nep-hea New Economics Papers
on Health Economics
Issue of 2017‒04‒16
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Health and Body Mass Index: No Simple Relationship By Hübler, Olaf
  2. Urban Water Disinfection and Mortality Decline in Developing Countries By Bhalotra, Sonia R.; Diaz-Cayeros, Alberto; Miller, Grant; Miranda, Alfonso; Venkataramani, Atheendar
  4. The Intergenerational Transmission of Depression in South African Adolescents By Katherine Eyal; Justine Burns
  5. Rising Inequality in Life Expectancy by Socioeconomic Status By Geoffrey T. Sanzenbacher; Anthony Webb; Candace M. Cosgrove; Natalia S. Orlova
  6. Global health financing towards 2030 and beyond By Trygve Ottersen; David B. Evans; Elias Mossialos; John-Arne Røttingen
  7. The Bilateral Relationship between Depressive Symptoms and Employment Status By Melisa Bubonya; Deborah A. Cobb-Clark; David C. Ribar
  8. Health effects of retirement. Evidence from Norwegian survey and register data By Grøtting, Maja Weemes; Lillebø, Otto Sevaldson
  9. Self-Rated Health and Primary Care Utilization: Is Selection into Healthcare Endogenously Determined? By Firat Bilgel; Burhan Can Karahasan
  10. Happiness in the Air: How Does a Dirty Sky Affect Mental Health and Subjective Well-being? By Zhang, Xin; Zhang, Xiaobo; Chen, Xi
  11. Informal, Formal, or Both? Assessing the Drivers of Home Care Utilisation in Austria Using a Simultaneous Decision Framework By Matthias Firgo; Klaus Nowotny; Alexander Braun
  12. Hiring subsidies for people with disabilities: Do they work? By Sergi Jiménez-Martín; Arnau Juanmarti Mestres; Judit Vall Castelló
  13. Understanding variations in hospital length of stay and cost: Results of a pilot project By Luca Lorenzoni; Alberto Marino
  14. The Effects of Female Education on Adolescent Pregnancy and Child Health: Evidence from Uganda fs Universal Primary Education for Fully Treated Cohorts By Kazuya Masuda; Chikako Yamauchi
  15. Aging, depression, and non-communicable diseases in South Africa By Manoj K Pandey, Vani S Kulkarni & Raghav Gaiha
  16. Cost-effectiveness analysis of PET-CT guided management for locally advanced head and neck cancer By Alison F Smith; Peter Hall; Claire Hulme; Janet A Dunn; Christopher C McConkey; Joy K Rahman; Christopher McCabe; Hisham Mehanna
  17. Malaria Risk and Civil Violence By Cervellati, Matteo; Esposito, Elena; Sunde, Uwe; Valmori, Simona

  1. By: Hübler, Olaf (Leibniz University of Hannover)
    Abstract: Many studies have shown that obesity is a serious health problem for our society. Empirical analyses often neglect a number of methodological issues and relevant influences on health. This paper investigates empirically whether neglecting these items leads to systematically different estimates. Based on data from the German Socio-Economic Panel, this study derives the following results. (1) Many combinations of weight and height lead to the same health status. (2) Obese people have a significantly worse state of health. (3) The hypothesis has to be rejected that weight is an exogenous influence on health. (4) High income helps to improve men's health while deviations between desired and actual working hours induce negative effects. (5) The more siblings a woman has and the lower her father's social status, the worse is her health status. (6) Smoking is not good for health, a well-known fact. Especially for underweight individuals we detect the negative influence on health. Women are less affected. (7) A healthy diet strengthens the resilience for individuals who are not obese. (8) Long but not too long sleeping hours and sporting activities during youth contribute to a good health status. (9) Weight fluctuations induce negative effects on the health of women only. (10) Four of the big five components of personality, namely openness, extraversion, conscientiousness and agreeableness, contribute to resilience against health problems for underweight people.
    Keywords: health, body mass index, underweight, obesity, gender, resilience, vulnerability
    JEL: D03 I12 J16 J24 J81
    Date: 2017–03
  2. By: Bhalotra, Sonia R. (University of Essex); Diaz-Cayeros, Alberto (Stanford University); Miller, Grant (Stanford University); Miranda, Alfonso (CIDE, Mexico City); Venkataramani, Atheendar (Massachusetts General Hospital)
    Abstract: Historically, improvements in the quality of municipal drinking water made important contributions to mortality decline in wealthy countries. However, water disinfection often does not produce equivalent benefits in developing countries today. We investigate this puzzle by analyzing an abrupt, large-scale municipal water disinfection program in Mexico in 1991 that increased the share of Mexico's population receiving chlorinated water from 55% to 85% within six months. We find that on average, the program was associated with a 37 to 48% decline in diarrheal disease deaths among children (over 23,000 averted deaths per year) and was highly cost-effective (about $1,310 per life year saved). However, we also find evidence that age (degradation) of water pipes and lack of complementary sanitation infrastructure play important roles in attenuating these benefits. Countervailing behavioral responses, although present, appear to be less important.
    Keywords: clean water, chlorination, child mortality, infectious disease, diarrhea, Mexico, cost-effectiveness, sanitation, behavioral responses
    JEL: I18 H41 J11
    Date: 2017–03
  3. By: Ramesh Chand Chauhan
    Abstract: Heart disease is the non-communicable disease which is the leading cause of death globally and in India also.. The causes and prevention of heart disease have been studied for years, and new information is emerging. The coronary artery diseases can play a crucial medico- legal role to decide the cause of sudden death whether natural or unnatural. There are certain occasions, when a person dies on the operating table or soon after surgery, and a coronary attack is probably the cause of death. A final coronary episode may sometimes be associated with an operative procedure supposedly due to hypertensive state. These conditions indicate that intervention of Forensic Pathologist is significant to decide the actual cause of death apart from injury or disease of vital organs. For the last several decades, saturated fat and cholesterol have been thought to be major contributors to coronary artery disease. However, recent studies are indicating that it may not be wise to strictly limit the intake of dietary saturated fatty acids or replace them with polyunsaturated fatty acids when taking other health conditions into consideration. Depending on a person’s genetics, diet may or may not be an important factor in preventing heart disease. Exercise is also the drug free way in preventing heart disease. When considering human development, humans still have a lot to learn about the human body and the interaction of diet, the environment, and genetics. Key Words: Angina, atherosclerosis, Coronary artery disease, cardiovascular disease, Heart Attack Policy
    Date: 2017–03
  4. By: Katherine Eyal (School of Economics, University of Cape Tow); Justine Burns (School of Economics, University of Cape Town)
    Abstract: Nationally representative data to measure mental health is rare in South Africa. Estimates of the size of the intergenerational transmission of depression in Africa, and in South Africa, are not numerous, in particular using recent nationally representative data, or in the adolescent sample. South Africa has high rates of depression compared to other countries, in particular among adolescents. Very little mental health treatment is available to adolescents, and the results of poor mental health during adolescence are many - including earlier child bearing, poor education, higher levels of HIV infection and low rates of future employment, among others.
    Keywords: Mental health, depression, adolescents, National Income Dynamic Study, South Africa
    Date: 2017
  5. By: Geoffrey T. Sanzenbacher; Anthony Webb; Candace M. Cosgrove; Natalia S. Orlova
    Abstract: Inequality in life expectancy is growing in the United States, but evidence is mixed regarding how much it has grown. Some studies have found that life expectancies have decreased for those with the lowest socioeconomic status (SES). Other studies have found that while inequality is rising, there have been life expectancy gains across the board. A primary difference in these studies is how SES is measured. Some studies use an absolute measure, such as years of school completed, while others use relative measures, such as a person’s ranking of years of school completed compared to others born at the same time. This study uses regression analysis to assign people a relative education ranking and, in doing so, attempts to isolate the changing relationship between SES and mortality from the fact that certain education-based groups, especially high school dropouts, actually have a lower SES level today than in the past. The study finds that when SES is defined in this way – relatively – inequality in mortality by SES is increasing but life expectancies have also increased across SES groups. The study also finds that white women in the bottom of the education distribution have experienced the least improvement of any group. This research suggests efforts to improve the finances of Social Security through higher retirement ages will have to reckon with the distributional effects of increasing inequality in mortality, but not with increases in mortality for large segments of the population.
    Date: 2017–04
  6. By: Trygve Ottersen; David B. Evans; Elias Mossialos; John-Arne Røttingen
    Abstract: Universal health coverage and healthy lives for all are now widely shared goals and central to the 2030 Agenda for Sustainable Development. Despite significant progress over the last decades, the world is still far from reaching these goals. Billions of people lack basic coverage of health services, live with unnecessary pain and disability, or have their lives cut short by avoidable or treatable conditions (Jamison et al., 2013; Murray et al., 2015; World Health Organization, World Bank, 2015). At the same time, millions are pushed into poverty simply because they need to use health services and must pay for them out-of-pocket. Fundamental to this situation is the way health interventions and the health system are financed. Numerous countries spend less than is required to ensure even the most essential health services, scarce funds are wasted, out-of-pocket payments remain high and disadvantaged groups get the least public resources despite having the greatest needs
    JEL: E6
    Date: 2017–04
  7. By: Melisa Bubonya (Melbourne Institute of Applied Economic and Social Research, the University of Melbourne); Deborah A. Cobb-Clark (School of Economics, The University of Sydney; Institute for the Study of Labor (IZA); and ARC Centre of Excellence for Children and Families over the Life Course); David C. Ribar (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne; Institute for the Study of Labor (IZA); and ARC Centre of Excellence for Children and Families over the Life Course)
    Abstract: This paper analyzes the bilateral relationship between depressive symptoms and employment status. We find that severe depressive symptoms are partially a consequence of economic inactivity. The incidence of depressive symptoms is higher if individuals have been out of a job for an extended period. Men’s mental health falls as they exit the labor force, while women’s worsens only after they have been out of the labor force for a period of time. Entering unemployment is also associated with a substantial deterioration in mental health, particularly for men. We also find that severe depressive symptoms, in turn, lead to economic inactivity. Individuals are less likely to be labor force participants or employed if they experience severe depressive symptoms. Men’s probability of being unemployed rises dramatically with the onset of depressive symptoms; women’s unemployment is increased by protracted depressive symptoms.
    Keywords: Mental health, unemployment, labor market status, HILDA survey, depressive symptoms, depression
    JEL: J01 J64 I14
    Date: 2017–03
  8. By: Grøtting, Maja Weemes (NOVA Norwegian Social Research); Lillebø, Otto Sevaldson (Department of Economics, University of Bergen)
    Abstract: We investigate the relationship between retirement and health, using comprehensive measures from survey- and register data with detailed information on socioeconomic status. Using regression discontinuity at the statutory retirement age of 67, we study health in terms of depression, physical health and acute hospital admissions, with the latter observed for the entire Norwegian population. Our findings suggest that retirement leads to better physical health outcomes for individuals with low socioeconomic status, both for subjective- and objective outcomes, and to increased symptoms of depression for individuals with high socioeconomic status. Our findings highlight the importance of heterogeneity in the health effects.
    Keywords: Retirement; Health; Socioeconomic Status; Gender; Regression Discontinuity Design
    JEL: I12 I14 I18 I38 J26
    Date: 2017–04–07
  9. By: Firat Bilgel (Okan University); Burhan Can Karahasan
    Abstract: This study assesses the causal effects of primary care utilization on subjective health status in Turkey using individual-level data from the 2012 Health Research Survey. Employing recursive bivariate models that take into account the possibility that selection into healthcare might be correlated with the subjective health status of the respondent, we find that selection into primary care is endogenously determined and that the utilization of preventive care significantly improves one’s self-rated health after controlling for sociodemographics, socioeconomic status, health behavior and risk factors and access to healthcare. The distribution of treatment effects suggests significant between- and within-inequalities in health gains from preventive care utilization in disfavor of chronic patients. Analysis also points out that barriers to healthcare access are associated with lower self-rated health and that significant location-based inequalities exist in the utilization of preventive care among chronic patients. GP care utilization however, only exerts a trivial causal effect on self-rated health exclusively among females, rural residents and chronic patients.
    Date: 2017–06–04
  10. By: Zhang, Xin; Zhang, Xiaobo; Chen, Xi
    Abstract: Previous studies evaluating the welfare cost of air pollution have not paid much attention to its potential effect on mental health and subjective well-being (SWB). This paper attempts to fill the gap by investigating the impact of air pollution on several key dimensions, including mental health status, depressive symptoms, moment-to-moment happiness, and evaluative happiness. We match a nationwide longitudinal survey in China with local air quality and rich weather conditions according to the exact time and place of survey. By making use of variations in exposure to air pollution for the same individuals over time, we show that air pollution reduces hedonic happiness and increases the rate of depressive symptoms, while life satisfaction has little to do with the immediate air quality. Our results shed light on air pollution as an important contributor to the Easterlin paradox that economic growth may not bring more happiness.
    Keywords: mental health,depression,hedonic happiness,life satisfaction,air pollution,Easterlin paradox
    JEL: I31 Q53 Q51
    Date: 2017
  11. By: Matthias Firgo (WIFO); Klaus Nowotny (WIFO); Alexander Braun
    Abstract: Understanding the relation between different types of long-term care and the determinants of individual choice of long-term care types is fundamental for efficient policy making in times of ageing societies. However, empirical research on this issue has revealed both national and methodological factors as crucial for the policy conclusions drawn. Thus, the purpose of the present paper is twofold: First, at least to our knowledge, it is the first comprehensive assessment of this kind for Austria. Second, it extends the scarce literature explicitly focusing on the combined use of informal and formal care in addition to the exclusive use of these services based on an econometric framework accounting for the simultaneity and interdependencies in these types of long-term care. Our results provide strong evidence for a task-specific and complementary relation of formal and informal home care in Austria, with the health status and functional limitations as the main determinants of individual choice.
    Keywords: long-term care, formal, informal, bivariate probit, SHARE, Austria
    Date: 2017–04–06
  12. By: Sergi Jiménez-Martín; Arnau Juanmarti Mestres; Judit Vall Castelló
    Abstract: This article evaluates the effectiveness of hiring subsidies targeted to people with disabilities. By exploiting the timing of implementation among the different Spanish regions of a subsidy scheme implemented in Spain during the period 1990-2014, we employ a differencesin- differences approach to estimate the impact of the scheme on the probability of DI beneficiaries of transiting to employment and on the propensity of individuals of entering the DI program. Our results show that the introduction of the subsidy scheme is in general ineffective at incentivizing transitions to employment, and in some cases it is associated with an increased propensity of transiting to DI. Furthermore, we show that an employment protection component incorporated to the subsidy scheme, consisting in the obligation for the employer to maintain the subsidized worker in employment, is associated with less transitions to permanent employment, more transitions to temporary employment and more transitions to DI, suggesting that these type of employment protection measures can have undesired effects for people with disabilities.
    Keywords: Disability, employment subsidies, labor market transitions, disability insurance, differences-in-differences.
    JEL: H24 H55 J08 J14
    Date: 2017–04
  13. By: Luca Lorenzoni (OECD); Alberto Marino (OECD)
    Abstract: Hospitals are the most expensive component of OECD health care systems, accounting for around one third of total health care expenditure. Given growing pressures on government budgets, this is an area of expenditure that has already been, and will continue to be, thoroughly scrutinised for potential increases in efficiency. One way to assess hospital efficiency is to measure the amount of resources each hospital uses to treat specific conditions. A care delivery process may be seen as more efficient – after accounting for broader health system and market factors that may constrain the hospital from operating at an efficient level – if it consumes fewer resources while delivering adequate care for the same condition, the dimension of efficiency under review here. In this light, measuring hospital length of stay and costs for a given condition helps the understanding of how efficient (better performing) hospitals are relative to each other. Through international comparative work, this paper helps policy makers understand the scope and nature of length of stay/costs variation across hospitals in OECD countries. It also explores whether characteristic of hospitals or of countries' regulatory and operating environments can explain differences in efficiency. Data on length of stay and costs to treat patients admitted to hospitals for nine tracing conditions/treatments were collected and analysed for Canada (Alberta province), France, Ireland and Israel for 2012-2014. Our analysis shows that hospitals with a number of beds ranging between 200 and 600, and not-for-profit hospitals report shorter length of stay and lower costs for several conditions/treatments. It also shows that variations in efficiency are more likely to exist at the hospital level for cardiac surgery (acute myocardial infarction with percutaneous transluminal coronary angioplasty and coronary artery bypass graft), and at country level for hysterectomy, caesarean section and normal delivery. These results shed some light on the importance of hospital payment system in fostering efficiency in care delivery for standard/high volume treatments such as normal delivery, whereas hospital management and organisation seem to drive efficiency for more complex/technology driven treatments such as bypass surgery.
    JEL: D24 I18
    Date: 2017–04–11
  14. By: Kazuya Masuda (Institute of Economic Research, Hitotsubashi University); Chikako Yamauchi (National Graduate Institute for Policy Studies, Tokyo, Japan)
    Abstract: Early pregnancy poses serious medical risk and economic burden to mother and neonatal children. While Economics literature generally explains negative relationship between female schooling and early fertility, it remains unclear whether this reflects a causal relationship. To fill in such a gap in literature, this paper examines the impact of female education on adolescent fertility, health investment behavior and the health status of their children in Uganda, focusing on the fully treated cohorts whose fees were abolished by Universal Primary Education policy (UPE) just before they entered schools. Education is instrumented by the interaction between across-cohorts differences in exposure to UPE and the differences in its effective benefits across districts with varying pre-program rates of completing primary education. We show that attending an additional year of schooling reduces the probability of marriage and that of giving birth before age 18 by 7.0-7.2 percentage points. Among those who become mothers, educated women use maternal care and infant immunization more often, and had lower probability that their child dies before 12 months after the birth. These results indicate that promoting the access to primary education among girls is an effective program to reduce adolescent pregnancy. It also shows the important role of maternal education in breaking the cycle of intergenerational transmission of the poor health in least developing countries by reducing child mortality. This in turn underscores the importance of considering the widespread benefits of female education in shaping the policy and institution influencing educational attainment.
    Date: 2017–04
  15. By: Manoj K Pandey, Vani S Kulkarni & Raghav Gaiha
    Abstract: This is the first study that offers a comprehensive analysis of depression among the old (60+ years) in South Africa. By using an analytical framewrok that builds on the (sparse) extant literature and a new dataset extracted from the four waves of the South African National Income Dynamics Study (2008, 2010, 2012 and 2014), we examine factors contributing to depression of people in this age cohort. Depending on whether the dependent variable is binary (self-reported depression for ≥ 3 days in a week) or continuous (as in two indices of depression), we use random effects probit estimator with Mundlak adjustment or simply random effects with Mundlak adjustment. It is found that, among the old, those in their sixties, the Africans and Coloureds, women, those suffering from multimorbidity, those in lower asset quartiles, and individuals suffering family bereavement are more likely to be depressed. Factors that attenuate depression include marriage, pension, affluence, and trust in a community and familiar neighbourhoods.
    Keywords: aging, depression, multimorbidity, non-communicable dieseases, South Africa
    JEL: I12 J13 J18
    Date: 2017
  16. By: Alison F Smith (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Peter Hall (Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK); Claire Hulme (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Janet A Dunn (Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK); Christopher C McConkey (Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK); Joy K Rahman (Institute of Head & Neck Studies and Education, University of Birmingham, UK); Christopher McCabe (Department of Emergency Medicine, University of Alberta, Edmonton, Canada); Hisham Mehanna (Institute of Head & Neck Studies and Education, University of Birmingham, UK)
    Abstract: Purpose: A recent large UK clinical trial demonstrated that positron-emission tomography–computed tomography (PET-CT)- guided administration of neck dissection in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned neck dissection (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required in order to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT guided management from a UK National Health Service (NHS) secondary care perspective.Methods: Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence events and mortality was simulated using a de novo Markov model. Health benefit was measured in quality adjusted life years (QALYs) and costs reported in 2015 British pounds. Model transition probabilities, costs and utilities were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader NHS & personal social services (PSS) costs on the results. Results: PET-CT management produced an average lifetime NHS secondary care cost saving of £1,485 [$2,133] (95% CI: -2,815 to 159) and an additional 0.13 QALYs (95% CI: -0.49 to 0.79). At a £20,000 [$28,736] willingness-to-pay per additional QALY threshold there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS & PSS perspective, PET-CT management produced an average saving of £700 [$1,005] (95% CI: -6,190 to 5,362) and had an 81% probability of being cost-effective. Conclusions: This analysis indicates that PET-CT guided management is cost-effective in the long-term and supports the case for adoption.
    Keywords: PET-CT, Head and Neck Cancer, Health Technology Assessment, Economic Evaluation
    JEL: I10 C11 C63 D80
    Date: 2017
  17. By: Cervellati, Matteo; Esposito, Elena; Sunde, Uwe; Valmori, Simona
    Abstract: Using high-resolution data from Africa over the period 1998-2012, this paper investigates the hypothesis that a higher exposure to malaria increases the incidence of civil violence. The analysis uses panel data at the 1° grid cell level at monthly frequency. The econometric identification exploits exogenous monthly within-grid-cell variation in weather conditions that are particularly suitable for malaria transmission. The analysis compares the effect across cells with different malaria exposure, which affects the resistance and immunity of the population to malaria outbreaks. The results document a robust effect of the occurrence of suitable conditions for malaria on civil violence. The effect is highest in areas with low levels of immunities to malaria. Malaria shocks mostly affect unorganized violence in terms of riots, protests, and confrontations between militias and civilians, rather than geo-strategic violence, and the effect spikes during short, labor-intensive harvesting periods of staple crops that are particularly important for the subsistence of the population. The paper ends with an evaluation of anti-malaria interventions.
    Keywords: Malaria Risk; Civil Violence; Weather Shocks; Immunity; Cell-level Data; Africa
    JEL: D74 J1
    Date: 2017–03–10

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