nep-hea New Economics Papers
on Health Economics
Issue of 2017‒03‒12
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Impact of Traineeships on the Employment of the Mentally Ill: The Role of Partial Compliance By Martini, Alberto; Rettore, Enrico; Barbetta, Gianpaolo
  2. State Health Insurance Mandates and Labor Market Outcomes: New Evidence on Old Questions By Antwi, Yaa Akosa; Maclean, J. Catherine
  3. You Drink, You Drive, You Die? The Dynamics of Youth Risk Taking in Response to a Change in the Legal Drinking Age By Boes, Stefan; Stillman, Steven
  4. Rising Health Expenditure Due to Non-Communicable Diseases in India: An Outlook By Barik, Debasis; Arokiasamy, Perianayagam
  5. Medicaid, Family Spending, and the Financial Implications of Crowd-Out By Marcus Dillender
  6. Effects of gender, education and health communication on the regularity of physical exercise: a 2016 Vietnamese cross-section survey By Quan-Hoang Vuong; Hiep-Hung Pham; Thu Trang Vuong
  7. The Causal Effect of Education on Health Behaviors: Evidence From Turkey By Aysit Tansel; Deniz Karaoglan
  8. The Effect of Survivors’ Benefits on Poverty and Health Indicators of Women and Children in Widowed-Mother Households: A Turkish Case Study By Oznur Ozdamar; Eleftherios Giovanis
  9. Socio-Economic Inequalities in Maternity Care Under Political Instability: Evidence from Egypt, Jordan and Yemen By Ahmed Shoukry Rashad; Mesbah Fathy Sharaf
  10. Out of Pocket Health Expenditures in Turkey in the Aftermath of the Reforms: Impact of Co-payments on Expenditures and Use of Health Services By Burcay Erus
  11. Who Pays More: Public, Private, Both or None? The Effects of Health Insurance Schemes and Health Reforms on Out-of-Pocket and Catastrophic Health Expenditures in Turkey By Eleftherios Giovanis; Oznur Ozdamar
  12. Health and fairness with other-regarding preferences By Aitor Calo-Blanco
  13. The Effect of Workplace Inspections on Worker Safety By Ling Li; Perry Singleton
  14. The Lasting Legacy of Seasonal Influenza: In-Utero Exposure and Labor Market Outcomes By Schwandt, Hannes
  15. Who Receives Medicaid in Old Age? Rules and Reality By Borella, Margherita; De Nardi, Mariacristina; French, Eric Baird
  16. On the Value of Birth Weight By Damian Clarke; Sonia Oreffice; Climent Quintana-Domeque
  17. An approach to the socieconomic determinants of infant and child mortality in Bolivia: Use of indirect methods of calculation of mortality and bivariate analysis. By Pamela Córdova Olivera; Marina Yurevna Nicolaeva
  18. Mortality and the Business Cycle: Evidence from Individual and Aggregated Data By van den Berg, Gerard J.; Gerdtham, Ulf-G.; von Hinke, Stephanie; Lindeboom, Maarten; Lissdaniels, Johannes; Sundquist, Jan; Sundquist, Kristina
  19. Is it the way you live or the job you have? Health effects of lifestyles and working conditions. By Elena Cottini; Paolo Ghinetti
  20. Sex differences in genetic associations with longevity in Han Chinese: sex-stratified genome-wide association study and polygenic risk score analysis By Yi Zeng; Huashuai Chen; Xiaomin Liu; Rui Ye; Enjun Xie; Zhihua Chen; Jiehua Lu; Jianxin Li; Yaohua Tian; Ting Ni; Lars Bolund; Kenneth C. Land; Anatoliy Yashin; Angela M. O'Rand; Liang Sun; Ze Yang; Wei Tao; Anastasia Gurinovic; Claudio Franceschi; Jichun Xie; Jun Gu; Yong Hou; Xiao Liu; Xun Xu; Jean-Marie Robine; Joris Deelen; Paola Sebastiani; P. Eline Slagboom; Thomas T. Perls; Elizabeth R. Hauser; William Gottschalk; Qihua Tan; Kaare Christensen; Mike Lutz; Xiao-Li Tian; Huanming Yang; Junxia Min; Chao Nie; James W. Vaupel
  21. Escaping the Holocaust: human and health capital of refugees to the US, 1940-42 By Blum, Matthias; Rei, Claudia
  22. Projecting Hospitals’ Profit Margins Under Several Illustrative Scenarios: Working Paper 2016-04 By Tamara Hayford; Lyle Nelson; Alexia Diorio
  23. Post-neonatal Mortality Impacts Following Grants from the Gavi Vaccine Alliance: An Econometric Analysis from 2000 to 2014 By Robert John KOLESAR; Martine AUDIBERT
  24. Goodbye smokers' corner: Health effects of school smoking bans By Pfeifer, Gregor; Reutter, Mirjam; Strohmaier, Kristina
  25. Causes of regional variation in healthcare utilization in Germany By Salm, Martin; Wübker, Ansgar
  26. Children's health, human capital accumulation, and R&D-based economic growth By Baldanzi, Annarita; Bucci, Alberto; Prettner, Klaus
  27. This paper assesses the impact of dentist remuneration on the incidence of potentially harmful dental x-rays. We use unique panel data which provide details of 1.3 million treatment claims by Scottish NHS dentists made between 1998 and 2007. Controlling for unobserved heterogeneity of both patients and dentists we estimate a series of fixed-effects models that are informed by a theoretical model of x-ray delivery and identify the effects on dental x-raying of dentists moving from a fixed salary to fee-for-service and patients moving from co-payment to exemption. We establish that there are significant increases in x-rays when dentists receive fee for service rather than salary payments and patients are made exempt from payment. There are further increases in x-rays when a patient switches to a fee for service dentist relative to them switching to a salaried one. By Martin Chalkley; Stefan Listl

  1. By: Martini, Alberto (University of Piemonte Orientale); Rettore, Enrico (University of Trento); Barbetta, Gianpaolo (Università Cattolica del Sacro Cuore)
    Abstract: Lavoro&Psiche is a RCT aimed at increasing employment among severely mentally ill patients, by offering them a structured job-search experience. The key feature of the treatment was the presence of a "job coach" entirely dedicated to support the job search of a small number (12-13) of mentally ill patients. What most often the job coach did was finding the patient a traineeship. If one were to consider only the effect of making the support of the coach available – the so-called Intention-To-Treat effect – it would be a disappointing statistically non significant 5 percentage point difference in the employment of treatment and control members, in the full post-treatment year. However, the impact of making something available is rarely the primary interest of policy-makers, who would rather know the effect of receiving it. The main difficulty in obtaining unbiased estimates of the latter is that 'who receives what' is no longer solely determined by randomization, but also by post-randomization events and decisions. During the implementation period of Lavoro&Psiche of 2011-12, an unprecedented wave of traineeship opportunities hit those enrolled in the demonstration, both in the experimental and in the control group. The main finding is that, for the subset of the experimental group that was induced by the offer to be involved in a traineeship the chances of having a job in the post-treatment year more than double from the 17% of those who did not do any traineeship to the 34% of those who did, well above the Intention-To-Treat impact estimates.
    Keywords: mental illness, RCT, traineeships, ITT, tests for selection bias, placebo tests, instrumental variables
    JEL: J78 J48 J38
    Date: 2017–02
  2. By: Antwi, Yaa Akosa (The Johns Hopkins Carey Business School); Maclean, J. Catherine (Temple University)
    Abstract: In this study we re-visit the relationship between private health insurance mandates, access to employer-sponsored health insurance, and labor market outcomes. Specifically, we model employer-sponsored health insurance access and labor market outcomes across the lifecycle as a function of the number of high cost mandates in place at labor market entrance. Our analysis draws on a long panel of workers from the National Longitudinal Survey of Youth 1979 and exploits variation in five high cost state mandates between 1972 and 1989. Four principal findings emerge from our analysis. First, we find no strong evidence that high cost state health insurance mandates discourage employers from offering insurance to employees. Second, employers adjust both wages and labor demand to offset mandate costs, suggesting that employees place some value on the mandated benefits. Third, the effects are persistent, but not permanent. Fourth, the effects are heterogeneous across worker types. These findings have implications for thinking through the full labor market effects of health insurance expansions.
    Keywords: mandated benefits, labor costs, health insurance
    JEL: H2 I13 J3
    Date: 2017–02
  3. By: Boes, Stefan (University of Lucerne); Stillman, Steven (Free University of Bozen/Bolzano)
    Abstract: This paper exploits the reduction in the legal drinking age in New Zealand from 20 to 18 to study the dynamics of youth risk taking. Using administrative data on the universe of road accidents over a fifteen year period spanning the law change, we undertake three complimentary analyses to examine the dynamics of alcohol-related and total vehicular accidents among youth. First, using an event history approach, we find no evidence that changing the drinking age from 20 to 18 led to more vehicular accidents or alcohol-related accidents among teens. This is true both in the short-run following the law change and when examining cumulative accidents for the affected cohorts. Next, using an age-based regression discontinuity design (RDD), we find that accidents do increase after one's 18th birthday, but this appears to be a short-run phenomenon. Finally, estimating flexible parametric regression models suggests that reducing the drinking age led to a decline in risky driving by youth who were already 15 at the time of the change but had no longer-run impacts. Overall, our results support the argument that the legal drinking age can be lowered without increasing detrimental outcomes for youth and call into question previous studies that have made policy recommendations by extrapolating from results identified using age-based RDDs.
    Keywords: drinking age, vehicular accidents, regression discontinuity design, dynamics, New Zealand
    JEL: I18 K42 C25
    Date: 2017–02
  4. By: Barik, Debasis; Arokiasamy, Perianayagam
    Abstract: With ongoing demographic transition, epidemiological transition has been emerged as a growing concern in India. The share of non-communicable disease in total disease burden has increased from 31% in 1990 to 45% in 2010. This paper seeks to explore the health scenario of India in the wake of the growing pace of non-communicable diseases such as diabetes and hypertension among Indian population using data from health and morbidity survey of the National Sample Survey Organisation (2004) and notifies about the resource needed to tackle this growing health risk. Given the share of private players (70%) in Indian health system, results indicate a higher private expenditure, mostly outof- pocket expense, on account of non-communicable diseases. A timely look into the matter may tackle a more dreadful situation in near future.
    Keywords: Non-communicable diseases, India, health care, South Asia, burden
    JEL: I10 I12 I15
    Date: 2016–08–03
  5. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research)
    Keywords: Medicaid eligibility, crowd-out, family spending
    JEL: D12 I13
  6. By: Quan-Hoang Vuong; Hiep-Hung Pham; Thu Trang Vuong
    Abstract: Nowadays, physical exercise and sports activities are regarded as the best means for people to keep fit and boost their health. In Vietnam, exercising on a daily basis is still underappreciated as twothirds of the population only exercise at trivial or low levels. Based on applying the baseline category logit model, we conduct an analysis to figure out the factors affecting people’s level of exercise. The findings show that males tend to engage in physical activities more than females, with the difference potentially being as high as 18.9%. In addition, females with a high educational background (university or higher) usually exercise less than those with lower education, perhaps due to their job’s attributes and their different routines. The opposite is the case in males, yet the differences for both genders are relatively small (only about 1%). The study also shows that those with higher BMI have higher activity levels. In particular, those with the highest BMI (BMI = 37.2) have a likelihood of regularly exercising as high as 74%. Furthermore, improved health communication systems and regular health check-ups at home are also associated with more frequent exercise and engagement in sport.
    Keywords: Physical exercise; Sports; Gender; Educational background; Body mass index; Health communication
    JEL: I10
    Date: 2017–03–02
  7. By: Aysit Tansel (Middle East Technical University); Deniz Karaoglan
    Abstract: This study provides causal effect of education on health behaviors in Turkey which is a middle income developing country. Health Survey of the Turkish Statistical Institute for the years 2008, 2010 and 2012 are used. The health behaviors considered are smoking, alcohol consumption, fruit and vegetable consumption, exercising and one health outcome namely, the body mass index (BMI). We examine the causal effect of education on these health behaviors and the BMI Instrumental variable approach is used in order to address the endogeneity of education to health behaviors. Educational expansion of the early 1960s is used as the source of exogenous variation in years of schooling. Our main findings are as follows. Education does not significantly affect the probability of smoking or exercising. The higher the education level the higher the probability of alcohol consumption and the probability of fruit and vegetable consumption. Higher levels of education lead to higher BMI levels. This study provides a baseline for further research on the various aspects of health behaviors in Turkey.
    Date: 2016–07
  8. By: Oznur Ozdamar (Adnan Menderes University); Eleftherios Giovanis
    Abstract: Survivors' benefits are cash payments made by government to family members when a worker dies. His or her spouse and unmarried children are entitled to receive these cash benefits. The payments are intended to help ease the financial strain caused by the loss of the worker's income. Survivors can receive benefits if the deceased partner was employed and contributed to Social Security long enough to be considered insured. Although these benefits aim to help single-head households who are in financial difficulties due to the loss of an additional household income, the remaining parents have generally serious challenges to do work both at labor market and home such as childrearing and house chores. Widows across the world therefore share two common experiences: a loss of social status and reduced economic circumstances. Prior research suggests that widowhood is much more common experience among women than men. Moreover, it is more likely to cause financial difficulties for women than for men, and financial strain reducing well-being of women. Using Cross-Sectional Income and Living Conditions Survey of Turkey (2006-2012), the first aim of this paper is to empirically analyze the effect of survivors’ benefits on poverty indicators of widowed-mother households and secondly to investigate whether survivors’ benefits promote health status of women and children in these families.
    Date: 2016–06
  9. By: Ahmed Shoukry Rashad; Mesbah Fathy Sharaf (Department of Economics, Faculty of Arts, University of Alberta, Edmonton, Canada)
    Abstract: Medical care during pregnancy is crucial for protecting women from health risks during and after pregnancy, and has been consistently linked to better child health outcomes. Improving maternal health is one of the Millennium Development Goals (MDGs). This paper examines the socio-economic inequalities in maternity care utilization in Egypt, Jordan, and Yemen after the Arab Spring, using the most recent rounds of the National Demographic and Health Survey. Concentration curves and concentration indices are used to examine the demographic and socio-economic correlates of maternity care utilization, and to assess the situation under the political instability that followed the Arab Spring. In addition, we investigate the underlying factors that generate the socio-economic inequalities in maternity care utilization by decomposing the concentration index into its determinants. The analysis yields that the degree of the socio-economic inequalities in maternity care utilization varies largely within the Arab world. The level of inequality is severe in Yemen, moderate in Egypt, and minor in Jordan. Results of the decomposition analysis show that socio-economic disparities in maternity care utilization are mainly due to the lack of economic resources and its correlates among the poor. The political instability in the region did not hinder Egypt and Jordan from improving the maternal health indicators at the national level. Increasing women education, especially among the poor, and poverty reduction measures focusing on rural communities could help narrow the inequalities in maternity care and hence improves population health outcomes.
    Date: 2016–06
  10. By: Burcay Erus (Bogaziçi University)
    Abstract: In 2002 Turkey started to implement reforms in health care aiming to ease access and increase efficiency. Reforms increased insurance coverage and resulted in higher number of outpatient and inpatient treatments at both public and private hospitals. To reign in consequent increase in health expenditures, a series of co-payments were instituted. Along with that primary care services were reformed through a family-medicine system that provided free access. The aim was to channel patients to primary care and hence cut on costs of secondary care. This work aims to measure the impact of these two measures, introduction of co-payments at secondary care and ease of access to free primary care, on out-of-pocket expenditures and access/use of healthcare services. We find that while contributory payments resulted in higher OOP health expenditures, especially for lower income households, the impact was small and did not hinder access to healthcare services. Indeed, possibly due to easier access to primary care, inability to see a doctor became less prevalent. Adverse effect of the contributory payments have been limited and have largely been countered by the provision of a easily available primary care system.
    Date: 2016–06–12
  11. By: Eleftherios Giovanis (University of Verona); Oznur Ozdamar
    Abstract: This study explores the determinants and characteristics of the out-of-pocket to capacity to pay and catastrophic health expenditures in Turkey using a detailed micro-level survey, the Household Budget Survey during the period 2002-2011. The results show that those who have public health insurance are less likely to face out-of-pocket to capacity to pay and catastrophic health expenditures, than those with private or without health insurance. In addition, the study explores the expansion of the health reform of 2003, where in 2008 the Green Card (Yesil Kart) holders are entitled, without fee, to the same services as those with public health insurance such as Emekli Sandigi, BAG-KUR, SSK. The analysis employs a differences-in-differences approach using a pseudo-panel based on propensity score matching. The results support that the difference of pocket health expenditures between the public health insurers and green card holders has been reduced. Furthermore, those who are located in rural areas are compared with those residing in urban areas, as the health reform in 2008 included expansion and improvement on the emergency services and infrastructure in rural areas.
    Date: 2016–10–25
  12. By: Aitor Calo-Blanco (Departamento de Economía. Universidade da Coruña)
    Abstract: We explore how to construct social preferences when individuals have other-regarding preferences over health and consumption. Our social evaluation also incorporates a view that aims to reduce inequalities that originate from factors for which individuals should not be deemed responsible.
    Keywords: Health, Fairness, Other-Regarding Preferences, Social Ordering Function.
    JEL: D62 D63 D71 I14
    Date: 2017–04
  13. By: Ling Li (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Perry Singleton (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244)
    Abstract: The Occupation Safety and Health Administration enforces safety regulations through workplace inspections. To identify the effect of inspections on worker safety, this study exploits quasi-experimental variation in inspections due to OSHA’s Site Specific Targeting plan. The SST plan used establishment-level data on accidents and injuries to target establishments for inspection. The primary inspection list consisted of establishments with case rates exceeding a cutoff. This cutoff generated a discontinuous increase in inspections, which is used to identify the effect of inspections on worker safety. Using the fuzzy regression discontinuity design and local linear regression, the estimated effect of an inspection on cases involving days away from work, job restrictions, and job transfers is -1.607 per 100 full-time equivalent workers. The effect is most pronounced among manufacturing establishments below the 90th percentile of the case-rate distribution.
    Keywords: OSHA; Worker Safety; Regression Discontinuity
    JEL: J28 K32
    Date: 2017–02
  14. By: Schwandt, Hannes (University of Zurich)
    Abstract: Pregnancy conditions have been shown to matter for later economic success, but many threats to fetal development that have been identified are difficult to prevent. In this paper I study seasonal influenza, a preventable illness that comes around every year and causes strong inflammatory responses in pregnant women. Using administrative data from Denmark, I identify the effects of maternal influenza on the exposed offspring via sibling comparison, exploiting both society-wide influenza spread and information on individual mothers who suffer strong infections during pregnancy. In the short term, maternal influenza leads to a doubling of prematurity and low birth weight, by triggering premature labor among women infected in the third trimester. Following exposed offspring into young adulthood, I observe a 9% earnings reduction and a 35% increase in welfare dependence. These long-term effects are strongest for influenza infections during the second trimester and they are partly explained by a decline in educational attainment, pointing to cognitive impairment. This effect pattern suggests that maternal influenza damages the fetus through multiple mechanisms, and much of the damage may not be visible at birth. Taken together, these results provide evidence that strong infections during pregnancy are an often overlooked prenatal threat with long-term consequences.
    Keywords: pregnancy conditions, seasonal influenza, labor market outcomes
    JEL: I10 J24 J3 J13
    Date: 2017–02
  15. By: Borella, Margherita; De Nardi, Mariacristina; French, Eric Baird
    Abstract: Medicaid is a government program that provides health insurance to the old who are sick and have little assets and income compared to their medical needs. Thus, it explicitly tests for income, assets, and health or medical needs to determine eligibility. We ask how these rules map into the reality of Medicaid recipiency and what observable characteristics are important to determine who ends up on Medicaid. The data show that both singles and couples with high retirement income can end up on Medicaid at very advanced ages. We find that, conditioning on a large number of observable characteristics, including those that directly relate to Medicaid eligibility criteria, single women are more likely to end up on Medicaid. So are non-whites, but, surprisingly, their higher recipiency is concentrated above the lower income percentiles. We also find that low-income people with a high school diploma or higher are much less likely to end up on Medicaid than their more educated counterparts. All of these effects are large and depend on retirement income in a very non-linear way.
    Keywords: Medicaid; Old Age; Recipiency
    Date: 2017–02
  16. By: Damian Clarke (Universidad de Santiago de Chile); Sonia Oreffice (University of Surrey); Climent Quintana-Domeque (University of Oxford and St Edmund Hall)
    Abstract: A large body of evidence documents the educational and labor market returns to birth weight, which are reflected in investments in large social safety net programs targeting birth weight and early life health. However, there is no direct evidence on the private valuation of birth weight. In this paper we estimate the willingness to pay (WTP) for birth weight in the US. Using a series of discrete choice experiments, we find that individuals are, on average, willing to pay $1.44 for each additional gram of birth weight. This marginal WTP is particularly high at low birth weights, and turns negative at higher weights. The WTP among parents is higher than among non-parents, and particularly than those who do not plan to have children. Nonetheless, a series of calculations suggest that even the parental WTP for birth weight falls short of the inferred public WTP from large social safety net programs, and is lower than the expected present value of birth weight in the labor market for a US-born child. We present a parsimonious model which is able to explain the different WTP by parental status and the discrepancy between our estimated private valuation and the returns in the labor market: Parents may underestimate the value of birth weight, opening the door for new policy interventions to increase health at birth via informational campaigns.
    Keywords: discrete choice experiments, early life health, value of health, willingness to pay
    JEL: C90 I10 J13
    Date: 2017–03
  17. By: Pamela Córdova Olivera (Centro de Investigaciones Económicas y Empresariales, Universidad Privada Boliviana); Marina Yurevna Nicolaeva (Centro de Investigaciones Económicas y Empresariales, Universidad Privada Boliviana)
    Abstract: Despite significant improvements in child and childhood health outcomes during the XXI Century in Latin America, rates of infant and childhood mortality remain unacceptably high in Bolivia being among the highest in the regio?n, only after Haiti, regarding poor child and childhood health. These results require scientific evidence on the best way to address its determinants. This study approaches theoretically the determinants of infant and childhood mortality in Bolivia focused on individual, household and contextual characteristics using the theoretical framework proposed by Mosley-Chen and Sastry. Furthermore, levels and magnitudes of mortality are preliminarily examined by using direct and indirect methods of estimation using the technique proposed by the Trussell version and Palloni-Heligman version of the method of Brass. Also a bivariate analysis is performed, which shows the relationships between infant and childhood mortality and variables at the household level, individual and contextual related to public policy.
    Keywords: Mortality, Bivariate Analysis, Public Policy.
    JEL: C10 O10
    Date: 2015–06
  18. By: van den Berg, Gerard J. (University of Mannheim); Gerdtham, Ulf-G. (Department of Economics, Lund University); von Hinke, Stephanie (Department of Economics, Bristol University); Lindeboom, Maarten (Tinbergen Institute, VU Amsterdam); Lissdaniels, Johannes (Department of Clinical Science, Lund University); Sundquist, Jan (Center for Primary Health Care Research, Lund University); Sundquist, Kristina (Center for Primary Health Care Research, Lund University)
    Abstract: There has been much interest recently in the relationship between economic conditions and mortality, with some studies showing that mortality is pro-cyclical, while others find the opposite. Some suggest that the aggregation level of analysis (e.g. individual vs. regional) matters. We use both individual and aggregated data on a sample of 20-64 year-old Swedish men from 1993 to 2007. Our results show that the association between the business cycle and mortality does not depend on the level of analysis: the sign and magnitude of the parameter estimates are similar at the individual level and the aggregate (county) level; both showing pro-cyclical mortality.
    Keywords: Mortality; Recessions; Business Cycle; Health; Unemployment; Income.
    JEL: E03 I10 I12
    Date: 2017–03–07
  19. By: Elena Cottini (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore); Paolo Ghinetti
    Abstract: This paper investigates the role of lifestyles (smoking, drinking and obesity) and working conditions (physical hazards, no support from colleagues, job worries and repetitive work) on health. Three alternative systems of simultaneous multivariate probit equations are estimated, one for each health measure: an indicator of self-assessed health, an indicator of physical health, an indicator of work-related mental health problems, using Danish data for 2000 and 2005. We find that while lifestyles are significant determinants of self-assessed health, they play a minor role for our indicators of physical health and mental health. The effect of lifestyles seems to be dominated by the effect of adverse working conditions, which significantly worsen health. This result is robust for all health dimensions considered.
    Keywords: working conditions; lifestyle; health .
    JEL: I1 I12 C3
    Date: 2017–03
  20. By: Yi Zeng (Max Planck Institute for Demographic Research, Rostock, Germany); Huashuai Chen; Xiaomin Liu; Rui Ye; Enjun Xie; Zhihua Chen; Jiehua Lu; Jianxin Li; Yaohua Tian; Ting Ni; Lars Bolund; Kenneth C. Land; Anatoliy Yashin; Angela M. O'Rand; Liang Sun; Ze Yang; Wei Tao; Anastasia Gurinovic; Claudio Franceschi; Jichun Xie; Jun Gu; Yong Hou; Xiao Liu; Xun Xu; Jean-Marie Robine; Joris Deelen; Paola Sebastiani; P. Eline Slagboom; Thomas T. Perls; Elizabeth R. Hauser; William Gottschalk; Qihua Tan (Max Planck Institute for Demographic Research, Rostock, Germany); Kaare Christensen; Mike Lutz; Xiao-Li Tian; Huanming Yang; Junxia Min; Chao Nie; James W. Vaupel (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Based on sex-stratified genome-wide association study (GWAS) of Han Chinese, 2,178 centenarians and 2,299 middle-aged controls, we identified 11 male- and 12 female-specific independent loci that are significantly associated with longevity ( P <10 -5 ), replicated in independent North and South regions in one sex, but are not significant ( P >0.05) in the other sex. We found that the association of rs60210535 at LINC00871 with longevity replicated well between Chinese females ( P =4.6x10 -5 ) and U.S. females ( P =9.0x10 -5 ), but was not significant in both Chinese and U.S. males ( P >0.05). We discovered that 11 male-specific and 34 female-specific pathways are significantly associated with longevity ( P <0.005, false discovery rate ( FDR ) <0.05). Male-specific pathways are enriched for inflammation and immunity genes, but female-specific pathways include tryptophan metabolic and PGC-1α pathways that converge to mitochondrial biogenesis. Polygenic risk score (PRS) analyses demonstrated that 11/12 male/female top loci ( P <10 -5 in one sex, P >0.05 in other sex), 44/58 male/female strong loci (10 -5 ≤ P <10 -4 in one sex, P >0.4 or P >0.35 in other sex), and 191/311 male/female moderate loci (10 -4 ≤ P <10 -3 in one sex, P >0.75 or P >0.7 in other sex) are jointly and highly associated with longevity exceeding a significance level P< 10 -8 in one sex, but not jointly associated with longevity in the other sex ( P >0.05). Our integrated PRS and novel sex-specific genetic relative benefit/loss ratio analyses indicate that females’ genetic constitution favors longevity more than males’. Further interdisciplinary collaborative efforts are warranted, such as replications from other populations, international meta-analyses with much larger sample size, lab tests, and in silico functional validations. Significance Statement: On average, women live significantly longer lives than men but they have lower physical performance and more adverse health outcomes at older ages compared to men: patterns that signify the male-female health-survival paradox (1). Research on sex differences in health and mortality has proliferated, but has yet to achieve a good understanding of the effects of genetic variants on the sex gap in longevity and health. Based on sex-stratified genome-wide association analysis (GWAS) of Han Chinese including centenarians with a sample size 2.7 times as large as other published largest single GWAS on longevity involving centenarians (2), the present study aims to contribute a better understanding of sex differences in genetic associations with longevity.
    JEL: J1 Z0
    Date: 2017–02
  21. By: Blum, Matthias; Rei, Claudia
    Abstract: The large-scale persecution of Jews during World War II generated massive refugee movements. Using data from 20,441 predominantly Jewish passengers from 19 countries traveling from Lisbon to New York between 1940 and 1942, we analyze the last wave of refugees escaping the Holocaust and verify the validity of height as a proxy for human and health capital. We further show this episode of European migration displays wellknown features of migrant self-selection: early migrants were taller than late migrants; a large migrant stock reduces migrant selectivity; and economic barriers to migration apply. Our Öndings show that Europe experienced substantial losses in human and health capital while the US beneÖtted from the immigration of European refugees.
    JEL: N34 F22 J24
    Date: 2016
  22. By: Tamara Hayford; Lyle Nelson; Alexia Diorio
    Abstract: Changes stemming largely from implementation of the Affordable Care Act (ACA) could affect hospitals’ finances significantly. Although the ACA reduces Medicare’s payment updates for hospitals, it also expands insurance coverage, which should reduce hospitals’ costs for uncompensated care. To examine the effects of those and other provisions of federal law, this paper calculates hospitals’ profit margins and the share of hospitals that might lose money in 2025 under several illustrative scenarios. The analysis focuses on about 3,000 hospitals that provide acute care and are subject to Medicare
    JEL: I11 I18
    Date: 2016–09–08
  23. By: Robert John KOLESAR; Martine AUDIBERT (Centre d'Etudes et de Recherches sur le Développement International(CERDI))
    Abstract: We completed a retrospective multivariate panel and longitudinal trend study to evaluate the effect of Gavi Vaccine Alliance grants on vaccine-preventable disease (VPD) post-neonatal mortality. Feasible Generalized Least Squares (fGLS) regression analysis was used to examine the association between VPD post-neonatal mortality rates and Gavi funding. We also applied segmented regression analysis to assess the structural trend in VPD post-neonatal mortality rates, the impact of Gavi funding, and trend changes following Gavi support. We separately tested a composite VPD mortality rate and five vaccine-preventable mortality rates: pertussis, meningitis, measles, diarrhea, and pneumonia (lower-respiratory infection) as dependent variables. All 77 countries eligible for Gavi assistance from 2000 to 2014 were included in the study. To isolate the effect of Gavi funding in our primary model, we controlled for known and likely predictors of child mortality. Among other factors, Gavi investment and corruption control/system efficiency are important elements to reduce vaccine-preventable mortality rates. For every $1 per capita invested by the Gavi Vaccine Alliance, there are highly statistically significant effects- decreasing the vaccine-preventable disease post-neonatal mortality rate by 2.535 per 1,000 live births. We also found Gavi investments to be significantly associated with reductions in four vaccine preventable disease-specific rates: pertussis, meningitis, diarrhea, and pneumonia. Furthermore, we found Gavi support to be significantly associated with both immediate impacts and trend changes on vaccine-preventable mortality rates. We conclude that Gavi investments in developing country immunization programs have measurably contributed to reductions in post-neonatal VPD mortality rates. Furthermore, we found evidence of a longer term catalytic effect of Gavi funding with accelerated reductions in the trend for post-neonatal meningitis, diarrhea, and pneumonia mortality rates.
    Keywords: Vaccines, Immunizations, Developing countries, Financing, Mortality reduction
    JEL: H43 H I00 I1 I
    Date: 2017–02
  24. By: Pfeifer, Gregor; Reutter, Mirjam; Strohmaier, Kristina
    Abstract: We estimate the causal impact of school smoking bans in Germany on the propensity and intensity of smoking. Using representative longitudinal data, we use variation in state, year, age cohort, school track, and survey time for implementation of such smoking bans to identify the effects of interest. The estimates from our multipledifferences approach show that six to ten years after intervention, propensity towards smoking is reduced by 7-16 percent, while the number of smoked cigarettes per day decreases by 8-13 percent. Our results still hold if we account for the clustered data structure by evaluating the effects with randomization inference.
    Keywords: school smoking ban,cigarette consumption,treatment effects,difference-in-differences,randomization inference
    JEL: I12 I18 C12 C21
    Date: 2017
  25. By: Salm, Martin; Wübker, Ansgar
    Abstract: Healthcare utilization varies widely between regions. Yet, the causes of regional variation are still not well understood, and they can also differ between countries and institutional settings. We exploit patient migration to examine which share of regional variation in ambulatory care use in Germany can be attributed to demand factors and to supply factors, respectively. Based on administrative claim-level data we find that regional variation can be overwhelmingly explained by patient characteristics. Our results contrast with previous results for other countries, and they suggest that institutional rules in Germany successfully constrain supply-side variation in ambulatory care use between German regions.
    Keywords: Healthcare spending,regional variation,Germany
    JEL: I11 I13 H51
    Date: 2017
  26. By: Baldanzi, Annarita; Bucci, Alberto; Prettner, Klaus
    Abstract: We analyze the effects of children's health on human capital accumulation and on long-run economic growth. For this purpose we design an R&D-based growth model in which the stock of human capital of the next generation is determined by parental education and health investments. We show that i) there is a complementarity between education and health: if parents want to have better educated children, they also raise health investments and vice versa; ii) parental health investments exert an unambiguously positive effect on long-run economic growth, iii) faster population growth reduces long-run economic growth. These results are consistent with the empirical evidence for modern economies in the twentieth century.
    Keywords: Children's Health,Education,Fertility,Economic Growth,Technological Progress,Long-run Economic Development
    JEL: I15 I25 J10 O30 O41
    Date: 2017
  27. By: Martin Chalkley (Centre for Health Economics, University of York, York, UK.); Stefan Listl (Department of Quality and Safety of Oral Health Care, Radboud University, Radboud, Netherlands.)
    Keywords: Healthcare, incentives, matched data, dentistry
    JEL: I11

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