nep-hea New Economics Papers
on Health Economics
Issue of 2016‒11‒20
thirty-six papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Stimulative Effect of an Unconditional Block Grant on the Decentralized Provision of Care By Mark Kattenberg; Wouter Vermeulen
  2. A Sales Tax Is Better at Promoting Healthy Diets than the Fat Tax and the Thin Subsidy By Kalamov, Zarko Y.
  3. Ensuring incentives for innovation and access to medicines: The balance struck in the Trans-Pacific Partnership Agreement on intellectual property (patent and regulatory data) protection for pharmaceutical products By Plank-Brumback, Rosine M.
  4. Access to medicines and incentives for innovation: The balance struck in the Trans-Pacific Partnership (TPP) on intellectual property (patent and data exclusivity) protection for pharmaceutical products By Artecona, Raquel; Plank-Brumback, Rosine M.
  5. Ownership and exit behavior: evidence from the home health care market By Chiara Orsini
  6. Tort Reform and the Length of Physician Office Visits By Panthöfer, Sebastian
  7. Screening through activation: differential effects of a youth activation programme By Hall, Caroline; Kotakorpi, Kaisa; Liljeberg, Linus; Pirttilä, Jukka
  8. Elderly Care, Child Care, and Labor Supply in an Aging Japan By Ryuta Ray Kato
  9. Sober mom, healthy baby? Effects of brief alcohol interventions in Swedish maternity care By Grönqvist, Erik; Norén, Anna; Sjögren, Anna; Svaleryd, Helena
  10. Cost-Sharing and Drug Pricing Strategies : Introducing Tiered Co-Payments in Reference Price Markets By Herr, Annika; Suppliet, Moritz
  11. Child Health, Human Capital and Adult Financial Behavior By Luik, Marc-André
  12. Why people born during World War II are healthier By Reyn van Ewijk; Maarten Lindeboom
  13. Demography of Global Aging By David E. Bloom; Elizabeth Mitgang; Benjamin Osher
  14. HIV/AIDS Perspective Paper By Pascal Geldsetzer; David E. Bloom; Salal Humair; Till Bärnighausen
  15. Longitudinal Aging Study in India: Biomarker Data Documentation By David E. Bloom; Perry Hu; P. Arokiasamy; Arun Risbud; T. V. Sekher; S.K. Mohanty; Varsha Kale; Jennifer O’Brien; Jinkook Lee
  16. The contribution of female health to economic development By David E. Bloom; Michael Kuhn; Klaus Prettner
  17. Cost-Containment Policies in Hospital Expenditure in the European Union By Christoph Schwierz
  18. Population Aging in India: Facts, Issues, and Options By Arunika Agarwal; Alyssa Lubet; Elizabeth Mitgang; S.K. Mohanty; David E. Bloom
  19. Vaccination and All Cause Child Mortality 1985-2011: Global Evidence from the Demographic and Health Surveys By Mark E. McGovern; David Canning
  20. A Flow Measure of Missing Women by Age and Disease By Stephan Klasen; Sebastian Vollmer
  21. Education, Gender, and State-Level Gradients in the Health of Older Indians: Evidence from Biomarker Data By Jinkook Lee; Mark E. McGovern; David E. Bloom; P. Arokiasamy; Arun Risbud; Jennifer O’Brien; Varsha Kale; Perry Hu
  22. Comparing the Relationship Between Stature and Later Life Health in Six Low and Middle Income Countries By Mark E. McGovern
  23. Ageing and Productivity: Introduction By David E. Bloom; Alfonso Sousa-Poza
  24. Children of Drought: Rainfall Shocks and Early Child Health in Rural India By Santosh Kumar; Ramona Molitor; Sebastian Vollmer
  25. The Global Demography of Aging: Facts, Explanations, Future By David E. Bloom; Dara Lee Luca
  26. Women’s satisfaction during pregnancy and at delivery in Tuscany (Italy) By Gustavo De Santis; Valentina Tocchioni; Chiara Seghieri; Sabina Nuti
  27. Do Leaders' Characteristics and Regime Transitions in Africa Matter for Citizens' Health Status? By Diaz-Serrano, Luis; Sackey, Frank Gyimah
  28. Energy Consumption and Health Outcomes in Africa By Youssef, Adel Ben; Lannes, Laurence; Rault, Christophe; Soucat, Agnes
  29. What Can Shocks to Life Expectancy Reveal About Bequest Motives? By Jens Kvaerner
  30. Sick Pay Reforms and Health Status in a Unionised Labour Market By Goerke, Laszlo
  31. Detailed Geographic Information, Conflict Exposure, and Health Impacts By Akresh, Richard; Caruso, German Daniel; Thirumurthy, Harsha
  32. Personality and Mental Health: The Role and Substitution Effect of Emotional Stability and Conscientiousness By Wehner, Caroline; Schils, Trudie; Borghans, Lex
  33. Infant Health, Cognitive Performance and Earnings: Evidence from Inception of the Welfare State in Sweden By Bhalotra, Sonia R.; Karlsson, Martin; Nilsson, Therese; Schwarz, Nina
  34. Disability: A Brief Conceptual Overview By Chacko, Anooja
  35. A 'healthy immigrant effect' or a 'sick immigrant effect'? Selection and policies matter By Constant, Amelie F.; Garcia-Munoz, Teresa; Neuman, Shoshana; Neuman, Tzahi
  36. Case Management for High-Cost Medicare Beneficiaries By Jennifer L. Schore; Randall S. Brown; Valerie A. Cheh

  1. By: Mark Kattenberg; Wouter Vermeulen
    Abstract: Understanding the impact of central government grants on decentralized health care provision is of crucial importance for the design of grant systems, yet empirical evidence on the prevalence of flypaper effects in this domain is rare. We study the decentralization of home care in the Netherlands and exploit the gradual introduction of formula-based equalization to identify the effect of exogenous changes in an unconditional block grant on local expenditure and utilization. Although spending the money on other items is explicitly allowed, a one euro increase in central government grants raises local expenditure by twenty to fifty cents. Adjustments occur through the number of hours as well as through substitution between basic and more advanced types of assistance. These findings suggest that conditioning of grants is not required for the central government to retain a moderate degree of control over the decentralized provision of care.
    Keywords: intergovernmental transfers, flypaper effect, decentralization of health care
    JEL: H42 H51 H71 H75
    Date: 2016–11
  2. By: Kalamov, Zarko Y.
    Abstract: Rising prevalence of obesity among adults and children is a major policy issue in many countries. Two widely discussed instruments to address obesity are a tax on unhealthy foods (fat tax) and a subsidy on healthy foods (thin subsidy). We compare these two policies to a sales tax on all food products, taking into account the different opportunity costs in terms of time for healthy and unhealthy meals. We show that the policy which reduces obesity under the most general conditions is the sales tax without the fat tax and the thin subsidy. Moreover, this policy is the only one which unambiguously stimulates healthy consumption.
    Keywords: fat tax,thin subsidy,sales tax,obesity
    JEL: D11 I12 I18 H31 H51
    Date: 2016
  3. By: Plank-Brumback, Rosine M.
    Abstract: The United Nations Economic Commission for Latin America and the Caribbean (ECLAC) commissioned this study to analyze the implications of the balance struck under the Trans-Pacific Partnership Agreement (TPPA) between the right to health and access to next-generation medicines on the one hand, and on the other, the private right to intellectual property protection and the need to maintain profit-earning incentives to spur innovation and research and development. The study focuses on the patent and data-related intellectual property protection provisions of the TPPA, specifically regarding pharmaceutical (small-molecule and biologic ) products, including on patent duration, linkage and term extensions as well as clinical test data protection and market exclusivity. The study considers the position of the United States in this respect, as it has been and remains the world’s principal demandeur for high intellectual property rights (IPR) standards in trade agreements, including the TPPA.
    Date: 2016–10–31
  4. By: Artecona, Raquel; Plank-Brumback, Rosine M.
    Abstract: This study addresses the balance struck under the Trans-Pacific Partnership Agreement (TPPA) between the right to health and access to medicines and the need to maintain the economic incentives to spur innovation and research and development through intellectual property protection. The analysis focuses on the patent and data-related intellectual property protection provisions of the TPPA, specifically regarding pharmaceutical (small-molecule and biologic) products, including on patent duration, linkage and term extensions as well as clinical test data protection and market exclusivity. Special attention is paid to the United States and its negotiating position with respect to those aspects of intellectual property rights, as it has been and remains the world’s principal demandeur for high intellectual property rights (IPR) standards in trade agreements, including the TPPA.
    Date: 2016–11
  5. By: Chiara Orsini
    Abstract: In the US health care system a high fraction of suppliers are not-for-profit companies. Some argue that non-profits are “for-profits in disguise” and I test this proposition in a quasi-experimental way by examining the exit behavior of home health care firms after a legislative change considerably reduced reimbursed visits per patient. The change allows me to construct a cross provider measure of restriction in reimbursement and to use this measure and time-series variation due to the passage of the law in my estimates. I find that exits among for-profit firms are higher than those of not-for-profit firms, rejecting the null that these sectors responded to the legislation in similar ways. In addition, my results expand the view that “not-for-profit” firms are a form of “trapped capital.” There is little capital investment in the home health care market, so the higher exit rates of for-profit firms after the law change indicate the possible role of labor inputs in generating differences in exit behavior across sectors.
    Keywords: long-term care; government restriction in financing; not-for-profit
    JEL: H32 I11 L31
    Date: 2016–01
  6. By: Panthöfer, Sebastian
    Abstract: By holding healthcare providers accountable for medical errors, the medical malpractice system should steer physicians towards providing adequate levels of care. This paper tests whether tort reforms induce physicians to be more or less careful when treating patients, using the length of office visits as a proxy for physician efforts. Analyzing data from the National Ambulatory Medical Care Survey on more than half a million physician office visits between 1993 and 2011, I find that caps on noneconomic damages, caps on punitive damages, and reforms of the joint-and-several liability rule have no impact on the time physicians spend with patients. Reforms of the collateral-source rule decrease the length office visits in some specifications and act as a substitute for managed care.
    Keywords: Managed care; Tort reform; Liability pressure
    JEL: K13 L11
    Date: 2016–11–07
  7. By: Hall, Caroline (IFAU - Institute for Evaluation of Labour Market and Education Policy); Kotakorpi, Kaisa (University of Turku, CESifo); Liljeberg, Linus (IFAU - Institute for Evaluation of Labour Market and Education Policy); Pirttilä, Jukka (UNU-WIDER, University of Tampere, CESifo)
    Abstract: We study the anatomy of responses to a major activation programme targeted at unemployed youth, introduced in Sweden in 2007. We use a regression discontinuity design to analyse individual reactions to the programme. We find that individuals who have a relatively high predicted probability of finding a job respond to the threat of activation, whereas there is no significant effect for individuals in a weaker labour market position. This is consistent with activation programmes working as a screening device between those who are able to find work on their own vs. those who are not. In addition to examining traditional predictors of poor labour market outcomes (e.g. education and school dropout status), we find a strong concentration of health problems among individuals with poor labour market prospects. We use register data covering the entire Swedish population, including very detailed information on health.
    Keywords: activation; unemployment; health; school drop-outs
    JEL: I10 J64 J68
    Date: 2016–09–15
  8. By: Ryuta Ray Kato (International University of Japan)
    Abstract: This paper numerically examines the impact of the financial and time cost of child care as well as elderly care on economic growth and welfare in an aging Japan within a dynamic general equilibrium framework of multi-period overlapping generations with endogenized labor supply. Simulation results indicate that the replacement rate of the public pension scheme becomes below 50 percent from year 2039, even if the currently accumulated public pension funds are used up for paying pension benefits by year 2115. Financial burdens for the first group (age 65 and over) and for the second group (age 40 - 64) in the public long-term care insurance in year 2060 become more than double and more than five times as much as the level of year 2010 in an aging Japan, respectively. While increased child benefits stimulate savings and thus they improve welfare, the impact of elimination of the time cost of child care and elderly care is quite mixed, depending on the gender and job contract types of workers within the household. When the time cost of elderly care spent by all workers irrespective of gender and job contract types is eliminated, many generations enjoy welfare gain, but when the time cost of child care by all workers is eliminated, then almost all generations, except for relatively elder generations, reversely suffer from welfare loss. When a starting age to contribute to the long-term care insurance becomes earlier from the current age of 40 to age 35, welfare of all generations improves.
    Keywords: Child Care, Child Benefits, Elderly Care, Long-Term Care Insurance, Public Pension, Female Labor Supply, Aging, Economic Growth, Simulation, CGE Model
    JEL: C68 H51 E62 H55 J16
    Date: 2016–11
  9. By: Grönqvist, Erik (IFAU - Institute for Evaluation of Labour Market and Education Policy); Norén, Anna (Department of Economics, Uppsala University); Sjögren, Anna (IFAU - Institute for Evaluation of Labour Market and Education Policy); Svaleryd, Helena (Department of Economics, UCLS and UCFS, Uppsala University)
    Abstract: A large body of research documents the importance of early life conditions for the health and human capital formation of children. The detrimental effects of alcohol exposure in utero are well documented, and therefore identifying effective methods for preventing harmful maternal alcohol consumption is of great importance. We exploit the stepwise introduction of alcohol screening and brief interventions at Swedish antenatal clinics, to evaluate the causal effect of enhanced alcohol prevention on infant health using a difference-in-differences strategy. We find that the program improves infant health measured by prescription of pharmaceutical drugs and hospitalizations during the child’s first year of life. The results suggest that effects are likely driven by changes in maternal behavior after the first trimester and seem to extend beyond the birth of the child.
    Keywords: alcohol prevention; brief intervention; AUDIT; antenatal care; Child health
    JEL: I12 I18
    Date: 2016–09–19
  10. By: Herr, Annika; Suppliet, Moritz
    Abstract: Health insurances curb price insensitive behavior and moral hazard of insureds through different types of cost-sharing, such as tiered co-payments or reference pricing. This paper evaluates the effect of newly introduced price limits below which drugs are exempt from co-payments on the pricing strategies of drug manufacturers in reference price markets. We exploit quarterly data on all prescription drugs under reference pricing available in Germany from 2007 to 2010. To identify causal effects, we use instruments that proxy regulation intensity. A difference-in-differences approach exploits the fact that the exemption policy was introduced successively during this period. Our main results first show that the new policy led generic firms to decrease prices by 5 percent on average, while brand-name firms increase prices by 7 percent after the introduction. Second, sales increased for exempt products. Third, we find evidence that differentiated health insurance coverage (public versus private) explains the identifed market segmentation.
    Keywords: pharmaceutical prices; cost-sharing; co-payments; reference pricing; regulation; firm behavior; health insurance
    JEL: I1 L11
    Date: 2016
  11. 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: 2016–11–14
  12. By: Reyn van Ewijk (Johannes Gutenberg University Mainz); Maarten Lindeboom (VU University Amsterdam)
    Abstract: During wars, countless people suffer, even during times without direct exposure to violence, as they are exposed to conditions such as poorer nutritional situations, stress, recessions, and sub optimally functioning health care systems. This was the situation during much of World War II in three occupied countries: France, Belgium and The Netherlands. Biological theory predicts that the health of those who were prenatally exposed to such adverse circumstances will be worse once they have reached old age. But for WWII, such effects have thus far been proven only for famines and other extreme exposures that differed from those experienced by the majority of women in these occupied countries who were pregnant during WWII. We show that – contrary to expectations – prenatal exposure to WWII in the three countries does not lead to poorer health among the older population. We even find a better health among exposed females, but demonstrate that this is due to selective mortality during infanthood among the war cohorts and to selective fertility during WWII. These selection effects are likely to be stronger during more extreme circumstances than the ones studied here. Therefore, previous research on long-term effects of such prenatal exposures may have underestimated effects. Negative health effects as a result of prenatal exposure to WWII in France, Belgium and The Netherlands – outside of the well-known effects of the Dutch famine – are absent or at most very small.
    Date: 2016
  13. By: David E. Bloom (Harvard T. H. Chan School of Public Health); Elizabeth Mitgang (Georgetown University Center on Medical Product Access, Safety, and Stewardship); Benjamin Osher (Massachusetts General Hospital)
    Abstract: Individuals aged 65 years and older currently make up a larger share of the population than ever before, and this group is predicted to continue growing both in absolute terms and relative to the rest of the population. This chapter begins by introducing the facts, figures, and forecasts surrounding the aging of populations across different countries at varying levels of development. In light of these trends, we examine challenges facing graying societies through the lenses of health, economics, and policy development. The chapter concludes with a selection of adaptable strategies that countries might consider to mitigate the strain—and to harness the full potential— of aging populations worldwide. JEL Codes:
    Keywords: Demography, health economics, health policy, noncommunicable diseases (NCDs), population aging
    Date: 2016–10
  14. By: Pascal Geldsetzer (Harvard T. H. Chan School of Public Health); David E. Bloom (Harvard T. H. Chan School of Public Health); Salal Humair (, Inc.); Till Bärnighausen (Harvard T. H. School of Public Health)
    Abstract: JEL Codes:
    Date: 2016–10
  15. By: David E. Bloom (Harvard T. H. Chan School of Public Health); Perry Hu (Division of Geriatrics, UCLA School of Medicine); P. Arokiasamy (International Institute for Population Studies); Arun Risbud (National AIDS Research Institute, Pune (NARI)); T. V. Sekher (Department of Population Policies & Programs, International Institute for Population Sciences); S.K. Mohanty (International Institute for Population Sciences); Varsha Kale; Jennifer O’Brien; Jinkook Lee (Rand Corporation)
    Abstract: JEL Codes:
    Date: 2016–10
  16. By: David E. Bloom (Harvard T. H. Chan School of Public Health); Michael Kuhn (Vienna Institute of Demography); Klaus Prettner (Institute of Statistics and Mathematical Methods in EconomicsAuthor-Email:
    Abstract: We analyze the economic consequences for less developed countries of investing in female health. In so doing we introduce a novel micro-founded dynamic general equilibrium framework in which parents trade off the number of children against investments in their education and in which we allow for health-related gender differences in productivity. We show that better female health speeds up the demographic transition and thereby the take-off toward sustained economic growth. By contrast, male health improvements delay the transition and the take-off because ceteris paribus they raise fertility. According to our results, investing in female health is therefore an important lever for development policies. However, and without having to assume anti-female bias, we also show that households prefer male health improvements over female health improvements because they imply a larger static utility gain. This highlights the existence of a dynamic trade-off between the short-run interests of households and long-run development goals. Our numerical analysis shows that even small changes in female health can have a strong impact on the transition process to a higher income level in the long run. Our results are robust with regard to a number of extensions, most notably endogenous investment in health care. JEL Codes: O11, I15, I25, J13, J16
    Keywords: economic development, educational transition, female health, fertility transition, quality-quantity trade-off
    Date: 2016–10
  17. By: Christoph Schwierz
    Abstract: As hospital inpatient care accounts for 30% of total health expenditure, and as health expenditure will continue rising, due to ageing populations and costly technological innovations, it is necessary to examine how to address the twin objectives of containing costs and ensuring high access and quality of services. Bed capacity has been reduced in all EU countries in the past decade, but cross-country variation in bed capacity and inpatient hospitalisations is considerable. Apart from being a cost factor, this impacts negatively on quality of care, as countries with more hospitalisations per capita tend to have also higher shares of preventable hospitalisations. This suggests that the reorganisation and rationalisation of hospital care particularly in countries with a high bed density is an important factor towards cost containment and possibly increasing quality of care. There are well tested options for cost containment at least in the short-term. Among these, the application of hard global budgets in combination with activity-based payments seems useful. Reducing operational costs has also been widely applied and proven to contribute to cost control in the short term. The impact of the many tools aiming at improving hospital performance via structural changes of the hospital and health care sector is more difficult to gauge. It depends among others on the role of the policy reform within the specific health system, whether it was applied at the same time with other health policy reforms and the time needed to see its effects. This applies to virtually all tools reviewed in this paper. The EU can play a supportive and active role in helping to identify the right tools for hospital reform by using its tools of economic governance, policy advice, evidence building and exchange of best practices and providing funding for investments in the sector.
    JEL: I11 I18
    Date: 2016–09
  18. By: Arunika Agarwal (Harvard T. H. Chan School of Public Health); Alyssa Lubet (Harvard T. H. Chan School of Public Health); Elizabeth Mitgang (Georgetown University Center on Medical Product Access, Safety, and Stewardship); S.K. Mohanty (International Institute for Population Sciences); David E. Bloom (Harvard T. H. Chan School of Public Health)
    Abstract: India, one of the world’s two population superpowers, is undergoing unprecedented demographic changes. Increasing longevity and falling fertility have resulted in a dramatic increase in the population of adults aged 60 and up, in both absolute and relative terms. This change presents wideranging and complex health, social, and economic challenges, both current and future, to which this diverse and heterogeneous country must rapidly adapt. This chapter first lays out the context, scope, and magnitude of India’s demographic changes. It then details the major challenges these shifts pose in the interconnected areas of health, especially the massive challenges of a growing burden of noncommunicable diseases; gender, particularly the needs and vulnerabilities of an increasingly female older adult population; and income security. This chapter also presents an overview of India’s recent and ongoing initiatives to adapt to population aging and provide support to older adults and their families. It concludes with policy recommendations that may serve as a productive next step forward, keeping in mind the need for urgent and timely action on the part of government, private companies, researchers, and general population. JEL Codes: J11; J14; N30
    Keywords: Population aging; Economic demography; Longevity
    Date: 2016–10
  19. By: Mark E. McGovern (Harvard Center for Population and Development Studies); David Canning (Harvard T.H. Chan School of Public Health, Department of Global Health and Population)
    Abstract: Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. In this paper, we estimate the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determine the relationship between vaccination coverage and under five mortality at the survey cluster level. Our data include approximately one million children in 68,490 clusters in 62 countries. We consider the childhood measles, Bacille Calmette-Gu´erin (BCG), Diphtheria-PertussisTetanus (DPT), Polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjust for selection bias caused by the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimate that children in clusters with complete vaccination coverage have relative risk of mortality 0.73 (95% Confidence Interval: 0.68, 0.77) that of children in a cluster with no vaccination. While widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing their coverage rates in order to reduce child mortality JEL Codes: J10, I10
    Keywords: Vaccinations, Child Mortality, Missing Data, Measles, Bacille Calmette-Gu´erin, DiphtheriaPertussis-Tetanus, Polio, Tetanus
    Date: 2016–10
  20. By: Stephan Klasen (University of Göttingen); Sebastian Vollmer (Center for Modern Indian Studies, Göttingen)
    Abstract: The existing literature on 'missing women' suggests that the problem is mostly concentrated in India and China, and mostly related to sex-selective abortions and neglect of female children. In a recent paper in the Review of Economic Studies, Anderson and Ray (AR) develop a new ‘flow’ measure of missing women in developing countries by comparing actual age-sex-specific mortality rates with 'expected' ones. Contrary to the existing literature on missing women, they, and the World Bank which subsequently followed this method, find that gender bias in mortality is much larger than previously found (4Ͳ5 million excess female deaths per year), is as severe among adults as it is among children in India, is larger in Sub-Saharan Africa than in China and India, and was a massive problem in the US around 1900.We show that the data for Sub-Saharan Africa used by AR are generated by simulations in ways that deliver the findings on Africa (and the US in 1900) by construction. We also show that the findings are entirely dependent on a highly implausible reference standard from rich countries that is inappropriately applied to settings in developing countries; the attempt to control for differences in the disease environment does not correct for this problem and fails basic plausibility checks. When a more appropriate reference standard is used, most of the new findings of AR disappear, the extent of gender bias in mortality is much smaller (though still substantial). JEL codes: J16, D63, I10
    Keywords: Missing women, gender bias, mortality, disease, age, Sub-Saharan Africa, China, India
    Date: 2016–10
  21. By: Jinkook Lee (Rand Corporation); Mark E. McGovern (Harvard Center for Population and Development Studies); David E. Bloom (Harvard T. H. Chan School of Public Health); P. Arokiasamy (International Institute for Population Studies); Arun Risbud (National AIDS Research Institute, Pune (NARI)); Jennifer O’Brien; Varsha Kale; Perry Hu (Division of Geriatrics, UCLA School of Medicine)
    Abstract: This paper examines health disparities in biomarkers among a representative sample of Indians aged 45 and older, using data from the pilot round of the Longitudinal Aging Study in India (LASI). Hemoglobin level, a marker for anemia, is lower for respondents with no schooling (0.7 g/dL less in the adjusted model) compared to those with some formal education. There are also substantial state and education gradients in underweight and overweight. The oldest old have higher levels of C-reactive protein (CRP) (1.1 mg/L greater than those aged 45-54), an indicator of inflammation and a risk factor for cardiovascular disease, as do those with greater body-mass index (an additional 1.2 mg/L for those who are obese compared to those who are of normal weight). We find no evidence of educational or gender differences in CRP, but respondents living in rural areas have CRP levels that are 0.8 mg/L lower than urban areas. We also find state-level disparities, with Kerala residents exhibiting the lowest CRP levels (1.96 mg/L compared to 3.28 mg/L in Rajasthan, the state with the highest CRP). We use the Blinder-Oaxaca decomposition approach to explain group-level differences, and find that state-level gradients in CRP are mainly due to heterogeneity in the association of the observed characteristics of respondents with CRP, as opposed to differences in the distribution of endowments across the sampled state populations. JEL Codes: I12, I14, D30, O15
    Keywords: Biomarkers, Health Disparities, Gender Differences, Blinder-Oaxaca Decomposition, Aging
    Date: 2016–10
  22. By: Mark E. McGovern (Harvard Center for Population and Development Studies)
    Abstract: This paper examines the relationship between stature and later life health in 6 emerging economi– es, each of which are expected to experience significant increases in the mean age of their populations over the coming decades. Using data from the WHO Study on Global Ageing and Adult Health (SAGE) and pilot data from the Longitudinal Ageing Study in India (LASI), I show that various measures of health are associated with height, a commonly used proxy for childhood environment. In the pooled sample, a 10cm increase in height is associated with between a 2 and 3 percentage point increase in the probability of being in very good or good self-reported health, a 3 percentage point increase in the probability of reporting no difficulties with activities of daily living or instrumental activities of daily living, and between a fifth and a quarter of a standard deviation increase in grip strength and lung function. Adopting a methodology previously used in the research on inequality, I also summarise the height-grip strength gradient for each country using the concentration index, and provide a decomposition analysis. JEL Codes: I12, I14, D30, O15
    Keywords: Early Life Conditions, Health, Ageing, Height, Inequality, Low and Middle Income Countries, LASI, SAGE
    Date: 2016–10
  23. By: David E. Bloom (Harvard T. H. Chan School of Public Health); Alfonso Sousa-Poza (University of Hohenheim, Stuttgart)
    Date: 2016–10
  24. By: Santosh Kumar (; Ramona Molitor (University of Passau); Sebastian Vollmer (Center for Modern Indian Studies, Göttingen)
    Abstract: Barker’s fetal origins hypothesis suggests a strong relationship between in utero conditions, health and overall child development after birth. Using nationally representative population survey, this paper analyzes the impact of rainfall on early child health in rural India. We find that drought experienced in utero has detrimental effects on nutritional status of children. Effects appear to be stronger for boys, low caste children, and children exposed to drought in the first trimester. Results are robust to alternative definitions of drought. Our estimates speculate that policies aimed at reducing vulnerability to negative rainfall shock may result into improved health and higher human capital accumulation in rain-dependent agrarian countries. JEL Codes: I25; J1; O12
    Keywords: Fetal origins hypothesis, undernutrition, rainfall, India
    Date: 2016–10
  25. By: David E. Bloom (Harvard T. H. Chan School of Public Health); Dara Lee Luca (Mathematica Policy Research)
    Abstract: Population ageing is the 21st century’s dominant demographic phenomenon. Declining fertility, increasing longevity, and the progression of large-sized cohorts to the older ages are causing elder shares to rise throughout the world. The phenomenon of population ageing, which is unprecedented in human history, brings with it sweeping changes in population needs and capacities, with potentially significant implications for employment, savings, consumption, economic growth, asset values, and fiscal balance. This chapter provides a broad overview of the global demography of aging. It reviews patterns, trends, and projections involving various indicators of population aging and their demographic antecedents and sequelae. The chapter also reviews theories economists use to explain the behavioral changes driving the most prominent demographic shifts. Finally, it discusses the changing nature of aging, the future of longevity, and associated policy implications, highlighting some key research issues that require further examination. JEL Codes: J11; J14; N30
    Keywords: Population aging; Economic demography; Longevity
    Date: 2016–10
  26. By: Gustavo De Santis (Dipartimento di Statistica, Informatica, Applicazioni "G. Parenti", Università di Firenze); Valentina Tocchioni (Dipartimento di Statistica, Informatica, Applicazioni "G. Parenti", Università di Firenze); Chiara Seghieri (Laboratorio Management e Sanità , Istituto di Management, Scuola Superiore Sant’Anna, Pisa); Sabina Nuti (Laboratorio Management e Sanità , Istituto di Management, Scuola Superiore Sant’Anna, Pisa)
    Abstract: The Tuscany region constitutes an excellence at the national level for the quality of its health services. Following the WHO guidelines on the prenatal and childcare services, it has an integrated path targeted at pregnant women, called "birth path", to take care of all clinical and non-clinical aspects of pregnancy, childbirth and postpartum. New mothers’ evaluation of the birth path was the object of a specific survey, conducted in Tuscany in 2012-2013, which is analyzed in detail in this paper. Focusing on the association of women’s socio-demographic characteristics and overall satisfaction of the care path using multilevel modelling, the main conclusion is that, while the average was high, significant differences in satisfaction levels emerge between women from different socio-demographic groups. Women’s satisfaction at childbirth is generally considered an important indicator of the quality of maternity services, with implications on the health and well-being of the mother and the child. However, the effect of women’s characteristics on satisfaction is under-investigated, especially in Italy: our research aims at filling this gap.
    Keywords: Tuscany, Italy, childbirth, pregnancy, satisfaction evaluation, birth experience, multilevel models, health system strategies
    JEL: I14 C25 C13 N34
    Date: 2016–11
  27. By: Diaz-Serrano, Luis (Universitat Rovira i Virgili); Sackey, Frank Gyimah (Universitat Rovira i Virgili)
    Abstract: Africa's quest to achieving improved health status and meeting the Millennium Development Goals targets cannot be effectively achieved without examining the quality of leadership, transitions and regimes and how they impact on the decisions and the policy effectiveness that bring about improved health and living standards of the citizenry. In this paper, we study the importance of leader characteristics and regime transitions on government's expenditure in health, and hence on infant mortality, as a development indicator. A unique dataset comprising 44 sub-Saharan African countries spanning from 1970 to 2010 was used for the study. To effectively analyze the impact of leader characteristics and regime transitions on the citizens' health status we control for leader fixed-effects since different leaders, among other things impact on outcomes differently and changes in policy to a large extent depend on the leader characteristics. The overall results are suggestive of a democratic advantage in the process of achieving effective health policy outcomes for promoting health and the wellbeing of the citizens in contemporary sub-Saharan Africa, at least in the long run. Whilst there is evidence of more private and public investments in the health sector under democratic leadership, Government's health policy is virtually non-existent under dictatorships and public sector investment in the health sector is on the decadence.
    Keywords: Africa, health policy, public health, private health, child mortality, democracy, autocracy, political leaders
    JEL: I15 H51 O55
    Date: 2016–10
  28. By: Youssef, Adel Ben (Université Côte d’Azur); Lannes, Laurence (World Bank); Rault, Christophe (University of Orléans); Soucat, Agnes (World Health Organization)
    Abstract: We examine causal links between energy consumption and health indicators (Mortality rate under-5, life expectancy, greenhouse effect, and government expenditure per capita) for a sample of 16 African countries over the period 1971-2010 (according to availability of countries' data). We use the panel-data approach of Kónya (2006), which is based on SUR systems and Wald tests with country specific bootstrap critical values. Our results show that health and energy consumption are strongly linked in Africa. Unilateral causality is found from energy consumption to life expectancy and child under-5 mortality for Senegal, Morocco, Benin, DRC, Algeria, Egypt, and South Africa. At the same time, we found a bilateral causality between energy consumption and health indicators in Nigeria. In particular, our findings suggest that electricity consumption Granger causes health outcomes for several African countries.
    Keywords: energy consumption, electricity, health, Panel VAR
    JEL: Q43 Q53 Q56
    Date: 2016–10
  29. By: Jens Kvaerner
    Abstract: This paper investigates how a shock to life expectancy, resulting from a cancer diagnosis, impacts consumption and saving decisions. I infer bequest motives by using a unique data set containing individual cancer diagnoses and wealth of all citizens in Norway. Cancer diagnoses are useful instruments for identifying bequest motives because they provide new information about life expectancy, which affects a person’s consumption plan differently depending on the relative strength of bequest and classical life-cycle-savings motives. My empirical estimates show strong evidence for bequest motives. A spouse creates a direct bequest motive; couples tend to respond to a cancer diagnosis by saving more. This result holds both across the wealth distribution and over the life-cycle. In contrast to couples, singles respond to a cancer diagnosis by spending more. However, a large part of the decrease in financial wealth among singles with children reflects transfers of wealth during a person’s lifetime, so-called inter vivos transfers.
    Date: 2016
  30. By: Goerke, Laszlo (IAAEU, University of Trier)
    Abstract: We theoretically analyse the effects of sick pay and employees' health on collective bargaining, assuming that individuals determine absence optimally. If sick pay is set by the government and not paid for by firms, it induces the trade union to lower wages. This mitigates the positive impact on absence. Moreover, a union may oppose higher sick pay if it reduces labour supply sufficiently. Better employee health tends to foster wage demands. If the union determines both wages and sick pay, we identify situations in which it will substitute wages for sick pay because adverse absence effects can be mitigated.
    Keywords: absence, employment, sick pay, trade union, wage determination
    JEL: D62 I13 I18 J22 J51 J52
    Date: 2016–10
  31. By: Akresh, Richard (University of Illinois at Urbana-Champaign); Caruso, German Daniel (World Bank); Thirumurthy, Harsha (University of North Carolina, Chapel Hill)
    Abstract: We estimate the impact of exposure to conflict on health outcomes using geographic information on households' distance from conflict sites – a more accurate measure of shock exposure – and compare the impact on children exposed in utero versus after birth. The identification strategy relies on exogenous variation in the conflict's geographic extent and timing. Conflict-exposed children have lower height-for-age, and impacts using GPS information are 2-3 times larger than if exposure is measured at the imprecise regional level. Results are robust to addressing endogenous migration. Health service disruptions and maternal stressors are potential explanations for the negative health effects on children.
    Keywords: child health, conflict, fetal origins hypothesis, Africa
    JEL: I12 J13 O12
    Date: 2016–10
  32. By: Wehner, Caroline (IZA); Schils, Trudie (Maastricht University); Borghans, Lex (Maastricht University)
    Abstract: A growing number of economic studies show that low emotional stability is typically negatively related to socioeconomic outcomes, while conscientiousness predicts desirable results. However, possible mechanisms behind these relations are far less explored. Gaining insights into the mechanisms is important, because this knowledge is crucial to develop pre- and intervention programs. We address this research gap by analyzing the relation between low emotional stability and mental ill-health as well as the possible substitution effect of conscientiousness both theoretically and empirically. Using the British Cohort Study, we find that low emotional stability at ages 10 and 16 significantly predicts mental ill-health at ages 16, 26, 30, 34 and 42 and that more conscientiousness significantly mitigates the negative relation between low emotional stability and mental health. Our results suggest that particularly both low emotionally stable and low conscientious individuals are more likely to experience mental ill-health related to a reduced problem-solving ability.
    Keywords: mental health, personality differences, health inequality, child development, socioeconomic disadvantage
    JEL: D03 I12 I14 I18 I24
    Date: 2016–10
  33. By: Bhalotra, Sonia R. (University of Essex); Karlsson, Martin (University of Duisburg-Essen); Nilsson, Therese (Lund University); Schwarz, Nina (University of Duisburg-Essen)
    Abstract: We estimate impacts of exposure to an infant health intervention trialled in Sweden in the early 1930s using purposively digitised birth registers linked to school catalogues, census files and tax records to generate longitudinal microdata that track individuals through five stages of the life-course, from birth to age 71. This allows us to measure impacts on childhood health and cognitive skills at ages 7 and 10, educational and occupational choice at age 16-20, employment, earnings and occupation at age 36-40, and pension income at age 71. Leveraging quasi-random variation in eligibility by birth date and birth parish, we estimate that an additional year of exposure was associated with improved reading and writing skills in primary school, and increased enrolment in university and apprenticeship in late adolescence. These changes are larger and more robust for men, but we find increases in secondary school completion which are unique to women. In the longer run, we find very substantial increases in employment (especially in the public sector) and income among women, alongside absolutely no impacts among men. We suggest that this may be, at least in part, because these cohorts were exposed to a massive expansion of the Swedish welfare state, which created more jobs for women than for men.
    Keywords: infant health, early life interventions, cognitive skills, education, earnings, occupational choice, programme evaluation, Sweden
    JEL: I15 I18 H41
    Date: 2016–11
  34. By: Chacko, Anooja
    Abstract: Disability is an umbrella term consisting of various deprivations and capacity limitations of people. As it generally decelerates the overall performance of people and society, it demands constant assessment. The definitions and classification should be done properly. The present paper makes a detailed conceptual overview of the concepts and classification of disability. The diverse instances of disabilities points out to the urgency for comprehensive policy action covering multiple aspects of livelihood vulnerability. In several cases disability serves as a feeding ground for poverty and other forms of discrimination. Hence it underscores the robust initiatives from the government to address the issue with due recognition.
    Keywords: disability, social model, medical model, livelihood
    JEL: I18 I19
    Date: 2015–05–07
  35. By: Constant, Amelie F. (UNU-MERIT, and Princeton University); Garcia-Munoz, Teresa (University of Granada); Neuman, Shoshana (Bar-Ilan University); Neuman, Tzahi (Hadassah-Hebrew University Medical Center)
    Abstract: Previous literature in a variety of countries has documented a "healthy immigrant effect" (HIE). Accordingly, immigrants arriving in the host country are, on average, healthier than comparable natives. However, their health status dissipates with additional years in the country. HIE is explained through the positive self-selection of the healthy immigrants as well as the positive selection, screening and discrimination applied by host countries. In this paper we study the health of immigrants within the context of selection and migration policies. Using SHARE data we examine the HIE comparing Israel and sixteen countries in Europe that have fundamentally different migration policies. Israel has virtually unrestricted open gates for Jewish people around the world, who in turn have ideological rather than economic considerations to move. European countries have selective policies with regards to the health, education and wealth of migrants, who also self-select themselves. Our results provide evidence that a) immigrants to Israel have compromised health and suffer from many health ailments, making them less healthy than comparable natives. Their health does not improve for up to 20 years of living in Israel, after which they become similar to natives; b) immigrants to Europe have better health than natives and their health advantage persists up to six years from their arrival, after which they are not significantly different than natives except in one case in which the health of immigrants became worse than that of natives after 21 years. Our results are important for migration policy and relevant for domestic health policy.
    Keywords: self-reported health status, immigration, Europe, Israel, older population, multilevel regression, SHARE
    JEL: C22 J11 J12 J14 O12 O15 O52
    Date: 2016–09–14
  36. By: Jennifer L. Schore; Randall S. Brown; Valerie A. Cheh
    Abstract: Based on the findings presented in this article, HCFA is conducting another set of demonstrations on case management and care coordination, which Mathematica is helping to design.
    JEL: I

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