nep-hea New Economics Papers
on Health Economics
Issue of 2017‒01‒22
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Relationships between health data, BMI, basic medical skills: some insights from a 2016 Vietnamese medical survey By Quan-Hoang Vuong
  2. A Framework for Testing the Equality Between the Health Concentration Curve and the 45-Degree Line By Khaled, Mohamed; Makdissi, Paul; Tabri, Paul; Yazbeck, Myra
  3. Hyperbolic discounting can be good for your health By Strulik, Holger; Trimborn, Timo
  4. Dynamic Changes in Determinants of Inequalities in Health in Europe with Focus on Retired - with Particular Regard to Retired Danes By Christiansen, Terkel; Lauridsen, Jørgen T.
  5. Is there additional value attached to health gains at the end-of-life? A re-visit By Gyrd-Hansen, Dorte
  6. Measuring the Effect of the Polygenic Risk Score on the Aging Rate By Effraimidis, Georgios; Levine, Morgan; Crimmins, Eileen
  7. Assessing the Propensity for Presenteeism with Sickness Absence Data By Richard, Sébastien; Skagen, Kristian; Pedersen, Kjeld Møller; Huver, Benjamin
  8. Physician Response to Target-Based Performance Payment By Oxholm, Anne Sophie
  9. Traffic Safety and Human Capital By Richard Guy Cox; Darren Grant
  10. The value of mortality risk reductions. Pure altruism - a confounder? By Gyrd-Hansen, Dorte; Kjær, Trine; Nielsen, Jytte Seested
  11. Decomposing Inequality in Diabetes Patients' Morbidity Patterns, Survival and Health Care Usage in Denmark By Sortsø, Camilla; Lauridsen, Jørgen; Emneus, Martha; Green, Anders; Jensen, Peter Bjødstrup
  12. Historical Migration Flows and Global Health Differences By Andersen, Thomas Barnebeck; Dalgaard, Carl-Johan; Skovsgaard, Christian Volmar; Selaya, Pablo
  13. An investigation into procedure (in)variance in the valuation of mortality risk reductions By Kjær, Trine; Nielsen, Jytte Seested
  14. The role of sickness in the evaluation of job search assistance and sanctions By van den Berg, Gerard J.; Hofmann, Barbara; Uhlendorff, Arne
  15. E-Health Market Development in the Netherlands: An Analysis of App Developer Strategies and their Drivers By van Gorp, A.F.
  16. How Well Are We Measuring Military Mental Health? By Margaret C. Wilmoth; Lareina N. La Flair; Melissa Azur; Bonnie L. Norton; Matthew Sweeney; Thomas V. Williams
  17. The Effect of the 2009 Influenza Pandemic on Absence from Work By Duarte, Fabian; Kadiyala, Srikanth; Masters, Samuel H.; Powell, David
  18. The Irony of RH Law Critics' Opposition to Comprehensive Sex Education By Abrigo, Michael R.M.; Paqueo, Vicente B.
  19. Inequalities by immigrant status in unmet needs for healthcare in Europe: the role of origin, nationality and economic resources By Caterina Francesca Guidi; Laia Palència; Silvia Ferrini and Davide Malmusi
  20. Health-Damaging Inputs, Workers' Health Status and Productivity Measurement By Konstantinos Chatzimichael; Margarita Genius; Vangelis Tzouvelekas
  21. Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004–2010 By Aaron Reeves; Martin McKee; Johan P. Mackenbach; Margaret Whitehead; David Stuckler
  22. Determinants of utilisation differences for cancer medicines in Belgium, Scotland and Sweden By Alessandra Ferrario
  23. Inequalities in longevity by education in OECD countries: Insights from new OECD estimates By Fabrice Murtin; Johan Mackenbach; Domantas Jasilionis; Marco Mira d’Ercole
  24. People's preferences for epidemic prevention measures By Caroline Orset
  25. Impact of health and recreation on work-life balance: A case study of expatriates. By Naithani, Pranav
  26. Determinants of Obesity in Turkey: A Quantile Regression Analysis from a Developing Country By Karaoglan, Deniz; Tansel, Aysit
  27. Competition and hospital quality: Evidence from a French natural experiment By Gobillon, Laurent; Milcent, Carine

  1. By: Quan-Hoang Vuong
    Abstract: Does owning a medicine cabinet or having practical first-aid knowledge and skillsat home have any effects on people's attitude towards periodic health examinations (GHEs)? In this study, we analyzed a dataset consisting of 2,068 observations to point out differences in periodic health examinations-taking tendencies between those with and without a family medicine cabinet; as well as between those who know and do not know how to use basic medical equipment. In addition, the factors of age, gender, job and marital status were also documented in relation to body mass index (BMI): the BMI of a Vietnamese person is average by conventional standards (the mean BMI = 20.848, SD = 2.67, CI = 20.73-20.96), and is directly proportional to age (βage=0.019, P
    Keywords: Periodic general health examinations; Medicine Cabinet; Medical Tools; BMI
    JEL: I18
    Date: 2017–01–13
  2. By: Khaled, Mohamed; Makdissi, Paul; Tabri, Paul; Yazbeck, Myra
    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 Härdle and Mammen (1993) test for correct parametric regression functional form, and applies it to the National Health Survey 2014.
    Keywords: felony records, criminal justice, drug offenders, recidivism, labor market
    Date: 2016–12
  3. By: Strulik, Holger; Trimborn, Timo
    Abstract: It has been argued that hyperbolic discounting of future gains and losses leads to time-inconsistent behavior and thereby, in the context of health economics, not enough investment in health and too much indulgence of unhealthy consumption. Here, we challenge this view. We set up a life-cycle model of human aging and longevity in which individuals discount the future hyperbolically and make time-consistent decisions. This allows us to disentangle the role of discounting from the time consistency issue. We show that hyperbolically discounting individuals, under a reasonable normalization, invest more in their health than they would if they had a constant rate of time preference. Using a calibrated life-cycle model of human aging, we predict that the average U.S. American lives about 4 years longer with hyperbolic discounting than he would if he had applied a constant discount rate. The reason is that, under hyperbolic discounting, experiences in old age receive a relatively high weight in life time utility. In an extension we show that the introduction of health-dependent survival probability motivates an increasing discount rate for the elderly and, in the aggregate, a u-shaped pattern of the discount rate with respect to age.
    Keywords: discount rates,present bias,health behavior,aging,longevity
    JEL: D03 D11 D91 I10 I12
    Date: 2016
  4. By: Christiansen, Terkel (COHERE); Lauridsen, Jørgen T. (COHERE)
    Abstract: Earlier studies of health inequality across European countries have shown intriguing results, in particular with respect to retirement status as one of the determinants of health inequality. A priori, one would expect that inequality in health and income would be associated. Theory suggests that health deteriorates with age, in particular for low income groups. Moreover, as income declines after retirement, elderly people tend to rank lower in the relative income ranking. Consequently, retirement status, and in particular early retirement due to health problems, is expected to contribute to inequalities in income-related inequalities in health. The present paper contributes to previous knowledge by looking further into the contribution by retired Europeans to income-related inequalities in health and the development in this contribution over time. The study is based on data from the first and the fourth waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), including individuals born in 1954 or earlier (wave 1) and 1960 or earlier (wave 2) from 10 European countries. Income-related inequality in health is measured using the concentration index. A decomposition of the index into its determinants allows a calculation of the contribution of each determinant’s separate contribution to inequality in health. The results presented here indicate that retirement status contributes substantially to income-related inequality in health across European countries, and that the variation can be explained by income differences as well as health differences, depending on the country considered. Furthermore, it is indicated that the contribution from retirement status falls for certain countries due to improved socioeconomic status as well as improved health of the retired.
    Keywords: Health inequality; retirement; SHARE data
    JEL: I14 J26
    Date: 2016–10–01
  5. By: Gyrd-Hansen, Dorte (COHERE)
    Abstract: Researchers have in recent years sought to establish whether the general public value treatment at the end-of-life (EOL) more highly than other treatments. Results are mixed, with social preferences most often exhibiting lack of preferences for EOL treatments. This nul-result may be driven by the often applied study design, where respondents are to choose between treatments targeting patients with varying fixed life-expectancies. When remaining life is certain and salient, a rule-of-rescue sentiment may drive preferences across all scenarios. This study presents a different design, where the comparator is a preventive intervention. We study preferences from both an individual and social perspective, and find no preference for an EOL premium when age is held constant. We test the interaction between age and EOL treatment, and finder stronger preferences when patients face premature death.
    Keywords: Stated preferences; priority setting; end-of-life treatment
    JEL: D61 I13 I14 I28
    Date: 2017–01–16
  6. By: Effraimidis, Georgios (COHERE); Levine, Morgan (Department of Human Genetics); Crimmins, Eileen (USC Davis School of Gerontology)
    Abstract: Population aging has emerged as a major demographic trend around the globe. Aging is a process that is determined by millions of genetic factors. The identification of the set of genetic factors that has a significant role in the aging process is a highly challenging task. This paper studies the association between genetic factors and the aging rate. We first calculate the so-called polygenic risk score (PRS) by following a well-designed algorithm for the selection of the significant single nucleotide polymorphisms (SNPs) and subsequently considering a weighted sum of those significant SNPs. Next, we construct a new mortality model, which allows the aging rate to depend on the PRS. Our statistical analysis is based on a rich dataset from the Health and Retirement Study.
    Keywords: Aging rate; Genome-wide association study; Mortality rate; Polygenic risk score
    JEL: C14
    Date: 2016–09–18
  7. By: Richard, Sébastien (Department of Business and Economics); Skagen, Kristian (COHERE); Pedersen, Kjeld Møller (COHERE); Huver, Benjamin (Department of Business and Economics)
    Abstract: Presenteeism occurs when an employee attends work while sick or unwell. It is a major Human Resource and organizational issue: in addition to productivity losses, presenteeism is believed to increase sickness absence and decrease self-rated health. However, by its very nature, presenteeism cannot be monitored in the same manner as sickness absence. We show how the probability of presenteeism can be estimated from simple absence data by means of a zero-inflated binomial regression analysis (ZINB). The approach is validated on a Danish data set that contains self-reported sickness absence and presenteeism, whereas causality and reliability are verified by conducting Monte-Carlo simulations. The objective of paper was to explore how far the traditional but costly tool used to assess presenteeism behaviour, a questionnaire, could advantageously be replaced by a statistical approach that relies on easily available information on sickness. We show that the ZINB model captures presenteeism well via the inflation process and delivers insight on both absenteeism and presenteeism. Using Monte Carlo simulations, we further highlight that the model can be used to compute a global indicator, propensity for presenteeism, even when important assumptions are violated.
    Keywords: Presenteeism; sickness absence; ZINB
    JEL: I10 J22 J28
    Date: 2017–01–12
  8. By: Oxholm, Anne Sophie (COHERE)
    Abstract: In many health care systems payers reward physicians for reaching predetermined performance targets. These targets may be based on measures for which own performance is difficult to predict. This paper uses a principal-agent model to analyse physicians’ response to a target-based performance payment and the role uncertainty about own performance plays. It is shown that physicians’ response depends on their type (determined by abilities and preferences), the size of the performance payment, and their uncertainty about own performance. Only in the presence of uncertainty do all physician types respond to the target payment, and they respond by increasing effort. Meanwhile, increased uncertainty leads some physician types to reduce the magnitude of their response and other types to increase their response. Therefore, when designing target-based payment schemes it is important to perform baseline measurements to assess the distribution of physician types and to predict physicians’ ability to assess own performance.
    Keywords: Health care; Pay for performance; Target-based payment; Uncertainty
    JEL: C91 I11
    Date: 2016–11–01
  9. By: Richard Guy Cox (Department of Economics, Arizona State University); Darren Grant (Department of Economics and International Business, Sam Houston State University)
    Abstract: This paper documents a large educational gradient in traffic fatality rates and investigates its source. Compared to individuals with a college education, those with at most a high school diploma are more than four times as likely to die in a traffic accident, a gradient exceeding that for all-cause mortality. More educated individuals’ health behaviors, such as drinking or seat belt use, support this gradient. A panel analysis of data from the Fatality Analysis Reporting System indicates that this gradient is, to a small degree, causal, particularly for males, who cause most traffic accidents.
    Keywords: human capital; traffic safety
    JEL: I12 I26 R41
    Date: 2017–01
  10. By: Gyrd-Hansen, Dorte (COHERE); Kjær, Trine (COHERE); Nielsen, Jytte Seested (Newcastle University Business School)
    Abstract: This paper examines public valuations of mortality risk reductions. We set up a theoretical framework that allows for altruistic preferences, and subsequently test theoretical predictions through the design of a discrete choice experiment. By varying the tax scenario (uniform versus individual tax), the experimental design allows us to verify whether pure altruistic preferences are present and the underlying causes. We find evidence of negative pure altruism. Under a coercive uniform tax system respondents lower their willingness to pay possibly to ensure that they are not forcing others to pay at a level that corresponds to their own – higher – valuations. This hypothesis is supported by the observation that respondents perceive other individuals’ valuations to be lower than their own. Our results suggest that public valuations of mortality risk reductions may underestimate the true societal value because respondents are considering other individuals’ welfare, and wrongfully perceive other people’s valuations to be low.
    Keywords: Altruism; Risk reduction; Willingness-to-pay; Stated preferences
    JEL: D60 D70 I10
    Date: 2016–05–01
  11. By: Sortsø, Camilla (COHERE); Lauridsen, Jørgen (COHERE); Emneus, Martha (Institute of Applied Economics and Health Research (ApEHR)); Green, Anders (Odense Patient Data Explorative Network (OPEN)); Jensen, Peter Bjødstrup (Odense Patient Data Explorative Network (OPEN))
    Abstract: Measurement of socioeconomic inequalities in health and health care, and understanding the determinants of such inequalities, are critical for achieving higher equity in health care through targeted health intervention strategies. The aim of the paper is to quantify inequality in diabetes morbidity patterns, survival and health care service usage and understand determinants of these inequalities in relation to socio-demographic and clinical morbidity factors. Further, to compare income level and educational level as proxies for Socio Economic Status (SES). Data on the entire Danish diabetes population in 2011 were applied. Patients’ unique personal identification number enabled individual patient data from several national registers to be linked. Cox survival method and a concentration index decomposition approach are applied. Results indicate that lower socioeconomic status is associated with higher morbidity, mortality and lower survival. Differences in diabetes patients’ morbidity patterns, time of diagnosis and health state at diagnosis as well as health care utilization patterns suggest that despite the Danish universal health care system use of services differ among patients of lower and higher SES. Especially outpatient services, rehabilitation and specialists in primary care show different usage patterns according to SES. Comparison of educational level and income level as proxy for patients’ SES indicate important differences in inequality estimates. This is a result of reversed causality between diabetes morbidity and income as well as income related inequality to a higher extent being explained by morbidity.
    Keywords: Health inequality; diabetes; morbidity patterns; health care service usage; decomposition; socio-economic inequality
    JEL: I12 I14 I18
    Date: 2016–02–10
  12. By: Andersen, Thomas Barnebeck (Department of Business and Economics, and COHERE); Dalgaard, Carl-Johan (Department of Economics); Skovsgaard, Christian Volmar (Department of Business and Economics, and COHERE); Selaya, Pablo (Department of Economics)
    Abstract: In this study we provide evidence that historical migration flows impact present-day global health differences. The underlying theory is based on three physiological facts. First, vitamin D deficiency is directly associated with increased risk of premature death. Second, the ability of humans to synthesize vitamin D from sunlight (i.e., ultraviolet radiation, UV-R) declines with the level of skin pigmentation. Third, the level of human skin pigmentation is the result of an evolutionary compromise between the costs of pigmentation (e.g., higher risk of vitamin D deficiency) and its benefits (e.g., lower risk of skin cancer); people living in high UV-R regions, as a result, became more intensely pigmented. Accordingly, when individuals indigenous to high UV-R regions migrate to low UV-R regions the risk of vitamin D deficiency rises markedly, which should in turn impact average health in the recipient region. We develop an empirical measure that allows us to explore the aggregate consequences of local populations’ differential risk of vitamin D deficiency, as caused by historical migration flows. Our proposed measure of risk of vitamin D deficiency holds strong explanatory power vis-à-vis health outcomes in a world sample as well as across US states.
    Keywords: Health; vitamin D; ultraviolet radiation; skin pigmentation; migration
    JEL: I10 J10 J15
    Date: 2016–02–04
  13. By: Kjær, Trine (COHERE); Nielsen, Jytte Seested (Newcastle University Business School)
    Abstract: This study seeks to investigate whether elicited preferences are affected by the presentation of mortality risks in a stated preference survey. A three-way split sample discrete choice experiment was conducted in which respondents were asked to express their willingness-to-pay for public risk reducing initiatives under different but outcome equivalent representation formats. Our results demonstrate that respondents exhibit much stronger preferences for public life saving interventions when these are framed in terms of avoided fatalities compared to corresponding mortality risk reductions. Furthermore, we find that less numerate respondents are more susceptible to the inclusion of the number of fatalities in the representation format. The same pattern is observed for respondents who express a higher degree of concern for a traffic accident. In conclusion our findings may justify presenting both type of risk information in valuation of mortality risk reductions in public settings.
    Keywords: Discrete choice experiment; framing; mortality risk; procedure invariance; public policy; stated preferences; willingness-to-pay
    JEL: D60 J17
    Date: 2016–04–01
  14. By: van den Berg, Gerard J. (University of Bristol, IFAU Uppsala, IZA, ZEW, CEPR); Hofmann, Barbara (University of Mannheim, IAB Nuremberg); Uhlendorff, Arne (CNRS, CREST, IAB Nuremberg, DIW, IZA)
    Abstract: Unemployment insurance agencies may combat moral hazard by punishing refusals to apply to assigned vacancies. However, the possibility to report sick creates an additional moral hazard, since during sickness spells, minimum requirements on search behavior do not apply. This reduces the ex ante threat of sanctions. Based on a large inflow sample into unemployment of male job seekers in West Germany in the year 2000, we analyze the effects of vacancy referrals and sanctions on the unemployment duration and the quality of job matches, in conjunction with the possibility to report sick. We estimate multispell duration models with selection on unobserved characteristics. We find that a vacancy referral increases the transition rate into work and that such accepted jobs go along with lower wages. We also find a positive effect of a vacancy referral on the probability of reporting sick. This effect is smaller at high durations, which suggests that the relative attractiveness of vacancy referrals increases over the time spent in unemployment. In our setting, with relatively severe sanctions, around 9 percent of sickness absence during unemployment is induced by vacancy referrals.
    Keywords: unemployment; vacancy referrals; physician; wage; unemployment Insurance; monitoring; moral hazard
    JEL: C21 C41 J64 J65
    Date: 2017–01–10
  15. By: van Gorp, A.F.
    Date: 2016
  16. By: Margaret C. Wilmoth; Lareina N. La Flair; Melissa Azur; Bonnie L. Norton; Matthew Sweeney; Thomas V. Williams
    Abstract: This article discusses two common methodological challenges in efforts to accurately estimate the prevalence of military mental health conditions: (1) problems with measures used to assess psychological functioning and prevalence of mental health conditions in military populations and (2) the use of nonprobability-based sampling methods.
    Keywords: Military mental health, psychological functioning, nonprobability-based sampling methods
    JEL: I
  17. By: Duarte, Fabian; Kadiyala, Srikanth; Masters, Samuel H.; Powell, David
    Abstract: In July 2009, the WHO declared the first flu pandemic in nearly 40 years. Although the health effects of the pandemic have been studied, there is little research examining the labor productivity consequences. Using unique sick leave data from the Chilean private health insurance system, we estimate the effect of the pandemic on missed days of work. We estimate that the pandemic increased mean flu days missed by 0.042 days per person-month during the 2009 peak winter months (June and July), representing an 800% increase in missed days relative to the sample mean. Calculations using the estimated effect imply a minimum 0.2% reduction in Chile's labor supply.
    Date: 2016–12
  18. By: Abrigo, Michael R.M.; Paqueo, Vicente B.
    Abstract: Sex-related risks, early sexual experience, and unwanted pregnancies are major concerns of Filipinos. These issues have long been battle grounds for the often rancorous debates about the provisions of the Reproductive Health (RH) Law. In December 2012, Congress approved a comprehensive RH Law that guarantees universal access to services, including age-appropriate health and sexuality education in schools. Critics then raised a public health concern, saying that exposing children to reproductive health care, especially mandatory sexuality education, leads to earlier sexual initiation and higher rates of sexual activity among them. Using the 2008 National Demographic and Health Surveys, this paper analyzes how sex education relates with the sexual behavior of women 15-24 years old. Our analysis of sexual behaviors by young adult females in recent national surveys does not corroborate this claim. Ultimately, it is ironic that their future is being jeopardized by well-meaning opposition to the RH Law, which calls for keeping women better informed about sex-related risks, unwanted pregnancies, their consequences, and ways of avoiding them.
    Keywords: Philippines, health, reproductive health, sexuality education, Reproductive Health Law, sex-related risks
    Date: 2016
  19. By: Caterina Francesca Guidi; Laia Palència; Silvia Ferrini and Davide Malmusi
    Abstract: The aim of the research is to assess whether there are inequalities in unmet needs for health care between natives and migrants within Europe. We used cross-sectional data from the European Statistics on Income and Living Conditions 2012. Our dependent variables were perceived unmet needs for medical and dental examination or treatment. Our main independent variable is immigrant status, defined using a combination of country of birth and citizenship (nationals born in the country of residence, reference; European Union-born nationals; non-EU born nationals; EU-born foreigners; non EU-born foreigners). The prevalence ratios of unmet needs according to immigrant status are obtained through sex-stratified robust Poisson regression models, sequentially adjusted by age, health status and socio-economic characteristics.The prevalence of medical unmet needs, adjusted by age and health status, is higher in foreign women, both EU-born and non-EU born, but it is no longer significant after the socioeconomic adjustment. For dental unmet needs, the risk is significantly higher for all foreigners, EU and non EU-born, men and women. Once adjusted for socioeconomic variables significant inequalities persist, although diminished, for both EU-born and non-EU-born foreign men and EU-born foreign women.This study contributes to the discussion of adequate access to healthcare systems and adaptation of services for migrants. While inequalities cannot be detected for naturalised immigrants, the higher risk of unmet need affecting foreigners, even within the EU, deserves further attention.
    Keywords: Unmet needs, health inequalities, migrant health, Europe
    Date: 2016–10
  20. By: Konstantinos Chatzimichael; Margarita Genius (Department of Economics, University of Crete, Greece); Vangelis Tzouvelekas (Department of Economics, University of Crete, Greece)
    Abstract: Since the seminal papers of Schultz (1961) and Becker (1962), a vast literature emerged analyzing the role of human capital on productivity growth rate. Using Griliches (1963, 1964) and Mincer (1974) theoretical developments, empirical research at a micro level concluded that indeed improvements in human capital account for significant gains in observed productivity rates among individual firms (e.g., Bartel and Lichtenberg,1987; Katz and Murphy, 1992). At the same time studies based on the endogenous growth model of Lucas (1988) and Romer (1986) attributed significant productivity improvements to human capital accumulation for a broad set of countries around the world (e.g., Hall and Jones, 1999; Bils and Klenow, 2000). A common ground throughout this literature, is that human capital is mainly determined by two factors: worker's educational level and health status. The intuition behind this assertion is simple. Formal or informal education decreases the marginal cost of acquiring production related information and the benefit of such information improves the allocative ability of firm workers. On the other hand, improved health status enhance workers' (skilled and unskilled) productivity by increasing their physical capacities, such as strength and endurance, as well as their mental capacities, such as cognitive functioning and reasoning ability. Another common feature of these empirical studies, is that they all assume that workers' health status is determined exogenously. Regardless the choice of variables used to proxy individual health status, this is assumed to be independent of working environment and production decisions made within the firm. The majority of empirical work commonly hypothesizes a strong relationship between nutritional intakes and wages to examine the effects of health on labor productivity mainly in rural areas in both developed and developing countries (Bliss and Stern, 1978; Deolalikar, 1988; Croppenstedt and Muller, 2000). A set of wage function estimates provides solid evidence that higher nutrition leads to increased productivity rates. This nutrition-productivity hypothesis is further confirmed by production function approaches using instrumental variables to correct for simultaneous equation bias (Strauss, 1986). Using different proxies for workers' health status, more recent micro-level research verifies the positive relationship between health variables and productivity for both skilled and unskilled workers (Strauss and Thomas, 1998; Schultz, 2002). However, empirical evidence worldwide rather suggests the opposite. In many sectors (if not all) workers' health status is not irrelevant to the workplace conditions and individual firm decisions. Evidence from medical studies indicates that health impairments account for 12-28 per cent productivity losses in construction sector (Meerding et al., 2005), while the relative figure in Information and Communications Technology (ICT) industry is 15 per cent (Hagberg et al., 2002). Further, according to the International Labour Organization (ILO), every year 160 billion workers suffer globally from illnesses due to work-related causes, while the relative total cost of these diseases accounts for approximately 4 per cent of world's GDP. According to a recent study by Eurostat (2010), about 8.6 per cent of the workers in the EU-27 face at least one work-related health problem in a period of 12 months, while the total time of lost work due to work-specific health impairments is approximately 367 million calendar days. There are two ways that workplace conditions are affecting workers' health status. First, the nature of working activities involved in firm production (e.g., construction sector) and second, the technological conditions that require the use of specific inputs that are at the same time hazardous for firm workers. Ensuring strict safety standards in a construction site (such as the height of handrails, shoring of trenches, and safe handling procedures) may reduce the adverse effects in workers health status from a potential accident. This is an instantaneous decision made by the firm (mostly imposed by the regulatory framework) and it's impact on individual productivity rates depends on the incidence of work accidents in the future. In terms of productivity improvements though, it is more important to analyze workers' health status when firms utilize specific inputs in their production process that are at the same time (directly or indirectly) harmful for individual workers, i.e., health-damaging inputs. This type of inputs entails a trade-off between firm production and workers' health status. This is particularly acute for hazards that do not have an immediate and recognizable effect. For instance pesticides materials in crop production, chemical substances in many manufacturing sectors, plastic or paint manufacturing, are all cases where health-damaging inputs are extensively used by firms posing serious health risks for their employees. In these sectors, workers seldom have perfect information about the health implications of their jobs and the use of this specific type of inputs. For many hazards, the true probabilities of being killed or getting ill are not known by anyone. Due to the retarded state of occupational medicine, even the underlying medical ramifications of different exposures to aspects of the workplace such as radiation, noise, high temperatures, and chemical vapors are little understood. This uncertainty is compounded by uncertainty with regard to the characteristics of the work situation, for example, the concentration of asbestos fibers in the air. Hence, in many instances safety application rules are not always followed by individual workers due either to improper firm management or lack of individual knowledge. Although the social cost of such health impairments might not be of the interest of the firms, the associated reductions in effective labor do matter for them since such reductions are accompanied by lower productivity rates. Hence, measuring the indirect effect of health-damaging inputs, through human capital deterioration, may indirectly enforce safety standards in working environments. If these productivity losses are important for individual firms, then indeed improving workers' knowledge or applying more effective management practices would result to significant gains for them. Along these lines, this paper contributes to the relevant literature by suggesting a theoretically consistent framework to analyze both the direct and the indirect effect of health-damaging inputs on total factor productivity growth. The decomposition framework is based on a primal approach requiring no assumptions about the structure of labor markets. It is applied to a panel of greenhouse producers from Western Crete, Greece observed during the 2003-07 cropping period. Due to the extensive use of chemical pesticides, farming is a particularly interesting example for measuring the adverse effects of health-damaging inputs on individual productivity rates. For measuring employees' health status, individual health indices are estimated using recently developed generalized propensity score (GPS) methods in a continuous treatment setting (Hirano and Imbens, 2004). To our knowledge this is the first attempt to construct an index of workers' health status that is endogenously determined, enabling the analysis of both direct and indirect effects of health damaging inputs on individual total factor productivity growth rates. Our empirical results may contribute to the ongoing debate for improving working conditions and reducing work-specific health impairments in many sectors.
    Keywords: Health-damaging inputs, Workers' health index, TFP growth, Greenhouse farms
    JEL: I12 I30 Q12 D24
    Date: 2017–01–11
  21. By: Aaron Reeves; Martin McKee; Johan P. Mackenbach; Margaret Whitehead; David Stuckler
    Abstract: Background Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. Methods We integrated panel data on 16 European countries for years 2004–2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. Results We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI −0.55 to −1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI −1.19 to −2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=−1.21 percentage points, 95% CI −0.37 to −2.06). Conclusions Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments.
    JEL: N0
    Date: 2016–12–13
  22. By: Alessandra Ferrario
    Abstract: Background Little comparative evidence is available on utilisation of cancer medicines in different countries and its determinants. The aim of this study was to develop a statistical model to test the correlation between utilisation and possible determinants in selected European countries. Methods A sample of 31 medicines for cancer treatment that obtained EU-wide marketing authorisation between 2000 and 2012 was selected. Annual data on medicines’ utilisation covering the in- and out-patient public sectors were obtained from national authorities between 2008 and 2013. Possible determinants of utilisation were extracted from HTA reports and complemented by contacts with key informants. A longitudinal mixed effect model was fitted to test possible determinants of medicines utilisation in Belgium, Scotland and Sweden. Results In the all-country model, the number of indications reimbursed positively correlated with increased consumption of medicines [one indication 2.6, 95% CI (1.8–3.6); two indications 2.4, 95% CI (1.4–4.3); three indications 4.9, 95% CI (2.2–10.9); all P
    Keywords: Medicines utilisation Multilevel mixedeffects data models Oncology Managed entry agreements Pharmaceutical policy
    JEL: I11
    Date: 2016–12–09
  23. By: Fabrice Murtin; Johan Mackenbach (Erasmus University Rotterdam); Domantas Jasilionis; Marco Mira d’Ercole
    Abstract: This paper assesses inequality in longevity across education and gender groups in 23 OECD countries around 2011. Data on mortality rates by age, gender, educationals attainment and for, 17 countries, cause of death, were collected from national sources, with similar treatment applied to all countries in order to derive comparable measures of longevity at age 25 and 65 by gender and education. These estimates show that, on average, the gap in life expectancy between high and low-educationed people is 8 years for men and 5 years for women at age 25 years, and 3.5 years for men and 2.5 years for women at age 65. Other measures of inequalities in longevity by education (such as country averages of age-standardised mortality rates and the slope index of inequality) do not significantly change the inequality ranking of countries relative to one based on life expectancy measures. While significant, differences in longevity between groups with low and high educational attainment account, on average, for around 10% of overall differences in ages of death. Cardio-vascular diseases are the first cause of death for all gender and education groups after age 65 years, and the first cause of mortality inequality between the high and low-education elderly. Ce document estime les inégalités de longévité par genre et niveaux d’éducation pour 23 pays de l’OCDE aux alentours de 2011. Des données de taux de mortalité par âge, sexe, éducation et, pour 17 pays, par cause de mortalité, ont été collectées à partir de sources statistiques nationales. Un traitement identique a été appliqué à toutes ces données afin d'obtenir des mesures comparables de longévité à 25 et 65 ans par sexe et niveau d’éducation. Ces estimations montrent que, en moyenne, les différences d’espérance de vie à 25 ans entre les personnes à haut et faible niveaux d’éducation sont de 8 ans pour les hommes et de 5 ans pour les femmes, alors que ces différences sont de 3.5 ans pour les hommes et de 2.5 ans pour les femmes à l’âge de 65 ans. D'autres mesures d’inégalité de longévité par niveau d’éducation (tels que les taux moyens de mortalité standardisés ou les indices de pente d’inégalité) fournissent globalement le même classement de pays en termes d’inégalité, par rapport aux indices basés sur l’espérance de vie. Toutefois les différences de longévité entre haut et faible niveaux d’éducation expliquent seulement 10% des differences d’âge à la mort parmi les personnes. Les maladies cardio-vasculaires sont la première cause de mortalité pour tous les groupes d’éducation et de genre après 65 ans, et la première cause d’inégalité de mortalité entre les seniors à haut et faible niveaux d’éducation.
    Keywords: cause of death, health, inequality, life expectancy, longevity, mortality, socioeconomic gradient
    JEL: I14 I18
    Date: 2017–01–14
  24. By: Caroline Orset
    Abstract: Due to its rapid spread and the delay in the discovery of drugs or vaccines to treat it, the epidemic can cause millions of deaths worldwide. Prevention measures are therefore an explicit objective of public health policy. We develop a questionnaire that allows us to analyze people's preferences for different prevention measures classified by epidemic severity. Failure to comply with the recommended prevention measures is both dangerous to the health of the population and economically costly to society. We see that part of our panel is willing to comply voluntarily with the recommended prevention measures. We show that the revelation of peo- ple's preferences allows us to determine the individual intangible (psychological) cost for prevention measures. This cost causes the individual not to voluntarily comply with prevention measures. We then propose government interventions to reduce intangible costs and motivate the individual to implement the recommended prevention measures. However, where these incentives fail, mandatory measures are an alternative.
    Keywords: Epidemic, Intangible cost, Prevention measures, Public health interventions
    JEL: I12 I18
    Date: 2017–01–19
  25. By: Naithani, Pranav
    Abstract: Factors influencing work-life balance are evolving at a very fast pace, thus creating a fecund ground for innovative work-life balance tools and techniques. The increasing significance of expatriates in the global workforce necessitates a targeted set of work-life balance initiatives to help expatriate workers contribute more effectively in the competitive work environment. Health and recreation are the two important life spheres which play a very important role in success or failure of an expatriate assignment. While work-life balance researches are being conducted globally in plenty, yet research on expatriate adjustment and expatriate work-life balance is still in its nascent stage especially in an expatriate dominated work environment in the Gulf Cooperation Council (GCC) countries. This research paper investigates the health and recreation spheres of expatriate academicians working in private higher education institutes in Bahrain, Oman and the UAE. The research paper illustrates and evaluates the health and recreation spheres in relation to the demographic factors of the respondents and suggests ways to improve work-life balance of expatriate employees.
    Keywords: Work-life balance, work-life conflict, expatriate adjustment, college teacher, middle-east.
    JEL: A3 I0 I00 I2 I23 I28 I3 I30 I38 J00 J6 L0 L00 M0 M00 Y8
    Date: 2016
  26. By: Karaoglan, Deniz; Tansel, Aysit
    Abstract: This study investigates the factors that may influence the obesity in Turkey which is a developing country by implementing Quantile Regression (QR) methodology. The control factors that we consider are education, labor market outcomes, household income, age, gender, region and marital status. The analysis is conducted by using the 2008, 2010 and 2012 waves of the Turkish Health Survey (THS) prepared by the Turkish Statistical Institute (TURKSTAT). The obesity indicator in our study is the individual’s Body Mass Index (BMI). QR regression results provide robust evidence that additional years of schooling has negative effect on individual’s BMI and this effect significantly raises across different quantiles of BMI. QR results also indicate that males tend to have higher BMI at lower quantiles of BMI, whereas females have higher BMI at the top quantiles. This implies that females have higher tendency to be obese in Turkey. Our findings also imply that the positive effect of age on individual’s BMI levels raises across the quantiles at a decreasing rate. In addition, the effect of living in urban or rural areas do not significantly differ at the highest quantile distributions of BMI. Our results also reveal that the negative effect of being single on BMI increases gradually in absolute value across the quantiles of BMI implying that single individuals have less tendency to be obese or overweight compared to the married or widowed/divorced individuals. Moreover, the negative effect of being in labor force on individual’s BMI increases across the quantiles of BMI implying that an individual is more likely to be obese if he/she is out of labor force. Finally, the impact of household income on BMI is positive and significant at all quantiles.
    Keywords: Obesity, adults, BMI, quantile regression, Turkey
    JEL: C21 I12 I18
    Date: 2017–01–16
  27. By: Gobillon, Laurent; Milcent, Carine
    Abstract: We evaluate the effect of a pro-competition reform gradually introduced in France over the 2004-2008 period on hospital quality measured with the mortality of heart-attack patients. Our analysis distinguishes between hospitals depending on their status: public (university or non-teaching), non-profit or for-profit. These hospitals differ in their degree of managerial and financial autonomy as well as their reimbursement systems and incentives for competition before the reform, but they are all under a DRG-based payment system after the reform. For each hospital status, we assess the benefits of local competition in terms of decrease in mortality after the reform. We estimate a duration model for mortality stratified at the hospital level to take into account hospital unobserved heterogeneity and censorship in the duration of stays in a flexible way. Estimations are conducted using an exhaustive dataset at the patient level over the 1999-2011 period. We find that non-profit hospitals, which have managerial autonomy and no incentive for competition before the reform, enjoyed larger declines in mortality in places where there is greater competition than in less competitive markets.
    Keywords: Competition; heart attack; hospital ownership; policy evaluation
    JEL: I11 I18
    Date: 2017–01

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