nep-hea New Economics Papers
on Health Economics
Issue of 2017‒05‒21
29 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Modelling Heterogeneity in the Resilience to Major Socioeconomic Life Events By Fabrice Etilé; Paul Frijters; David W. Johson; Michael A. Shields
  2. Human Capital and Shocks: Evidence on Education, Health and Nutrition By Elizabeth Frankenberg; Duncan Thomas
  3. Cost of Service Regulation in U.S. Health Care: Minimum Medical Loss Ratios By Steve Cicala; Ethan M.J. Lieber; Victoria Marone
  4. Infant Mortality and the Repeal of Federal Prohibition By David S. Jacks; Krishna Pendakur; Hitoshi Shigeoka
  5. Sharing R&D Risk in Healthcare via FDA Hedges By Adam Jørring; Andrew W. Lo; Tomas J. Philipson; Manita Singh; Richard T. Thakor
  6. Regional Variations in Access to Healthcare among Japanese Individuals over 50 Years Old: An analysis using JSTAR (Japanese) By SHOJI Keishi; IBUKA Yoko
  7. Environmental policy and inequality: A matter of life and death By Karine Constant
  8. A Health Literacy RCT toward Improvement of Programmatic Outcomes of Tuberculosis Control in the Tribal Areas of Pakistan Governance Support Program Post-Crisis By Musharraf Cyan; Michael Price; Mark Rider
  9. Family Size Effects on Child Health: Evidence on the Quantity-Quality Trade-off using the NLSY By Kabir Dasgupta; Keisha T.-Solomon
  10. Literature Review - the vaccine supply chain By Duijzer, E.; van Jaarsveld, W.L.; Dekker, R.
  11. Information, Switching Costs, and Consumer Choice: Evidence from Two Randomized Field Experiments in Swedish Primary Health Care By Anell, Anders; Dietrichson, Jens; Ellegård, Lina Maria; Kjellsson, Gustav
  12. The benefits of combining early aspecific vaccination with later specific vaccination By Duijzer, E.; van Jaarsveld, W.L.; Dekker, R.
  13. Parental Work Hours and Childhood Obesity: Evidence Using Instrumental Variables Related to Sibling School Eligibility By Charles Courtemanche; Rusty Tchernis; Xilin Zhou
  14. Capitalizing Obesity By Bichler, Shimshon; Nitzan, Jonathan
  15. Economic Downturns and Babies’ Health By Alessie, R.; Angelini, V.; Mierau, J.O.; Viluma, L.;
  16. Short- and Long-Term Effects of Adolescent Alcohol Access: Evidence from Denmark By Nabanita Datta Gupta; Anton Nielsson; Abdu Kedir Seid
  17. The Lifelong Costs of Urban Smogs By Ball, Alastair
  18. Evaluating the Effects of a Targeted Home Visiting Program on Maternal and Child Health Outcomes By Sandner, Malte; Cornelissen, Thomas; Jungmann, Tanja; Herrmann, Peggy
  19. Healer or Gatekeeper? Physicians' Role Conflict When Symptoms Are Non-Verifiable By Carlsen, Benedicte; Nyborg, Karine
  20. Maternal Socio-Economic Status and the Well-Being of the Next Generation(s) By Buckles, Kasey
  21. The future of Long Term Care in Europe. An investigation using a dynamic microsimulation model By Vincenzo Atella; Federico Belotti; Ludovico Carrino; Andrea Piano Mortari
  22. Lifestyle and Income-related Inequality in Health in South Africa By Alfred Kechia Mukong; Corne Van Walbeek; Hana Ross
  23. The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act By Maclean, J. Catherine; Saloner, Brendan
  24. The Effects of Health Insurance Parity Laws for Substance Use Disorder Treatment on Traffic Fatalities: Evidence of Unintended Benefits By Popovici, Ioana; Maclean, J. Catherine; French, Michael
  25. The Distribution of Returns to Education for People with Disabilities By Henderson, Daniel J.; Houtenville, Andrew; Wang, Le
  26. Nudging Households to Take Up Health Insurance: Evidence from a Randomized Experiment in Burkina Faso By Bocoum, Fadima; Grimm, Michael; Hartwig, Renate; Zongo, Nathalie
  27. Is work bad for health? The role of constraint vs choice By Andrea Bassanini; Eve Caroli
  28. Are Recessions Good for Staffing in Nursing Homes? By R. Tamara Konetzka; Karen B. Lasater; Edward C. Norton; Rachel M. Werner
  29. Can at Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa? By Adrienne M. Lucas; Nicholas L. Wilson

  1. By: Fabrice Etilé (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, INRA - Institut National de la Recherche Agronomique, PSE - Paris School of Economics); Paul Frijters (CEPR - Center for Economic Policy Research - CEPR, LSE - London School of Economics and Political Science); David W. Johson (Monash University [Malaysia]); Michael A. Shields (Monash University [Malaysia])
    Abstract: Using a novel, dynamic finite mixture model applied to 12 years of nationally representative panel data, we explore individual heterogeneity in the total psychological response (our measure of resilience) to ten major adverse life events, including serious illness, redundancy and crime victimisation. Importantly, this model takes into account that individuals are not randomly selected into adverse events, that some events are anticipated in advance of their occurrence, and that the immediate psychological response and the speed of adaptation may differ across individuals. Additionally, we generate a ‘standardised event’ in order to document the distribution of general resilience in the population. We find considerable heterogeneity in the response to adverse events, with the total psychological loss of people with low resilience being several times larger than the average loss. We also find that resilience is strongly correlated with clinical measures of mental health, but only weakly correlated with cognitive and non-cognitive traits. Finally, we find that resilience in adulthood to some extent is predictable by childhood socioeconomic circumstances; the strongest predictor we identify is good childhood health.
    Keywords: Psychological Health, Resilience, Life Events, Childhood, Panel,Data, Mixture Model
    Date: 2017–03
  2. By: Elizabeth Frankenberg; Duncan Thomas
    Abstract: Human capital, including health and nutrition, has played a key role in the literature on poverty traps. Economic shocks that affect human capital during early life are thought to translate into permanently reduced levels of human capital and, thereby, push individuals into poverty. Three potential concerns in this literature are explored with empirical evidence drawn from primary longitudinal survey data collected before and after two major shocks in Indonesia: the 1998 financial crisis and the 2004 Indian Ocean tsunami. First, it is very hard to identify shocks that are unanticipated and uncorrelated with other factors that affect human capital outcomes. Second, and related, there is abundant evidence that individuals, families and communities invest in strategies that are designed to mitigate the impact of such shocks. The nature and effectiveness of the myriad array of these behaviors vary with the context in ways that are not straightforward to measure or model. Third, the impacts of shocks on human capital outcomes in the short and longer-term may differ precisely because of the behavioral changes of individuals and their families so that drawing inferences about the longer-term impacts based on negative impacts in the short term can be very misleading. The picture of remarkable resilience that emerges from investigating the impacts of major shocks on child health and human capital in Indonesia is nothing short of stunning.
    JEL: I1 I2 O1 O15
    Date: 2017–04
  3. By: Steve Cicala; Ethan M.J. Lieber; Victoria Marone
    Abstract: In health insurance markets, an insurer's Medical Loss Ratio (MLR) is the share of premiums spent on medical claims. As part of the goal of reducing the cost of health care coverage, the Affordable Care Act introduced minimum MLR provisions for all health insurance sold in fully-insured commercial markets as of 2011, thereby explicitly capping insurer profit margins, but not levels. This cap was binding for many insurers, with over $1 billion of rebates paid in the first year of implementation. We model this constraint imposed upon a monopolistic insurer, and derive distortions analogous to those created under cost of service regulation. We test the implications of the model empirically using administrative data from 2005–2013, with insurers persistently above the minimum MLR threshold serving as the control group in a difference-in-difference design. We find that rather than resulting in reduced premiums, claims costs increased nearly one-for-one with distance below the regulatory threshold, 7% in the individual market, and 2% in the group market.
    JEL: I10 L5 L98
    Date: 2017–04
  4. By: David S. Jacks; Krishna Pendakur; Hitoshi Shigeoka
    Abstract: Exploiting a newly constructed dataset on county-level variation in prohibition status from 1933 to 1939, this paper asks two questions: what were the effects of the repeal of federal prohibition on infant mortality? And were there any significant externalities from the individual policy choices of counties and states on their neighbors? We find that dry counties with at least one wet neighbor saw baseline infant mortality increase by roughly 3% while wet counties themselves saw baseline infant mortality increase by roughly 2%. Cumulating across the six years from 1934 to 1939, our results indicate an excess of 13,665 infant deaths that could be attributable to the repeal of federal prohibition in 1933.
    JEL: H73 I18 J1 N3
    Date: 2017–04
  5. By: Adam Jørring; Andrew W. Lo; Tomas J. Philipson; Manita Singh; Richard T. Thakor
    Abstract: The high cost of capital for firms conducting medical research and development (R&D) has been partly attributed to the government risk facing investors in medical innovation. This risk slows down medical innovation because investors must be compensated for it. We analyze new and simple financial instruments, Food and Drug Administration (FDA) hedges, to allow medical R&D investors to better share the pipeline risk associated with FDA approval with broader capital markets. Using historical FDA approval data, we discuss the pricing of FDA hedges and mechanisms under which they can be traded and estimate issuer returns from offering them. Using various unique data sources, we find that FDA approval risk has a low correlation across drug classes as well as with other assets and the overall market. We argue that this zero-beta property of scientific FDA risk could be a main source of gains from trade between issuers of FDA hedges looking for diversified investments and developers looking to offload the FDA approval risk. We offer proof of concept of the feasibility of trading this type of pipeline risk by examining related securities issued around mergers and acquisitions activity in the drug industry. Overall, our argument is that, by allowing better risk sharing between those investing in medical innovation and capital markets more generally, FDA hedges could ultimately spur medical innovation and improve the health of patients.
    JEL: G11 G12 G13 G22 G23 G31 I18 K23 L65 O32
    Date: 2017–04
  6. By: SHOJI Keishi; IBUKA Yoko
    Abstract: Studies have repeatedly reported regional variations in health conditions within a country, but the reason behind such disparities is still under debate. In this study, among the contributors to health disparities, we focus on healthcare-seeking behavior. We examine how regional characteristics affect such behavior of individuals over 50 years old regarding screening and controlling common chronic conditions such as hypertension, hypercholesterolemia, and diabetes. Our analysis using the Japanese Study of Aging and Retirement (JSTAR) shows that there are differences of at least three to 10 percentage points in the proportion of those who seek care across 10 areas covered. On applying a multilevel regression framework, we find that the vast majorities of these differences are due to composition effects, namely, the difference in the distribution of health risk at the individual level. We also find that regional characteristics do not play a major role in explaining the difference in healthcare-seeking activities. However, the concentration of healthcare resources in a region is found to be correlated with the decision to seek healthcare for certain chronic conditions, suggesting that the role of healthcare resources could differ by chronic condition.
    Date: 2017–05
  7. By: Karine Constant (Université Paris Est, Erudite)
    Abstract: This paper analyzes the economic implications of an environmental policy when we take into account the life expectancy of heterogeneous agents. In a framework in which everyone suffers from pollution, but health status depends also on individual human capital, we find that the economy may be stuck in a trap in which inequalities persistently grow, when the initial pollution intensity of production is too high. Moreover, we emphasize that such inequalities are costly in the long run for the economy, in particular in terms of health and growth. Therefore, we study whether a tax on pollution associated with an investment in pollution abatement can be used to overcome this situation. We show that a stricter environmental policy may allow the economy to escape from the inequality trap while it enhances its long-term growth rate, when initial inequalities are not too high.
    Keywords: Endogenous growth, Environmental policy, Human capital, Inequality, Longevity
    JEL: I14 O44 Q56 Q58
    Date: 2017–05
  8. By: Musharraf Cyan (Department of Economics, Andrew Young School of Policy Studies, Georgia State University); Michael Price (Department of Economics, Andrew Young School of Policy Studies, Georgia State University); Mark Rider (Department of Economics, Andrew Young School of Policy Studies, Georgia State University)
    Abstract: According to World Health Organization, 9 million people contracted tuberculosis (TB) in 2013 and in the same time period 1.5 million died from the disease (WHO, 2013). The agency estimated that in the same year 550,000 children became ill with TB and 80,000 HIV-negative children died of TB. Further that close to half a million people developed multidrug resistant TB (MDR-TB) requiring longer and costlier treatment. Pakistan is one of the 5 countries with high incidence of tuberculosis and possibly rising numbers of MDR and XDR (extensively drug resistant) varieties of the infection. In recognition of the worldwide case of resurgence of tuberculosis, Pakistan implements a National TB Control Program. One of its most important components works in the Federally Administration Tribal Areas (FATA) that are afflicted by violence and militancy for the past one decade. The traditional tribal culture and the security issues complicate access to communities. This evaluation was carried out as part of the FATA Governance Support Program’s capacity building initiatives under PCNA implementation and direct support to Directorate of M&E FATA Secretariat. TBCP was selected from a list of important projects under implementation in FATA. The program was selected due to its importance to health outcomes in the region as well as potential of policy lessons to be learnt for achieving higher results through evidence led programmatic initiatives. This evaluation was also planned to plug in gaps in information. TBCP implementation has been an ongoing program in the tribal areas since 2007. Other than the individuals coming to the diagnosis centers and patients returning for tests and additional doses of medication, little is known about the population’s knowledge of tuberculosis and attitudes toward accessing healthcare. This lack of information debilitates outreach efforts and reduces the scope of planning interventions suited to population characteristics. The evaluation seeks to provide these pieces of information for strengthening TBCP implementation in FATA and initiate evidence led interventions for improving programmatic outcomes.
    Date: 2017–05
  9. By: Kabir Dasgupta (NZ Work Research Institute, Faculty of Business, Economics, and Law, Auckland Univeristy of Technology); Keisha T.-Solomon
    Abstract: In this study, we use matched mother-child data from the National Longitudinal Surveys to study family size effects on child health. Focussing on body weight indicators as our health outcome of interest, we examine the effects of exogenous variations in family size on child health. We find no significant empirical support in favor of the quantity-quality trade-off theory. To combat potential empirical concerns associated with cross-sectional analysis, we make use of the panel aspects of the data and employ child fixed effects. Findings from our panel data analysis suggest that birth of a younger sibling is related to a decline in the likelihood of being overweight. Furthermore, birth of younger siblings at higher parities leads to a significant drop in the likelihood of obesity (but may also lead to an increase in the child’s probability of being underweight).
    Keywords: Family Size; Children; Underweight; Overweight; Obesity; Health; Instrumental Variables; Fixed Effects.
    Date: 2017–04
  10. By: Duijzer, E.; van Jaarsveld, W.L.; Dekker, R.
    Abstract: Vaccination is one of the most effective ways to prevent the outbreak of an infectious disease. This medical intervention also brings about many logistical questions. In recent years, in the Operations Research/Operations Management community there is growing interest in the logistical aspects of vaccination. However, publications on this topic are somewhat scattered: most papers focus on particular logistical aspects only and a broad overview is missing. This potentially leads to contributions being overlooked and makes it difficult to identify open research questions. In this literature review we use a supply chain perspective and propose a classification for the literature on vaccine logistics in order to structure this relatively new field and highlight promising research directions. Thereto we distinguish between the following four components: (1) composition, (2) production, (3) allocation and (4) distribution. We use this classification to derive the unique characteristics of the vaccine supply chain. We find that the vaccine supply chain can among others be characterized by high uncertainty in both supply and demand; asymmetry between supplier, public health organization and end customer; complex political decisions concerning allocation and the crucial importance of deciding and acting in time. Our review yields a framework for Operations Research/Operations Management research in vaccine logistics. Based on this framework we discuss for each component in the vaccine supply chain the related decision problems, the current status and future research possibilities.
    Keywords: vaccine, supply chain, logistics, public health, global health
    Date: 2017–01–30
  11. By: Anell, Anders (Department of Business Administration, Lund University); Dietrichson, Jens (The Danish National Centre for Social Research (SFI)); Ellegård, Lina Maria (Department of Economics, Lund University); Kjellsson, Gustav (Department of Economics, University of Gothenburg)
    Abstract: Consumers of services that are financed by a third party, such as publicly financed health care or firm-sponsored health plans, are often allowed to freely choose provider. The rationale is that consumer choice may improve the matching of consumers and providers and spur quality competition. Such improvements are contingent on consumers having access to comparative information about providers and acting on this information when making their choice. However, in the presence of information frictions and switching costs, consumers may have limited ability to find suitable providers. We use two large-scale randomized field experiments in primary health care to examine if the choice of provider is affected when consumers receive comparative information by postal mail and small costs associated with switching are reduced. The first experiment targeted a subset of the general population in the Swedish region Skåne, and the second targeted new residents in the region, who should have less prior information and lower switching costs. In both cases, the propensity to switch provider increased significantly after the intervention. The effects were larger for new residents than for the general population, and were driven by individuals living reasonably close to alternative providers.
    Keywords: Consumer choice; Information; Switching costs; Primary health care; Field experiments
    JEL: D83 I11 I18
    Date: 2017–05–17
  12. By: Duijzer, E.; van Jaarsveld, W.L.; Dekker, R.
    Abstract: Timing is of crucial importance for successful vaccination. To avoid a large outbreak, vaccines are administered preferably as quickly as possible. However, in the early stages of an outbreak the information on the disease is limited and waiting with the intervention allows to design a more tailored vaccination strategy. In this paper we study the resulting tradeoff between timing of vaccination and the effectiveness of the response. We model disease progression using the seminal SIR model, and consider a decision maker who allocates her budget over two vaccine types: an early aspecific vaccine and a later specific vaccine. We analytically characterize the switching curve separating the parameter space region where the late specific vaccine is preferred from the region where the early aspecific type is preferred. More importantly, we show that the decision maker should not only consider pure strategies, i.e., strategies which spend the entire budget on one of the types. Instead, she should suitably invest in both vaccine types to benefit both from the early response and from the good vaccine. We prove that at the switching curve, such a hybrid strategy is strictly better than either of the pure strategies due to the non-linear dynamics of epidemics. Numerical experiments show that the associated benefit of hybrid strategies over pure strategies in terms of reduction of the number of infections may be more than 50%. Such experiments also substantiate our restriction to two vaccine types.
    Keywords: optimization, vaccination, mathematical modelling, infectious diseases, SIR model
    Date: 2017–02–07
  13. By: Charles Courtemanche (Georgia State University); Rusty Tchernis (Georgia State University); Xilin Zhou (Georgia State University)
    Abstract: This study exploits plausibly exogenous variation from the youngest sibling’s school eligibility to estimate the effects of parental work on the weight outcomes of older children. Data come from the 1979 cohort of the National Longitudinal Survey of Youth linked to the Child and Young Adult Supplement. We first show that mothers’ work hours increase gradually as the age of the youngest child rises, whereas mothers’ spouses’ work hours exhibit a discontinuous jump at kindergarten eligibility. Leveraging these insights, we develop an instrumental variables model that shows that parents’ work hours lead to larger increases in children’s BMI z-scores and probabilities of being overweight and obese than those identified in previous studies. We find no evidence that the impacts of maternal and paternal work are different. Subsample analyses find that the effects are concentrated among advantaged households, as measured by an index involving education, race, and mother’s marital status.
    Keywords: childhood obesity, maternal employment, women's labor supply
    JEL: I12 J22
    Date: 2017
  14. By: Bichler, Shimshon; Nitzan, Jonathan
    Abstract: In his 2014 article, 'Food Price Inflation as Redistribution', Joseph Baines shows the intimate correspondence between differential profit and world hunger. But the capitalization of food is a dialectical process. As Michael Harrington noted more than half a century ago in his seminal book 'The Other America', the other side of affluence is poverty; and among the American poor, the other side of hunger is overweight and obesity. Over the next fifty years, the global proportion of undernourished people has diminished while that of the obese has risen; and since the early 2000s, for the first time in history, the obese have outnumbered the undernourished. How has this remarkable hunger-to-obesity transformation evolved? What forms of capital drive the obesity epidemic, including its counter-movements of anti-obesity drugs, non-communicable disease treatments, diets, surgical fixes and psychological interventions? What are the material/ideal technologies that shift the world toward ever more destructive yet profitable forms of mass overfeeding? What policies and legislation have supported this shift, and how have they been imposed on the world’s population? And most importantly, what are the qualitative and quantitative links, if any, between these various strategies of sabotage on the one hand and differential profit and capitalization on the other?
    Keywords: Power,Business Enterprise,Capital & Accumulation,Civilization & Social Systems,Demographics,Institutions
    Date: 2016
  15. By: Alessie, R.; Angelini, V.; Mierau, J.O.; Viluma, L.;
    Abstract: We study the impact of provincial unemployment levels on birthweight using a sample of over 50,000 respondents from Lifelines – a cohort study from the northeastern Netherlands and we allow the effects to differ by babies’ gender. We find that during periods of high unemployment fertility decreases and male babies are born with lower birthweight. The effect of unemployment on birthweight is particularly strong for boys born to older mothers and for babies born to smoking mothers. In addition, we study whether the effects are attributable to changes in cohort composition or in health behaviour of pregnant women. Our results indicate that even though the women who are pregnant during economic downturns are more likely to have higher socio-economic status, the total effect of economic downturns on babies’ health is negative.
    Keywords: Birthweight; Unemployment; Cohort Studies;
    JEL: I10 J13 J11
    Date: 2017–05
  16. By: Nabanita Datta Gupta (Department of Economics and Business Economics, Aarhus University, Denmark); Anton Nielsson (Lund University and Aarhus University); Abdu Kedir Seid (Aarhus University)
    Abstract: We exploit changes in minimum legal alcohol purchasing ages in Denmark in order to estimate effects on short- and long-term health outcomes, as well as on human capital formation. Employing a difference-in-differences approach for immediate outcomes and a “regression kink design” for long-term outcomes, we bring comprehensive evidence on the health and education effects of three reforms, which affected alcohol availability along different dimensions and margins – 1) establishing an off-premise alcohol purchase age of 15 (1998), 2) raising the off-premise alcohol purchase age to 16 (2004), and 3) increasing the purchase age of beverages exceeding 16.5% in alcohol content from 16 to 18 (2011). Our findings show significant short-term effects of the first and third reforms in terms of reducing injuries and alcohol-related conditions, and some long-term effects of the first reform in terms of reducing injuries and increasing the probability of obtaining a high-school degree. We find, however, no effects of the second reform and little impact of any of the reforms on mortality. Effects of spirits (reform 3) are driven by males, and there is no consistent evidence on differential impacts by socioeconomic status.
    Keywords: minimum legal drinking ages, injuries, alcohol-related conditions, difference-in-differences, regression kink
    JEL: I12 I18
    Date: 2017–05–15
  17. By: Ball, Alastair (Birkbeck, University of London)
    Abstract: Exposure to smoggy days is a common part of urban life, but can be avoided by vulnerable populations with municipal investment in warnings. This paper provides the first evidence on the long-term effects of early exposure to smog. Variation comes from exposure to the Great London Smog of 1952. Affected cohorts are tracked for up to sixty years using the Office of National Statistics Longitudinal Study. Exposure to the four day smog reduced the size of the surviving cohort by 2% and caused lasting damage to human capital accumulation, employment, hours of work, and propensity to develop cancer.
    Keywords: pollution, fetal origins, Great London Smog
    JEL: Q53 I12 I18
    Date: 2017–04
  18. By: Sandner, Malte (University College London); Cornelissen, Thomas (University of York); Jungmann, Tanja (University of Rostock); Herrmann, Peggy (Hannover Medical School (MHH))
    Abstract: We evaluate the effects of home visiting targeted towards disadvantaged first-time mothers on maternal and child health outcomes. Our analysis exploits a randomized controlled trial and combines rich longitudinal survey data with unique administrative health data. In a context in which the target group has comprehensive health care access, we find that home visiting has no effects on most types of health utilization, health behaviors, and physical health measures. However, the intervention has a remarkably robust and sizable positive effect on maternal mental health, reducing depressions reported in the survey data and prescriptions of psycholeptics recorded in the administrative data.
    Keywords: child health, disadvantaged families, mental health, early childhood intervention
    JEL: I14
    Date: 2017–04
  19. By: Carlsen, Benedicte (Uni Research Rokkan Centre); Nyborg, Karine (University of Oslo)
    Abstract: Although physicians are often expected to be gatekeepers to health insurance benefits such as paid sick leave, research indicates a substantial reluctance to reject patient requests for sickness certificates. We show that private information on the patient's part creates a conflict between the healer and gatekeeper roles: if a patient reports subjective symptoms indicating a need for sick leave, the physician is unable to tell if the patient is truly sick or a shirker. We show that even if most physicians prefer to be good gatekeepers, all of them may trust their patients in Nash equilibrium. These ideas are illustrated using results from focus group interviews with Norwegian primary care physicians.
    Keywords: sicklisting, subjective diagnoses, asymmetric information, focus group interviews
    JEL: D11 D21 H42 I11 I18
    Date: 2017–04
  20. By: Buckles, Kasey (University of Notre Dame)
    Abstract: A rich literature in economics and the social sciences has shown that improvements in women's socio-economic status (SES) can also improve the well-being of their children. This chapter identifies several channels for this effect, drawing on both theoretical and empirical work in economics. Empirical evidence on the effects of maternal SES on child outcomes like health, education, and labor market success is presented, with a focus on recent work using new data sets and methodological innovations that allow for credible identification. The chapter also discusses emerging evidence that shocks to maternal well-being can affect not only a woman's own children, but future generations as well. Finally, the chapter highlights several fertile areas for future work.
    Keywords: maternal socio-economic status, intergenerational transmission of education, intergenerational transmission of income, child well-being, infant health, child health, child quality production function
    JEL: I14 I24 I3 J1
    Date: 2017–04
  21. By: Vincenzo Atella (DEF and CEIS,University of Rome "Tor Vergata"); Federico Belotti (DEF and CEIS,University of Rome "Tor Vergata"); Ludovico Carrino (King's College London); Andrea Piano Mortari (CEIS, University of Rome "Tor Vergata")
    Abstract: In this paper we investigate the evolution of public European LTC systems in the forthcoming decades, using the Europe Future Elderly Model (EuFEM), a dynamic microsimulation model which projects the health and socio-economic characteristics of the 50+ population of ten European countries, augmented with the explicit modelling of the eligibility rules of 5 countries. The use of SHARE data allows to have a better understanding of the trends in the demand for LTC differentiated by age groups, gender, and other demographic and social characteristics in order to better assess the distributional effects. We estimate the future potential coverage (or gap of coverage) of each national/regional public home-care system, and then disentangle the differences between countries in a population and a regulation effects. Our analysis offers new insights on how would the demand for LTC evolve over time, what would the distributional effects of different LTC policies be if no action is taken, and what could be potential impact of alternative care policies.
    Keywords: Dynamic Microsimulation, Long Term Care, Forecast, disability, Regulation
    JEL: I11 I18 C53 C63 J14 J11
    Date: 2017–05–08
  22. By: Alfred Kechia Mukong; Corne Van Walbeek; Hana Ross
    Abstract: Evidence suggests that lifestyle factors may explain the income-related inequality in self-reported health. This paper expands this literature by examining the contribution of smoking and alcohol consumption, incorporating more objective measures of health directly associated with these lifestyle practices. The Erreygers' corrected concentration index is used to measure health inequalities over time. The indices are decomposed into observable covariates including smoking and alcohol use. We find significant smoking-related and income-related inequalities in both self-reported and lifestyle-related ill health. The results suggest that smoking and alcohol use make significant contributions to income related inequality in health. Smoking participation accounts for up to 7.35% of all measured inequality in health and 3.11% of the inequality in self-reported health. The estimates are generally higher for all measured inequality in health (up to 14.67%) and lower for inequality in self-reported health (1.78%) when smoking duration is considered. Alcohol consumption accounts for 27.83% of all measured inequality in health and 3.63% of the inequality in self-reported health. This suggests that policies that reduce unhealthy behaviors of individuals, such as reducing tobacco consumption and harmful alcohol use, can improve population health outcomes and reduce health inequalities.
    Keywords: health, South Africa Income, Lifestyle, Erreygers
    Date: 2017–04
  23. By: Maclean, J. Catherine (Temple University); Saloner, Brendan (Johns Hopkins University)
    Abstract: We examine the early effects of U.S. state Medicaid expansions under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization. We couple administrative data on admissions to specialty SUD treatment and prescriptions for medications used to treat SUDs in outpatient settings with a differences-in-differences design. We find no evidence that admissions to specialty treatment changed in expanding states relative to non-expending states. However, post expansion, Medicaid-reimbursed prescriptions for medications used to treat SUDs in outpatient settings increased by 33% in expanding states relative to non-expanding states. Among patients admitted to specialty SUD treatment, we find that in expanding states Medicaid insurance and use of Medicaid to pay for treatment increased by 58% and 57% following the expansion. In an extension to the main analyses we find no evidence that the expansions affected fatal alcohol poisonings or drug-related overdoses. Overall, our findings provide evidence on the early effects of the ACA on SUD treatment utilization with the newly-eligible Medicaid population.
    Keywords: healthcare, public insurance, Medicaid, substance use disorders
    JEL: I1 I13 I18
    Date: 2017–04
  24. By: Popovici, Ioana (Nova Southeastern University); Maclean, J. Catherine (Temple University); French, Michael (University of Miami)
    Abstract: Each year, 10,000 individuals die in alcohol-impaired traffic accidents in the United States, while psychoactive drugs are involved in 20% of all fatal traffic accidents. We investigate whether state parity laws for substance use disorder (SUD) treatment have the unintended benefit of reducing fatal traffic accidents. Parity laws compel insurers to cover SUD treatment in private insurance markets, thereby reducing the financial costs of and increasing access to treatment for beneficiaries. We employ over 20 years of administrative data from the national Fatal Accident Reporting System coupled with a differences-in-differences research design to investigate the potential spillover effects of parity laws to traffic safety. Our findings indicate that passage of a state parity law reduces fatal traffic accident rates by 4.1 to 5.4%. These findings suggest that government regulations requiring insurers to cover SUD treatment can significantly improve traffic safety, possibly by reducing the number of impaired drivers on roadways.
    Keywords: traffic fatalities, substance use disorder (SUD) treatment, traffic safety, health insurance parity laws
    JEL: I1 I13 I18
    Date: 2017–04
  25. By: Henderson, Daniel J. (University of Alabama); Houtenville, Andrew (University of New Hampshire); Wang, Le (University of Oklahoma)
    Abstract: This note takes a first look at the distribution of returns to education for people with disabilities, a particularly disadvantaged group whose labor market performances have not been well studied or documented. Using a nonparametric approach, we uncover significant heterogeneity in the returns to education for these workers, which is drastically masked by the conventional parametric methods. Based on these estimates, we construct the Sharpe ratio of human capital investment (taking into account its substantial risk), and our results corroborate on the claimed importance of human capital in improving these workers' wages. Our stochastic dominance tests, however, show that the returns to education for workers with disabilities, as a group, may have been affected more adversely in the most recent recession, relative to their non-disabled counterparts.
    Keywords: disability, education, risk, heterogeneity
    JEL: C14 I12 I26 I31
    Date: 2017–04
  26. By: Bocoum, Fadima (Institute de Recherche en Sciences de Santé (IRSS)); Grimm, Michael (University of Passau); Hartwig, Renate (University of Namur); Zongo, Nathalie (Association Songui Manégré- Aide au développement Endogène (ASMADE))
    Abstract: In this paper we analyze the impact of a randomized information package on the understanding and uptake of community based health insurance. The information package consists of a detailed brochure which is distributed to households through home visits, a video also presented in people's homes and a personalized phone reminder. Overall, we find significant treatment effects on insurance uptake at the margin, although insurance uptake is low in general. We also find evidence for a better understanding of insurance principles among treated households, in particular in poorer households and in households with literate household heads. Finally, we see that treated households share the information they received with their neighbors and this also has positive effects on their understanding of insurance principles. We find further suggestive evidence that information sharing remains locally concentrated and does not surpass a radius of 1 km. Our findings contribute to the understanding how knowledge about the functioning of insurance can be enhanced in a context where the concept of insurance is largely unknown and where strong cultural beliefs prevail, and eventually, how insurance uptake can be increased, although the latter may take more time.
    Keywords: health insurance, take-up, encouragement design, learning, financial education
    JEL: D83 G22 I13 M31 O33
    Date: 2017–04
  27. By: Andrea Bassanini (OECD - Organisation for Economic Cooperation and Development); Eve Caroli (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine)
    Abstract: This paper reviews the literature on the impact ofwork on health. We consider work along two dimensions: (i) the intensive margin, i.e. how many hours an individual works and (ii) the extensive margin, i.e. whether an individual is in employment or not, independent of the number of hours worked. We show that most of the evidence on the negative health impact of work found in the literature is based on situations in which workers have essentially no control (no choice) over theamount of work they provide. In essence, what is detrimental to health is not so much work per se as much as the gap which may exist between the actual and the desired amount of work, both at the intensive and extensive margins.
    Abstract: Dans cet article, nous passons en revue la littérature sur l'impact du travail sur la santé. Nous considérons le travail selon deux dimensions : (i)la marge intensive, à savoir le nombre d'heures travaillées par un individu et (ii) la marge extensive, c'est-à-dire le fait qu'un individu soit ou non en emploi, indépendamment du nombre d'heures travaillées. Nous montrons que l'effet néfaste du travail sur la santé, mis en évidence dans la littérature, est basé sur des situations dans lesquelles les salariés n'ont, pour l'essentiel, aucun contrôle (aucun choix) sur la quantité de travail qu'ils fournissent. Dans les faits, l'effet néfaste sur la santé ne proviendrait pas tant du travail en soi que de l'écart éventuel entre la quantité de travail effectivement fournie et la quantité désirée, tant à la marge intensive qu'à la marge extensive.
    Keywords: individual choice,job loss,hours worked,retirement,work,health,choix individuel,Santé,travail,retraite,heures travaillées,licenciement
    Date: 2017–04–21
  28. By: R. Tamara Konetzka; Karen B. Lasater; Edward C. Norton; Rachel M. Werner
    Abstract: The quality and cost of care in nursing homes depend critically on the number and types of nurses. Recent research suggests that the nursing supply adjusts to macroeconomic conditions. However, prior work has failed to consider the effect of macroeconomic conditions on demand for nurses through the effect on revenues. We test how county-level unemployment rates affect direct-care staffing rates in nursing homes using California data. We exploit the wide variation in the unemployment rates across counties and over time in 2005–2012. We also test whether there are heterogeneous effects of unemployment rates by facility size, staffing level, and profit status. We find that as unemployment rates increase, staffing by registered nurses (RNs) decreases but staffing by licensed practical nurses (LPNs) increases. The increase in LPNs is larger in large nursing homes, nursing homes with higher staffing levels, and in for-profit nursing homes. We also find that as unemployment rates increase, nursing home revenue decreases. While the effect of macroeconomic conditions on nursing supply may be important for cost and quality of care, the mechanism is not simple, direct, or homogeneous for all types of nurses and nursing homes.
    JEL: E32 I11 J44 L84
    Date: 2017–05
  29. By: Adrienne M. Lucas; Nicholas L. Wilson
    Abstract: The single largest item in the United States foreign aid health budget is antiretroviral therapy (ART) for the treatment of HIV/AIDS. Many supply- and demand-side factors in sub-Saharan Africa could cause smaller than expected epidemiological effects of this at scale drug provision. We provide what appears to be the first quasi-experimental evidence on the effect of at scale drug provision in a poor country, using the phased roll-out of ART in Zambia, a setting where approximately 1 in 6 adults are HIV positive. Combining anthropometric data from national household surveys and a spatially-based triple difference specification, we find that local ART introduction increased the weight of high HIV likelihood adult women. This finding from a clinically difficult setting suggest that the generalized challenges of scalability of ART for adult health in sub-Saharan Africa are surmountable.
    JEL: H51 I12 I15 I18 O12 O15
    Date: 2017–05

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