nep-hea New Economics Papers
on Health Economics
Issue of 2016‒12‒11
twenty-six papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Affordable Care Act as Retiree Health Insurance: Implications for Retirement and Social Security Claiming By Alan L. Gustman; Thomas L. Steinmeier; Nahid Tabatabai
  2. Regular Information and Health: Evidence from a Field Experiment with Undergraduate Students. By Marianne Bernatzky; José María Cabrera; Alejandro Cid
  3. Income-Related Health Transfers Principles and Orderings of Joint Distributions of Income and Health By Mohamed Khaled; Paul Makdissi; Myra Yazbeck
  4. The Effect of Temporary and Intense Exposure to Particulate Matter on Birth Outcomes in Montevideo By Ana Inés Balsa; Marcelo Caffera; Juanita Bloomfield
  5. The Dynamic Effects of Health on the Employment of Older Workers By Richard Blundell; Jack Britton; Monica Costa Dias; Eric French
  6. The Impact of Massachusetts Health Insurance Reform on Labor Mobility By Norma B. Coe; Wenliang Hou; Alicia H. Munnell; Patrick J. Purcell; Matthew S. Rutledge
  7. Health insurance coverage and firm performance: Evidence using firm level data from Vietnam By Yamada, Hiroyuki; VU, Manh Tien
  8. Harder, better, faster... yet stronger? Working conditions and self-declaration of chronic diseases By Eric Defebvre
  9. Will you still need me, will you still feed me when I’m 64? The Health Impact of Caregiving By P.L. de Zwart; P. Bakx; E.K.A. van Doorslaer
  10. Physician performance pay: Evidence from a laboratory experiment By Brosig-Koch, Jeannette; Hennig-Schmidt, Heike; Kairies-Schwarz, Nadja; Wiesen, Daniel
  11. Health and Safety in EU Agriculture By Thomson, Kenneth
  12. Does health care expenditure counter adverse effects of obesity on health: Evidence from global data By Bansal, Sangeeta; Zilberman, David
  13. Globalisation and national trends in nutrition and health -a grouped fixed-effects approach to inter-country heterogeneity By Lisa Oberländer; Anne-Célia Disdier; Fabrice Etilé
  14. Killer Debt: The Impact of Debt on Mortality By Argys, Laura; Friedson, Andrew; Pitts, M. Melinda
  15. The dynamics of informal care provision in an Australian household panel survey: Previous work characteristics and future care provision By Nguyen, Ha; Connelly, Luke B.
  16. Can Artificial Intelligence Heal Human Hearts? A randomized controlled trial on the effects of internet cognitive behavioral therapy with artificial intelligence on depression (Japanese) By SO Mirai; SEKIZAWA Yoichi; TAKEBAYASHI Yoshitake
  17. Does democracy reduce the HIV epidemic? Evidence from Kenya By Antoine Marsaudon; Josselin Thuilliez
  18. The Determinants of self-medication: evidence from urban Vietnam By Hoai, Nguyen Trong; Dang, Thang
  19. Health Shocks and Short-Term Consumption GrowthAuthor-Name: Sowmya Dhanaraj By sowmya
  20. The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes By Andrew Goodman-Bacon
  21. Behavior Change for Early Childhood Nutrition: Effectiveness of Health Worker Training Depends on Maternal Information in a Randomized Control Trial By Singh, Prakarsh; Masters, William A.
  22. Impact of Water and Sanitation on Selected Water Borne Diseases in India By Brijesh C. Purohit
  23. Health Shocks and Inter-Generational Transmission of Inequality By Sowmya Dhanaraj
  24. Does Health IT Adoption Lead to Better Information or Worse Incentives? By Gautam Gowrisankaran; Keith A. Joiner; Jianjing Lin
  25. Health Shocks and Coping Strategies: State Health Insurance Scheme of Andhra Pradesh, India By Sowmya Dhanaraj
  26. Health, Human Capital and Domestic Violence By Nicholas W. Papageorge; Gwyn C. Pauley; Mardge Cohen; Tracey E. Wilson; Barton H. Hamilton; Robert A. Pollak

  1. By: Alan L. Gustman (Dartmouth College); Thomas L. Steinmeier (Texas Tech University); Nahid Tabatabai (Dartmouth College)
    Abstract: Using data from the Health and Retirement Study, we examine the effects of the Affordable Care Act (ACA) on retirement. We first calculate retirements (and in related analyses changes in expected ages of retirement and/or Social Security claiming) between 2010, before ACA, and 2014, after ACA, for those with health insurance at work but not in retirement. This group experienced the sharpest change in retirement incentives from ACA. We then compare retirement measures for those with health insurance at work but not in retirement with retirement measures for two other groups: those who, before ACA, had employer provided health insurance both at work and in retirement, and those who had no health insurance either at work or in retirement. To complete a difference-in-difference analysis, we make the same calculations for members of an older cohort over the same age span. We find no evidence that ACA increases the propensity to retire or changes the retirement expectations of those who, before ACA, had coverage when working, but not when retired. An analysis based on a structural retirement model suggests that eventually ACA will increase the probability of retirement by those who initially had health insurance on the job but did not have employer-provided retiree health insurance. But the retirement increase is quite small, only about half a percentage point at each year of age. The model also suggests that much of the effect of ACA on retirement will be realized within a few years of the change in the law.
    Date: 2016–09
  2. By: Marianne Bernatzky; José María Cabrera; Alejandro Cid
    Abstract: We run a randomized controlled trial with the aim of evaluating the effects of a health seminar complemented with weekly reminders on health outcomes. Our research design exploits the excess of applicants over the intervention capacity. In this 4-month intervention with undergraduate students, we provide information on preventive behaviors and healthy habits and on how to modify personal behaviors that could derive in chronical illnesses. We find that all students who were subject to the treatment improved their knowledge relative to the control group. But they were not able to translate it into healthier behaviors, neither self-reported nor objectively measured by a physician. We hypothesize that high discount rates, overconfidence and the lack of complementary inputs may explain our findings.
    Keywords: randomized trial; exercise; healthy habits; text message
  3. By: Mohamed Khaled (School of Economics, The University of Queensland); Paul Makdissi (School of Economics, The University of Queensland); Myra Yazbeck (School of Economics, The University of Queensland)
    Abstract: The objective of this article is to provide the analyst with the necessary tools that allow for a robust ordering of joint distributions of health and income. We contribute to the literature on the measurement and inference of socioeconomic health inequality in three distinct but complementary ways. First, we provide a formalization of the socioeconomic health inequality-specific ethical principle introduced by Erreygers Clark and van Ourti, (2012). Second, we propose new graphical tools and dominance tests for the identification of robust orderings of joint distributions of income and health associated with this new ethical principle. Finally, based on both pro-poor and pro-extreme ranks ethical principles we address a very important aspect of dominance literature: the inference. To illustrate the empirical relevance of the proposed approach, we compare joint distributions of income and a health-related behaviour in the United States in 1997 and 2014.
    Keywords: Health concentration curves, health range curves, socioeconomic health inequality, dominance, inference
    JEL: D63 I10
    Date: 2016–11–28
  4. By: Ana Inés Balsa; Marcelo Caffera; Juanita Bloomfield
    Abstract: Background: Prior estimates of the correlation between ambient air pollutants’ concentrations and perinatal health show dispersion in magnitudes, as well as positive and negative signs. These differences may be partially explained by the diverse array of methodological approaches between studies, including the set of confounders considered. Objectives: This study explores the effect of breathable particulate matter with diameter of 10 micrometers or less (PM10) on perinatal outcomes in Uruguay, a middle-income country in South America with levels of PM10 that in general do not exceed the recommended thresholds. The analyzed outcomes are: birth weight (BW), the risk of low birth weight (LBW) and the risk of a pre-term birth (PTB). Methods: We exploit the fact that in 2011 the ashes and dust resulting from the eruption of the Puyehue volcano in Chile more than doubled monthly averages of PM10 concentration levels in Montevideo, Uruguay. Using prenatal and birth data for 2010-2013, we estimate the associations between mother’s average exposure to PM10 in each trimester-of-pregnancy and perinatal outcomes controlling for a rich set of covariates. Results: We find that exposure to high levels of PM10 concentration (above 50 µg/m³ for the trimester average) during the third trimester of pregnancy is associated with higher rates of low birth weight and prematurity, and lower birth weight. These effects are quite robust to different specifications, and are particularly large for pregnancies exposed to concentration levels above 70 µg/m³, suggesting non-linear effects. The impact of PM10 on BW and on the rate of LBW appears to be driven primarily by an effect on prematurity. Conclusions: Exploiting a natural experiment, our study shows that exposure to high levels of PM10 during the third trimester of pregnancy can trigger preterm births.
  5. By: Richard Blundell (Institute for Fiscal Studies); Jack Britton (Institute for Fiscal Studies); Monica Costa Dias (Institute for Fiscal Studies); Eric French (Institute for Fiscal Studies)
    Abstract: Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimate a dynamic model of health and employment. We estimate how transitory and persistent health shocks affect employment over time. In a first step we formulate and estimate a dynamic model of health. The procedure accounts for measurement error and the possibility that people might justify their employment status by reporting bad health. We find that health is well represented by the sum of a transitory white noise process and a persistent AR(1) process. Next, we use the method of simulated moments to estimate the employment response to these shocks. We find that persistent shocks have much bigger effects on employment than transitory shocks, and that these persistent shocks are long lived. For this reason employment is strongly correlated with lagged health, a fact that the usual cross sectional estimates do not account for. We also show that accounting for the dynamics of health and employment leads to larger estimates of the effect of health on employment than what simple OLS estimates of health on employment would imply. We argue that the dynamic effect of health on employment could be generated by a model with human capital accumulation, where negative health shocks slowly reduce the human capital stock, and thus gradually causes people to exit the labor market.
    Date: 2016–09
  6. By: Norma B. Coe; Wenliang Hou; Alicia H. Munnell; Patrick J. Purcell; Matthew S. Rutledge
    Abstract: This paper examines the impact of the Massachusetts Health Insurance reform of 2016 on job mobility and employment exit using administrative data from the Social Security Administration. The Massachusetts reform mandated that every resident have insurance coverage and facilitated this initiative by requiring employers to offer coverage, as well as expanding Medicaid and creating health insurance exchanges with subsidized premiums. These elements provided the basis for the Patient Protection and Affordable Care Act (ACA) passed nationwide in 2010, so the experience of workers in Massachusetts provides evidence for how the ACA may affect labor market efficiency. Of particular interest is the extent to which Massachusetts’ reform reduced “job lock” – the phenomenon in which workers stay with employers to maintain their health insurance coverage, rather than move to a more productive match at another employer (especially a small firm unlikely to offer coverage) or exit employment entirely. The project measures differential effects by age, gender, and firm size, and tries to disentangle the effects of the employer mandate and the individual mandate by identifying individuals who cross state lines between home and work.
    Date: 2016–12
  7. By: Yamada, Hiroyuki; VU, Manh Tien
    Abstract: In literature, there is limited direct evidence regarding the effect of health insurance coverage on firm performance and worker productivity. In this paper, we study the impacts of health insurance on medium and large-scale domestic private firms’ performance and productivity in Vietnam, using a large firm level census dataset. We deploy propensity-score matching methods, and find statistically positive health insurance effects on both aggregate profit and profit per worker for both complying and non-complying medium and large-scale firms. Given the full sample results, we recommend an improvement in government monitoring as one of the important policy options to induce medium and large-scale firms to contribute to health insurance premiums for their employees.
    Keywords: Health insurance, Medium and large-scale firms, Propensity-score matching, Vietnam, Health insurance, Medium and large-scale firms, Propensity-score matching, Vietnam, D22, I13, I15, I18, O25
  8. By: Eric Defebvre
    Date: 2016
  9. By: P.L. de Zwart (University Medical Center Groningen, The Netherlands); P. Bakx (Erasmus University Rotterdam, The Netherlands); E.K.A. van Doorslaer (Erasmus University Rotterdam, The Netherlands)
    Abstract: Informal care may substitute for formal long-term care that is often publicly funded or subsidized. The costs of informal caregiving are borne by the caregiver and may consist of worse health outcomes and, if the caregiver has not retired, worse labor market outcomes. We estimate the impact of providing informal care to one’s partner on the caregiver's health using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). We exploit the panel structure of the data and use statistical matching to deal with selection bias and endogeneity. We find that in the short run caregiving has a substantial negative effect on the health of caregivers. These negative effects should be taken into account when comparing the costs and benefits of formal and informal care provision. These negative effects are potentially short-lived, however: we do not find any evidence that the health effects persist after 4 or 7 years.
    Keywords: long term care; informal caregiving; health; SHARE
    JEL: I12 I13 I19
    Date: 2016–12–02
  10. By: Brosig-Koch, Jeannette; Hennig-Schmidt, Heike; Kairies-Schwarz, Nadja; Wiesen, Daniel
    Abstract: We present causal evidence from a controlled experiment on the effect of pay for performance on physicians' behavior and patients' health benefits. At a within-subject level, we introduce performance pay to complement either fee-for-service or capitation. Performance pay is granted if a health care quality threshold is reached, and varies with the patients' severity of illness. We find that performance pay significantly reduces overprovision of medical services due to fee-for-service incentives, and underprovision due to capitation; on average, it increases the patients' health benefit. The magnitude of these effects depends, however, on the patients' characteristics. We also find evidence for a crowding-out of patient-regarding behavior due to performance pay. Health policy implications are discussed.
    Abstract: Mit Hilfe eines kontrollierten Experiments präsentieren wir kausale Evidenz zur Wirkung einer leistungsbasierten Vergütung (Pay-for-Performance) auf das Arztverhalten und den Patientennutzen. Auf individueller Ebene führen wir Pay-for-Performance entweder basierend auf einer Einzelleistungsvergütung oder einer Kopfpauschale ein. Die leistungsbasierte Vergütung, die an den Schweregrad der Erkrankung angepasst ist, wird ausgezahlt, sobald die Behandlungsqualität einen bestimmten Schwellenwert erreicht. Wir beobachten, dass Pay-for-Performance die mit der Einzelleistungsvergütung verbundene Überversorgung und die mit der Kopfpauschale verbundene Unterversorgung signifikant reduziert sowie die Patientennutzen im Durchschnitt erhöht. Die Stärke dieser Effekte variiert jedoch mit den Patientencharakteristika. Darüber hinaus finden wir Hinweise darauf, dass Pay-for-Performance Patienten-orientiertes Verhalten verdrängen kann. Implikationen für die Gesundheitspolitik werden diskutiert.
    Keywords: Fee-for-service,capitation,pay for performance,laboratory experiment,crowding-out
    JEL: C91 I11
    Date: 2016
  11. By: Thomson, Kenneth
    Abstract: Health and safety have long been recognised officially as issues in EU agricultural occupation, but pose specific problems of definition, measurement and policy action. About 500 people per year die while working in EU agriculture, forestry and fishing, and there are about 150,000 non-fatal accidents at such work, as well as work-related physical and mental health problems. Incidence rates are generally higher than in other sectors. Moreover, on-farm accidents happen to a very wide range of ages, from the very young to the relatively old. There is no clear pattern of incidence rates across EU Member States, for a number of possible reasons. Policy action can take a number of forms, but must take into account changes in farming technology, and the need to reach a wide range of potential casualties.
    Keywords: agriculture, occupation, health, safety, accidents, Health Economics and Policy, Labor and Human Capital,
    Date: 2016
  12. By: Bansal, Sangeeta; Zilberman, David
    Abstract: There is evidence that obesity is a risk to health and longevity of life. This is the first paper to use cross-country data to analyze the effect of obesity levels on life expectancy, and the trade-off between health expenditure and obesity levels. It uses a panel data of 194 countries for the years 2002, 2005 and 2010. We find that life expectancy has non-monotonic relationship with obesity levels. At low prevalence of obesity, life expectancy is increasing in obesity levels, but beyond a certain threshold level of obesity prevalence, an increase in obesity level reduces life expectancy. Countries that spend more on health expenditure are able to counter the effects of increased obesity on life expectancy. Incremental effect of health expenditure in enhancing life expectancy is higher for countries where obesity prevalence is low. The impact of health expenditure on increasing life expectancy is higher for women. The results are consistent over three data sets: when the health indicator is life expectancy at birth, mortality rate between age group 15-60 years, and healthy life expectancy.
    Keywords: Health Economics and Policy,
    Date: 2016–11
  13. By: Lisa Oberländer (PSE - Paris School of Economics, PSE - Paris-Jourdan Sciences Economiques - CNRS - Centre National de la Recherche Scientifique - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC)); Anne-Célia Disdier (PSE - Paris School of Economics, PSE - Paris-Jourdan Sciences Economiques - CNRS - Centre National de la Recherche Scientifique - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC)); Fabrice Etilé (PSE - Paris School of Economics, PSE - Paris-Jourdan Sciences Economiques - CNRS - Centre National de la Recherche Scientifique - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC))
    Abstract: Using a panel dataset of 70 countries spanning 42 years (1970-2011), we investigate the distinct effects of economic and social globalisation on national trends in markers of diet quality (supplies of animal protein, free fat and sugar, prevalence of diabetes, average body mass index). Our key methodological contribution is the application of the grouped fixedeffects estimator, which extends linear fixed-effects models to include both time-invariant and time-varying unobserved heterogeneity, under the assumption that both the latter and the former follow group-specific patterns. We find that increasing social globalisation has a significant impact on the supplies of animal protein and sugar available for human consumption. Specific components of social globalisation like personal contacts with foreigners and above all information flows drive these results. Economic globalisation has no effect on dietary outcomes, and has a negative impact on health. These findings suggest that the social and cultural aspects of globalisation should deserve greater attention in studies of the nutrition transition.
    Keywords: obesity,economic globalisation,social globalisation,grouped fixed-effects,panel data
    Date: 2016–11
  14. By: Argys, Laura (University of Colorado Denver); Friedson, Andrew (University of Colorado Denver); Pitts, M. Melinda (Federal Reserve Bank of Atlanta)
    Abstract: This study analyzes the effect of individual finances (specifically creditworthiness and severely delinquent debt) on mortality risk. A large (approximately 170,000 individuals) subsample of a quarterly panel data set of individual credit reports is utilized in an instrumental variables design. The possibility of the reverse causality of bad health causing debt and death is removed by instrumenting for individual finances post 2011 using the exposure to the housing crisis based on their 2005 residence. Worsening creditworthiness and increases in severely delinquent debt are found to lead to increases in individual mortality risk. This result has implications for the benefit of policies such as the social safety net, which aims to protect individual finances, by adding reduced mortality to the benefit of any intervention.
    Keywords: debt; mortality; creditworthiness
    JEL: D14 I1
    Date: 2016–11–01
  15. By: Nguyen, Ha; Connelly, Luke B.
    Abstract: This study contributes to a small literature on the dynamics of informal care by examining the informal care provision choices of working age Australians. We focus on the impact of previous work characteristics (including work security and flexibility) on subsequent care provision decisions and distinguish between care that is provided to people who cohabit and people who reside elsewhere, as well as between the provision of care as the primary caregiver, or in a secondary caring role. Our dynamic framework of informal care provision accounts for state-dependence, unobserved heterogeneity and initial conditions. For both males and females, we find the existence of positive state-dependence in all care states in both the short- and medium-term. Furthermore, the inertia in care provision appears to be stronger for more intensive care. We also find previous employment status has a significant deterrent effect on current care provision decisions. The effects on employment, however, differ according to the type of previous work, the type of care currently provided, and the gender of the caregiver. We also find that workers with perceptions of greater job security are nevertheless less likely to provide subsequent care. Our results also suggest that workers’ perceptions about work flexibility and their stated overall satisfaction with work actually have no impact on their subsequent decisions to provide care in any capacity.
    Keywords: informal care, labour supply, dynamic multinomial choice models, panel data
    JEL: C23 J14
    Date: 2016–11
  16. By: SO Mirai; SEKIZAWA Yoichi; TAKEBAYASHI Yoshitake
    Abstract: Background: In spite of recent high expectations of internet-based cognitive behavioral therapy (iCBT), iCBT still holds limitations including effect sustainability, function improvement, and dropout. Therefore, we focused on iCBT-AI in which automatic feedback by text or animation expressing empathy or indicating instruction is given to users with respect to their input after analysis conducted by a natural language processing (NLP) system, which is one area of artificial intelligence (AI). Since there is no evidence of iCBT using AI technology so far, we evaluated its effectiveness. Methods: 1,187 participants recruited from the website were randomly assigned into three groups; iCBT-AI, conventional iCBT without AI, and waitlist as control. Those allocated to interventional arms were encouraged to perform each exercise at least once a week for seven weeks. The primary outcome was moderate-to-severe depression defined as a PHQ-9 score of 10 or higher. Intention-to-treat analyses were performed. Results: The dropout rate was significantly lower in iCBT-AI than iCBT (p Conclusion: Although iCBT-AI has no significant short-term antidepressant effect, iCBT-AI seems to have an exclusive potential to reduce moderate-to-severe depression in the future. Further research is required.
    Date: 2016–11
  17. By: Antoine Marsaudon (PSE - Paris-Jourdan Sciences Economiques - CNRS - Centre National de la Recherche Scientifique - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC), PSE - Paris School of Economics); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics)
    Abstract: Does democracy help Kenyan citizens to struggle against the HIV epidemic? Yet, very little attention has been devoted to establish whether political regimes react differently to the HIV infection. Using an electoral definition of democracy makes a contribution in understanding which aspects of political rules matter to manage the disease. Using a difference-in-difference design that draws upon pre-existing variations in HIV intensity and cohort's exposure to democracy, we find that a person living under democracy is less likely to have a HIV infection. Further, we present some evidence of ethnic favoritism and gender disparities during periods of non-democracy.
    Keywords: Institution,Democracy,HIV,Health,Kenya
    Date: 2016–11
  18. By: Hoai, Nguyen Trong; Dang, Thang
    Abstract: This study examines the primary determinants of self-medications among urban citizens in Ho Chi Minh City, Vietnam. To achieve the research objective, the questionnaire is designed to elicit the respondents’ necessary information using in-depth personal interviews. Employing logistic models the paper finds that the probability of self-medication is positively associated with the respondents’ high school degree or vocational certificate, married status, and income while it is negatively related to employed status, the number of children, the geographical distance from home to the nearest hospital, doing exercise, and living in a central region. Meanwhile, using Poisson models the paper finds that the frequency of self-medication is positively associated with the respondents’ high school and vocational, married, income, and chronic disease while the frequency of self-medication is adversely related to male, employed, children number, distance, being close to health professional and central areas.
    Keywords: Self-medication; Ho Chi Minh City; Vietnam
    JEL: I11 I18
    Date: 2016–06–01
  19. By: sowmya (Madras School of Economics)
    Abstract: Health shocks can affect the household economy through a substantial rise in out-of-pocket medical expenditure and/or loss of income. In such a situation, households use a range of coping mechanisms to protect nonmedical consumption. This study empirically investigates whether households are able to insure consumption in the short-term when one or more members face serious illness/death. We also analyse if health shocks have asymmetrical effects on household welfare depending on the members facing the shocks and if access to micro-credit and social capital improves the smoothing ability of the households.Length: 29 pages
    Keywords: health shocks, coping strategies, non-medical consumption, micro-credit, social capitalClassification-JEL: I15, I31
    Date: 2015–08
  20. By: Andrew Goodman-Bacon
    Abstract: This paper exploits the original introduction of Medicaid (1966-1970) and the federal mandate that states cover all cash welfare recipients to estimate the effect of childhood Medicaid eligibility on adult health, labor supply, program participation, and income. Cohorts born closer to Medicaid implementation and in states with higher pre-existing welfare-based eligibility accumulated more Medicaid eligibility in childhood but did not differ on a range of other health, socioeconomic, and policy characteristics. Early childhood Medicaid eligibility reduces mortality and disability and, for whites, increases extensive margin labor supply, and reduces receipt of disability transfer programs and public health insurance up to 50 years later. Total income does not change because earnings replace disability benefits. The government earns a discounted annual return of between 2 and 7 percent on the original cost of childhood coverage for these cohorts, most of which comes from lower cash transfer payments.
    JEL: I13 J10 N32
    Date: 2016–12
  21. By: Singh, Prakarsh (Amherst College); Masters, William A. (Tufts University)
    Abstract: We carry out a randomized control trial to test for interaction effects between training state-employed caregivers and providing mothers information to improve nutrition of preschool children aged 2-6 in rural India. Salaried caregivers are supposed to provide a mid-day meal and also advise mothers on health and nutrition for their child. Our one-day caregiver training covered basic health and nutrition facts with advice on how to communicate with mothers for behavior change at home. We find that this training was effective only when we provided the mothers with an independent source of nutrition information, and that the combined treatment was effective only among younger caregivers. Results are consistent with behavior change as a costly investment that is more attractive when done earlier in life, and greater response to information that is confirmed and reinforced from multiple sources.
    Keywords: child underweight, child malnutrition, child health, ICDS, Punjab, South Asia
    JEL: M53 I12 I38 J38
    Date: 2016–11
  22. By: Brijesh C. Purohit (Madras School of Economics)
    Abstract: One of the Millennium Development Goals is to provide improved sanitation facilities along with availability of potable water; which are indeed the two basic needs for human survival. However, despite significant investments over the last 20 years, India still faces the most daunting sanitation challenge and its sanitation is rated as the second worst in the world after China. At present only 28 per cent of people in rural areas have access to toilets leading to severe burden of preventable diseases. With a view to assessing health impact of water borne diseases this study provides first an assessment of direct impact of water and sanitation facilities on incidence of selected diseases in major Indian states. This is followed by an estimation of input efficiency estimates for 28 Indian States. This is done using data envelopment analysis. It is suggested by our results that there is a positive impact of reducing the incidence of selected diseases by the state investments on water and sanitation facilities. However, the differentials impact across states of these inputs in reducing the incidence of four water borne diseases, namely, acute diarrhoea, enteric fever, viral hepatitis and malaria could be minimized to a certain extent if these inputs are targeted more effectively and some changes are made in other funding sources like NRHM.
    Keywords: Health, water borne diseases, states, efficiency Classification-JEL: Q 25, Q 28, H 51, C 14
    Date: 2015–08
  23. By: Sowmya Dhanaraj (Madras School of Economics)
    Abstract: This study explores the inter-generational effects of health shocks using longitudinal data of Young Lives project conducted in the southern state of India, Andhra Pradesh for two cohorts of children (younger and older). It is found that health shocks to poorer parents reduce investments in human capital of children thereby reducing their future earnings, and perpetuating poverty and inequality. There is a temporary delay in primary school enrollment in the case of younger cohort, while schooling attainment is reduced by 0.26 years for older children. This paper further contributes to the literature on important dimensions like role of timing of the shocks and the pathways through which they affect human capital investment, differential effects of paternal and maternal shocks on different cohort groups, ability of the children and quality of schooling in schooling attainment.
    Keywords: Parental health shocks, school enrollment, grade attainmentClassification-JEL: O15, O12, I30
    Date: 2015–09
  24. By: Gautam Gowrisankaran; Keith A. Joiner; Jianjing Lin
    Abstract: We evaluate whether hospital adoption of electronic medical records (EMRs) leads to increases in billing where financial gains are large or where hassle costs of complete coding are low. The 2007 Medicare payment reform varied both financial incentives and hassle costs of coding. We find no significant impact of financial incentives on billing levels, inconsistent with bill inflation. However, the reform led to increases in reported severity for medical relative to surgical patients at EMR hospitals, consistent with EMRs decreasing coding costs for medical patients. Greater post-reform completeness of coding with EMRs may increase Medicare costs by $689.6 million annually.
    JEL: H51 I11 I13 O33
    Date: 2016–12
  25. By: Sowmya Dhanaraj (Madras School of Economics)
    Abstract: The objectives of the study are three-fold: to investigate who are vulnerable to welfare loss from health shocks, what are the household responses to cope with the economic burden of health shocks and if policy responses like state health insurance schemes are effective in reducing the economic vulnerability. Existing literature have investigated the impact of state health insurance schemes in reducing the vulnerability to financials risks of medical care using catastrophic health expenditure (CHE) measure. This has several limitations like setting arbitrary threshold levels, exclusion of those that did not seek medical care due to inability to pay and non-accounting for risks posed by different sources of financing. So we use self-reported measure of reduction in economic well-being of households due to serious illness or death of one or more members from the recent Young Lives longitudinal study in Andhra Pradesh, India. Three-level random intercept logistic regression analysis that accounts for role of contextual or environmental factors like access to healthcare is used to determine the characteristics of vulnerable population and effectiveness of the state insurance scheme.
    Keywords: Health shocks, coping strategies, state health insurance scheme, three-level random intercept modelClassification-JEL: I10, I13
    Date: 2015–09
  26. By: Nicholas W. Papageorge; Gwyn C. Pauley; Mardge Cohen; Tracey E. Wilson; Barton H. Hamilton; Robert A. Pollak
    Abstract: We study the impact of health shocks on domestic violence and illicit drug use. We argue that health is a form of human capital that shifts incentives for risky behaviors, such as drug use, and also changes options outside of violent relationships. To estimate causal effects, we examine chronically ill women before and after a medical breakthrough and exploit differences in these women's health prior to the breakthrough. We show evidence that health improvements induced by the breakthrough reduced domestic violence and illicit drug use. Our findings provide support for the idea that health improvements can have far-reaching implications for costly social problems. The policy relevance of our findings is compounded by the fact that both domestic violence and illicit drug use are social problems often seen as frustratingly impervious to interventions. One possible reason is that the common factors that drive them, such underlying health or labor market human capital, are themselves very persistent over time. Our study provides a unique test of this hypothesis by examining what happens when factors underlying violence or drug use exogenously shift due to a medical technological advancement. Our findings suggest that both violence and drug use could be reduced by improving women's access to better healthcare.
    JEL: I12 J24
    Date: 2016–12

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.