nep-hea New Economics Papers
on Health Economics
Issue of 2017‒03‒19
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Mental and Physical Burden of Caregiving By Stroka, Magdalena
  2. “Is your commute really making you fat?”: The causal effect of commuting distance on height-adjusted weight By Lorenz, Olga; Goerke, Laszlo
  3. *K-means and Cluster Models for Cancer Signatures By Zura Kakushadze; Willie Yu
  4. The income-health gradient: Evidence from self-reported health and biomarkers using longitudinal data on income By Davillas, Apostolos; Jones, Andrew M.; Benzeval, Michaela
  5. Issues of unequal access to public health in India By Barik, Debasis; Thorat, Amit
  6. Birth Order and Child Health By Björkegren, Evelina; Svaledry, Helena
  7. Competition and physician behaviour: Does the competitive environment the propensity to issue sickness certificates? By Brekke, Kurt R.; Holmås, Tor Helge; Monstad, Karin; Straume, Odd Rune
  8. The Effects of Birth Weight on Hospitalizations and Sickness Absences By Helgertz, Jonas; Nilsson, Anton
  9. Month of Birth and Child Height in 40 Countries By Joseph Cummins; Neha Agarwal; Anaka Aiyar; Arpita Bhattacharjee; Christian Gunadi; Deepak Singhania; Matthew Taylor; Evan Wigton-Jones
  10. Out of Pocket Health Expenditure and Household Budget: Evidence from Arab Countries By Reham Rizk; Hala Abou-Ali
  11. The Link between Health Condition Costs and Standard of Living: A Structural Equation Modelling By Oznur Ozdamar; Eleftherios Giovanis
  12. Household’s Expenditure in Health and Education: Effects on Poverty and Child Poverty Estimates in Five Middle Income Countries: India, Mexico, South Africa, Russian Federation and Peru By Hicham Ait Mansour
  13. Recent Trends in the Probability of High Out-of- Pocket Medical Expenses in the US By Katherine Baird
  14. Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels By Suhui Li; Patricia Pittman; Xinxin Han; Timothy John Lowe
  15. The Incidence of High Medical Expenses by Health Status in Seven Developed Countries By Katherine Baird
  16. National Intelligence and Private Health Expenditure: Do High IQ Societies Spend More on Health Insurance? By Burhan, Nik Ahmad Sufian; Salleh, Fauzilah; Burhan, Nik Mohd Ghazi
  17. Was The First Public Health Campaign Successful? The Tuberculosis Movement and Its Effect on Mortality By D. Mark Anderson; Kerwin Kofi Charles; Claudio Las Heras Olivares; Daniel I. Rees
  18. Trigger Warning: The Causal Impact of Gun Ownership on Suicide By Alexander F. McQuoid; Charles Moore; Stephen Sawyer; David C. Vitt
  19. Do hospitals respond to rivals’ quality and efficiency? a spatial econometrics approach By Francesco Longo; Luigi Siciliani; Hugh Gravelle; Rita Santos
  20. Road accidents fatalities trends and safety management in South Africa By Ncube, Prince; Cheteni, Priviledge; Sindiyandiya, Kholeka
  21. Zika Virus Prevalence, Correlates and Preventive Behaviors: New Evidence from Survey Data By Carvalho, José-Raimundo; de Oliveira, Victor Hugo; Quintana-Domeque, Climent
  22. The Green Jobs and Health Care Impact Evaluation: Findings from the Implementation Study of Four Training Program for Unemployed and Disadvantaged Workers By Elizabeth Copson; Karin Martinson; Valerie Benson; Michael Benson; Annalisa Mastri; Karen Needels; Julie Williams
  23. The Green Jobs and Health Care Impact Evaluation: Findings from the Impact Study of Four Training Programs for Unemployed and Disadvantaged Workers By Karin Martinson; Julie Williams; Karen Needels; Laura Peck; Shawn Moulton; Nora Paxton; Annalisa Mastri; Elizabeth Copson; Hiren Nisar; Alison Comfort; Melanie Brown-Lyons
  24. Does Single Motherhood Hurt Infant Health among Young Mothers? By Kim, Albert Young-Il; Lee, Jungmin
  25. Catastrophic and Impoverishing Effects of Out-Of-Pocket Health Expenditure: New Evidence from Egypt By Ahmed Rashad; Mesbah Sharaf
  26. Paying ‘Til it Hurts: High Medical Spending among the Poor and Elderly in Ten Developed Countries By Katherine Baird
  27. Absolute or relative? A comparative analysis of the relationship between poverty and mortality By Johan Fritzell; Johan Rehnberg; Jennie Bacchus Hertzman; Jenni Blomgren

  1. By: Stroka, Magdalena
    Abstract: This study evaluates the mental and physical strain experienced by informal caregivers. Econometric problems due to individuals selecting themselves in to informal care provision are tackled by using informative and detailed data from the largest sick ness fund in Germany and applying propensity score matching techniques. The fi ndings suggest tha t carers take more psychoactive drugs as well as analgesics and gastrointestinal agents. Thus, in formal caregiving appears to be a burdensome task with implications for both mental and physical health.
    JEL: I10 D10 J10
    Date: 2016
  2. By: Lorenz, Olga; Goerke, Laszlo
    Abstract: This paper explores the causal relationship between commuting distance and height-adjusted weight (BMI) in Germany, using micro-level data for the period 2004 – 2012. In contrast to previous papers, we find no evidence that longer commutes are associated with a higher BMI. The non-existence of a relationship between BMI and commuting distance prevails when physical activity and eating habits are adjusted for.
    JEL: D00 I12 R41
    Date: 2016
  3. By: Zura Kakushadze; Willie Yu
    Abstract: We present *K-means clustering algorithm and source code by expanding statistical clustering methods applied in to quantitative finance. *K-means is essentially deterministic without specifying initial centers, etc. We apply *K-means to extracting cancer signatures from genome data without using nonnegative matrix factorization (NMF). *K-means' computational cots is a faction of NMF's. Using 1,389 published samples for 14 cancer types, we find that 3 cancers (liver cancer, lung cancer and renal cell carcinoma) stand out and do not have cluster-like structures. Two clusters have especially high within-cluster correlations with 11 other cancers indicating common underlying structures. Our approach opens a novel avenue for studying such structures. *K-means is universal and can be applied in other fields. We discuss some potential applications in quantitative finance.
    Date: 2017–03
  4. By: Davillas, Apostolos; Jones, Andrew M.; Benzeval, Michaela
    Abstract:  This paper adds to the literature on the income-health gradient by exploring the association of short- and long-term income with a wide set of self-reported health measures and objective nurse-administered and blood-based biomarkers as well as employing estimation techniques that allow for analysis “beyond the mean†and accounting for unobserved heterogeneity. The income-health gradients are greater in magnitude in case of long-run rather than cross- sectional income measures. Unconditional quantile regressions reveal that the differences between the long-run and the short-run income gradients are more evident towards the right tails of the distributions, where both higher risk of illnesses and steeper income gradients are observed. A two-step estimator, involving a fixed-effects income model at the first stage, shows that the individual-specific selection effects have a systematic impact in the long-run income gradients in self-reported health but not in biomarkers, highlighting the importance of reporting error in self-reported health.
    Date: 2017–03–16
  5. By: Barik, Debasis; Thorat, Amit
    Abstract: Even after more than 50 years of independence, health in India remains a luxury and only the rich can afford it. People visit equally poor private practitioners, ignoring the available public health units, and pay beyond their capacity. Quality health services, either public or private, with some government regulation, can help to improve the present scenario. The adivasi and the dalits are still away from the health equity and face more challenges than the others. Well-equipped health facilities in the vicinity and knowledge of disease conditions can improve the access of public health services. Rather than focusing on the doorstep services, well-equipped PHCs even can do better.
    Keywords: Unequal, Access, Health Care, India, caste
    JEL: I14
    Date: 2015–09–17
  6. By: Björkegren, Evelina (Department of Economics); Svaledry, Helena (Department of Economics)
    Abstract: Previous research has established that birth order affects outcomes such as educational achievements, IQ and earnings. The mechanisms behind these effects are, however, still largely unknown. In this paper, we examine birth-order effects on health, and whether health at young age could be a transmission channel for birth-order effects observed later in life. We find no support for the birth-order effect having a biological origin; rather firstborns have worse health at birth. This disadvantage is reversed in early age and later-born siblings are more likely to be hospitalized for injuries and avoidable conditions, which could be related to less parental attention. In adolescence and as young adults, younger siblings are more likely to be of poor mental health and to be admitted to hospital for alcohol induced health conditions. We also critically test for reverse causality by estimating fertility responses to the health of existing children. We conclude that the effects on health are not severely biased; however, the large negative birth-order effects on infant mortality are partly due to endogenous fertility responses. Overall our results suggest that birth order effects are due to differential parental investment because parents’ time and resources are limited.
    Keywords: Birth order; child Health; parental behavior; endogenous fertility
    JEL: I12 J13 J24
    Date: 2017–03–14
  7. By: Brekke, Kurt R. (Dept. of Economics, Norwegian School of Economics and Business Administration); Holmås, Tor Helge (Uni Research Rokkan Centre); Monstad, Karin (Uni Research Rokkan Centre); Straume, Odd Rune (University of Minho)
    Abstract: Competition among physicians is widespread, but compelling empirical evidence on the impact on service provision is limited, mainly due to lack of exogenous variation in the degree of competition. In this paper we exploit that many GPs, in addition to own practice, work in local emergency centres, where the matching of patients to GPs is random. This allows us to observe the same GP in two different competitive environments; with competition (own practice) and without competition (emergency centre). Using rich administrative patient-level data from Norway for 2006-14, which allow us to estimate high-dimensional fi…xed-effect models to control for time-invariant patient and GP heterogeneity, we …nd that GPs with a fee-for-service (…fixed salary) contract are 11 (8) percentage points more likely to certify sick leave at own practice than at the emergency centre. Thus, competition has a positive impact on GPs’sick listing that is reinforced by …nancial incentives.
    Keywords: Physicians; Competition; Sickness certification
    JEL: I11 I18 L13
    Date: 2017–02–12
  8. By: Helgertz, Jonas (Department of Economic History, Lund University); Nilsson, Anton (Department of Economic History, Lund University)
    Abstract: This study examines the causal effects of birth weight on two health-related outcomes: inpatient hospitalizations and sickness absences, distinguishing between different diagnoses. Our analysis exploits differences within siblings and within twin pairs, using full population Swedish register data on cohorts born between 1973 and 1995, observed through childhood and in adulthood. In childhood, there is a strong relationship between birth weight and days in inpatient care. This is mostly driven by perinatal conditions during infancy, but substantial effects on other conditions are also found. Effects reduce in size when the child grows older. There are also significant and important effects in adulthood, and these are stronger than the ones found in late childhood. In adulthood, the strongest and most consistent effects are obtained for mental conditions. This holds for both hospital visits and sickness absences, but is most striking for hospital visits, where mental diagnoses may account for almost the entire effect of a lower birth weight. Overall, we provide evidence that birth weight does matter for both short- and long-term health outcomes and that the effects may not be smaller than what more traditional OLS regressions suggest.
    Keywords: birth weight; childhood Health; adulthood Health; fetal origins hypothesis
    JEL: I10 I12 N10
    Date: 2017–03–17
  9. By: Joseph Cummins (Department of Economics, University of California Riverside); Neha Agarwal (University of California, Riverside); Anaka Aiyar (Cornell University); Arpita Bhattacharjee (University of California, Riverside); Christian Gunadi (University of California, Riverside); Deepak Singhania (University of California, Riverside); Matthew Taylor (University of California, Riverside); Evan Wigton-Jones (University of California, Riverside)
    Abstract: Lokshin and Radyakin (2012) present evidence that month of birth affects child physical growth in India. We replicate these correlations using the same data and demonstrate that they are the result of spurious correlations between month of birth, age-at-measurement and child growth patterns in developing countries. We repeat the analysis on 39 additional countries and show that there is no evidence of seasonal birth effects in child height-for-age z-score in any country. Furthermore, we demonstrate that the Demographic and Health Survey data used to estimate the correlation is not suitable for the task due to a previously unrecognized source of measurement error in child month of birth. We document results from several papers that should be re-interpreted in light of this issue.
    Keywords: child health; month of birth; anthropometrics; Demographic & Health Survey
    JEL: I15 J13 O15
    Date: 2017–03
  10. By: Reham Rizk (British University in Egypt); Hala Abou-Ali
    Abstract: This paper assesses the prevalence of out-of-pocket catastrophic health expenditure and pinpoints the factors associated with its risk in Egypt and Palestine. Data used in this research is obtained from the ERF Harmonized Household Income and Expenditure Surveys for Egypt and Palestine in 2010/2011. Finite mixed models are applied to assess the socio-economic indicators of catastrophic impacts of out-of-pocket health expenditure. The results suggest that rich households are more likely to incur catastrophic health expenditure compared to the poor households. The probability of catastrophic health expenditure is higher in rural areas and among elderly household members.
    Date: 2016–01–12
  11. By: Oznur Ozdamar (Adnan Menderes University); Eleftherios Giovanis
    Abstract: This study employs a Structural Equation Modelling (SEM) to explore the health related costs using the Standard of Livings (SoL) approach in Turkey, employing data from the crosssectional Household Budget Survey (HBS) over the period 2002-2013. The SEM allows us to investigate all these concerns simultaneously. A health condition index is created regarding questions related to the mental and physical limitations (disability) of people. The study extends the previous research by the following ways. First, a SEM framework is introduced, which accounts for the measurement error in both SoL and health-condition indices and it allows for the simultaneous estimation of the link between health condition costs and SoL using structural equations. The underlying theory of the SoL approach is that a household’s SoL is a function of needs and income and the additional costs of disability can be estimated by comparing the standard of livings of household with and without disabled members and controlling for other source of variation. The results show that disability has a significant and negative impact on SoL. Second, exploiting the health reform of 2008, a quasi-experiment approach using difference-in-difference (DID) regression within a SEM framework between the disabled and non-disabled households takes place. The disability related costs consist of the 23 per cent of the household income corresponding to 4,000 Turkish Liras (TL).
    Date: 2016–01–11
  12. By: Hicham Ait Mansour
    Abstract: There is a wide agreement among poverty research community that conventional estimates of poverty (i.e., money-metric measures) do not take into account out of pocket payments of health care. Significant household health spending would overestimate total household expenditure, which results in an underestimation of poverty measured in terms of household expenditure. The present working paper uses Luxembourg Income Study Center data to explore the impact of household health payments on poverty and child poverty estimates in five middle-income countries (India, Mexico, South Africa, Russian Federation and Peru). It also extends this analysis to cover education expenditure as well and how it might exert similar effects on these poverty estimates.
    Keywords: poverty, child poverty, expenditure poverty, out of pocket health expenditure, out of pocket education expenditure, middle income countries.
    Date: 2016–06
  13. By: Katherine Baird
    Abstract: Objective: This paper measures large out-of-pocket expenses by health condition, income, and elderly status, and estimates changes in them between 2010 and 2013. Data Source: The paper uses nationally-representative household survey data. Study Design: Logistic regression estimates the probabilities of high expenses by demographic groups in the two study years. Households have large out-of-pocket expenses when these exceed 5% or alternatively 10% of income. Data Collection/Abstraction Method: The study uses 99.5% of the 344,000 individuals in the two samples. Principle Findings: Despite favorable conditions, the large numbers of Americans exposed to high out-of-pocket expenditures has not declined much. Conclusions: The magnitude of financial risk and trends in them underscore the need to monitor the ACA’s success in reducing Americans’ exposure to large medical bills.
    Keywords: out of pocket, insurance, financing equity, Affordable Care Act
    Date: 2016–06
  14. By: Suhui Li; Patricia Pittman; Xinxin Han; Timothy John Lowe
    Abstract: This study examines nurse-related clinical nonlicensed personnel (CNLP) in U.S. hospitals between 2010 and 2014, including job categories, trends in staffing levels, and the possible relationship of substitution between this group of workers and registered nurses (RNs) and/or licensed practical nurses (LPNs).
    Keywords: CNLP, Hospitals, Nurse Staffing Levels
    JEL: I
  15. By: Katherine Baird
    Abstract: Health care policy seeks to ensure that citizens are protected against excessive out-of-pocket (OOP) expenses. Yet rising health care costs are pressuring private and social insurance schemes to shift toward more cost-sharing measures. This paper uses household surveys from seven countries to measure the burden of health expenditures for individuals with similar health conditions. It compares countries based on the extent to which citizens—those with health problems in particular—devote a large share of their income to medical expenses. The paper finds that in all countries but France, and to a lesser extent Slovenia, unhealthy citizens face considerably higher medical costs than do the healthy. As many as one-quarter of less healthy citizens in the U.S., Poland, Russia and Israel have large OOP expenses. The paper finds increased exposure to high medical expenses within countries is also associated with increased disparities between the unhealthy and healthy in the financial burden of OOP costs. The levels of high OOP spending uncovered, and their disparate weight on those with health problems (who are also disproportionately poor and elderly) underscore the potential for high OOP expenses to undermine core objectives of health care systems, including those of equitable financing, equal access, and improved medical outcomes.
    Keywords: Cost of illness, Health insurance, Health policy, Healthcare financing, Cost sharing
    Date: 2016–05
  16. By: Burhan, Nik Ahmad Sufian; Salleh, Fauzilah; Burhan, Nik Mohd Ghazi
    Abstract: Studies show that high IQ people practice healthier lifestyles, which result in better health status. However, do such people spend more on healthcare? We employed hierarchical multiple regression analysis to examine the impact of national average IQ on private health expenditure, especially health insurance at cross-country level. Controlling for income, the old-age dependency ratio, and government expenditure on health, we found that IQ was positively significant on out-of-pocket healthcare expenditure but negatively associated with private health insurance expenditure. We suggest that high IQ societies pay less for health insurance because they are more capable of preventing illnesses or injuries and they live in healthier and safer environments, which are less vulnerable to diseases. In addition, they are more efficient at calculating risk and making choices according to their future healthcare needs. Hence, with price dispersion and various choices of premium schemes available within the health insurance industry, high IQ people may be more efficient at obtaining lower effective prices of premiums.
    Keywords: health insurance; income; intelligence; national IQ; private health expenditure; public health
    JEL: H51 I13 I25 J24
    Date: 2015–06–15
  17. By: D. Mark Anderson; Kerwin Kofi Charles; Claudio Las Heras Olivares; Daniel I. Rees
    Abstract: The U.S. tuberculosis movement pioneered many of the strategies of modern public health campaigns. Dedicated to eradicating a specific disease, it was spearheaded by voluntary associations and supported by the sale of Christmas seals. Although remarkable in its scope and intensity, the effectiveness of the tuberculosis (TB) movement has not been studied in a systematic fashion. Using newly digitized mortality data at the municipal level for the period 1900-1917, we explore the effectiveness of the measures championed by the TB movement. Our results suggest that the adoption of a municipal reporting requirement was associated with a 6 percent decrease in pulmonary TB mortality, while the opening of a state-run sanatorium was associated with an almost 4 percent decrease in pulmonary TB mortality. However, these and other anti-TB measures can explain, at most, only a small portion of the overall decline in pulmonary TB mortality observed during the period under study.
    JEL: I1
    Date: 2017–03
  18. By: Alexander F. McQuoid (United States Naval Academy); Charles Moore (United States Naval Academy); Stephen Sawyer (United States Naval Academy); David C. Vitt (Farmingdale State College SUNY)
    Abstract: With a growing debate over tighter rearm regulations, we consider an often overlooked consequence of increased rearm access: an increase in rearm suicides. Using data from the federal criminal background check system, we consider the impact of rearm ownership of rearm suicide rates. To deal with concerns of identi cation, we instrument for rearm background checks with state-year level Google search intensity for phrases that re ect fear of future gun shortages and learning about the constitutional rights of rearm owners. We nd that an increase in rearm ownership has a sizable and statistically signi cant impact on rearm suicide rates. A 10% increase in rearm ownership increases rearm suicide rates by 2.8%. Furthermore, we nd no e ect of gun ownership on non- rearm suicide rates, suggesting our ndings are not simply capturing a suicide method substitution e ect. The results are robust to a variety of validity tests. Our results make clear the link between rearm ownership and rearm suicide rates, which have increased dramatically over the last decade.
    Date: 2017–03
  19. By: Francesco Longo (Department of Economics and Related Studies, University of York, York, UK); Luigi Siciliani (Department of Economics and Related Studies, University of York, York, UK); Hugh Gravelle (Centre for Health Economics, University of York, York, UK.); Rita Santos (Centre for Health Economics, University of York, York, UK.)
    Abstract: We investigate whether hospitals in the English National Health Service increase their quality (mortality, emergency readmissions, patient reported outcome, and patient satisfaction) or efficiency (bed occupancy rate, cancelled operations, and cost indicators) in response to an increase in quality or efficiency of neighbouring hospitals. We estimate spatial cross-sectional and panel data models, including spatial cross-sectional instrumental variables. Hospitals generally do not respond to neighbours’ quality and efficiency. This suggests the absence of spillovers across hospitals in quality and efficiency dimensions and has policy implications, for example, in relation to allowing hospital mergers.
    Keywords: quality, efficiency, hospitals, competition, spatial econometrics
    JEL: C21 C23 I11 L3 L11
  20. By: Ncube, Prince; Cheteni, Priviledge; Sindiyandiya, Kholeka
    Abstract: Road related fatalities remain high in South Africa compared to other African nations. The purpose of this study was to analyse the determinants of road accident fatalities in South Africa’s transport sector. The determinants were examined using the ordinary least squares (OLS) method. The results suggest that drunken driving, paved roads and use of seatbelts are some of the determinants in the number of road related fatalities. The study recommends that the South African government put strict measures in dealing with drunk driving that has contributed to the unnecessary loss of life, especially during holiday periods.
    Keywords: drunk driving, road safety management, Haddon matrix, enforcement, seatbelts
    JEL: H0 M2 R4
    Date: 2016
  21. By: Carvalho, José-Raimundo (Universidade Federal do Ceará); de Oliveira, Victor Hugo (Instituto de Pesquisa e Estratégia Econômica do Ceará (IPECE)); Quintana-Domeque, Climent (University of Oxford)
    Abstract: Brazilian health authorities have recommended that pregnant women take meticulous precaution to avoid mosquito bites, and use contraceptive methods to postpone/delay pregnancies. In this article, we present new estimates on the Zika virus prevalence, its correlates and preventive behaviors in the Northeast of Brazil, where the outbreak initiated, using survey data collected between March 30th and June 3rd of 2016. The target population are women aged 15-49 in the capital cities of the nine states of the Northeast region of Brazil. We find that more educated women are less likely to report suffering from Zika (or its symptoms), and more likely to avoid pregnancy in the last 12 months and being informed about the association between Zika and microcephaly. In addition, more educated women are more likely to follow preventive measures against the Zika virus: having used long and light-colored clothes, having used mosquito repellent or insecticides, having used mosquito protective screens or kept windows closed, and having dumped standing water where mosquitoes can breed.
    Keywords: flavivirus, education, information, prevention, survey data
    JEL: I1 J1
    Date: 2017–02
  22. By: Elizabeth Copson; Karin Martinson; Valerie Benson; Michael Benson; Annalisa Mastri; Karen Needels; Julie Williams
    Abstract: This report presents implementation study findings from a study sponsored by the Department of Labor to examine the effects of training sponsored by American Recovery and Reinvestment Act of 2009 grants. The training was designed to improve the earnings of unemployed and other disadvantaged workers.
    Keywords: career pathways, training, ARRA grants, health care jobs, energy jobs, green jobs
    JEL: J
  23. By: Karin Martinson; Julie Williams; Karen Needels; Laura Peck; Shawn Moulton; Nora Paxton; Annalisa Mastri; Elizabeth Copson; Hiren Nisar; Alison Comfort; Melanie Brown-Lyons
    Abstract: This report presents impact findings from a study sponsored by the Department of Labor to examine the effects of training sponsored by American Recovery and Reinvestment Act of 2009 grants. The training was designed to improve the earnings of unemployed and other disadvantaged workers.
    Keywords: career pathways, training, ARRA grants, health care jobs, energy jobs, green jobs
    JEL: J
  24. By: Kim, Albert Young-Il (Sogang University); Lee, Jungmin (Seoul National University)
    Abstract: Does single motherhood adversely affect infant health? This question is not easy to answer because of the endogeneity of coresidence during pregnancy. In this paper, we exploit quasi-natural variation in single motherhood from the moment of conception to that of birth arising from marriageable age restrictions and the reform of the laws in Korea. The Korean birth certificate dataset is unique in that it allows us to distinguish coresidence and legal marital status and further to identify the duration of pregnancy period without a partner. Results show that although coresidence with the partner during pregnancy is seemingly beneficial for infant health, it is mostly driven by selection into coresidence. Further, we do not find any significant advantage of legal marriage among young mothers.
    Keywords: single motherhood, coresidence, marriage, marriageable age, birth weight, LBW, preterm birth, quasi-natural experiment
    JEL: I12 J12 K36
    Date: 2017–02
  25. By: Ahmed Rashad (The American University in Cairo); Mesbah Sharaf (University of Alberta)
    Abstract: Conventional poverty estimates do not take into account out-of-pocket (OOP) health payments. OOP health payments could cause financial catastrophe to households, which may push them into poverty. OOP payments are the principle means of financing healthcare in Egypt. This paper investigates the catastrophic and the impoverishing impact of OOP health payments in Egypt. A nationally representative sample of 10,550 households from the Eighth round of the Egyptian Family Observatory Survey is used. OOP payments for healthcare are considered catastrophic if exceeding 40% of the household’s capacity to pay. The impoverishing impact of OOP health payments is evaluated using poverty head counts and poverty gaps before and after the OOP payments. The determinants of catastrophic health expenditures are examined using a multivariate logistic regression. Results show that OOP health payments drive 6% of households to encounter financial catastrophe. 7.4% of households fell below the poverty line after controlling for healthcare expenditures. OOP health expenditures have exacerbated the normalized poverty gap by 1.4%. The multivariate logistic regression shows that when compared to urban households, rural households are more likely to incur catastrophic health expenditure (Odd Ratio (OR) =1.73; 95% Confidence Interval (CI) = 1.38-2.17). The odds of catastrophic health expenditure are higher among households with no private health insurance (OR=2.74; 95% CI=1. 55-4.82), and households whose heads are unemployed (OR=2. 30; 95% CI= 1.80-2.95). A female headed household has less risk to incur catastrophic health expenditure compared to a male headed household (OR=0.71; 95% CI= 0.52-0.96). Large households are less likely to encounter catastrophic health expenditure than small households (OR=0.78; 95% CI= 0.72-0.84). Having a sick member with chronic disease is a risk factor for catastrophic health expenditure (OR=5.08; 95% CI= 1.78-14.4). Households with young children (less than five years) are more likely to face financial catastrophe than households without young children (OR=1.36; 95% CI= 1.11-1.66). OOP health expenditures have catastrophic and impoverishing effects in Egypt. Poverty reduction policies in Egypt should target vulnerable households with high risk of experiencing catastrophic health expenditure.
    Date: 2015–11
  26. By: Katherine Baird
    Abstract: This paper measures high medical expenses in ten developed countries, both overall and by income and age, providing some of the best evidence to date on the extent of high medical spending across and within countries. Using comparable household-level data on out-of pocket (OOP) medical expenditures made available through the Luxembourg Income Study (LIS), we measure high spending when it exceeds a threshold share of household income. The results show that the U.S. is far from alone in its failure to protect individuals from large medical expenses. In five of the other nine countries, one-quarter or more of poor households devoted at least 5 percent of household income to OOP expenses. The rate of high spending in the US is similar to Japan’s, but below that in Russia, Poland, Israel, and Switzerland. The high levels of exposure to large medical expenses in most countries indicates the need to develop robust measures of excessive spending that capture both future risk as well as past burdens.
    Keywords: out of pocket spending, health care financing, financing equity, comparative health policy
    Date: 2016–02
  27. By: Johan Fritzell; Johan Rehnberg; Jennie Bacchus Hertzman; Jenni Blomgren
    Abstract: Objectives: We aimed to examine the cross-national and cross-temporal association between poverty and mortality, in particular differentiating the impact of absolute and relative poverty. Methods: We employed pooled cross-sectional time series analysis. Our measure of relative poverty was based upon the standard 60 percent of median income. The measure of absolute, or fixed, poverty we based upon the US poverty threshold. Our analyses were conducted on data for 30 countries between 1978 and 2010, a total of 149 data points. We separately studied infant, child and adult mortality. Results: Our findings highlight the importance of relative poverty for mortality. Especially for infant and child mortality we found that our estimates of fixed poverty is close to zero either in the crude models, or when adjusting for GDP. Conversely, the relative poverty estimates increased when adjusting for confounders. Our results seemed robust to a number of sensitivity tests. Conclusions: If we agree that risk of death is important, the public policy implication of our findings is that relative poverty, which has close associations to overall inequality, should be a major concern also among rich countries.
    Date: 2015–05

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