nep-hea New Economics Papers
on Health Economics
Issue of 2017‒05‒28
fifteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Early lead exposure and outcomes in adulthood By Grönqvist, Hans; Nilsson, J Peter; Robling, Per-Olof
  2. Macroeconomic Effects of Medicare By Juan Carlos Conesa; Daniela Costa; Parisa Kamali; Timothy J. Kehoe; Vegard M. Nygard; Gajendran Raveendranathan; Akshar Saxena
  3. The Effects of Health Insurance Parity Laws for Substance Use Disorder Treatment on Traffic Fatalities: Evidence of Unintended Benefits By Ioana Popovici; Johanna Catherine Maclean; Michael T. French
  4. Parental Work Hours and Childhood Obesity: Evidence using Instrumental Variables Related to Sibling School Eligibility By Charles Courtemanche; Rusty Tchernis; Xilin Zhou
  5. People's preferences for epidemic prevention measures By Caroline Orset
  6. Inequality of Opportunity in Health in Indonesia By Sabine Mage-Bertomeu; Marta Menéndez; Florence Jusot
  7. Motivated Health Risk Denial and Preventative Health Care Investments By Schwardmann, Peter
  8. Interactions Between Financial Incentives and Health in the Early Retirement Decision By Pilar Garcia-Gomez; Titus J. Galama; Eddy van Doorslaer; Angel Lopez-Nicolas
  9. Effects of the Affordable Care Act on Safety Net Hospitals By Laurie Felland; Peter Cunningham; Annie Doubleday; Cannon Warren
  10. Patient Dismissal by Primary Care Practices (Journal Article) By Ann O’Malley; Kaylyn Swankoski; Deborah Peikes; Jesse Crosson; Nancy Duda; Timothy Day; Shannon Heitkamp
  11. Excess female mortality in Africa By Siwan Anderson; Debraj Ray
  12. Swine Flu and The Effect of Compulsory Class Attendance on Academic Performance By Goulas, Sofoklis; Megalokonomou, Rigissa
  13. The 'Soda Tax' is Unlikely to Make Mexicans Lighter: New Evidence on Biases in Elasticities of Demand for Soda By Andalón, Mabel; Gibson, John
  14. Female Suicide and the Concept of the Midlife Crisis By Oswald, Andrew J.; Tohamy, Ahmed
  15. Medical-Demographic Differentiation According to Educational Level By Shulgin, Sergey; Scherbov, Sergey; Zinkina, Yulia; Novikov, Kirill

  1. By: Grönqvist, Hans (Department of economics, Uppsala university, IFAU, UCLS); Nilsson, J Peter (Institute for International Economic Studies, Stockholm University, IFAU, UCLS); Robling, Per-Olof (Institute for Social Research, Stockholm University,)
    Abstract: We exploit the phase-out of leaded gasoline to isolate the impact of early childhood lead exposure on outcomes in adulthood. By combining administrative data on school performance, high school graduation, crime, earnings, and cognitive and non-cognitive skills with a novel measure of lead exposure, we follow 800,000 children from birth into adulthood. We find that reduced lead exposure improves the adult outcomes, particularly among boys. Below certain thresholds, the relationship becomes much weaker. Non-cognitive traits (externalizing behavior, conscientiousness, and neuroti-cism) follow a similar non-linear dose response pattern and seem to be the key mediators between early lead exposure and adult outcomes.
    Keywords: environmental policy; human capital; crime; non-cognitive skills
    JEL: I18 K42 Q53
    Date: 2017–05–15
  2. By: Juan Carlos Conesa; Daniela Costa; Parisa Kamali; Timothy J. Kehoe; Vegard M. Nygard; Gajendran Raveendranathan; Akshar Saxena
    Abstract: This paper develops an overlapping generations model to study the macroeconomic effects of an unexpected elimination of Medicare. We find that a large share of the elderly respond by substituting Medicaid for Medicare. Consequently, the government saves only 46 cents for every dollar cut in Medicare spending. We argue that a comparison of steady states is insufficient to evaluate the welfare effects of the reform. In particular, we find lower ex-ante welfare gains from eliminating Medicare when we account for the costs of transition. Lastly, we find that a majority of the current population benefits from the reform but that aggregate welfare, measured as the dollar value of the sum of wealth equivalent variations, is higher with Medicare.
    JEL: E21 E62 H51 I13
    Date: 2017–05
  3. By: Ioana Popovici; Johanna Catherine Maclean; Michael T. French
    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.
    JEL: I1 I13 I18
    Date: 2017–05
  4. By: Charles Courtemanche; Rusty Tchernis; Xilin Zhou
    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 in the household. 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.
    JEL: I12 J22
    Date: 2017–05
  5. By: Caroline Orset (ECO-PUB - Economie Publique - INRA - Institut National de la Recherche Agronomique - AgroParisTech)
    Abstract: Due to its rapid spread and the delay in the discovery of drugs or vaccines to treat it, the epidemic can cause millions of deaths worldwide. Prevention measures are therefore an explicit objective of public health policy. We develop a questionnaire that allows us to analyze people's preferences for different prevention measures classified by epidemic severity. Failure to comply with the recommended prevention measures is both dangerous to the health of the population and economically costly to society. We see that part of our panel is willing to comply voluntarily with the recommended prevention measures. We show that the revelation of peo-ple's preferences allows us to determine the individual intangible (psychological) cost for prevention measures. This cost causes the individual not to voluntarily comply with prevention measures. We then propose government interventions to reduce intangible costs and motivate the individual to implement the recommended prevention measures. However, where these incentives fail, mandatory measures are an alternative.
    Keywords: epidemic,intangible cost,prevention measures,public health interventions
    Date: 2017–04–03
  6. By: Sabine Mage-Bertomeu (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine); Marta Menéndez (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine); Florence Jusot (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine)
    Abstract: Whereas health equity issues are undoubtedly more relevant in developing countries, research on healthinequalities and, more specifically, on inequality of opportunity in the health dimension, remains scarce in this context. This paper explores the degree of inequality of opportunity in health in a developing country, using the 2007 Indonesian Family Life Survey, a large-scale survey with extremely rich information about individualhealth outcomes (biomarkers and self-reports) and individual circumstances.We compute a continuous synthetic index of global health status based on a comprehensive set of healthindicators and subsequently implement non-parametric and parametric methods in order to quantify the level ofinequality of opportunity in the health dimension. Our results show large inequality of opportunities in health inIndonesia, compared to European countries. Concerning transmission mechanisms, parental (particularly maternal) vital status appears as the main channel. Compared to what has been observed in more developed countries, the effect of parental education on health is relatively smaller, and mainly indirect (passing through descendants’ socioeconomic, marital and migration statuses), while the existence of long-term differences in health related to religion, language spoken and particularly province of location suggest a relatively higher relevance of community belonging variables for health equity in the context of a developing country asIndonesia.
    Abstract: Les pays en développement sont particulièrement concernés par la question des inégalités de santé et notamment celle de l’inégalité des chances. Néanmoins, très peu de travaux sont proposés dans le cadre des économies endéveloppement. Cet article étudie l’ampleur des inégalités des chances en matière de santé en Indonésie à partir de données recueillies par l’enquête IFLS (Indonesian Family Life Survey) de 2007 qui propose une information individuelle détaillée sur l’état de santé (bio-marqueurs et auto-évaluation) mais aussi sur l’environnement socioéconomique.Un indicateur synthétique continu de l’état de santé global calculé à partir d’un ensemble complet d’informations sur la santé est dans un premier temps proposé. Des méthodes paramétriques et non paramétriques sont ensuitemobilisées pour mesurer le niveau de l’inégalité des chances dans le domaine de la santé. Les résultats mettenten évidence une importante inégalité des chances relative à l’état de santé en Indonésie par rapport au niveau d’inégalité observée dans les pays européens. Le principal vecteur de transmission de l’inégalité est le statut de santé des parents (statut vital) et en particulier celui de la mère. L’impact du niveau d’éducation des parents estindirect (agissant sur l’environnement socio-économique, le statut marital et la migration des descendants) et est beaucoup plus faible que celui généralement observé dans des économies plus développées. Les disparités à long terme de l’état de santé liées à la religion, à la langue pratiquée et plus encore à la région d’habitation suggèrentque les variables d’appartenance communautaire sont prépondérantes pour analyser la question de l’équité en santé dans un pays en développement comme l’Indonésie.
    Keywords: health,Indonesia,Equality of opportunity,continuous health index,stochastic dominance,santé,indicateur continu de santé,dominance stochastique,Indonésie,Egalité des chances
    Date: 2017–04–13
  7. By: Schwardmann, Peter (University of Munich)
    Abstract: People deny health risks, invest too little in disease prevention, and are highly sensitive to the price of preventative health care, especially in developing countries. Moreover, private sector R and D spending on developing-country diseases is almost non-existent. To explain these empirical observations, I propose a model of motivated belief formation, in which an agent\'s decision to engage in health risk denial balances the psychological benefits of reduced anxiety with the physical cost of underprevention. I use the model to study firms\' price-setting behaviour and incentive to innovate. I also show that tax-funded prevention subsidies are welfare enhancing.
    Keywords: health risk denial; optimal expectations; motivated beliefs; disease prevention; self-protection;
    JEL: D03 I15 I11 I18
    Date: 2017–05–20
  8. By: Pilar Garcia-Gomez (Erasmus University Rotterdam, the Netherlands); Titus J. Galama (University of Southern California, US); Eddy van Doorslaer (Erasmus University Rotterdam, the Netherlands); Angel Lopez-Nicolas (Universidad Politecnica de Cartagena, Spain)
    Abstract: We present a theory of the relation between health and retirement that generates testable predictions regarding the interaction of health, wealth and financial incentives in retirement decisions. The theory predicts (i) that wealthier individuals (compared to poorer individuals) are more likely to retire for health reasons(affordability proposition), and (ii) that health problems make older workers more responsive to financial incentives encouraging retirement (reinforcement proposition). We test these predictions using administrative data on older employees in the Dutch healthcare sector for whom we link adverse health events, proxied by unanticipated hospitalizations, to information on retirement decisions and actual incentives from administrative records of the pension funds. Exploiting unexpected health shocks and quasi-exogenous variation in nancial incentives for retirement due to reforms, we account for the endogeneity of health and financial incentives. Making use of the actual individual pension rights diminishes downward bias in estimates of the effect of pension incentives. We find support for our affordability and reinforcement propositions. Both propositions require the benefits function to be convex, as in our data. Our theory and empirical findings highlight the importance of assessing financial incentives for their potential reinforcement of health shocks and point to the possibility that differences in responses to financial incentives and health shocks across countries may relate to whether the benefit function is concave or convex.
    Keywords: pensions; health; retirement; disability; health investment; lifecycle model; health capital
    JEL: C33 D91 H55 I10 I12 J00 J24 J26 J45 D91
    Date: 2017–04–27
  9. By: Laurie Felland; Peter Cunningham; Annie Doubleday; Cannon Warren
    Abstract: This study examines the early effects of the ACA on 10 safety net hospitals, both in states that expanded income eligibility for Medicaid under the ACA and those that did not.
    Keywords: Affordable care act, Safety Net Hospitals
    JEL: I
  10. By: Ann O’Malley; Kaylyn Swankoski; Deborah Peikes; Jesse Crosson; Nancy Duda; Timothy Day; Shannon Heitkamp
    Abstract: This research letter describes patient dismissal practices based on a survey of over 800 primary care practices.
    Keywords: primary care, patient dismissal, CPC, clinicians, health, alternative payment models
    JEL: I
  11. By: Siwan Anderson; Debraj Ray
    Abstract: o developed countries, there are far fewer women than men in parts of the developing world. Estimates suggest that more than 200 million women are demographically missing’ worldwide. To explain the global ‘missing women’ phenomenon, research has mainly ocused on excess female mortality in Asia. However, as emphasized in our earlier research, at least 0 per cent of the missing women are ‘missing’ from Africa. This paper employs a novel ethodology to determine how the phenomenon of missing women is distributed across Africa. oreover, it provides estimates of the extent of excess female mortality within different age groups nd by disease category. The empirical results reiterate the importance of excess female mortality or women in Africa.
    Date: 2017
  12. By: Goulas, Sofoklis; Megalokonomou, Rigissa
    Abstract: We use a natural experiment that relaxed class attendance requirements for one school year to explore students' marginal propensity to skip class, and to examine the effects of their absences on scholastic outcomes. We exploit exogenous variation resulting from a one-time policy Greece implemented allowing high school students to miss 30 percent more class hours without penalty during the 2009-10 academic year, a period when officials feared outbreaks of swine flu. Using a new dataset, we analyze which students missed more classes, and the effect of these absences on scholastic outcomes across the distribution of student ability, income, and peer quality. We find that while the swine flu itself did not affect the student population, the relaxed class attendance policy caused an increase in absences of roughly 10 hours per student, with more absences taken by those who had higher academic performance records, have academically weaker peers in their classes, or who live in poorer neighborhoods. End-of-year exam results show a positive effect of the relaxed attendance policy on grades across the ability distribution. The magnitude of the positive effect of absences on grades increases as we move to right of the ability distribution. Our results suggest that students who may have the resources or the human capital accumulation to learn outside the classroom may have lower performance when a strict attendance policy forces them to stay in class.
    Keywords: human capital, returns to education, attendance, instrumental variables, natural experiment
    JEL: H75 I26
    Date: 2016–12–06
  13. By: Andalón, Mabel (University of Melbourne); Gibson, John (University of Waikato)
    Abstract: Mexico's 'soda tax' has been predicted to reduce average weights by two to four pounds, based on extant estimates of an own-price elasticity of quantity demand for soda of between −1.0 and −1.3. These estimates ignore consumer responses on the quality margin and correlated measurement errors. We use Mexican household budget survey data and city-level soda prices to estimate unrestricted demand models that correct for both errors. The corrected own-price elasticity of quantity demand is just −0.2 to −0.3, so tax-induced soda price increases might cut average weights by less than one pound, which is too small to improve health.
    Keywords: demand, household surveys, quality, price, soda taxes, Mexico
    JEL: D12 I10
    Date: 2017–05
  14. By: Oswald, Andrew J. (University of Warwick); Tohamy, Ahmed (University of Warwick)
    Abstract: The idea that humans – especially females – are prone to some form of 'midlife crisis' has typically been viewed with extreme skepticism by social scientists. We point out the potential equivalence between an age U-shape in a new well-being literature and a matching hill-shape in especially female suicide risk (evident in 28 countries and visible in the United States even 30 years ago). This concordance between two currently separate kinds of evidence, including a result on non-human primates, is apparently not known to many researchers or public commentators. It may be necessary to reconsider traditional thinking on the midlife crisis.
    Keywords: happiness, aging, suicide, well-being, GHQ, mental-health, depression, life-course
    JEL: I12 I31
    Date: 2017–05
  15. By: Shulgin, Sergey (Russian Presidential Academy of National Economy and Public Administration (RANEPA)); Scherbov, Sergey (Russian Presidential Academy of National Economy and Public Administration (RANEPA)); Zinkina, Yulia (Russian Presidential Academy of National Economy and Public Administration (RANEPA)); Novikov, Kirill (Russian Presidential Academy of National Economy and Public Administration (RANEPA))
    Abstract: In this paper, the relationship between the health status of people and the level of education is investigated. The main objective of the study is to analyze how the state of health depends on the level of education. The work evaluates the age functions of various medical and demographic factors, as well as their dependence on the level of education. Estimates of several models of the expected life expectancy (HALE) for Russia are made and an assessment of the survival tables for Russian men and women with different levels of education is done.
    Date: 2017–04

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