nep-hea New Economics Papers
on Health Economics
Issue of 2017‒08‒06
nineteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Mutation Clusters from Cancer Exome By Zura Kakushadze; Willie Yu
  2. Sex and the Mission: The Conflicting Effects of Early Christian Investments on the HIV Epidemic in sub-Saharan Africa By Cagé, Julia; Rueda, Valeria
  3. Spatial error regressions for testing the Cancer-EKC By Tommaso Luzzati; Angela Parenti; Tommaso Rughi
  4. Heterogenous Mechanisms in WWII Stress Transmission: Evidence from a Natural Experiment By Vincenzo Atella; Edoardo Di Porto; Joanna Kopinska
  5. Child Migration and the Health Status of Parents Left Behind By Fengming CHEN
  6. Mental health and employment transitions: a slippery slope By Don Webber; Dom Page; Michail Veliziotis
  7. English Skills and the Health Insurance Coverage of Immigrants By Marcus Dillender
  8. For Whom the Bell Tolls: Road Safety Effects of Tolls on Uncongested SCUT Highways in Portugal By Alfredo Marvão Pereira; Rui Marvão Pereira; João Pereira dos Santos
  9. "Why the Compulsive Shift to Single Payer? Because Healthcare Is Not Insurable" By L. Randall Wray
  10. The Welfare Effects of Long-Term Health Insurance Contracts By Benjamin R. Handel; Igal Hendel; Michael D. Whinston
  11. Addressing Childhood Obesity Through Multisector Collaborations: Evaluation of a National Quality Improvement Effort By Margaret B. Hargreaves; Cara Orfield; Todd Honeycutt; Michaela Vine; Charlotte Cabili; Brandon Coffee-Borden; Michaella Morzuch; Lydie A. Lebrun-Harris; Sylvia K. Fisher
  12. Association Between Extending CareFirst's Medical Home Program to Medicare Patients and Quality of Care, Utilization, and Spending By G. Greg Peterson; Kristin Lowe Geonnotti; Lauren Hula; Timothy Day; Laura Blue; Keith Kranker; Boyd Gilman; Kate Stewart; Sheila Hoag; Lorenzo Moreno
  13. Economy-Wide Effects of Mortality Risk Reductions from Environmental Policies By Alex Marten; Stephen C. Newbold
  14. SSeCKS/AKAP12 Induces Repulsion Between Human Prostate Cancer and Microvessel Endothelial Cells Through the Activation of Semaphorin 3F By Wen Xie; Wei Su; Lijuan Zhang; Qingkun Shang; Bing Su
  15. The Landscape of US Generic Prescription Drug Markets, 2004-2016 By Ernst R. Berndt; Rena M. Conti; Stephen J. Murphy
  16. Estimating Public Spending on Health by Levels of Care for National Health Accounts: An Illustration of Use of Data on Withdrawals by Drawing and Disbursing Officers (DDOs) in India. By Choudhury, Mita; Dubey, Jay Dev
  17. Parental depressive symptoms and the child labor-schooling nexus: evidence from Mexico By Björn Nilsson
  18. Promoting prenatal health care in poor rural areas through conditional cash transfers: evidence from JUNTOS in Peru By Díaz, Juan José; Saldarriaga, Víctor
  19. The effects of providing eldercare on daughters’ employment and mental health in Japan By Oshio, Takashi; Usui, Emiko

  1. By: Zura Kakushadze; Willie Yu
    Abstract: We apply our statistically deterministic machine learning/clustering algorithm *K-means (recently developed in to 10,656 published exome samples for 32 cancer types. A majority of cancer types exhibit mutation clustering structure. Our results are in-sample stable. They are also out-of-sample stable when applied to 1,389 published genome samples across 14 cancer types. In contrast, we find in- and out-of-sample instabilities in cancer signatures extracted from exome samples via nonnegative matrix factorization (NMF), a computationally costly and non-deterministic method. Extracting stable mutation structures from exome data could have important implications for speed and cost, which are critical for early-stage cancer diagnostics such as novel blood-test methods currently in development.
    Date: 2017–07
  2. By: Cagé, Julia; Rueda, Valeria
    Abstract: This article investigates the long-term historical impact of missionary activity on the prevalence of HIV/AIDS in sub-Saharan Africa. On the one hand, missionaries were the first to invest in modern medicine in a number of countries. On the other hand, the Christian influence on norms may have affected sexual beliefs and behaviors. We built a new geocoded dataset locating Protestant and Catholic missions in the early 20th century, as well as their health investments. We show that missionary presence has conflicting effects on HIV today. Regions close to historical mission stations exhibit higher HIV prevalence. This higher prevalence is robust to multiple specifications accounting for urbanization. Less knowledge about condom use is a likely channel. Moreover, among regions historically close to missionary settlements, proximity to a mission with a health investment is associated with lower HIV prevalence. Safer sexual behaviors around missions with health investments are a possible explanatory channel.
    Keywords: health investments; historical persistence; HIV/AIDS; missions; sexual behavior
    JEL: D72 N37 N77 O33 Z12 Z13
    Date: 2017–07
  3. By: Tommaso Luzzati; Angela Parenti; Tommaso Rughi
    Abstract: Why do we observe increasing rates of new cancers cases? Is this mainly the outcome of higher life expectancy and better life conditions brought about by economic development? Do environmental degradation and changes in life-styles play also a role? To answer these questions we empirically assessed the relationship between per capita income and new cancer cases (incidence) by using a cross-sectional dataset from 121 countries. When looking at the overall incidence rate (i.e., all-sites cancer), we found no support for a cancer-EKC hypothesis (inverted-U relationship). Actually, incidence increases with per capita income, even after controlling for population ageing, improvement in cancer detection, and omitted spatially correlated variables. Hence, a role in cancer occurrence has to be attributed also to changes in lifestyles and to deterioration of environmental quality brought about by economic growth. Looking at the eight most common site-specific cancers not only confirms the existing evidence of different patterns in rich and poor countries, but also helps understanding the estimated relationship for the overall incidence rates.
    Keywords: Economic development; Cancer; Environmental Kuznets Curve; Environmental degradation; Spatial error models.
    Date: 2017–01–01
  4. By: Vincenzo Atella (Università di Roma Tor Vergata, CEIS Tor Vergata and CHP Stanford University); Edoardo Di Porto (Università di Napoli Federico II, CSEF and UCFS, Uppsala University); Joanna Kopinska (CEIS Tor Vergata, Università di Roma Tor Vergata)
    Abstract: This paper analyses how in utero exposure to maternal stress from WWII affects long-term health and economic outcomes and describes different mechanisms at work, showing that current health conditions are heterogeneously related to the type of fetal stressor. We exploit the Italian armistice of September 8th 1943 as exogenous variation in the war intensity, providing WWII long-run causal effects on objectively measured health and economic outcomes. We find that in utero exposure to intense WWII events had long- lasting effects on health and that Nazi massacres predict late-onset depression, while nutritional deprivation suffered in large cities had lasting effects on diabetes. Finally, we innovate by showing that these effects increase with the age of the treated individuals.
    Keywords: Fetal programming hypothesis; War exposure; Nazi massacres, Stress; Famine; Chronic diseases; Health expenditure, Long-term effects, Italy.
    JEL: I1 O1
    Date: 2017–08–01
  5. By: Fengming CHEN
    Abstract: I investigate the causal effect of child migration the health status their parents left behind. I mainly focus on the respondents who are more than 50 years old and have only two children to simplify the situations of child migration. Using 2010 wave of China Family Panel Studies (CFPS), I employ propensity score matching method to correct the problem of self-selection and evaluate the causal effect of having migrant children on the health status of the elderly left behind. Results show that, in the case of one child migrating for work, child migration has no impact on the health status of their parents. As the substitutive relationship exists among child siblings, the child staying at home would provide more support to their parents and cancel out the impact of child migration. The incentive of free riding for migrant children is very strong, which reduces the benefit of remittances for the elderly.
    Date: 2017–05
  6. By: Don Webber (University of the West of England, Bristol); Dom Page (University of the West of England, Bristol); Michail Veliziotis (University of the West of England, Bristol)
    Abstract: Mental health status is associated with labour market outcomes. Existing literature illustrates that permanent workers with poor mental health select into temporary employment. However, it is unclear whether people with poor mental health stay in temporary employment or take a further step down the employment ladder. This paper examines the influence of poor mental health across the full set of employment transitions and reveals that women with poor mental health descend into unemployment, whereas men with poor mental health sink into inactivity. Given that one in four people will experience poor mental health at some point in their lives, we argue that more attention needs to be focused on supporting people in work rather than catching them as they slide into ever more precarious employment.
    Keywords: Employment transitions; Anxiety; Depression; Psychiatric problems; UK
    JEL: I12 I31 J23
    Date: 2017–01–02
  7. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research)
    Keywords: language skills, immigrants, health insurance, Medicaid
    JEL: J15 I13
  8. By: Alfredo Marvão Pereira (Department of Economics, The College of William and Mary, Williamsburg VA 23187); Rui Marvão Pereira (Department of Economics, The College of William and Mary, Williamsburg VA 23187); João Pereira dos Santos (Nova School of Business and Economics, Faculdade de Economia – Universidade Nova de Lisboa)
    Abstract: We present a difference-in-differences analysis of the road safety effects of introducing tolls on SCUT highways in Portugal, a policy motivated purely by financial considerations, as congestion was never an issue. Using negative binomial count models and a comprehensive dataset on all mainland municipalities covering 2008 to 2014, we find that introducing tolls led to an increase in the total numbers of accidents and of road injuries in municipalities where SCUT highways are located. Additionally, we register a change in the composition thereof, with fewer occurrences on highways (including on SCUT highways) and an increase on national and other roads. Finally, we find that most effects pertain to light injuries. No statistically significant effects were identified for fatal or serious injuries. Furthermore, as a result of introducing tolls on SCUT highways, we estimate that around 20% of the toll revenue collected is lost on the costs linked to road accidents. This questions the rationale of introducing such tolls, even on a revenue-raising standpoint.
    Keywords: Road safety, Accident, Injury, Toll, Difference-in-differences, SCUT, Portugal
    JEL: R10 R41
    Date: 2017–07
  9. By: L. Randall Wray
    Abstract: The growing political momentum for a universal single-payer healthcare program in the United States is due in part to Republican attempts to repeal and replace the Affordable Care Act (Obamacare). However, according to Senior Scholar L. Randall Wray, it is Obamacare's successes and its failures that have boosted support for a single-payer system. Even after Obamacare, the US healthcare system still has significant gaps in coverage--all while facing the highest healthcare bill in the world. In this policy note, Wray argues that the underlying challenge for a system based on private, for-profit insurance is that basic healthcare is not an insurable expense. It is time to abandon the current, overly complex and expensive payments system and reconsider single payer for all. Social Security and Medicare provide a model for reform.
    Date: 2017–07
  10. By: Benjamin R. Handel; Igal Hendel; Michael D. Whinston
    Abstract: Reclassification risk is a major concern in health insurance. We use a rich dataset with individual-level information on health risk to empirically study one possible solution: dynamic contracts. Empirically, dynamic contracts with one-sided commitment substantially reduce the reclassification risk present with spot contracting, achieving close to the first-best for consumers with flat net income paths. Gains are smaller for consumers with net income growth, and these consumers prefer ACA-like community rating over dynamic contracts. However, lower risk aversion, sufficient switching costs, or government insurance of pre-age-25 health risks can raise welfare with dynamic contracts above the level in ACA-like markets.
    JEL: G22 I13
    Date: 2017–07
  11. By: Margaret B. Hargreaves; Cara Orfield; Todd Honeycutt; Michaela Vine; Charlotte Cabili; Brandon Coffee-Borden; Michaella Morzuch; Lydie A. Lebrun-Harris; Sylvia K. Fisher
    Abstract: The Healthy Weight Collaborative (HWC) represents a national quality improvement effort to increase uptake of evidence-based community-based interventions to address obesity among children.
    Keywords: Evaluation , Quality improvement , Collaboration , Obesity , Children
    JEL: I I0 I1
  12. By: G. Greg Peterson; Kristin Lowe Geonnotti; Lauren Hula; Timothy Day; Laura Blue; Keith Kranker; Boyd Gilman; Kate Stewart; Sheila Hoag; Lorenzo Moreno
    Abstract: CareFirst, the largest commercial insurer in the mid-Atlantic Region of the United States, runs a medical home program focusing on financial incentives for primary care practices and care coordination for high-risk patients.
    Keywords: CareFirst, Medical Home, Medicare Patients, Quality of Care, Utilization, Spending
    JEL: I
  13. By: Alex Marten; Stephen C. Newbold
    Abstract: The general equilibrium (GE) effects of environmental policies have long been a concern of stake-holders and researchers due to the potential for economy-wide feedbacks that could affect the efficiency and incidence of those policy interventions. Concerns about the potential economy-wide effects of environmental regulations are most often focused on the costs of compliance, while the beneficial outcomes of these policies are typically excluded from GE analyses. However, both regulators and researchers have recently shown interest in general equilibrium (GE) assessments of the benefits and economy-wide impacts of mortality risk reductions. GE models are able to capture feedbacks that may be important for understanding the welfare implications of environmental policies. In a study of the cumulative effects of the Clean Air Act, the U.S. Environmental Protection Agency found estimates for the benefits of air quality improvements that were more than an order of magnitude smaller under a GE approach com- pared with a traditional partial equilibrium (PE) approach. It has been suggested that these results are evidence that the PE benefits of environmental regulations are implausibly large. However, previous GE analyses of environmental or public health policies have characterized the expected health improvements using highly simplified approximations whose validity have yet to be closely examined. We present the first explicit characterization of mortality risk changes in a GE model applied to environmental regulations. We find that reductions in mortality risks can have significant GE feedbacks and that these effects are important for estimating the benefits, economic impacts, and potentially the costs of environmental policies. Our results suggest that the previously used approximations for incorporating mortality risk reductions in GE models may be the main source of the large discrepancies between GE and PE benefits estimates in previous studies, and may introduce significant errors into estimates of the economy-wide impacts of environmental policies.
    Keywords: mortality risk reduction benefits, general equilibrium, air quality
    JEL: Q50 Q53
    Date: 2017–07
  14. By: Wen Xie; Wei Su; Lijuan Zhang; Qingkun Shang; Bing Su
    Abstract: Metastasis remains the primary cause of prostate cancer related death. Cancer cells need to contact endothelial cells and disrupt endothelial junctions to cross the endothelium for invasion and metastasis.
    Keywords: SSeCKS/AKAP12, Semaphorin 3F, Cell repulsion, Prostate cancer
    JEL: I
  15. By: Ernst R. Berndt; Rena M. Conti; Stephen J. Murphy
    Abstract: Since the 1984 passage of the Waxman-Hatch Act, generic prescription drugs have become central to disease treatment and generic drug entry and price competition has been vigorous in the U.S. Nonetheless, recent policy concern has focused on potential supply inadequacy and price increases among selected generic drugs. Details regarding the supply of generic drugs throughout the product life cycle are surprisingly unstudied. Here, we examine manufacturer entry, exit, the extent of competition and the relationship between supply structure and inflation adjusted prices among generic drugs. Our empirical approach is descriptive and reduced form, following recent innovations on the older structure-conduct-performance tradition. We employ quarterly national data on quantities, wholesale dollar sales and manufacturers from QuintilesIMS National Sales Perspective data, 2004Q4–2016Q3. Defining a market as the molecule-dosage-form, we observe that median sizes of drug markets are predominantly small, with annual inflation adjusted sales revenues of less than $10 million but increasing over time. The median number of manufacturers in each market is about two, the mean about four. We find evidence to suggest decreasing numbers of suppliers over our study period, particularly following implementation of the Affordable Care Act in 2010 and the Generic Drug User Fee Amendments of 2012, attributable both to more exit and less entry. Approximately 40 percent of markets are supplied by one manufacturer; the share of markets supplied by one or two manufacturers is observed to increase over time and is more likely among non-oral drugs and those belonging to selected therapeutic classes. We find evidence to suggest prices of generic drugs are statistically significantly increasing over time, particularly following the implementation of the 2010 Affordable Care Act and the 2012 Generic Drug User Fee Amendments. Price increases are positively correlated with reduced manufacturer counts and alternative measures of increased supplier concentration, holding all else constant. Our results suggest the market for generic drugs is largely comprised of small revenue products the supply of which has tended towards duopoly or monopoly in recent years. Therefore, it is surprising generic drug prices have not been observed to be higher and potentially risen more over our study period. This issue merits further study; we suggest several testable hypotheses based in economic theory.
    JEL: I11
    Date: 2017–07
  16. By: Choudhury, Mita (National Institute of Public Finance and Policy); Dubey, Jay Dev (National Institute of Public Finance and Policy)
    Abstract: This paper illustrates the use of information on withdrawals by Drawing and Disbursing Officers (DDOs) for improving estimates of public spending for National Health Accounts (NHAs) in India. Using information from two selected States (Karnataka and Rajasthan), the study highlights the advantages of combining DDO-level information with budgetary data for two purposes (i) mapping public spending to different provider classes of the international System of Health Accounts 2011 (SHA 2011) and (ii) mapping public spending to different types of healthcare providers in India. The benefits of using DDO-level information are found to be higher while mapping expenditure to healthcare providers in India than mapping to international categories of the SHA 2011. In particular, while mapping public spending to different types of healthcare providers in India, the improvement in precision of estimates brought about by DDO-level information was found to be significant in the two States.
    Keywords: National Health Accounts (NHA) ; Health Expenditure Estimates ; Public Health Spending ; Health Provider Spending ; Drawing and Disbursing Officers (DDOs) ; Indian States
    JEL: H51 H72
    Date: 2017–07
  17. By: Björn Nilsson (Université Paris-Dauphine, PSL Research University,IRD, LEDa, DIAL)
    Abstract: Research in psychology has suggested that parental depression translates into bad parenting and worsened behavioral outcomes for children. In this article, I look at the e ect of depression on child education and labor outcomes in Mexico. Using a rich panel data set and making use of violent assault as a source of exogenous variation in depressive symptoms, I estimate the impact of a shock to parents' mental health on a series of child outcomes. The ndings suggest that worsened parental mental health increases the probability of grade repetition and market work for children. The e ects are not driven by those children whose parents had the worst mental health status at the onset of the survey, and are robust to alternative speci - cations. Given the documented extensive underutilization of mental health services in Mexico, public interventions in this domain have the potential to come with positive externalities and be cost-ecient.
    Keywords: Mental health, Parenting, Grade repetition, Child labor, Mexico.
    JEL: D10 I10 I12 O54
    Date: 2017–05
  18. By: Díaz, Juan José (Grupo de Análisis para el Desarrollo (GRADE)); Saldarriaga, Víctor (Grupo de Análisis para el Desarrollo (GRADE))
    Abstract: Se evaluaron los efectos de JUNTOS, un programa de transferencias monetarias condicionadas dirigido a los hogares rurales pobres del Perú, en el uso de atención de salud prenatal por parte de mujeres expuestas al programa durante su embarazo más reciente. Se implementó la técnica de estimación de diferencias en diferencias para estimar los efectos de JUNTOS en el uso de atención de salud prenatal, la calidad de la atención de salud prenatal, el uso de atención de salud en el momento del parto, y complicaciones obstétricas durante el parto. Se utilizó información pública de las Encuestas Demográficas y de Salud del periodo 2004-2014. Los resultados sugieren que el programa ha incrementado el uso de atención de salud prenatal. Aún más resaltante, los hallazgos también sugieren una mejora en la calidad de la atención de salud recibida y una disminución de las complicaciones obstétricas durante el parto.
    Keywords: Programa Juntos, Atención prenatal, Zonas rurales, Pobreza, Transferencias monetarias, Perú, Prenatal Care, Rural areas, Poverty, Monetary transfers, Peru
    JEL: I18
    Date: 2017
  19. By: Oshio, Takashi; Usui, Emiko
    Abstract: We examine the association between informal parental care and daughters’ employment and mental health in Japan, using the 2008-2013 waves of the Longitudinal Survey of Middle-aged and Elderly Persons, a large and nationally representative panel survey of middle-aged Japanese people. We find that caregiving reduces the probability of employment by only 2.8 percent, after controlling for time-invariant individual heterogeneity, while caregiving is not associated with either hours or days worked per week for those who are working. We further observe that employment does not increase the psychological distress already experienced by the caregivers as a result of their caregiving role.
    Keywords: informal caregiving, employment, work hours, labor supply, mental health, instrumental variable models, fixed-effects models
    JEL: J22 J14
    Date: 2017–05

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