL: I1 Q53
    Date: 2016–11
  13. By: Powell, David; Pacula, Rosalie Liccardo; Taylor, Erin Audrey
    Abstract: Drug overdoses involving opioid analgesics have increased dramatically since 1999, representing one of the United States' top public health crises. Opioids have legitimate medical functions, but improving access may increase abuse rates even among those not prescribed the drugs given that opioids are frequently diverted to nonmedical use. We have little evidence about the causal relationship between increased medical access to opioids and spillovers resulting in abuse. We use the introduction of the Medicare Prescription Drug Benefit Program (Part D) as a large and differential shock to the geographic supply of opioids. Part D increased opioid utilization for the 65+ population, and we show that this increase in utilization led to significant growth in the overall supply of opioids in high elderly share states relative to low elderly share states. This relative expansion in opioid supply resulted in an escalation in opioid-related substance abuse treatment admissions and opioid-related mortality among the Medicare-ineligible population, implying meaningful spillovers to individuals who did not experience any change in prescription drug benefits. The evidence suggests that increased opioid supply is associated with economically-important levels of diversion for nonmedical purposes. Our estimates imply that a 10% increase in medical opioid distribution leads to a 7.4% increase in opioid-related deaths and a 14.1% increase in substance abuse treatment admission rates for the Medicare-ineligible population.
    JEL: I11 I12 I13
    Date: 2016–09
  14. By: Saied Toossi (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244)
    Abstract: Although previous studies have established the effectiveness of using small reward-based incentives in inducing the choice and consumption of healthier foods among children, little is known about their impact outside of experimental settings or their effectiveness over time when administered daily. This paper presents the results of a field experiment conducted to provide insight on these matters. The study employs a pretest-posttest within-subject design and was conducted at a summer program catering to low-income children between the ages of 5 and 12. Corroborating existing studies, the introduction of small reward-based incentives was found to induce large increases in the number of children choosing the healthy dessert options after lunch but disaggregating the results by week and days suggests that their impact diminishes over time. Attempts to ascertain their effect outside of experimental settings did not indicate that the introduction of rewards had any adverse effects, but also did not provide definitive results. Consequently, further research is needed in this regard
    Keywords: Field Experiment; Food Choice; Child Behavior; Incentives; Temporal Effects; Ripple Effects; Nutrition
    JEL: C91 C93 J13 I12
    Date: 2016–11
  15. By: Matilde Bombardini; Bingjing Li
    Abstract: Has the expansion in exports affected pollution and health outcomes across different prefectures in China in the two decades between 1990 and 2010? We exploit variation in the initial industrial composition to gauge the effect of export expansion due to the decline in tariffs faced by Chinese exporters. We construct two export shocks at the prefecture level: (i) PollutionExportShock represents the pollution content of export expansion and is measured in pounds of pollutants per worker; (ii) ExportShock measures export expansion in dollars per worker. The two measures differ because prefectures specialize in different products: while two prefectures may experience the same shock in dollar terms, the one specializing in the dirty sector has a larger PollutionExportShock. We instrument export shocks using the change in tariffs faced by Chinese producers exporting to the rest of the world. We find that the pollution content of export affected pollution and mortality. A one standard deviation increase in PollutionExportShock increases infant mortality by 2.2 deaths per thousand live births, which is about 13% of the standard deviation of infant mortality change during the period. The dollar value of export expansion tends to reduce mortality, but is not always statistically significant. We show that the channel through which exports affect mortality is pollution concentration: a one standard deviation increase in PollutionExportShock increases SO2 concentration by 5.4 micrograms per cubic meter (the average is around 60). We find a negative, but insignificant effect on pollution of the dollar-value export shocks, a potential “technique” effect whereby higher income drives demand for clean environment. We find that only infant mortality related to cardio-respiratory conditions responds to exports shocks, while deaths due to accidents and other causes are not affected.
    JEL: F1 I1 Q53
    Date: 2016–11
  16. By: KARBOWNIK, Krzysztof; WRAY, Anthony
    Abstract: We utilize the individual-level World War I Draft Registration Cards matched to late-nineteenth century hurricane paths and the 1940 U.S. Census to explore whether fetal and early childhood exposure to stress caused by hurricanes affects human capital development and labor market outcomes in adulthood. Difference-in-differences estimates indicate that white males who were born in the South and experienced a hurricane either in utero or as infants had lower income at ages 42 to 53. They are robust to alternate specifications of either the treatment or outcome variables, as well as changes in the tolerance for imperfectly matched historical data.
    Keywords: Prenatal stress, natural disasters, labor market outcomes
    JEL: I10 J24 Q54
    Date: 2016–11
  17. By: Daniela Casale (Economics, University of the Witwatersrand)
    Abstract: The focus of this discussion paper is on the relationship between child health and education outcomes in the National Income Dynamics Study (NIDS) panel data. NIDS collects detailed information on the health status of children, including anthropometric data, and on their progression through the schooling system, providing the unique opportunity to analyse the implications of child health for human capital accumulation over the life-cycle at the national level. The 1993 Project for Statistics on Living Standards and Development (PSLSD) also collected data on both anthropometric and education outcomes for a nationally representative sample, but only at the cross-section, while other longitudinal studies for South Africa with this information are region-specific, have smaller sample sizes, and are from a much earlier period.
    Date: 2016
  18. By: G. Greg Peterson; Jelena Zurovac; Randall S. Brown; Kenneth D. Coburn; Patricia A. Markovich; Sherry A. Marcantonio; William D. Clark; Anne Mutti; Cara Stepanczuk
    Abstract: Even if demonstrated in a randomized trial, successful results from one test may not replicate in other settings or time periods.
    Keywords: Care Management Program, Randomized Trial
    JEL: I
  19. By: Cally Ardington (SALDRU, School of Economics, University of Cape TownAuthor-Email:); Megan Little (SALDRU, UCT)
    Abstract: The HIV/AIDS pandemic continues to have a devastating impact, particularly on the lives of sub-Saharan African children. In addition to reversing the downward secular trend in infant and child mortality, HIV/AIDS has orphaned millions of children. Substantial progress has been made in reducing mother-to-child transmission, but rates of orphanhood continue to climb despite increased availability of antiretroviral therapy. UNAIDS estimates that in sub-Saharan Africa in 2014, 11 million children under the age of 18 had lost one or both of their parents to AIDS (UNAIDS 2016). Recent empirical evidence suggests that children in sub-Saharan Africa who have suffered parental loss are at risk of poorer educational outcomes (Beegle, de Weerdt and Dercon 2006; Bicego, Bicego et al 2003; Case, Paxson and Ableidinger 2004; Evans and Miguel 2007; Guarcello et al. 2004; Monasch and Boerma 2004; Ardington and Leibbrandt 2010; Case and Ardington 2006; Ardington 2009). In South Africa, there are significant differences in the impact of a mother and a father's death. The loss of a child's mother is a strong predictor of poor schooling outcomes, while the loss of a child's father is a significant correlate of poor household socioeconomic status. In two localised longitudinal studies, Case and Ardington (2006) and Ardington and Leibbrandt (2009) use the timing of mothers' deaths relative to children's educational shortfalls to argue that mothers' deaths have a causal effect on children's education. They cannot, however, answer the question of why children whose mothers have died fall behind in school.
    Date: 2016
  20. By: Laurie Felland
    Abstract: This paper focuses on collaborations among FQHCs, other safety-net providers and agencies, and some more mainstream providers (those that serve large populations of commercial and Medicare patients).
    Keywords: Federally Qualified Health Centers, FQHC, Medi-Cal
    JEL: I
  21. By: Eric J. Lammers; Catherine G. McLaughlin; Michael Barna
    Abstract: This study extends knowledge about EHRs' relationship with quality of care and utilization.
    Keywords: EHR, Hospital Admissions, Medicare Beneficiaries
    JEL: I
  22. By: Michael F. Pesko; Janet M. Currie
    Abstract: We use United States birth record data to estimate the effect of e-cigarette minimum legal sale age laws on cigarette use and birth outcomes for pregnant teenagers. While these laws may have reduced e-cigarette use, we hypothesize that these laws may have also increased cigarette use during pregnancy by making it more difficult to use e-cigarettes to reduce/quit smoking. We use cross-sectional and panel data models to find that e-cigarette minimum legal sale age laws increase underage pregnant teenagers’ smoking by 2.1 percentage points. The laws may have also modestly improved select birth outcomes, perhaps by reducing overall nicotine exposure from vaping and smoking combined.
    JEL: I12 I18
    Date: 2016–11
  23. By: Haizhen Lin; Daniel W. Sacks
    Abstract: Nonlinear cost-sharing in health insurance encourages intertemporal substitution be- cause patients can reduce their out-of-pocket costs by concentrating spending in years when they hit the deductible. We test for such intertemporal substitution using data from the RAND Health Insurance Experiment, where people were randomly assigned either to a free care plan or to a cost-sharing plan which had coinsurance up to a maximum dollar expenditure (MDE). Hitting the MDE—leading to an effective price of zero—has a bigger effect on monthly health care spending and utilization than does being in free care, because people who hit the MDE face high future and past prices. As a result, we estimate that sensitivity to short-lasting price changes is about twice as large as sensitivity to long-lasting changes. These findings help reconcile conflicting estimates of the price elasticity of demand for health care, and suggest that high deductible health plans may be less effective than hoped in controlling health care spending.
    JEL: D12 G22
    Date: 2016–11
  24. By: Velenkosini Matsebula (SALDRU, UCT); Vimal Ranchhod (SALDRU, University of Cape Town)
    Abstract: We make use of multiple waves of National Income Dynamics Study data, from 2008 to 2015, to investigate the socio-economic factors that correlate with the prevalence and onset of diabetes. Our analysis follows a cohort of 3470 older adults aged forty and above, who are interviewed four times over a six-year period. We use linear probability models and estimate the likelihood of diabetes as a function of age, race, gender, education, income, exercise, and obesity. Our primary findings are that age and obesity correlate strongly with diabetes, while income does not have a statistically significant effect, conditional on the other covariates. Our regression estimates indicate that, of individuals who reported not being diabetic in Wave 1, those who were obese and morbidly obese were 12.9 and 16.7 percentage points more likely to have experienced the onset of diabetes respectively, relative to those with a BMI in the healthy range. In addition, frequent exercise does appear to have a slight protective effect against the onset of diabetes, and there is some evidence that better educated people have a lower risk of onset of the disease.
    Date: 2016

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