nep-hea New Economics Papers
on Health Economics
Issue of 2017‒01‒08
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Value of a QALY and VSI Estimated with the Chained Approach By Olofsson, Sara; Gerdtham , Ulf-G; Hultkrantz , Lars; Persson , Ulf
  2. Atmospheric Pollution and Child Health in Late Nineteenth Century Britain By Bailey, Roy E.; Hatton, Timothy J.; Inwood, Kris
  3. Elections and externalities of health expenditures: Spatial patterns and opportunism in the local budget allocation By Jorge Ferreira; Alexandre Alves; Emilie Caldeira
  4. Illness-related absence among preschool children: Insights from a health intervention in Swedish preschools By Hall, Caroline; Lindahl, Erica
  5. A Framework for Testing the Equality Between the Health Concentration Curve and the 45-Degree Line By Mohamad A. Khaled; Paul Makdissi; Rami Tabri; Myra Yazbeck
  6. The transmission of health across 7 generations in China, 1789-1906 By Jean-Francois Maystadt; Giuseppe Migali
  7. Hospital Characteristics and the Agency for Healthcare Research and Quality Inpatient Quality Indicators: A Systematic Review By L. D. Engineer; B. D. Winters; C. M. Weston; A. Zhang; R. Sharma; E. Bass; D. Jones; A. Rosen; F. B. Yoon; A. Borzecki; S. M. Dy
  8. The Impact of Depression on Employment of Older Workers in Europe By Justine Knebelmann; Christopher Prinz
  9. Impact of a Text Messaging Program on Adolescent Reproductive Health: A Cluster–Randomized Trial in Ghana By Slawa Rokicki; Jessica Cohen; Joshua A. Salomon; Günther Fink
  10. 2012 and 2014 Regional Partnership Grants to Increase the Well-Being of and to Improve the Permanency Outcomes for Children Affected by Substance Abuse: Third Annual Report to Congress By Prepared by Mathematica Policy Research
  11. The Twin Instrument By Bhalotra, Sonia R.; Clarke, Damian
  12. Excess Mortality, Institutionalization and Homelessness Among Status Indians in Canada By Akee, Randall K. Q.; Feir, Donna
  13. Depression for Economists By Jonathan de Quidt; Johannes Haushofer
  14. Health begins with people: An RCT study to test the effects of a housing provider?s health interventions By Paul Cheshire; Jemma Mouland; Steve Gibbons
  15. Bayesian Poisson log-bilinear models for mortality projections with multiple populations By Katrien Antonio; Anastasios Bardoutsos; Wilbert Ouburg
  16. Sanitation, Disease Externalities, and Anemia: Evidence From Nepal By Diane Coffey; Michael Geruso; Dean Spears
  17. Agricultural Fires and Infant Health By Marcos A. Rangel; Tom Vogl

  1. By: Olofsson, Sara (The Swedish Institute for Health Economics (IHE), Lund, Sweden); Gerdtham , Ulf-G (Department of Economics, Lund University); Hultkrantz , Lars (Örebro University, School of Business, Sweden); Persson , Ulf (The Swedish Institute for Health Economics (IHE), Lund, Sweden)
    Abstract: The value of a Quality-Adjusted Life-Year (QALY) and the Value of a Statistical Injury (VSI) are important measures within health economics and transport economics. Several studies have therefore estimated people’s WTP for these estimates, but most results show problems with scale insensitivity. The Chained Approach (CA) is a method developed to reduce this problem. The objective of this study was to estimate the value of a QALY and VSI in the context of non-fatal road traffic accidents using CA. Data was collected from a total of 800 individuals in the Swedish adult general population using two web-based questionnaires. The result showed evidence of scale sensitivity both within and between samples. The value of a QALY based on trimmed individual estimates where close to constant at €300,000 irrespective of the type and size of the QALY gain. The study shows promising results for using the original CA to estimate the value of a QALY and VSI. It also supports the use of a constant value of a QALY, but at a higher level than what is currently applied by HTA’s.
    Keywords: contingent valuation; chained approach; scale sensitivity; quality-adjusted life-years; willingness-to-pay
    JEL: D61 D80 I18 J17
    Date: 2016–12–13
  2. By: Bailey, Roy E. (University of Essex); Hatton, Timothy J. (University of Essex); Inwood, Kris (University of Guelph)
    Abstract: Atmospheric pollution was an important side effect of coal-fired industrialisation in the nineteenth century. In Britain emissions of black smoke were on the order of fifty times as high as they were a century later. In this paper we examine the effects of these emissions on child development by analysing the heights on enlistment during the First World War of men born in England and Wales in the 1890s. We use the occupational structure to measure the coal intensity of the districts in which these men were observed as children in the 1901 census. We find strong negative effects of coal intensity on height, which amounts to difference of almost an inch between the most and least polluted localities. These results are robust to a variety of specification tests and they are consistent with the notion that the key channel of influence on height was via respiratory infection. The subsequent reduction of emissions from coal combustion is one factor contributing to the improvement in health (and the increase in height) during the twentieth century.
    Keywords: atmospheric pollution, health and height
    JEL: I15 N13 Q53
    Date: 2016–12
  3. By: Jorge Ferreira; Alexandre Alves; Emilie Caldeira
    Abstract: In this paper, we tested the hypothesis that policy makers? choices concerning health spent at the local level are spatially correlated and electorally oriented. We check the influence of a set of demographic, electoral and economic determinants of public health activity. We performed a spatial panel data analysis encompassing 399 municipalities in the period from 2005 to 2012, estimating six models, namely: all years, all years controlling by election type, non-electoral years, electoral years, central-elections years and local-elections years. Our contribution to the literature lies in three findings. Firstly, we show that health spent is driven for (global and local) positive spatial autocorrelation, and it is persistent, which means that independent of electoral calendar, there exists spatial effects in the allocation of spent. The parametric estimation that best fitted with data was Spatial Error Model Estimation (SEM), and the lambda value for all models were the same (0.099), indicating that the spatial correlation affects both electoral and non-electoral year?s expenditures, in central and local elections. In other words, we found a positive spillover effect in the public health spent at the local level. Exogenous effects (normative power of the law when it comes to minimum values of health spent in the municipalities) and correlated effects (the role of local health infrastructure, particularly in local-election years) help to understand the channels of this spatial dependence. A second issue is that elections are strong enough to change the allocation pattern in local governments, probably as a political strategy to seduce voters. Health spent seems to have a politically motivated component, stronger to local elections (considering incumbent?s reelection and/or his goal of electing the supported successor), but still significant in central elections. Considering that less than 5% of Brazilian tax burden is in the local level, the relevance of central elections is probably tied to grants access. The last point is the difference between central and local-elections effects. The main channels to explain the per capita health expenditure level in municipalities, according to all Models, are demographic issues related to aged people (positive effect) and young people (negative effect). Moreover, in election-years the positive aged people effect increases and the negative young people effect smooths. Another important issue is that population density variable changes from a negative effect (in all years and non-electoral years? models) to a positive effect in election-years models. This suggests that the more a municipality is dense populated, the more efficient will be the campaign spent to seduce voters, and one effective instrument to do that is by increasing public health expenditure in elections years.
    Keywords: Health expenditure. Local Expenditures. Elections. Spatial econometrics.
    JEL: H72 H75 I18 C31 C33
    Date: 2016–12
  4. By: Hall, Caroline (IFAU - Institute for Evaluation of Labour Market and Education Policy); Lindahl, Erica (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: We evaluate the effect of a preschool health intervention aimed at reducing infections through improved hygiene practices and training of the staff. The large-scale design enables us to study heterogeneous effects with respect to several child and preschool characteristics that are assumed to be associated with the initial level of absence, and thereby the potential magnitude of the effect. We find no reduction, on average, in children’s illness-related absence. This conclusion holds across different age groups of preschool children, and for preschools with varying levels of absence before the intervention. However, we do find some evidence for a decline in illness-related absence among children enrolled in preschool sections with relatively few children. We find some empirical support for that the intervention consisted of components with opposing effects on illness-related absence, which may explain the zero average effect.
    Keywords: preschool; absence due to illness
    JEL: J13 J48
    Date: 2016–12–13
  5. By: Mohamad A. Khaled (School of Economics, The University of Queensland); Paul Makdissi (Department of Economics, University of Ottawa); Rami Tabri (School of Economics, University of Sydney, Australia); Myra Yazbeck (School of Economics, The University of Queensland)
    Abstract: The health concentration curve is the standard graphical tool to depict socioeconomic health inequality in the literature on health inequality. This paper shows that testing for the absence of socioeconomic health inequality is equivalent to testing if the regression function of health on income is a constant function that is equal to average health status. In consequence, any test for parametric specification of a regression function can be used to test for the absence of socioeconomic health inequality (subject to regularity conditions). Furthermore, this paper illustrates how to test for this equality using the Hardle and Mammen (1993) test for correct parametric regression functional form, and applies it to the National Health Survey 2014.
    Keywords: Health concentration curves, socioeconomic health inequality, inference
    JEL: D63 I10
    Date: 2016–12–30
  6. By: Jean-Francois Maystadt; Giuseppe Migali
    Abstract: We study the intergenerational transmission of health using linked registered data from China between 1789 and 1906. We first document the intergenerational correlations across 7 generations. We then identify intergenerational causal associations comparing children born from twin mothers or fathers. In particular, we find a strong and persistent intergenerational elasticity between mothers and children of about 0.52. The intergenerational association from fathers is much weaker and seems to be largely driven by genetic factors. The estimates remain relatively stable up to generation 5 and are robust to different checks. Overall, our results highlight the nurturing role of women in explaining the intergenerational transmission of health, stressing the key role played by women in affecting children's health outcomes in developing countries.
    Keywords: Intergenerational correlations, causal effects, long-term health outcomes
    JEL: I14 I29 I3
    Date: 2017
  7. By: L. D. Engineer; B. D. Winters; C. M. Weston; A. Zhang; R. Sharma; E. Bass; D. Jones; A. Rosen; F. B. Yoon; A. Borzecki; S. M. Dy
    Abstract: The Agency for Healthcare Research and Quality Inpatient Quality Indicators (IQIs) include inpatient mortality for selected procedures and medical conditions.
    Keywords: hospital characteristics, inpatient quality Indicators
    JEL: I
  8. By: Justine Knebelmann (International Growth Centre); Christopher Prinz
    Abstract: According to the World Health Organization, depression is the highest ranking cause of disease in middle- and high income countries; it costs Europe around EUR 118 billion a year, mostly through lost productivity on the labour market, i.e. labour supply loss, sickness absence, and poor performance at the workplace. Using data from waves 1, 2 and 4 of the Survey of Health, Ageing and Retirement in Europe (SHARE), this paper seeks to assess the magnitude of the impact of depression on labour market outcomes of older workers, a population sub-group whose participation in the labour market is ever more crucial in view of rapid population ageing. For each of the studied outcomes, analyses show a substantial impact of depression, measured with the European Depression Scale. Using different methods to address endogeneity this paper finds that depression decreases the probability of being employed by 22 to 51 percentage points among the 50 to 64 year old age group. Older workers with the most symptoms are more than twice as likely as others to exit employment before retirement age. Finally, depression increases annual sickness absence duration by 7.2 days on average. These figures show the necessity for national and firm-level employment policies and programmes targeting the 50 and over population to include prevention of depression, increased awareness of depression and adequate medical support.
    JEL: C23 C31 I10 J22 J26
    Date: 2016–12–21
  9. By: Slawa Rokicki; Jessica Cohen; Joshua A. Salomon; Günther Fink
    Abstract: Objectives: To evaluate whether text-messaging programs can improve reproductive health among adolescent girls in low- and middle-income countries. Methods: We conducted a cluster–randomized controlled trial among 756 female students aged 14 to 24 years in Accra, Ghana, in 2014. We randomized 38 schools to unidirectional intervention (n=12), interactive intervention (n=12), and control (n=14). The unidirectional intervention sent participants text messages with reproductive health information. The interactive intervention engaged adolescents in text-messaging reproductive health quiz games. The primary study outcome was reproductive health knowledge at 3 and 15 months. Additional outcomes included self-reported pregnancy and sexual behavior. Analysis was by intent-to-treat. Results: From baseline to 3 months, the unidirectional intervention increased knowledge by 11 percentage points (95% confidence interval [CI]=7, 15) and the interactive intervention by 24 percentage points (95% CI=19, 28), from a control baseline of 26%. Although we found no changes in reproductive health outcomes overall, both unidirectional (odds ratio [OR]=0.14; 95% CI=0.03, 0.71) and interactive interventions (OR=0.15; 95% CI=0.03, 0.86) lowered odds of self-reported pregnancy for sexually active participants. Conclusions: Text-messaging programs can lead to large improvements in reproductive health knowledge and have the potential to lower pregnancy risk for sexually active adolescent girls.
    Keywords: Reproductive health; Sexual education; Adolescent health; Mobile health; Text messaging; Global health
    JEL: I10 I25 J13
    Date: 2017–01
  10. By: Prepared by Mathematica Policy Research
    Abstract: The purpose of this third report to Congress is twofold: (1) to provide an early description of the families being served by the RPG2 projects and the services they are receiving; and (2) to introduce the 2014 RPG3 projects. The report focuses on activities from April 2014 through March 2015.
    Keywords: RPG, Regional Partnership Grants, child welfare, substance abuse treatment, cross-site evaluation, technical assistance, Children’s Bureau, evidence-based practices
    JEL: I
  11. By: Bhalotra, Sonia R. (University of Essex); Clarke, Damian (Universidad de Santiago de Chile)
    Abstract: Twin births are often construed as a natural experiment in the social and natural sciences on the premise that the occurrence of twins is quasi-random. We present new population-level evidence that challenges this premise. Using individual data for more than 18 million births (more than 500,000 of which are twins) in 72 countries, we demonstrate that indicators of the mother's health and health-related behaviours and exposures are systematically positively associated with the probability of a twin birth. The estimated associations are sizeable, evident in richer and poorer countries, and evident even in a sample of women who do not use IVF. The positive selection of women into twinning implies that estimates of impacts of fertility on parental investments and on women's labour supply that use twin births to instrument fertility will tend to be downward biased. This is pertinent given the emerging consensus that these relationships are weak. Using two large samples, one for developing countries and one for the United States, and focusing upon twin-instrumented estimates of the quantity–quality trade-off, we demonstrate the nature of the bias and estimate bounds on the true parameter.
    Keywords: twins, fertility, maternal health, miscarriage, bounds, quantity-quality trade-off, parental investment
    JEL: J12 J13 C13 D13 I12
    Date: 2016–12
  12. By: Akee, Randall K. Q. (University of California, Los Angeles); Feir, Donna (University of Victoria)
    Abstract: In this paper we use confidential-use Census and administrative data to produce the first national estimates of excess mortality, institutionalization and homelessness for the largest Indigenous population in Canada from the ages of 5 to 64. We identify mortality rates at least twice the Canadian average and find exceptionally high mortality rates for young Indigenous women and girls – up to four times the Canadian average at certain ages. We show mortality rates are even higher on reserve – up to five times the Canadian average. These relative mortality rates are higher than the relative mortality rates of African Americans and the Native Americans to non-Hispanics in the United States. We also estimate very high rates of institutionalization and homelessness, especially among men and as a result there are stark gender ratio imbalances among this population. We speculate that this gender imbalance may play a role in excess female mortality in addition to several other socioeconomic factors.
    Keywords: mortality, First Nations, Native American, Status Indian, homelessness, institutionalization, gender bias
    JEL: J10 J15 J16 I15 I14 I32
    Date: 2016–12
  13. By: Jonathan de Quidt; Johannes Haushofer
    Abstract: Major depressive disorder (MDD) is one of the most prevalent mental illnesses worldwide. Existing evidence suggests that it has both economic causes and consequences, such as unemployment. However, depression has not received significant attention in the economics literature. In this paper, we present a simple model which predicts the core symptoms of depression from economic primitives, i.e. beliefs. Specifically, we show that when exogenous shocks cause an agent to have pessimistic beliefs about the returns to her effort, this agent will exhibit depressive symptoms such undereating or overeating, insomnia or hypersomnia, and a decrease in labor supply. When these effects are strong enough, they can generate a poverty trap. We present descriptive evidence that illustrates the predicted relationships.
    JEL: D03 I1 I15 I3
    Date: 2016–12
  14. By: Paul Cheshire; Jemma Mouland; Steve Gibbons
    Abstract: Abstract Recent research has been increasingly showing that it is not the houses or the neighbourhoods in which people live that make them sick or poor: rather it is their personal characteristics. Still this does not mean that interventions aimed at occupants of social housing may not be effective in improving health. The structure of social housing provision in Britain means that there are many large social landlords. Landlords have particular access to their tenants and this paper presents the results of an Randomised Control Trial designed to evaluate the impacts of simple health interventions on the health of poorer residents over 50 living in 5 inner London boroughs. The study was carried out between February 2013- May 2015. Participants were randomly divided into three groups: a control group (n= 186), a group receiving additional signposting to health services (n= 172); and a group receiving intensive support from a dedicated health and wellbeing support worker (n= 174). The intervention period was 18 months. The main outcomes measured were self-reported health and wellbeing ratings and NHS usage. Randomisation was computer-generated and participants and assessors were blinded to the allocation. Perhaps the single most important finding was that the initial base line health evaluation revealed 25 (4.5%) of the total sample as having such severe health problems that significant and immediate intervention was required. This set of people was taken out of the trail and directed to treatment. In purely scientific terms this is unfortunate since it means that all intervention effects are likely underestimated since these were people whose health was critical. On the other hand it shows that the simplest possible intervention to a targeted group (older and poorer people), just an individual health status assessment, can produce significant health improvements. For the 95% staying in the trial significant effects were found for planned hospital usage, with the intensive intervention group?s usage reducing by 39% in comparison to control group?s increase of 11% (p= 0.004). Significant effects were also found for nights in hospital where the signposting intervention?s usage decreased (35%) significantly in comparison to the control group?s increased usage (13%) (p= 0.022). The intensive intervention group?s usage in fact reduced more (62%) but variance was high (20.198), affecting significance. Substantive effects were identified for emergency GP usage, where group 3 reduced their usage by 15%, a substantive difference (p= 0.055) to group 2?s 181% increase. *The study was initiated and funded by Family Mosaic
    Keywords: Randomised Control Trail; Neighbourhood Effects; Health interventions
    JEL: I18 C93 R29
    Date: 2016–12
  15. By: Katrien Antonio; Anastasios Bardoutsos; Wilbert Ouburg
    Abstract: Life insurers, pension funds, health care providers and social security institutions face increasing expenses due to continuing improvements of mortality rates. The actuarial and demographic literature has introduced a myriad of (deterministic and stochastic) models to forecast mortality rates of single populations. This paper presents a Bayesian analysis of two related multi-population mortality models of log-bilinear type, designed for two or more populations. Using a larger set of data, multi-population mortality models allow joint modelling and projection of mortality rates by identifying characteristics shared by all subpopulations as well as sub-population speci?c e?ects on mortality. This is important when modeling and forecasting mortality of males and females, regions within a country and when dealing with index-based longevity hedges. Our ?rst model is inspired by the two factor Lee & Carter model of Renshaw and Haberman (2003) and the common factor model of Carter and Lee (1992). The second model is the augmented common factor model of Li and Lee (2005). This paper approaches both models in a statistical way, using a Poisson distribution for the number of deaths at a certain age and in a certain time period. Moreover, we use Bayesian statistics to calibrate the models and to produce mortality forecasts. We develop the technicalities necessary for Markov Chain Monte Carlo ([MCMC]) simulations and provide software implementation (in R) for the models discussed in the paper. Key bene?ts of this approach are multiple. We jointly calibrate the Poisson likelihood for the number of deaths and the times series models imposed on the time dependent parameters, we enable full allowance for parameter uncertainty and we are able to handle missing data as well as small sample populations. We compare and contrast results from both models to the results obtained with a frequentist single population approach and a least squares estimation of the augmented common factor model.
    Keywords: projected life tables, multi-population stochastic mortality models, Bayesian statistics, Poisson regression, one factor Lee & Carter model, two factor Lee & Carter model, Li & Lee model, augmented common factor model
    Date: 2015
  16. By: Diane Coffey; Michael Geruso; Dean Spears
    Abstract: Anemia impairs physical and cognitive development in children and reduces human capital accumulation. The prior economics literature has focused on the role of inadequate nutrition in causing anemia. This paper is the first to show that sanitation, a public good, significantly contributes to preventing anemia. We identify effects by exploiting rapid and differential improvement in sanitation across regions of Nepal between 2006 and 2011. Within regions over time, cohorts of children exposed to better community sanitation developed higher hemoglobin levels. Our results highlight a previously undocumented externality of open defecation, which is today practiced by over a billion people worldwide.
    JEL: I15 J1 O1
    Date: 2016–12
  17. By: Marcos A. Rangel; Tom Vogl
    Abstract: Fire has long served as a tool in agriculture, but this practice's human capital consequences have proved difficult to study. Drawing on data from satellites, air monitors, and vital records, we study how smoke from sugarcane harvest fires affects infant health in the Brazilian state that produces one-fifth of the world's sugarcane. Because fires track economic activity, we exploit wind for identification, finding that late-pregnancy exposure to upwind fires decreases birth weight, gestational length, and in utero survival, but not early neonatal survival. Other fires positively predict health, highlighting the importance of disentangling pollution from economic activities that drive it.
    JEL: H23 I15 O13 Q53
    Date: 2016–12

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