nep-hea New Economics Papers
on Health Economics
Issue of 2017‒03‒26
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Traffic Safety in Korea: Understanding the Vulnerability of Elderly Pedestrians By Martin W. Adler; Rudiger Ahrend
  2. Old, Frail, and Uninsured: Accounting for Puzzles in the U.S. Long-Term Care Insurance Market By Braun, R. Anton; Kopecky, Karen A.; Koreshkova, Tatyana
  3. Measuring social protection for long-term care By Tim Muir
  4. A Novel Approach to Estimating the Demand Value of Road Safety By Christoph M. Rheinberger; Felix Schläpfer; Michael Lobsiger
  5. The Determinants of Child Health Disparities in Jordan By Caroline Krafft
  6. On the Failure of Scientific Research: An Analysis of SBIR Projects Funded by the U.S. National Institutes of Health By Andersen, Martin; Bray, Jeremy; Link, Albert
  7. Social Determinants of Health Inequalities in South Africa: A Decomposition Analysis By Kehinde O. Omotoso; Steven F. Koch
  8. Caregiving and Work: The Relationship between Labor Market Attachment and Parental Caregiving By Sean Fahle; Kathleen McGarry
  9. Gender Differentials in Health: A Differences-in-Decompositions Estimate By Kehinde O. Omotoso; Steven F. Koch
  10. Private versus Social Incentives for Pharmaceutical Innovation By Inés Macho-Stadler; David Pérez-Castrillo; Paula González
  11. Inequity in healthcare use among older people after 2008: The case of Southern European Countries By Tavares, L.; Zantomio, F.;
  12. Head-to-head: is it time for a dedicated tax to fund the NHS? By Richard Layard; John Appleby
  13. Rational addiction and time consistency:an empirical test By Pierani, P.; Tiezzi, S.;
  14. The income-health gradient: Evidence from self-reported health and biomarkers using longitudinal data on income By Davillas, A.; Jones, A.M.; Benzeval, M.;
  15. Smoking behaviour in Germany: evidence from the SOEP By Daniela Heilert; Ashok Kaul
  16. Evolving health expenditure landscape of the BRICS nations and projections to 2025 By Jakovljevic, Mihajlo; Potapchik, Elena; Popovich, Larisa; Barik, Debasis; Getzen, Thomas E.
  17. Poor Health Reporting? Using Vignettes to Recover the Health Gradient by Wealth By Laura Rossouw; Teresa Bago d'Uva; Eddy van Doorslaer
  18. Hospital interdependence in a competitive institutional environment: Evidence from Italy By Lisi, D.; Moscone, F.; Tosetti, E.; Vinciotti, V.;
  19. Revising Infant Mortality Rates for the Early 20th Century United States By Katherine Eriksson; Gregory T. Niemesh; Melissa Thomasson
  20. Anchoring Bias in Face-To-Face Time-Trade-Off Valuations Of Health States By Mario García-Molina; Liliana Alejandra Chicaíza
  21. The Impact of College Education on Old-Age Mortality: A Study of Marginal Treatment Effects By Evan Taylor
  22. Socioeconomic disadvantage and suicidal behaviour during times of economic recession and recovery By David McDaid
  23. A cause-of-death decomposition of the young adult mortality hump By Adrien Remund; Carlo G. Camarda; Timothy Riffe
  24. The economy wide impact of HIV/AIDS and the funding dilemma in Africa: Evidence from a dynamic life cycle horizon By Judith Kabajulizi; Judith Kabajulizi; Mthuli Ncube
  25. The Impact of Information Technology on the Diffusion of New Pharmaceuticals By Kenneth J. Arrow; Kamran Bilir; Alan T. Sorensen
  26. Examining Multi-Level Correlates of Suicide by Merging NVDRS and ACS Data By David A Boulifard; Bernice A Pescosolido
  27. Smog in Our Brains: Gender Differences in the Impact of Exposure to Air Pollution on Cognitive Performance By Chen, Xi; Zhang, Xiaobo; Zhang, Xin

  1. By: Martin W. Adler (Free University Amsterdam); Rudiger Ahrend (OECD)
    Abstract: Pedestrians are vulnerable in traffic, with frequently reported injuries and fatalities. These risks are believed to be correlated with socio-economic attributes such as age, income or education levels. For Korea, it is shown that elderly pedestrians have a higher mortality risk than other road users. On a municipal level, risk factors are high car ownership, an aging population and low population density; factors associated with rural areas. Some tentative evidence also points to financially stronger municipalities having better traffic safety, which could reflect a larger capacity to maintain roads and implement road safety measures.
    Keywords: accident, ageing population, elderly, inclusiveness, Korea, pedestrian, regional, Traffic safety
    JEL: C25 H76 R41
    Date: 2017–03–27
  2. By: Braun, R. Anton (Federal Reserve Bank of Atlanta); Kopecky, Karen A. (Federal Reserve Bank of Atlanta); Koreshkova, Tatyana (Concordia University)
    Abstract: Half of U.S. 50-year-olds will experience a nursing home (NH) stay before they die, and a sizeable fraction will incur out-of-pocket expenses in excess of $200,000. Given the extent of NH risk, it is surprising that only about 10 percent of individuals over age 62 have private long-term care insurance (LTCI). This market also has a number of other puzzling features. Many applicants are denied coverage by insurers. Coverage of those who have insurance is incomplete. Insurance premia are high relative to an actuarily fair benchmark. Using a model that features agents with private information about their NH entry risk and an insurer who optimally chooses menus of LTCI contracts subject to participation and incentive compatibility constraints, this paper shows that these puzzles can be attributed to adverse selection, overhead costs on the insurer, and Medicaid. The model also accounts for the lack of correlation between NH entry and LTCI ownership. This final property is novel because our setup has only one dimension of private information.
    Keywords: long-term care insurance; Medicaid; adverse selection; insurance rejections
    JEL: E62 H31 H52 H55
    Date: 2017–03–01
  3. By: Tim Muir (OECD)
    Abstract: This report presents the first international quantification and comparison of levels of social protection for long-term care (LTC) in 14 OECD and EU countries. Focusing on five scenarios with different LTC needs and services, it quantifies the cost of care; the level of coverage provided by social protection systems; the out-of-pocket costs that people are left facing; and whether these costs are affordable. The cost of care varies widely between countries but it is always high relative to typical incomes, meaning that LTC is often unaffordable in the absence of social protection. All countries studied have some form of social protection for LTC, but even where coverage is comprehensive, people pay some of the cost out of pocket. Coverage for home care for moderate or severe needs is often insufficient, leaving people with large out-of-pocket costs. In contrast, all countries studied ensure that institutional care is affordable. Unless family and friends can provide informal care, many people will be unable to afford LTC in their own home, leaving them with unmet needs or at risk of early institutionalisation. Benefits are usually means-tested to provide more support to those less able to afford to contribute, but it is still those with lowest incomes that are most likely to face unaffordable costs. Some countries provide financial support to informal carers, but this rarely comes close to compensating them for the time they spend providing LTC. When designing social protection systems for LTC, countries need to look systematically at the level of protection provided to people in different scenarios. Many countries aim to support people with LTC needs to remain in their own home for longer, but the results presented here suggest that gaps in social protection make this unaffordable for people with low income. Addressing these gaps should be a priority for future reforms.
    JEL: I13
    Date: 2017–03–27
  4. By: Christoph M. Rheinberger (European Chemicals Agency (ECHA)); Felix Schläpfer (Kalaidos University of Applied Sciences); Michael Lobsiger (B,S,S. Economic Consultants Ltd.)
    Abstract: We estimate the demand value of road safety improvements in Switzerland from survey data using a novel elicitation approach. Individuals’ responses to questions about how much public spending on road safety should be increased are combined with observations of income, tax rate, and road usage to estimate the economic value of a statistical accident avoided. Information obtained from a risk-risk tradeoff elicitation allows us to distinguish willingness-to-pay values for various degrees of accident severity. Our most comprehensive estimate of the value of a statistical accident avoided amounts to CHF 11.0 million ($11.6 million); the corresponding value per statistical life is close to CHF 4.2 million ($4.5 million). We explore the sensitivity of these estimates to anchoring and other framing effects and find that the popularity of specific road safety programs is influenced by both the availability of different choice options and the provision of partisan cues expressing political endorsement or opposition.
    Keywords: Road Safety, Value of Life, Public Goods
    JEL: H41 I38 J17
    Date: 2017–03
  5. By: Caroline Krafft (University of Minnesota)
    Abstract: The first few years of children’s lives provide a crucial window for their human development. Malnutrition, as a form of faltering development in the early years of life, has lasting consequences in terms of education, labor market, and adult health outcomes. Early childhood is also the period when inequality originates and the intergenerational transmission of poverty and inequality begins. It is therefore important to identify the causes of poor health in early childhood and to understand what drives inequality in early health and nutrition in order to provide children with equal chances for healthy growth. In Jordan, there are substantial socio-economic disparities in children’s health and nutrition. This paper examines the determinants and mediators of health disparities in children’s height and weight in Jordan, focusing on factors that might mediate socio-economic disparities, including parental health knowledge, food quantity and quality, health conditions, the health environment, and prenatal development. While this paper demonstrates that the health environment and food quantity and quality contribute to inequality in child health, these effects mediate only a small share of socio-economic disparities. A large share of inequality in children’s health is determined prenatally, for instance through disparities in fetal growth.
    Date: 2015–09
  6. By: Andersen, Martin (University of North Carolina at Greensboro, Department of Economics); Bray, Jeremy (University of North Carolina at Greensboro, Department of Economics); Link, Albert (University of North Carolina at Greensboro, Department of Economics)
    Abstract: The Small Business Innovation Research (SBIR) program is the primary source of public funding in the United States for research by small firms on new technologies, and the National Institutes of Health (NIH) is a major contributor to that funding agenda. Although previous research has explored the determinants of research success for NIH SBIR projects, little is known about the determinants of project failure. This paper provides important, new evidence on the characteristics of NIH SBIR projects that fail. Specifically, we find that firms that have a founder with a business background are less likely to have their funded projects fail. We also find, after controlling for the endogenous nature of woman-owned firms, that such firms are also less likely to fail.
    Keywords: technology; innovation; R&D; small firms; SBIR; NIH
    JEL: O31 O32 O33 O38
    Date: 2017–03–15
  7. By: Kehinde O. Omotoso (Department of Economics, University of Pretoria, Pretoria, South Africa); Steven F. Koch (Department of Economics, University of Pretoria, Pretoria, South Africa)
    Abstract: This study uses information collected on social determinants of health (SDH) and on a variety of health indicators in the 2004 and 2014 questionnaires of the South African General Household Surveys (GHSs) to explain how changes in the SDH have impacted health inequalities over the last decade, the second since the end of Apartheid. Specifically, the Oaxaca-type decomposition of change in a concentration index is used to illustrate how changes in health inequalities over time are attributable to changes in inequality in the determinants of health, and changes in their elasticities. This study finds that rising inequalities in ill-health are largely explained by widening inequalities among those residing in the urban areas and in the relatively richer provinces. Meanwhile, rising inequality in medical aid coverage and utilisation of private health care are mainly attributable to inequalities in educational attainment and racial composition. However, changing elasticities in SDH, rather than rising inequalities, are found to be important factors in explaining inequality in the utilisation of public health care.
    Date: 2017–03
  8. By: Sean Fahle (State University of New York-Buffalo); Kathleen McGarry (University of California-Los Angeles and NBER)
    Abstract: There has been much concern over the provision of long-term care and the stresses it imposes on the family members who provide that care. However, despite the importance of this issue, it has been difficult to assess a causal relationship between caregiving and work. A chief concern is that those with weaker attachments to the labor force may be more willing to provide care—inducing a negative correlation when caregiving itself does not negatively affect employment. In this study we draw on 20 years of data from the Health and Retirement Study to examine anew the relationship between parental caregiving and work. We use two alternative identification strategies: First, we exploit the multiple observations per person existing in our data to estimate a fixed effects model for the relationship between caregiving and work. Second, we use unique data from the Social Security Administration on earnings histories to control for a woman’s labor market behavior long before the potential need to provide care.We find evidence that caregivers have at least a strong, and by some measures a stronger, relationship to the labor market than non-caregivers. Rather than labor force attachment, the provision of care appears to be driven primarily by parental need and by the availability of alternative caregivers, particularly sisters. However, we also find that caregiving has negative long-term effects on employment and earnings and can thus be detrimental to the financial well-being of caregivers.
    Date: 2017–01
  9. By: Kehinde O. Omotoso (Department of Economics, University of Pretoria, Pretoria, South Africa); Steven F. Koch (Department of Economics, University of Pretoria, Pretoria, South Africa)
    Abstract: We analyse changes in gendered health differentials between 2005 and 2014, using data from population-weighted General Household Surveys (GHS) in South Africa. We also assess the contribution of observed characteristics in explaining those differentials. We find that the gender gap in health narrowed by approximately 2% between 2005 and 2014, and the narrowing of that gap can be mainly attributed to changes in educational attainment and social grant receipt. Specifically, there has been a relative increase in receipt of formal education by women, which explains about 1.11% of the gap reduction, while the relative increase in social grant receipt by women explains approximately 28% of the reduction. Thus, improvements in gender equality, as it relates to health, are furthered by policies addressing inequality in educational attainment and social protection. However, about 76% of the reduction is explained by changes in returns to various male/female attributes.
    Date: 2017–03
  10. By: Inés Macho-Stadler; David Pérez-Castrillo; Paula González
    Abstract: We provide a theoretical framework to contribute to the current debate regarding the tendency of pharmaceutical companies to direct their R&D toward marketing products that are ?follow-on? drugs of already existing drugs, rather than toward the development of breakthrough drugs. We construct a model with a population of patients who can be treated with drugs that are horizontally and vertically differentiated. In addition to a pioneering drug, a new drug can be marketed as the result of an innovative process. We analyze physician prescription choices and the optimal pricing decision of an innovative ?firm. We also characterize the incentives of the innovative firm to conduct R&D activities, disentangling the quest for breakthrough drugs from the firm effort to develop follow-on drugs. Our results offer theoretical support for the conventional wisdom that pharmaceutical firms devote too many resources to conducting R&D activities that lead to incremental innovations.
    Keywords: pharmaceuticals, R&D activities, me-too drugs, breakthrough drugs, incremental innovation, radical innovation
    JEL: I11 I18 O31 H51
    Date: 2015–12
  11. By: Tavares, L.; Zantomio, F.;
    Abstract: Despite the sizeable cuts in public healthcare spending, part of the austerity measures recently undertaken in Southern European countries, little attention has been devoted to monitoring distributional aspects of healthcare usage. This study aims at measuring socioeconomic inequities in primary and secondary healthcare experienced some time after the crisis onset in Italy, Spain and Portugal. The analysis, based on data drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE), focuses on older people, who generally face significantly higher healthcare needs, and whose health appeared to have worsened in the aftermath of the crisis. The Horizontal Inequity indexes reveal remarkable socioeconomic inequities in older people’s access to secondary healthcare in all three countries. In Portugal, the one country facing most severe healthcare budget cuts and where user charges apply also to GP visits, even access to primary care exhibits a significant pro-rich concentration. If reducing inequities in older people’s access to healthcare remains a policy objective, austerity measures maybe pulling the Olive belt countries further away from achieving it.
    Keywords: Healthcare access; Older People; Horizontal Equity; Concentration Index;
    JEL: I13 I14 H51
    Date: 2017–03
  12. By: Richard Layard; John Appleby
    Abstract: A dedicated tax is the only way that we can be sure the government is reflecting public wishes, says Richard Layard, but John Appleby argues it would not protect funding from economic uncertainty
    JEL: N0
    Date: 2017–02–08
  13. By: Pierani, P.; Tiezzi, S.;
    Abstract: This paper deals with one of the main empirical problems associated with the rational addiction model, namely that the demand equation derived from the rational addiction theory is not empirically distinguishable from models with forward looking behavior, but with time inconsistent preferences. The implication is that, even when forward†looking behavior is supported by data, the standard rational addiction equation cannot identify time consistency in preferences. In fact, we show that the possibility of testing for exponential versus non-exponential time discounting is nestled within the general rational addiction model. We propose a test that uses only the information obtained from the general specification and the price effects. We use a panel of Italian individuals to estimate a rational addiction model for tobacco. GMM estimators deal with errors in variables and unobserved heterogeneity. The results conform to the theoretical predictions. We find evidence that tobacco consumers are forward looking. Our test of time consistency does not reject the hypothesis that smokers in our sample actually discount exponentially.
    Keywords: rational addiction; general versus standard empirical specification; time consistency; GMM;
    JEL: C23 D03 D12
    Date: 2017–03
  14. By: Davillas, A.; Jones, A.M.; Benzeval, M.;
    Abstract: This paper adds to the literature on the income-health gradient by exploring the association between short- and long-term income and 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 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.
    Keywords: biomarkers; health inequalities; panel data; Understanding Society;
    JEL: C1 C5 I14
    Date: 2017–03
  15. By: Daniela Heilert; Ashok Kaul
    Abstract: As in most OECD countries, smoking prevalence and cigarette consumption have been decreasing in Germany since the early 2000s. This paper analyses whether smoking prevalence and cigarette consumption, as well as their development over time, differ between socio-economic subgroups. Identifying these differences provides insights into the effect of policy interventions on German smoking behaviour. Based on data from the Socio-Economic Panel (SOEP), a large longitudinal study of the German population, we find that both the decline in smoking prevalence and the decline in average cigarette consumption were probably driven by a behavioural change of younger people, as well as of those with a high educational level and those with a high income. People who quit smoking were on average more highly educated, had a higher income and had most likely a lower cigarette consumption (before quitting). In contrast, smoking prevalence increased among people who were older than 45 and had a low educational level and among those who were unemployed. Smoking prevalence among women was relatively constant over time. Indeed, the smoking prevalence of women and men converged over time, especially in older age groups. Daily cigarette consumption of smokers increased among 66-to-75-year-olds, although it decreased in all other age groups. One explanation might be that the tobacco control measures were successful only in certain socio-economic subgroups. Not only smoking prevalence, but also smoking intensity was higher among men, among those with a lower educational level and among those with a lower income. Especially for younger birth cohorts, smoking prevalence among those with a lower educational level was particularly high. Thus, based on data from 1998 through 2014, the so-called social gradient in smoking was only a distinct feature of younger birth cohorts, and not of older ones.
    Keywords: Smoking prevalence, cigarette consumption, tobacco control measures, SOEP
    JEL: I12 I18
    Date: 2017–03
  16. By: Jakovljevic, Mihajlo; Potapchik, Elena; Popovich, Larisa; Barik, Debasis; Getzen, Thomas E.
    Abstract: Global health spending share of low/middle income countries continues its long-term growth. BRICS nations remain to be major drivers of such change since 1990s. Governmental, private and out-of-pocket health expenditures were analyzed based on WHO sources. Medium-term projections of national health spending to 2025 were provided based on macroeconomic budgetary excess growth model. In terms of per capita spending Russia was highest in 2013. India's health expenditure did not match overall economic growth and fell to slightly less than 4% of GDP. Up to 2025 China will achieve highest excess growth rate of 2% and increase its GDP% spent on health care from 5.4% in 2012 to 6.6% in 2025. Russia's spending will remain highest among BRICS in absolute per capita terms reaching net gain from $1523 PPP in 2012 to $2214 PPP in 2025. In spite of BRICS' diversity, all countries were able to significantly increase their investments in health care. The major setback was bold rise in out-of-pocket spending. Most of BRICS' growing share of global medical spending was heavily attributable to the overachievement of People's Republic of China. Such trend is highly likely to continue beyond 2025.
    Keywords: BRICS; global health; health expenditure; trend; medical spending; emerging markets; future forecasts; projections
    JEL: I11 I15
    Date: 2016–02–16
  17. By: Laura Rossouw (Stellenbosch University, South Africa); Teresa Bago d'Uva (Erasmus University Rotterdam, The Netherlands); Eddy van Doorslaer (Erasmus University Rotterdam, The Netherlands, and Stellenbosch University, South Africa)
    Abstract: In spite of the well-known wide disparities in wealth and in objective measures of health like mortality in countries like South Africa, health inequality by wealth in self-reported health measures appears to be nearly non-existent. We test and correct for reporting heterogeneity in sixteen domains of self-assessed health by wealth and race among elderly South Africans using anchoring vignettes. We find that significant reporting differences between high and low wealth groups lead to severe underestimation of the health-wealth gap: poorer individuals rate the same health relatively higher than richer. Using hierarchical ordered probit (HOPIT) modeling, we show that a significant and substantial health disadvantage of the poor emerges after correction. We also address the question whether and how health inequality and reporting heterogeneity are confounded by race. We find that within race groups - especially among Blacks but also among Whites - reporting heterogeneity leads to the underestimation of the health inequalities between richest and poorest. Finally, we show that the apparent Black (vs White) health disadvantage within the top wealth quintile disappears once we correct for reporting tendencies. All in all, our findings suggest that reporting tendencies are an important source of bias in the measurement of health disparities and that anchoring vignettes and HOPIT models can play a role in correcting for these biases.
    Keywords: self-assessed health; vignettes; health measurement; inequality; South Africa
    JEL: D30 D31 I10 I14
    Date: 2017–03–14
  18. By: Lisi, D.; Moscone, F.; Tosetti, E.; Vinciotti, V.;
    Abstract: In this paper we study the impact of competition on hospital adverse health outcomes, using data on patients admitted to hospitals located in the Lombardy region in Italy between 2004 and 2013. We propose an economic framework that incorporates both short and long range forms of competition among hospitals. In a set up where prices are regulated, and under the assumption that hospitals are profit maximisers, hospital managers compete locally in quality to attract more patients. At the same time, managers have an incentive to compete with all other hospitals within the Lombardy region as their relative quality performance will potentially affect their future states. Our empirical model exploits methods from the graphical modelling literature to estimate local rivals, as well as the degree of local and global interdependence among hospitals. Our results show a significant positive degree of short and long range dependence, which suggests the existence of forms of local and global competition among hospitals with relevant implications for the healthcare policy.
    Keywords: hospital interdependence; stochastic games; graphical modelling; spatial econometrics;
    JEL: I11 I18 C31 C73
    Date: 2017–03
  19. By: Katherine Eriksson; Gregory T. Niemesh; Melissa Thomasson
    Abstract: Accurate vital statistics are required to understand the evolution of racial disparities in infant health and the causes of rapid secular decline in infant mortality during the early twentieth century. Unfortunately, infant mortality rates prior to 1950 suffer from an upward bias stemming from a severe underregistration of births. At one extreme, African-American births in Southern states went unregistered at the rate of 15 to 25 percent. In this paper, we construct improved estimates of births and infant mortality in the United States for the 1915-1940 period using recently released complete count decennial census microdata combined with the counts of infant deaths from published sources. We check the veracity of our estimates with a major birth registration study completed in conjunction with the 1940 Decennial Census, and that the largest adjustments occur in states with less complete birth registration systems. An additional advantage of our census-based estimation method is the extension back of the birth and infant mortality series for years prior to published estimates of registered births, enabling previously impossible comparisons and estimations. Finally, we show that underregistration can bias effect estimates even in a panel setting with specifications that include location fixed effects and place-specific linear time trends.
    JEL: I19 J11 N32
    Date: 2017–03
  20. By: Mario García-Molina; Liliana Alejandra Chicaíza
    Abstract: A usual method for valuing health states is Time Trade-Off (TTO). It has been found in web surveys that TTO is affected by anchoring, as the starting point in the task affects the results, thus violating procedural invariance. The aim of this study is to explore whether anchoring is also present in face to face interviews. 147 Colombian subjects (111 male, 36 female) valued 5 better than death EQ-5D health states in a face to face interviews. Subjects were randomized to two different starting points. We tested for the presence of anchoring by means of a battery of non-parametric tests, including Kolmogorov-Smirnov and Wilcoxon-Mann-Whitney tests. Shapiro Wilk test discarded normality for all the distributions. In all tests anchoring was significant for 4 out of 5 health states, which was supported also by visual analysis of the Box and Whiskers diagrams. A higher starting point increased the elicited value by 15% - 188%. The health state with no anchoring was one with near perfect health. The size of the anchoring effect was not uniform among health states. In conclusion, anchoring effects may bias face-to-face TTO valuations. The size of the anchoring effect is small compared to other situations, such as business valuations, but it is still relevant for health policy.
    Keywords: Time trade-off, Health state valuation, Starting point, Anchoring bias, EQ-5D, Colombia.
    JEL: D03 D61 D81 I13
    Date: 2017–03–17
  21. By: Evan Taylor
    Abstract: Using a newly constructed dataset that links 2000 U.S. Census long-form records to Social Security Administration data files, I evaluate the effect of college education on mortality. In an OLS regression, women and men who have at least some college education have 20% lower mortality rates than those with a high school degree or less. I proceed with an empirical design intended to illuminate the extent to which this relationship is causal, estimating marginal treatment effects (MTEs) using the proximity of the nearest college to individuals' birthplace as an instrument. Results indicate positive selection into college education (in terms of longevity) for both women and men. Selection drives almost all of the mortality gap for women. For men, longevity gains from college attendance are concentrated among individuals with unobserved variables that make them unlikely attend college. This suggests that men who would benefit most from receiving college education in terms of mortality reductions are those who are not attending.
    Date: 2017–01
  22. By: David McDaid
    JEL: N0
    Date: 2017
  23. By: Adrien Remund (Max Planck Institute for Demographic Research, Rostock, Germany); Carlo G. Camarda (Max Planck Institute for Demographic Research, Rostock, Germany); Timothy Riffe (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: We propose a method to decompose the young adult mortality hump by cause of death. This method is based on a flexible shape-decomposition of mortality rates that separates cause-of-death contributions to the hump from senescent mortality. We apply the method to US males and females from 1959 to 2010. Results show divergences between time trends of hump and observed deaths, both for all-cause and cause-specific mortality. The study of the hump shape reveals age, period and cohort effcts, suggesting that it is formed by a complex combination of different forces of biological and socioeconomic nature. Male and female humps share some traits in all-cause shape and trend, but also differ by their overall magnitude and cause-specific contributions. Notably, among males the contributions of traffic and other accidents were progressively replaced by those of suicides, homicides and poisonings, whereas among females traffic accidents remained the major contributor to the hump.
    JEL: J1 Z0
    Date: 2017–03
  24. By: Judith Kabajulizi; Judith Kabajulizi; Mthuli Ncube
    Abstract: The HIV pandemic, even though it is still a major killer in Africa, seems to have been tamed medically into a chronic disease through advances in treatment drugs (ARTs). However, the full economic costs, over a lifecycle horizon, of keeping people on treatment and implementing prevention measures, are still not fully quantified and are unfolding. Indeed, the economic effects of the HIV/AIDS disease, and also the economic effects of various interventions, also need to be better understood. Sub-Saharan Africa (SSA) disproportionately bears the burden of HIV/AIDS compared to the rest of the word. Over 70% of the people living with HIV (PLWHIV) are resident in SSA, of which 82% are adults. It is evident that the productive segment of the population is afflicted by the devastating health effects of the pandemic. The economic impact of AIDS is felt at all levels of economic analysis: micro, meso and macro. At the micro level, the household experiences increased costs of healthcare expenditure. Additionally the household faces indirect costs of reduced earnings and income when the productive household members are infected. At the meso level, sectors that are labour intensive are faced with low labour productivity. The increased demand for healthcare implies that health sector incurs higher budget allocations, which may necessitate a reduction of the budgets of other government functions. At the macro level, there is loss in economy-wide productivity due to increased absenteeism of sufferers and carers of sick people. Increased mortality from AIDS leads to a reduction in total labour force supply. There is a change in the skill composition of the labour force if AIDS affects one category of skilled labour relatively more. And finally, aggregate savings decline as a result of households resorting to assets and savings for immediate health expenditures, and the reduced capacity to earn income. The advances made in treatment of HIV/AIDS since the advent of anti-retroviral therapies (ART) in 1996 have meant that people can live longer while on treatment. Ultimately HIV/AIDS has become a chronic ailment that continuously draws resources from the health system. The commitment by governments to avail ART to those who need it constitutes a long-term financial liability which can be conceptualised as a debt liability. The dilemma for SSA countries is that they continue to grapple with the challenge of finding adequate resources to finance their health systems and yet also have to increase expenditure for HIV interventions. In exploring the “moral duty of rescue” for PLWHIV, Collier, Sterck and Manning (2015) conclude that funding HIV interventions spans beyond the infected person and the governments of the affected countries, especially for resource poor countries. On the other hand, it is also evident that donor funding for HIV has been gradually dwindling and its sustainability is not certain. The purpose of this paper is to model the economy-wide impact of HIV/AIDS taking into account various modes of funding HIV/AIDS interventions for selected SSA countries. This study extends the previous CGE methodologies by incorporating updating equations that emphasize the cost impact channel of HIV/AIDS interventions. Specifically, given the long term debt liability feature of HIV interventions, the impact on the countries’ debt burden is explicitly modelled, in addition to the impact on growth rate in GDP, investment, private consumption and the trade account. The study countries are purposefully selected to fulfil one of three criteria. A country with high prevalence rates of HIV and (i) resource rich – Botswana, currently resource poor but with prospects of future natural resource exploitation - Uganda, and (iii) currently resource poor and no prospects of future natural resources exploitation -Malawi. We explore different ways of funding the HIV interventions including government capital expenditure, foreign grants, tax financing, domestic borrowing, and foreign borrowing including financial innovations such as diaspora bonds and future-flows securitisation, among others. We use a recursive dynamic model in order to capture the lagged effects of HIV/AIDS-related health effects and the HIV intervention investments over time. It is an adaption of the “core” version of the Maquette for MDG Simulations (MAMS) model developed by the Word Bank group and documented in (Lofgren, Cicowiez, & Diaz-Bonilla, 2013). Technically the model is comprised of a static (within-period) equilibrium solution where producers maximise profit and consumers maximise utility in a given set of institutional constraints, and a dynamic (between-period) equilibrium solution. For the dynamic component, exogenous variables are updated to reflect changes in HIV/AIDS induced population and labour supply growth rates, capital accumulation and total factor productivity growth changes. Additionally, the HIV related government expenditure patterns and sources of funding are updated over the model period. The dynamic module captures the tracking of assets and liabilities of the households and the government, a feature that makes it suitable to predict the impact of HIV intervention cost on debt sustainability. Model solutions are analysed and presented as comparative growth rates over the model horizon. The impact of HIV/AIDS –with no intervention is contrasted with the baseline results. Similarly the impact of HIV/ AIDS-with intervention and different sources of financing the cost of intervention is contrasted with the baseline. Results present the baseline growth path and deviations from the baseline caused by changes in exogenous variables, holding other factors constant. Specifically each country results will show the impact on growth rates in GDP, and as a share of GDP, growth in consumption (private and government), investment (private and government), exports and imports, domestic and foreign debt. At the intermediate level, sectoral growth rates and sector shares are reported. The mechanisms of adjustment: exchange rate dynamics, interest rate payments (domestic and foreign), and factor income changes are explicitly captured and reported.
    Keywords: Malawi, Uganda, Botswana, General equilibrium modeling, Developing countries
    Date: 2015–07–01
  25. By: Kenneth J. Arrow; Kamran Bilir; Alan T. Sorensen
    Abstract: How does information affect the diffusion of innovations? This paper evaluates the influence of physicians' access to detailed drug information on their decisions about which products to prescribe. Combining data on prescriptions and use of a point-of-care electronic drug reference database for over 125,000 individual U.S. physicians, we find that those using the reference prescribe a significantly more diverse set of products, are faster to begin prescribing new generic drugs, and also have a greater propensity to prescribe generics in general. Notably, physicians using the reference database are not faster to prescribe new branded drugs. Given that a new generic drug resembles its branded equivalent clinically, these results are consistent with database users responding primarily to the increased accessibility of non-clinical information such as drug price and insurance formulary data; the results also suggest improvements to physician information access could have important implications for the costs and efficiency of medical care. We address possible selection effects in physician types by relying on within-doctor variation and an instrument for adoption timing that is based on the marketing strategy of the drug reference firm.
    JEL: I10 O33
    Date: 2017–03
  26. By: David A Boulifard; Bernice A Pescosolido
    Abstract: This paper describes a novel database and an associated suicide event prediction model that surmount longstanding barriers in suicide risk factor research. The database comingles person-level records from the National Violent Death Reporting System (NVDRS) and the American Community Survey (ACS) to establish a case-control study sample that includes all identified suicide cases, while faithfully reflecting general population sociodemographics, in sixteen USA states during the years 2005 2011. It supports a statistical model of individual suicide risk that accommodates person-level factors and the moderation of these factors by their community rates. Named the United States Multi-Level Suicide Data Set (US-MSDS), the database was developed outside the RDC laboratory using publicly available ACS microdata, and reconstructed inside the laboratory using restricted access ACS microdata. Analyses of the latter version yielded findings that largely amplified but also extended those obtained from analyses of the former. This experience shows that the analytic precision achievable using restricted access ACS data can play an important role in conducting social research, although it also indicates that publicly available ACS data have considerable value in conducting preliminary analyses and preparing to use an RDC laboratory. The database development strategy may interest scientists investigating sociodemographic risk factors for other types of low-frequency mortality.
    Keywords: suicide risk, multi-level modeling, public use microdata areas, disclosure avoidance
    Date: 2017–01
  27. By: Chen, Xi; Zhang, Xiaobo; Zhang, Xin
    Abstract: While there is a large body of literature on the negative health effects of air pollution, there is much less written about its effects on cognitive performance for the whole population. This paper studies the effects of contemporaneous and cumulative exposure to air pollution on cognitive performance based on a nationally representative survey in China. Bymerging a longitudinal sample at the individual level with local air-quality data according to the exact dates and counties of interviews, we find that contemporaneous and cumulative exposure to air pollution impedes both verbal and math scores of survey subjects. Interestingly, the negative effect is stronger for men than for women. Specifically, the gender difference is more salient among the old and less educated in both verbal and math tests.
    Keywords: cognitive performance,air pollution,gender difference
    JEL: I24 Q53 Q51 J16
    Date: 2017

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