nep-hea New Economics Papers
on Health Economics
Issue of 2017‒02‒05
thirty-one papers chosen by
Yong Yin
SUNY at Buffalo

  1. The lasting health and income effects of public health formation in Sweden By Lazuka, Volha
  2. Motivation and Competition in Health Care By Anthony Scott; Peter Sivey
  3. A Standardized Method for the Evaluation of Adherence to Practice Guidelines By Stephanie Thomas
  4. To prevent abortions, many states have cut funding for women’s health, reducing access, including to preventive care. Merging BRFSS data with clinic locations from a network of women’s health clinics, this paper estimates the relative impact of an increase in the driving distance to the nearest clinic on preventive care. For Hispanics women, a 100-mile increase decreases the rates of clinical breast exams by 23%, Pap tests by 16% and checkups by 14%. For non-Hispanics, there are no statistically significant results. By David J.G. Slusky
  5. Determinants of Obesity in Turkey: A Quantile Regression Analysis from a Developing Country By Deniz Karaoglan; Aysit Tansel
  6. Why Is the Practice of Levirate Marriage Disappearing in Africa? HIV/AIDS as an Agent of Institutional Change By Kudo, Yuya
  7. Physician ethics: undermined or enhanced by modes of payment? By Zweifel, Peter; Janus, Katharina
  8. Determinants of CD4 Immune Recovery Among Individuals on Antiretroviral Therapy in South Africa By World Bank
  9. Evaluating Willingness to Pay as a Measure of the Impact of Dyslexia in Adults By Herrera, Daniel; Shaywitz, Bennett; Holahan, John; Marchione, Karen; Michaels, Reissa; Shaywitz, Sally; Hammitt, James
  10. Not for everyone: Personality, mental health, and the use of online social networks By Howley, P.; Boyce, C.;
  11. How we fall apart: Similarities of human aging in 10 European countries By Abeliansky, Ana Lucia; Strulik, Holger
  12. The Dutch Healthcare System in International Perspective By Mikkers, Misja
  13. The economics in 'Global Health 2035': a sensitivity analysis of the value of a life year estimates. By Chang, Angela.Y; Hammitt, James; Resch, S.C; Robinson, Lisa
  14. Valuing Non-fatal Health Risks: Monetary and Health-Utility Measures By Hammitt, James
  15. Cost-sharing in health insurance and its impact in a developing country– Evidence from a quasi-natural experiment By Nguyen, Ha; Connelly, Luke B.
  16. Adult Health Outcomes during War: The Case of Afghanistan By Parlow, Anton
  17. Japan's Long-term Care Insurance after 15 Years: Shall we return to the welfare program system or keep pursuing market mechanisms? (Japanese) By SUZUKI Wataru
  18. To 'Vape' or Smoke? A Discrete Choice Experiment among Adult Smokers By Marti, Joachim; Buckell, John; Maclean, J. Catherine; Sindelar, Jody L.
  19. Causes and Consequences of Fragmented Care Delivery: Theory, Evidence, and Public Policy By Leila Agha; Brigham Frandsen; James B. Rebitzer
  20. Building the Evidence Base for Tele-Emergency Care: Efforts to Identify a Standardized Set of Outcome Measures By Yael Harris; Boyd Gilman; Marcia M. Ward; Jonathan Ladinsky; Jacqueline Crowley; Cannon Warren; Craig Caplan
  21. An Examination of Hospital Nurse Staffing and Patient Experience with Care: Differences between Cross-Sectional and Longitudinal Estimates By Grant R. Martsolf; Teresa B. Gibson; Richele Benevent; H. Joanna Jiang; Carol Stocks; Emily D. Ehrlich; Ryan Kandrack; David I. Auerbach
  22. Professional Development Tools to Improve the Quality of Infant and Toddler Care: A Review of the Literature (Snapshot) By Nikki Aikens; Lauren Akers; Sally Atkins-Burnett
  23. Is American Health Care Uniquely Inefficient? Evidence from Prescription Drugs By Margaret Kyle; Heidi L. Williams
  24. Final Impacts of the POWER Through Choices Program By Reginald D. Covington; Brian Goesling; Christina Clark Tuttle; Molly Crofton; Jennifer Manlove; Roy F. Oman; Sara Vesely
  25. Educational gain in cause-specific mortality: accounting for confounders By Govert E. Bijwaard; Mikko Myrskylä; Per Tynelius; Finn Rasmussen
  26. Do Minimum Wage Increases Influence Worker Health? By Horn, Brady P.; Maclean, J. Catherine; Strain, Michael R.
  27. Social Networks and Mental Health Problems: Evidence from Rural-to-Urban Migrants in China By Meng, Xin; Xue, Sen
  28. Competition and Hospital Quality: Evidence from a French Natural Experiment By Gobillon, Laurent; Milcent, Carine
  29. Early Cannabis Use and School to Work Transition of Young Men By Williams, Jenny; van Ours, Jan C.
  30. Health Insurance Expansions and Provider Behavior: Evidence from Substance Use Disorder Providers By Maclean, J. Catherine; Popovici, Ioana; Stern, Elisheva Rachel
  31. Joint Lifetime Financial, Work and Health Decisions: Thrifty and Healthy Enough for the Long Run? By Yannis Mesquida; Pascal St-Amour

  1. By: Lazuka, Volha (Department of Economic History, Lund University)
    Abstract: Socio-economic inequalities are remarkable in contemporary developed countries and continue to grow. The sources of these phenomena are not understood, and there is no agreement as to when in an individual’s life they originate, from early childhood to adulthood. The literature showing that health in infancy may be an important factor in later-life health and income trajectories is expanding, but empirical evidence is still scarce. This paper is the first to link differences in individual access to better health care during infancy to income and health outcomes in old age. Due to the public health care reform that became one of the first elements of the Swedish welfare state, between 1890 and 1917, all rural areas established local health districts that implemented preventive measures with regard to the spread of infectious diseases. Using administrative longitudinal population data and exploiting exogenous variation in the timing of the implementation of the reform across parishes, we examine whether individuals treated in their infancy have an advantage in old age. Our findings indicate that treatment in the public health care system in infancy leads to a significant reduction in mortality, with the largest effects on cardiovascular diseases and to an increase in individual permanent incomes. The effects are universal across different subpopulations, with somewhat stronger responses among individuals from poor socio-economic backgrounds.
    Keywords: Sweden; Life-course; Reform; Early-life; Health District; Mortality; Income
    JEL: I14 I15 I38 J26
    Date: 2017–01–27
  2. By: Anthony Scott (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Peter Sivey (School of Economics, Finance and Marketing, RMIT University)
    Abstract: Non-pecuniary sources of motivation are a strong feature of the health care sector and the impact of competitive incentives may be lower where pecuniary motivation is low. We test this hypothesis by measuring the marginal utility of income of physicians from a stated-choice experiment, and examining whether this measure influences the response of physicians to changes in competition on prices charged. We find that physicians exploit a lack of competition with higher prices only if they have a high marginal utility of income.
    Keywords: FDoctors, incentives, competition, motivation
    JEL: I11
    Date: 2017–01
  3. By: Stephanie Thomas
    Abstract: Practice guidelines are widely used in medical settings as a means of improving efficiency and quality of care by aligning service provision with evidence of what is effective. The objective of this work is to propose a methodology for the effective evaluation of the match of clinical practice data with a practice guideline. The proposed methodology uses a combination of existing analytical techniques which minimize the need for the analyst to specify a functional form for the process generating the clinical data. The methodology is illustrated in an application to a set of field data on the supplemental oxygen administration decisions of volunteer medical first responders. The result is a methodology for evaluation of guideline adherence which leverages existing patient care records and is generalizable across clinical contexts. In addition, the results are visually intuitive, supporting communication across diverse audiences.
    Keywords: adherence to guidelines, health care utilization, performance evaluation, medical first responders
    JEL: C12 C18 C52 I1 I18
    Date: 2016–10
  4. By: David J.G. Slusky (Department of Economics, The University of Kansas;)
    Keywords: Women’s Health, Preventive Care, Ethnicity
    JEL: H75 I18 J13
    Date: 2017–01
  5. By: Deniz Karaoglan (Bahcesehir University, Department of Economics); Aysit Tansel (Middle East Technical University, IZA Bonn, ERF, Cairo)
    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 all quantiles.
    Keywords: Obesity, adults, BMI, quantile regression, Turkey
    JEL: I12 I18 C21
    Date: 2017–02
  6. By: Kudo, Yuya
    Abstract: Levirate marriage, whereby a widow is inherited by male relatives of her deceased husband, has anecdotally been viewed as informal insurance for widows who have limited property rights. This study investigates why this widespread practice in sub-Saharan Africa has recently been disappearing. A developed game-theoretic analysis reveals that levirate marriage arises as a pure strategy subgame perfect equilibrium when a husband's clan desires to keep children of the deceased within its extended family and widows have limited independent livelihood means. Female empowerment renders levirate marriage redundant because it increases widows' reservation utility. HIV/AIDS also discourages a husband's clan from inheriting a widow who loses her husband to HIV/AIDS, reducing her remarriage prospects and thus, reservation utility because she is likely to be HIV positive. Consequently, widows' welfare tends to decline (increase) in step with the deterioration of levirate marriage driven by HIV/AIDS (female empowerment). By exploiting long-term household panel data drawn from rural Tanzania and testing multiple theoretical predictions relevant to widows' welfare and women's fertility, this study finds that HIV/AIDS is primarily responsible for the deterioration of levirate marriage. Young widows in Africa may need some form of social protection against the influence of HIV/AIDS.
    Keywords: Women welfare, Social customs, Marriage, Diseases, Tanzania, Female empowerment, HIV/AIDS, Informal insurance, levirate marriage, Social institution, Widowhood protection
    JEL: J12 J13 J16 Z13
    Date: 2017–01
  7. By: Zweifel, Peter; Janus, Katharina
    Abstract: Background: In the medical literature ((Begley (1987), Gervais et al. (1999), American Academy of Dermatology (2000)), the view prevails that any change away from fee-for-service (FFS) jeopardizes medical ethics, defined as motivational preference in this article. The objective of this contribution is to test this hypothesis by first developing two theoretical models of behavior, building on the pioneering works of Ellis and McGuire (1986) and Pauly and Redisch (1973). Medical ethics is reflected by a parameter α which indicates how much importance the physician attributes to patient well-being relative to his or her own income. Accordingly, a weakening of ethical orientation amounts to a fall in the value of α. While economic theory traditionally takes preferences as predetermined, such a change is possible in the light of Evolutionary Economics (Bolle, 2000). Methods: The model based on Ellis and McGuire (1986) depicts the behavior of a physician in private practice, while the one based on Pauly and Redisch (1973) applies to providers who share resources such as in hospital or group practice. Two changes in the mode of payment are analyzed, one from FFS to prospective payment (PP), the other, to pay-for-performance (P4P). One set of predictions relates physician effort to a change in the mode of payment; another, physician effort to a change in α, the parameter reflecting ethics. Using these two relationships, a change in ethics can observationally be related to a change in the mode of payment. The predictions derived from the models are pitted against several case studies from diverse countries. Results: A shift from FFS to PP is predicted to give rise to a negative observed relationship between medical ethics of physicians in private practice under a wide variety of circumstances, more so than a shift to P4P, which can even be seen as enhancing medical ethics provided physician effort has a sufficiently high marginal effectiveness in terms of patient well-being. This prediction is confirmed to a considerable degree by circumstantial evidence coming from the case studies. As to physicians working in hospital or group practice, the prediction is again that an observer will infer that a transition in hospital payment from FFS to PP weakens their ethical orientation. However, this prediction is not fully borne out; a likely reason is that hospitals also differ strongly in terms of their organizational culture, a factor that is not held constant in the case studies. A transition to P4P may lead observers to conclude that it actually enhances medical ethics of healthcare providers working in hospital or group practice. This prediction receives a degree of empirical support from the case studies. Conclusion: The claim that moving away from FFS undermines medical ethics is far too sweeping. It can only in part be justified by observed relationships, which even may suggest that a transition to P4P strengthens medical ethics.
    JEL: I11 J44 D64
    Date: 2016
  8. By: World Bank
    Keywords: Health, Nutrition and Population - HIV AIDS Health, Nutrition and Population - Health Monitoring & Evaluation
    Date: 2016–02
  9. By: Herrera, Daniel; Shaywitz, Bennett; Holahan, John; Marchione, Karen; Michaels, Reissa; Shaywitz, Sally; Hammitt, James
    Abstract: While much is known about dyslexia in school-age children and adolescents, less is known about its effects on quality of life in adults. Using data from the Connecticut Longitudinal Study we provide the first estimates of the monetary value of improving reading, speaking, and cognitive skills to dyslexic and non-dyslexic adults. Using a stated-preference survey, we find that dyslexic and non-dyslexic individuals value improvements in their skills in reading speed, reading aloud, pronunciation, memory, and information retrieval at about the same rate. Because dyslexics have lower self-reported levels on these skills, their total willingness to pay to achieve a high level of skill is substantially greater than for non-dyslexics. However, dyslexic individuals’ willingness to pay (averaging $3000 for an improvement in all skills simultaneously) is small compared with the difference in earnings between dyslexic and non-dyslexic adults. We estimate that dyslexic individuals earn 15 percent less per year (about $8000) than non-dyslexic individuals. Although improvements in reading, speaking and cognitive skills in adulthood are unlikely to eliminate the earnings difference that reflects differences in educational attainment and other factors, stated-preference estimates of the value of cognitive skills may substantially underestimate the value derived from effects on lifetime earnings and health.
    Keywords: Dyslexia, contingent valuation, willingness to pay, reading
    JEL: D03 D12 L13 L22 L81
    Date: 2017–01
  10. By: Howley, P.; Boyce, C.;
    Abstract: Much previous research has examined the relationship between online socialising and mental health, but conclusions are mixed and often contradictory. In this present paper we unpack the online social networking - mental health relationship by examining to what extent the relationship between these variables is personality-specific. Consistent with the idea that communicating through the internet is fundamentally different from face-to-face socializing, we find that on average, use of social networking web-sites is negatively associated with mental health. However, we find that the mental health response is dependent upon an individual’s underlying personality traits. Specifically, individuals who are either relatively extraverted or agreeable are not substantively affected from spending significant amounts of time on social networking web-sites. On the other hand, individuals who are relatively more neurotic or conscientiousness are much more likely to experience substantive reductions in their mental health from using social networking web-sites. We suggest that if the aim of public policy is to mitigate the adverse mental health effects from excessive internet use, then one-size-fits all measures will likely be misplaced. More generally, our research highlights the importance of conducting differentiated analyses of internet users when examining the health effects from internet use.
    Keywords: personality traits; psychological health; internet; social interaction;
    JEL: I10
    Date: 2017–01
  11. By: Abeliansky, Ana Lucia; Strulik, Holger
    Abstract: We analyze human aging, understood as health deficit accumulation, for a panel of European individuals. For that purpose, we use four waves of the Survey of Health, Aging and Retirement in Europe (SHARE dataset) and construct a health deficit index. Results from log-linear regressions suggest that, on average, elderly European men and women develop about 2.5 percent more health deficits from one birthday to the next. In non-linear regression (akin to the Gompertz-Makeham model), however, we find much greater rates of aging and large differences between men and women as well as between countries. Interestingly, these differences follow a particular regularity (akin to the compensation effect of mortality). They suggest an age at which average health deficits converge for men and women and across countries.
    Keywords: health,aging,health deficit index,Europe,gender differences,compensation law,human life span
    JEL: I10 I19
    Date: 2017
  12. By: Mikkers, Misja (Tilburg University, School of Economics and Management)
    Abstract: In this address, important aspects of the Dutch system of managed competition are discussed from the economic perspective, highlighting both its merits and the major challenges posed by the development of this system. Reasons for government intervention in healthcare markets are provided, and the outline the different types of healthcare systems are sketched. Followed by a description of the Dutch healthcare system and healthcare outcomes in different countries are compared. The inaugural address concludes with some suggestions for improving the Dutch system.
    Date: 2016
  13. By: Chang, Angela.Y; Hammitt, James; Resch, S.C; Robinson, Lisa
    Abstract: In “Global health 2035: a world converging within a generation,” The Lancet Commission on Investing in Health (CIH) adds the value of increased life expectancy to the value of growth in gross domestic product (GDP) when assessing national well-being. To value changes in life expectancy, the CIH relies on several strong assumptions to bridge gaps in the empirical research. It finds that the value of a life year (VLY) averages 2.3 times GDP per capita for low- and middle-income countries (LMICs) assuming the changes in life expectancy they experienced from 2000 to 2011 are permanent. We investigate the sensitivity of this estimate to the underlying assumptions, including the effects of income, age, and life expectancy, and the sequencing of the calculations. We find that reasonable alternative assumptions regarding the effects of income, age, and life expectancy may reduce the VLY estimates to 0.2 to 2.1 times GDP per capita for LMICs. Removing the reduction for young children increases the VLY, while reversing the sequencing of the calculations reduces the VLY
    Date: 2017–01
  14. By: Hammitt, James
    Abstract: Metrics for valuing environmental, health, and safety policies should be consistent with both the preferences of affected individuals and social preferences for distribution of health risks in the population. Two classes of metrics are widely used: monetary measures (e.g., willingness to pay) and health-utility measures (e.g., quality-adjusted life years (QALYs), disability-adjusted life years (DALYs)), both of which are summed across the population. Health-utility measures impose more structure than monetary measures, with the result that individuals’ preferences often appear inconsistent with these measures; for the same reason, health-utility measures help protect against cognitive errors and other sources of incoherence in valuation. This paper presents theoretical and empirical evidence comparing these metrics and examining how they co-vary.
    JEL: D6 L1 Q51
    Date: 2017–01
  15. By: Nguyen, Ha; Connelly, Luke B.
    Abstract: Though the impact of cost-sharing on health care demand is well documented in developed countries, evidence from developing countries is rare. This paper’s contribution is to analyse the impact of increasing coinsurance in a developing nation -Vietnam – by exploiting a quasi-natural experiment in that country. In 2007, the Vietnam government reintroduced a 20 percent coinsurance for individuals who hold voluntary health insurance policies. As individuals with compulsory health insurance were exempt from this re-imposition of coinsurance, this policy change may be regarded as a quasi-natural experiment. To exploit this change, we use a difference-in-difference approach to examine whether the increase in coinsurance effectively reduced the demand for health care services among those affected. We find it has no statistically significant effect on the quantity of health care demanded. We however find that those who were under 18 or in low income households reduced their health care use after the increase in coinsurance. These findings hold – at least in the short-run, with a variety of different outcomes and estimators.
    Keywords: Health insurance, Difference-in-difference, Cost-sharing, Developing country, Vietnam
    JEL: G22 I13 I18
    Date: 2017–01
  16. By: Parlow, Anton
    Abstract: In using spatial variations of the conflict experience in Afghanistan, I estimate mortality and health risks for adults, and thus a casual effect of war on these health outcomes. I find limited support that adults are more likely to die in areas more affected by the conflict than others. However, I find pronounced effects on adult health outcomes, e.g. adults are more likely to be sick in the provinces affected by violence. Though, this effect reverses in sign once focusing on women of reproductive age which could be driven by reported improvements in maternal health services in these provinces.
    Keywords: Armed Conflicts, Adult Health, Mortality
    JEL: I12 O12
    Date: 2016–12–15
  17. By: SUZUKI Wataru
    Abstract: Fifteen years have passed since Japan introduced the public long-term care insurance (LTCI) system in 2000. From an economics perspective, we review the experiences that Japan accumulated in running the LTCI system, evaluate the positive and negative aspects of the present system, and propose some feasible reforms to improve the system. One of the major reasons for introducing the LTCI system in 2000 was to stimulate a jump in the supply of long-term services in Japan through reforming the system from a heavily regulated and tax-subsidized welfare program into a market-oriented program which permits for-profit private providers to enter the market. Initially, the LTCI system successfully met its goal of expanding care services and alleviating the excessive burden of family care givers. However, a series of "anti-market" fiscal control measures introduced afterward severely damaged the usability of the system. We suspect that the ongoing additional fiscal control measures will revert the LTCI system into the old welfare program, making the initial success of market reform futile. Can Japan seek a way to overcome the negative spiral of fiscal control measures and worsening usability of the system? Full utilization of market mechanisms, as the initial reformers had pursued, could be the correct answer. Specific market-oriented reforms include constructing a full-funded system through a LTC version of the Medical Saving Account (MSA), permitting mixed usage of insurance covered and non-covered services to give service providers more freedom in price control, deregulating the barriers to entry, introducing cash payment for family care givers, and privatizing the insurance management.
    Date: 2016–12
  18. By: Marti, Joachim (Imperial College London); Buckell, John (Yale University); Maclean, J. Catherine (Temple University); Sindelar, Jody L. (Yale University)
    Abstract: A growing share of the United States population uses e-cigarettes. In response, policymakers are considering regulating e-cigarettes, or have already done so, due to concerns regarding e-cigarettes' public health impact. However, there is currently little population-based evidence to inform these regulatory choices. More information is needed on how policy-relevant factors will likely drive smokers' decision to use e-cigarettes. To provide this information we conduct an online survey and discrete choice experiment to investigate how adult tobacco cigarette smokers' demand for cigarette type varies by four policy-relevant attributes: 1) whether e-cigarettes are considered healthier than tobacco cigarettes, 2) the effectiveness of e-cigarettes as a cessation device, 3) bans on use in public places such as bars and restaurants, and 4) price. Overall, we find that the demand for e-cigarettes is motivated more by smokers' health concerns than by the desire to avoid smoking bans or higher prices. However, results from latent class models reveal three distinct groups of smokers, those who prefer: tobacco cigarettes, e-cigarettes, and using both products. Each group responds differently to the cigarette attributes suggesting that policies will have different impacts across the groups.
    Keywords: e-cigarettes, smoking, discrete choice experiments, preference heterogeneity, regulation
    JEL: C35 I12 I18
    Date: 2017–01
  19. By: Leila Agha; Brigham Frandsen; James B. Rebitzer
    Abstract: Fragmented health care occurs when care is spread out across a large number of poorly coordinated providers. We analyze care fragmentation, an important source of inefficiency in the US healthcare system, by combining an economic model of regional practice styles with an empirical study of Medicare enrollees who move across regions. Roughly sixty percent of cross-regional variation in care fragmentation is independent of patients’ clinical needs or preferences for care. A one standard deviation increase in regional fragmentation is associated with a 10% increase in utilization. Our analysis also identifies conditions under which anti-fragmentation policies can improve efficiency.
    JEL: D20 I10
    Date: 2017–01
  20. By: Yael Harris; Boyd Gilman; Marcia M. Ward; Jonathan Ladinsky; Jacqueline Crowley; Cannon Warren; Craig Caplan
    Abstract: The environmental scan identified numerous ED-specific measures and a limited set of telehealth-specific measures, but no clearly defined measures specific to tele-ED.
    Keywords: Tele-Emergency care, Evidence Base, Outcome measures
    JEL: I
  21. By: Grant R. Martsolf; Teresa B. Gibson; Richele Benevent; H. Joanna Jiang; Carol Stocks; Emily D. Ehrlich; Ryan Kandrack; David I. Auerbach
    Abstract: This article presents findings to study the association between hospital nurse staffing and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
    Keywords: Hospital nurse staffing, patient experience with care, cross-sectional estimates, longitudinal estimates
    JEL: I
  22. By: Nikki Aikens; Lauren Akers; Sally Atkins-Burnett
    Abstract: The literature review report for the Professional Development Tools to Improve the Quality of Infant and Toddler Care (Q-CCIIT PD Tools) project summarizes the state of the field, highlighting the most promising approaches for enhancing caregiver interactions with caregivers serving infants and toddlers.
    Keywords: infant and toddler caregivers, professional development, family child care, center-based care for infants and toddlers
    JEL: I
  23. By: Margaret Kyle; Heidi L. Williams
    Abstract: Alan Garber and Jonathan Skinner (2008) famously conjectured that the US health care system was “uniquely inefficient” relative to other countries. We test this idea using cross-country data on prescription drug sales newly linked with an arguably objective measure of relative therapeutic benefits, or drug quality. Specifically, we investigate how higher and lower quality drugs diffuse in the US relative to Australia, Canada, Switzerland, and the UK. Our tabulations suggest that lower quality drugs diffuse more in the US relative to high quality drugs, compared to each of our four comparison countries – consistent with Garber and Skinner’s conjecture.
    JEL: H51 I1 O3
    Date: 2017–01
  24. By: Reginald D. Covington; Brian Goesling; Christina Clark Tuttle; Molly Crofton; Jennifer Manlove; Roy F. Oman; Sara Vesely
    Abstract: This report presents the final impact findings from a large-scale demonstration project and evaluation of POWER Through Choices (PTC), a comprehensive sexual health education curriculum designed specifically for youth in foster care, the juvenile justice system, and other out-of-home care settings.
    Keywords: Pregnancy, unprotected sex, sex education, adolescents, HIV, STDs, teens, contraceptives, abstinence, foster care, child welfare, juvenile justice
    JEL: I
  25. By: Govert E. Bijwaard; Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany); Per Tynelius; Finn Rasmussen
    Abstract: For many causes of death a negative educational gradient has been found. This association may be partly explained by confounding factors that affect both education attainment and mortality. We correct the cause-specific educational gradient for observed individual background and unobserved family factors, using an innovative method based on months lost due to a specific cause of death re-weighted by the probability to attain a higher education level. We use men with brothers in the Swedish Military Conscription Registry (1951-1983), linked to administrative Swedish registers. These data, comprising 700,000 men, allow us to distinguish five education levels and many causes of death. The empirical results reveal that improving education from primary to higher education would lead to 20 months longer survival between 18 and 63. The reduction in death due to external causes when improving education is attributable to most of these gains. Ignoring confounding would underestimate the educational gains, especially for the low educated. Implied by our results is that if 50,000 men from the 1951 cohort had had the 1983 education distribution they would have saved 22% of the person-years between ages 18 and 63 that were lost to death.
    JEL: J1 Z0
    Date: 2017–01
  26. By: Horn, Brady P. (University of New Mexico); Maclean, J. Catherine (Temple University); Strain, Michael R. (American Enterprise Institute for Public Policy Research)
    Abstract: This study investigates whether minimum wage increases in the United States affect an important non-market outcome: worker health. To study this question, we use data on lesser-skilled workers from the 1993-2014 Behavioral Risk Factor Surveillance Surveys coupled with differences-in-differences and triple-difference models. We find little evidence that minimum wage increases lead to improvements in overall worker health. In fact, we find some evidence that minimum wage increases may decrease some aspects of health, especially among unemployed male workers. We also find evidence that increases reduce mental strain among employed workers.
    Keywords: minimum wage, self-reported health, differences-in-differences
    JEL: I1 I11 I18
    Date: 2017–01
  27. By: Meng, Xin (Australian National University); Xue, Sen (Jinan University)
    Abstract: Over the past two decades, more than 160 million rural residents have migrated to cities in China. They are usually separated from their rural families and work in an unfamiliar, and sometimes hostile, city environment. This paper investigates to what extent city social networks alleviate mental health problems among these migrants. Using the longitudinal migrant survey from the Rural-to-Urban Migration in China (RUMiC) project, we find that larger social networks are significantly correlated with fewer mental health problems in both OLS and fixed effect estimates. To mitigate the endogeneity issue, we use past rainfall in the home county and the distance between home village and the closest transportation centre as the instrument variables for city social networks. The instrument variable estimates and fixed effect instrumental variable estimates suggest that an additional person in the city social networks of migrants reduces GHQ 12 by 0.12 to 0.16 Likert points. The results are robust for migrants who are less educated, who work long hours and who do not have access to social insurances in the city.
    Keywords: mental health, social networks, migration, China
    JEL: I12 I18 J61
    Date: 2017–01
  28. By: Gobillon, Laurent (Paris School of Economics); Milcent, Carine (Paris School of Economics)
    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, hospital ownership, policy evaluation, heart attack
    JEL: I11 I18
    Date: 2017–01
  29. By: Williams, Jenny (University of Melbourne); van Ours, Jan C. (Erasmus University Rotterdam)
    Abstract: We study the impact of early cannabis use on the school to work transition of young men. Our empirical approach accounts for common unobserved confounders that jointly affect selection into cannabis use and the transition from school to work using a multivariate mixed proportional hazard framework in which unobserved heterogeneities are drawn from a discrete mixing distribution. Extended models account for school leavers' option of returning to school rather than starting work as a competing risk. We find that early cannabis use leads young men to accept job offers more quickly and at a lower wage rate compared to otherwise similar males who did not use cannabis. These effects are present only for those who use cannabis for longer than a year before leaving school. Overall, our findings are consistent with a mechanism whereby early non-experimental cannabis use leads to greater impatience in initial labor market decision-making.
    Keywords: multivariate duration models, discrete factors, cannabis use, job search, wages
    JEL: C41 I12 J01
    Date: 2017–01
  30. By: Maclean, J. Catherine (Temple University); Popovici, Ioana (Nova Southeastern University); Stern, Elisheva Rachel (Temple University)
    Abstract: We examine how substance use disorder (SUD) treatment providers respond to private health insurance expansions induced by state equal coverage ('parity') laws for SUD treatment. We use data on the near universe of specialty SUD treatment providers in the United States between 1997 and 2010 in an event study analysis. During this period, 18 states implemented parity laws. Following the passage of a state parity law we find that providers are less likely to participate in public markets, are less likely to provide charity care, increase the quantity of healthcare provided, and become more selective of the type of patients they are willing to admit.
    Keywords: healthcare, provider behavior, substance use disorders, health insurance mandates
    JEL: I1 I11 I18
    Date: 2017–01
  31. By: Yannis Mesquida (University of Lausanne); Pascal St-Amour (University of Lausanne and Swiss Finance Institute)
    Abstract: Lifetime financial-, work- and health-related decisions made by agents are intertwined with one another. Understanding how these decisions are made is essential to gauge if saving in financial, retirement and human assets is adequate or not. This paper numerically solves, simulates, and structurally estimates a dynamic life cycle model of allocations (consumption/savings, leisure/work and health expenditures), statuses (health, financial and pension wealth) and welfare, allowing for (partially) adjustable exposure to morbidity and mortality risks. Using the simulated life cycle variables as benchmark, our results show that observed choices are not fully consistent with an optimal, forward-looking strategy. Whereas financial savings and pension claims are both adequate, individuals in the data are not healthy enough, and consequently face a shorter life horizon than expected. Moreover, full insurance, and age-increasing wages would optimally point to more spending and less leisure to maintain health than currently observed. As a consequence, observed post-retirement income is too low, and explains a sharp drop in consumption after 65 that is inconsistent with optimizing behavior. Relaxing assumptions on full insurance and pension regimes only partially alleviates these discrepancies.
    Keywords: Defined Benefits and Contributions Plans, Consumption, Leisure, Health Expenditures, Mortality and Morbidity Risks, Optimal Savings
    JEL: D91 I12 J22

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