nep-hea New Economics Papers
on Health Economics
Issue of 2017‒06‒04
eighteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Running with a Mask? The Effect of Air Pollution on Marathon Runners’ Performance By Fu, Shihe; Guo, Mengmeng
  2. The Healing Power of Hope By Harker, Patrick T.
  3. The effect of inadequate access to healthcare services on emergency room visits in Australia By Nerina Vecchio; Nicholas Rohde
  4. Let Them Eat Lunch: The Impact of Universal Free Meals on Student Performance By Amy Ellen Schwartz; Michah W. Rothbart
  5. Empirical Study on the Utilization and Effects of Health Checkups in Japan By INUI Tomohiko; ITO Yukiko; KAWAKAMI Atsushi; MA Xin Xin; NAGASHIMA Masaru; ZHAO Meng
  6. The NHS and Social Care: Prospects for Funding, Staffing and Performance into the 2020s By Alistair McGuire
  7. Unintended Impacts: How roads change health and nutrition for ethnic minorities in Congo By Jacqueline Doremus
  8. Finance and Growth: Household Savings, Public Investment, and Public Health in Late Nineteenth-Century New Jersey By Howard Bodenhorn
  9. Is Preventive Care Worth the Cost? Evidence from Mandatory Checkups in Japan By Toshiaki Iizuka; Katsuhiko Nishiyama; Brian Chen; Karen Eggleston
  10. Foreign and Domestic Trends in the Development of Competition in Health Care: Recognition and Measurement of Professional Reputation By Gabueva, Larisa A.; Pavlova, Nina F.
  11. Institutional Study of Russian Health By Nazarov, Vladimir; Sokolov, Denis
  12. Non-Price Competition in Russian Health Care: Development of State Control and Insurance Expertise of the Quality and Safety of Medical Activities By Gabueva, Larisa
  13. he Effect of Physical Activity on Student Performance in College: An Experimental Evaluation By Fricke, Hans; Lechner, Michael; Steinmayr, Andreas
  14. Role of Non-Governmental Organizations in Healthcare Sector of India By Das, Nimai; Kumar, Rajeev
  15. Health Plan Payment in U.S. Marketplaces: Regulated Competition with a Weak Mandate By Timothy Layton; Ellen J. Montz; Mark Shepard
  16. The Effect of Malpractice Law on Physician Supply: Evidence from Negligence-Standard Reforms By Michael D. Frakes; Matthew B. Frank; Seth A. Seabury
  17. Patients Compliance and Follow-Up Rate after Tooth Extraction By Faheem, Samra
  18. The Effect of Insurance Expansions on Smoking Cessation Medication Use: Evidence from Recent Medicaid Expansions By Johanna Catherine Maclean; Michael F. Pesko; Steven C. Hill

  1. By: Fu, Shihe; Guo, Mengmeng
    Abstract: Using a sample of over 0.3 million marathon runners in 37 cities and 55 races in China in 2014 and 2015, we estimate the air pollution elasticity of finish time to be 0.041. Our causal identification comes from the exogeneity of air pollution on the race day because runners are required to register a race a few months in advance and we control for city fixed effects, seasonal effects, and weather condition on the race day. Including individual fixed effects also provides consistent evidence. Our study contributes to the emerging literature on the effect of air pollution on short-run productivity, particularly on the performance of athletes engaging outdoor sports and other workers whose jobs require intensive physical activities.
    Keywords: Air pollution; marathon; outdoor behavior; mega events; short-run productivity
    JEL: I18 Q53 R11 Z10
    Date: 2017–05–31
  2. By: Harker, Patrick T. (Federal Reserve Bank of Philadelphia)
    Abstract: In a commencement address at the Jefferson College of Health Professions and Jefferson College of Pharmacy, Philadelphia Fed President Patrick Harker focused on the connection between health and economic prosperity.
    Keywords: economic prosperity; personal health
    Date: 2017–05–25
  3. By: Nerina Vecchio; Nicholas Rohde
    Keywords: Emergency room visits, Healthcare access shortfalls, Propensity score matching
    JEL: I10
    Date: 2017–08
  4. By: Amy Ellen Schwartz (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Michah W. Rothbart (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244)
    Abstract: This paper investigates the impact of extending free school lunch to all students, regardless of income, on academic performance in New York City middle schools. Using a difference-in-difference design and unique longitudinal, student level data, we derive credibly causal estimates of the impacts of “Universal Free Meals” (UFM) on test scores in English Language Arts (ELA) and mathematics, and participation in school lunch. We find UFM increases academic performance by as much as 0.059 standard deviations in math and 0.083 in ELA for non-poor students, with smaller, statistically significant effects of 0.032 and 0.027 standard deviations in math and ELA for poor students. Further, UFM increases participation in school lunch by roughly 11.0 percentage points for non-poor students and 5.4 percentage points for poor students. We then investigate the academic effects of school lunch participation per se, using UFM as an instrumental variable. Results indicate that increases in school lunch participation improve academic performance for both poor and non-poor students; an additional lunch every two weeks increases test scores by roughly 0.08 standard deviations in math and 0.07 standard deviations in ELA. Finally, we explore potential unintended consequences for student weight outcomes, finding no evidence that UFM increases probability of obesity or overweight, or BMI. Results are robust to an array of alternative assumptions about sample and specifications.
    Keywords: School Food, Academic Performance, Free Lunch, Childhood Obesity
    JEL: I24 I38 H52
    Date: 2017–05
  5. By: INUI Tomohiko; ITO Yukiko; KAWAKAMI Atsushi; MA Xin Xin; NAGASHIMA Masaru; ZHAO Meng
    Abstract: Health checkups have been commonly considered as an important measure to improve population health. The Japanese government has urged health insurers to promote health checkups, including the specific health checkups (SHC) which was recently implemented in 2008 to cover the whole population between ages 40 and 74. However, there remains a large gap between the actual prevalence and the goals set by the government. Using the Comprehensive Survey of Living Conditions (CSLC) survey data from 1995 to 2013 in Japan, we conduct an empirical study to answer three questions: Which factors determinate the prevalence of general health checkups in Japan at the regional level? Which factors affect the decisions on taking health checkups at the individual level? Does SHC have any effects on various health outcomes? Our results suggest that there is a great regional disparity in the prevalence of health checkups in Japan, even after accommodating for various socio-economic factors. In addition, despite the government's promotion policies, little improvement is observed in the prevalence of health checkups from 1995 to 2013. Moreover, at the individual level, the participation rate for health checkups by non-regular/part-time workers and by the enrollees of the National Health Insurance is lower than that of their counterparts. Lastly, although SHC since 2008 appeared to have a positive effect on the probability of taking health checkups, so far it has little effect on health status, smoking behavior, and medical expenses.
    Date: 2017–05
  6. By: Alistair McGuire
    Abstract: Health featured prominently in the 2016 referendum on the UK's membership of the European Union (EU), with the Leave campaign's claim that Brexit would mean that £350 million extra money per week could be transferred from the UK's EU budget contributions to the NHS. Although the current Conservative government has ruled this out, arguing that any change in UK public expenditure plans is conditional on the Brexit negotiations with the EU, the NHS remains a central focus of all the main parties' election manifestos. The fundamental issue is whether the NHS is adequately funded. Related to arguments over the level of funding are questions about the delivery of healthcare: in essence, what role efficiency savings and internal competition for NHS resources should play in giving appropriate incentives in the delivery of healthcare; and whether service provision is deteriorating. Funding for the delivery of social care for the elderly faces its own crisis - and it has become a controversial issue in the election debate.
    Keywords: 2017 General Election, health, NHS, social care, healthcare, Conservative government, Labour Party, Liberal Democrat Party, Brexit, Health and Social Care Act 2012
    Date: 2017–05
  7. By: Jacqueline Doremus (Department of Economics, California Polytechnic State University)
    Abstract: We investigate how a road connection in a remote area of Congo changes hunger and illness for ethnic minorities. Ethnic minorities’ production activities are highly local, making it hard to construct a valid counter-factual. We exploit a natural experiment: a river boundary between two forests, one of which builds roads to satisfy eco-certification. We find the road increases trade and leads to the export of farmed food products. People and households increase production and specialize. Ethnic minorities, net buyers of exported food during this season, face higher prices and lower real wages. We find the road increases their frequency of hunger and illness. In Central Africa, hunting restrictions accompany roads to prevent over exploitation of fauna. We find the restrictions reduce hunting effort for all households. Households shift consumption to fish but, on net, consume protein less frequently, with non-fisher households seeing the largest decreases.
    Keywords: ethnic inequality, rural roads, nutrition, poverty, Africa, Congo
    JEL: O12 J15 J24 O18 Q12 F14
    Date: 2017
  8. By: Howard Bodenhorn
    Abstract: Saving is essential to the health of economies because it provides the wherewithal for investment. In the late nineteenth century, saving was also essential to the health of urban working-class households. This study brings together information from surveys of household spending and saving, reports of savings banks and insurance companies, water and sewer authorities, and health commissioners to illuminate the connections between household savings and health improvements. Contemporary financial institutions positively influenced economic growth by allocating capital to highly productive employments, including public infrastructure. Specifically, investments in waterworks contributed to the long-run decline in typhoid infection, which improved worker health and productivity.
    JEL: I15 N31
    Date: 2017–05
  9. By: Toshiaki Iizuka; Katsuhiko Nishiyama; Brian Chen; Karen Eggleston
    Abstract: Using unique individual-level panel data, we investigate whether preventive medical care triggered by health checkups is worth the cost. We exploit the fact that biomarkers just below and above a threshold may be viewed as random. We find that people respond to health signals and increase physician visits. However, we find no evidence that additional care is cost effective. For the “borderline type” (“pre-diabetes”) threshold for diabetes, medical care utilization increases but neither physical measures nor predicted risks of mortality or serious complications improve. For efficient use of medical resources, cost effectiveness of preventive care must be carefully examined.
    JEL: I10
    Date: 2017–05
  10. By: Gabueva, Larisa A. (Russian Presidential Academy of National Economy and Public Administration (RANEPA)); Pavlova, Nina F. (Russian Presidential Academy of National Economy and Public Administration (RANEPA))
    Abstract: In recent years, in the context of rejection of non-rigid state regulation of budgetary and autonomous health institutions, large participation of big private foreign companies in the security functions of the industry (equipment, medicines and supplies, food and so forth.), coming to the market of network domestic private clinics, which "take away" a big part of work from the state programs for free medical insurance, the issue of establishing new competitive advantages for stable public and private clinics, which would be based on knowledge and information generated by the human resource. The article is devoted to the analysis of these tendencies in competition of health care companies.
    Date: 2017–02
  11. By: Nazarov, Vladimir (Russian Presidential Academy of National Economy and Public Administration (RANEPA)); Sokolov, Denis (Russian Presidential Academy of National Economy and Public Administration (RANEPA))
    Abstract: The paper presents the institutional analysis of the Russian health care system in 2014-2015 and roles and strategies of its main elements – medical centres, insurance companies, patients and etc. Economic analysis was conducted using the qualitative methods of anthropology and sociology, and the discourse method. Main recommendations contain introduction of variable schemes of cofounding payments for patients, allowing doctors from inpatient department to practice in outpatient department, development of private medicine in rural areas and in large cities, adjusting tariffs of the Mandatory Medical Insurance to the market ones and etc.
    Date: 2017–02
  12. By: Gabueva, Larisa (Russian Presidential Academy of National Economy and Public Administration (RANEPA))
    Abstract: Competition in the field of health care should not only be Manufacturers of medical services of all forms of ownership, but, above all Patients making conscious choice of institutions for treatment and Prevention of health problems. State control can create all conditions for a safe and Choice by a citizen of a doctor, institution, regardless of which The program is serviced by a person: compulsory insurance, VMI (Voluntary medical insurance) or for his own by direct payment of services in a medical organization under a contract. This process, in our opinion, will contribute to the growth of the "Index Openness "of medical organizations, a correct evaluation of the results of their Activities.
    Date: 2017–02
  13. By: Fricke, Hans; Lechner, Michael; Steinmayr, Andreas
    Abstract: What is the role of physical activity in the process of human capital accumulation? Brain research provides growing evidence of the importance of physical activity for various aspects of cognitive functions. An increasingly sedentary lifestyle could thus be not only harmful to population health, but also disrupt human capital accumulation. This paper analyzes the effects of on-campus recreational sports and exercise on educational outcomes of university students. To identify causal effects, we randomize ?nancial incentives to encourage students’ participation in on-campus sports and exercise. The incentives increased participation frequency by 0.26 times per week (47%) and improved grades by 0.14 standard deviations. This effect is primarily driven by male students and students at higher quantiles of the grade distribution. Results from survey data suggest that students substitute off-campus with on-campus physical activities during the day but do not signi?cantly increase the overall frequency. Our ?ndings suggest that students spend more time on campus and are better able to integrate studying and exercising, which may enhance the effectiveness of studying and thus improve student performance.
    Keywords: Sports, physical activity, human capital, student achievement, randomized experiment
    JEL: C93 I12 I18 I23 J24
    Date: 2017–05
  14. By: Das, Nimai; Kumar, Rajeev
    Abstract: This is the first-ever study to estimate role of the non-governmental sector in health sector of India. It is a background study to support the National Health Account of India (2016) by Government of India. It found that the current health expenditure of non-governmental sector is INR 10,091 crore, which constitute about 2% of total health expenditure and around 0.09% of GDP with reference period 2013-14
    Keywords: India, non-governmental organizations, health system, health expenditure
    JEL: C83 I18 Z18
    Date: 2016–09–16
  15. By: Timothy Layton; Ellen J. Montz; Mark Shepard
    Abstract: The Affordable Care Act Marketplaces were introduced in 2014 as part of a reform of the U.S. individual health insurance market. While the individual market represents a small slice of the U.S. population, it has historically been the market segment with the lowest rates of take-up and greatest concerns about access to robust coverage. As part of the reform of the individual insurance market, the Marketplaces invoke many of the principles of regulated competition including (partial) community rating of premiums, mandated benefits, and risk adjustment transfers. While the Marketplaces initially appeared to be successful at increasing coverage and limiting premium growth, more recent outcomes have been less favorable and the stability of the Marketplaces is currently in question. In this paper, we lay out in detail how the Marketplaces adopt the tools of regulated competition. We then discuss ways in which the Marketplace model deviates from the more conventional model and how those deviations may impact the eventual success or failure of these new markets.
    JEL: I11 I13
    Date: 2017–05
  16. By: Michael D. Frakes; Matthew B. Frank; Seth A. Seabury
    Abstract: We explore whether the composition of the physician work force is impacted by the clinical standards imposed on physicians under medical liability rules. We theorize that physicians of particular backgrounds will be attracted to regions when the malpractice laws of those regions favor the type of medicine characteristic of those backgrounds. To test this prediction, we rely on a quasi-experiment made possible by states shifting from local to national customs as the basis for setting standards at court, a distinction that captures meaningful differences in the clinical expectations of the law in light of the well documented phenomenon of regional variations in medical practices. Using data from the Area Health Resource File from 1977 to 2005, we find that the rate of surgeons among practicing physicians increases by 2-2.4 log points following the adoption of national-standard laws in initially low surgery-rate regions—i.e., following a change in the law that effectively expects physicians to increase practice intensities. We find that this response is nearly three times greater in rural counties. We also find that this supply effect is unidirectional, with no evidence to suggest that surgeons retreat when initially high-surgery-rate regions change their laws so as to expect less intensive practice styles.
    JEL: I18 K13
    Date: 2017–05
  17. By: Faheem, Samra
    Abstract: Abiding to post-operative instructions properly may help rapid recovery from surgical procedure. The study aims to check the follow-up rate and compliance of patients who sternly follow the post-operative instructions after non-surgical permanent tooth extraction through health status of the socket. Study Design: This cross-sectional study involved 100 consenting patients was performed at dental OPDs of DOW University of Health Sciences Karachi. One week after procedure information about health status of socket was obtained through questionnaire and clinical examination. Data (age, gender, socket status) analyzed using Pearson’s chi square test with P-value ≤0.05 was considered significant. Out of 100 patients, 66 appear for follow-up where 34 remain absent. 66 patients who completed the study include 31 male and 34 female, with the mean age of 43.06±16.19 years from which 18 cases report poor socket status and 48 cases report good socket hygiene. No significant difference between age, gender, and socket status was reported (P › 0.05). This study showed no statistical association of age and gender with the health status of socket. Additionally, it highlights the need to properly educate patients on the effect of compliance and the various complications and factors affecting, after tooth extraction due to non-compliance.
    Keywords: Cross-sectional study; Follow-up procedure; Patients compliance; Postoperative instructions; Tooth extraction
    JEL: C12 D60 I11 I12 I19
    Date: 2017–04–10
  18. By: Johanna Catherine Maclean; Michael F. Pesko; Steven C. Hill
    Abstract: In this study we explore the early effects of recent Medicaid expansions on prescriptions and Medicaid payments for evidence-based smoking cessation prescription medications: Zyban, Chantix, and Nicotrol. We estimate differences-in-differences models using data on the universe of prescription medications sold in retail and online pharmacies for which Medicaid was a third-party payer. Our findings suggest that expansions increased prescriptions for smoking cessation medications by 36% and total payments for these medications increased by 28%. We provide evidence these payments were financed by state Medicaid programs and not patients themselves. Overall our findings suggest that the recent Medicaid expansions allowed low-income smokers to access effective cessation medications.
    JEL: I1 I13 I18
    Date: 2017–05

This nep-hea issue is ©2017 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.