nep-hea New Economics Papers
on Health Economics
Issue of 2017‒12‒11
sixteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Can Community Driven Care be integrated in the European Welfare System? Institutional Challenges and Historical Lessons. By Lakomaa, Erik; Sanandaji, Tino
  2. Price-Linked Subsidies and Health Insurance Markups By Sonia Jaffe; Mark Shepard
  3. Remittances and healthcare consumption: human capital investment or responses to shocks? Evidence from Peru By Gabriella Berloffa; Sara Giunti
  4. Affordable Care Act Medicaid Expansions and the Impact on Nurses By Michael DiNardi
  5. Can social safety nets protect public health? The effect of India's workfare and foodgrain subsidy programmes on anaemia By Sudha Narayanan; Nicolas Gerber; Udayan Rathore; Karthikeya Naraparaju
  6. Disease and Fertility: Evidence from the 1918 Influenza Pandemic in Sweden By Boberg-Fazlic, Nina; Ivets, Maryna; Karlsson, Martin; Nilsson, Therese
  7. Exercise Improves Academic Performance By Cappelen, Alexander W; Charness, Gary; Ekström, Mathias; Gneezy, Uri; Tungodden, Bertil
  8. Readiness of electronic health record systems to contribute to national health information and research By Jillian Oderkirk
  9. Growing old, unhealthy and unequal: an exploratory study on the health of Portuguese individuals aged 50+ By Isabel Correia Dias; Priscila Ferreira; Lígia Costa Pinto; Marieta Valente; Paula Veiga
  10. The effect of changing the number of elective hospital admissions on the levels of emergency provision By Sergi Jimenez-Martin; Catia Nicodemo; Stuart Redding
  11. Deaths from natural disasters: How important are income, income inequality and geography? By Hebe Nicholson; Nick Hanley; Laure Kuhfuss; Allan Findlay
  12. Investment in Education, Obesity and Health Behaviours By BARONE, Adriana; NESE, Annamaria
  13. Immigration and the Reallocation of Work Health Risks By Osea Giuntella; Fabrizio Mazzonna; Catia Nicodemo; Carlos Vargas Silva
  14. Is owning your Home Good for your Health? Evidence from exogenous variations in subsidies in England By Munford, L.A.; Fichera, E.; Sutton, M.;
  15. The Effects of Immigration on NHS Waiting Times By Osea Giuntella; Catia Nicodemo; Carlos Vargas Silva
  16. Diet, physical activity and sedentary behaviours: Analysis of trends, inequalities and clustering in selected oecd countries By Sahara Graf; Michele Cecchini

  1. By: Lakomaa, Erik (Institute for Economic and Business History Resarch); Sanandaji, Tino (Institute for Economic and Business History Resarch)
    Abstract: Parallel to the formal (health) care organizations in Europe, private or public, a number of community driven care projects have emerged. They may supplement the formal organizations by reducing costs or provide care to groups that for some reason do not have access to the formal sector. Drawing on Ostromian theory of commons, and on the previous theory and research on open software development (which share some of the characteristics of “open care”) we use cases of historical cases of community driven care to examine the prospects for such project to help remedy the cost crisis in the care sector. We explore under which institutional settings “open care” is likely to emerge and when open care projects have potential to scale. It is found that open care is more likely to emerge and prosper when they build on existing organizational structures; where the participants do not need to create new hierarchies or governance structures and where they share common values. The paper may serve policy makers aiming to design institutions or regulation, that facilitate, or at least not impede, the emergence of community based care.
    Keywords: Commons; health care; Europe; Institutions; social entreprenurship
    JEL: D02 D71 L11 L19 L31 L38
    Date: 2017–09–29
  2. By: Sonia Jaffe (Becker Friedman Institute For Research in Economics); Mark Shepard (Harvard University)
    Abstract: Subsidies in many health insurance programs depend on prices set by competing insurers – as prices rise, so do subsidies. We study the economics of these “price-linked” subsidies compared to “fixed” subsidies set independently of market prices. We show that price-linked subsidies weaken competition, leading to higher markups and raising costs for the government or consumers. However, price-linked subsidies have advantages when insurance costs are uncertain and optimal subsidies increase as costs rise. We evaluate this tradeoff empirically using a model estimated with administrative data from Massachusetts’ health insurance exchange. Relative to fixed subsidies, price-linking increases prices by up to 6% in a market with four competitors, and about twice as much when we simulate markets with two insurers. For levels of cost uncertainty reasonable in a mature market, we find that the losses from higher markups outweigh the benefits of price-linking.
    Keywords: health insurance, health care pricing
    JEL: I11 I13 L11
    Date: 2017–11
  3. By: Gabriella Berloffa; Sara Giunti
    Abstract: This paper estimates the effect of international remittances on healthcare consumption. We test whether consumption decisions of remittance-receiving households with respect to healthcare are driven by the occurrence of health shocks or reveal different preferences to invest in human capital. Using data from the "Peruvian National Survey of Households", we find that remittances have a positive impact on healthcare consumption shares and a negative one on consumption goods, net of the remittance-related income effect. This suggests a tendency to devote larger shares of income from remittances to human capital investment, compared to other sources of income. This propensity is independent of the occurrence of a health shock, confirming the role of migrant transfers for human capital accumulation.
    Date: 2017
  4. By: Michael DiNardi
    Abstract: Shortages in healthcare labor markets and decreases in quality of care were major concerns voiced by critics of the 2010 Patient Protection and Affordable Care Act. I use the 2014 expansions in Medicaid coverage as a plausibly exogenous increase in the demand for nurses to estimate the effects on nurse labor market outcomes and quality of care measures. Using a difference-in-differences strategy, I find the 2014 Medicaid expansions increased nursesâ weekly hours worked by 1.5 percent (0.55 hours). Increases in hours worked are larger for rural nurses, likely due to larger increases in insurance coverage in rural areas from the Medicaid expansions. In disaggregated analyses, employment of licensed practical nurses increased by 15 percent, but I do not find any statistically significant effects on registered nurse employment. Weekly hours worked increased by 2.4 percent (0.89 hours) for licensed practical nurses and by 1.2 percent for registered nurses (0.46 hours). I do not find any consistent negative effects on quality of care as measured by patient ratings of nursing care and hospital-acquired infection rates.
    JEL: I13 I18 J23
    Date: 2017–11–30
  5. By: Sudha Narayanan (Indira Gandhi Institute of Development Research); Nicolas Gerber (Center for Development Research, University of Bonn); Udayan Rathore (Indira Gandhi Institute of Development Research); Karthikeya Naraparaju (Indian Institute of Management, Indore)
    Abstract: Can large-scale social safety nets be nutrition sensitive even if they do not explicitly incorporate health and nutrition as programmatic goals? This paper focuses on the consequences of a countrywide guaranteed workfare programme (MGNREGA) and subsidised food distribution scheme (PDS) in India for the prevalence of anaemia, examining whether individuals in districts with a broader reach of these mega-programmes are less likely to be anaemic. Using an Instrumental Variable (IV) approach to address the endogeneity of programme scale, we find that an individual residing in a district where the programmes have broader reach is less likely to suffer from all forms of anaemia and has a lower haemoglobin deficit from the benchmark suggested by the World Health Organisation (WHO) - ranging between 0.91 to 6.2 percentage points for a 10 percentage point expansion in programme scale. While the PDS seems to be more effective in reducing the incidence of mild anaemia than moderate or severe anaemia, while the strength of effects for MGNREGA seem to be the least for mild. These are catch-all effects that represent partial and general equilibrium impacts through multiple pathways. Programme interaction effects suggest the MGNREGA and PDS may be substitutes - associated improvements in anaemia for regions with higher PDS access (MGNREGA participation) are more pronounced when the scale of MGNREGA participation (PDS access) is low. There exist nonlinearities in these relationships with the efficacy of both programmes varying across scales of implementation.
    Keywords: safety nets, PDS, MGNREGA, India, anaemia
    JEL: I18 J08 J48 H55
    Date: 2017–10
  6. By: Boberg-Fazlic, Nina (University of Southern Denmark); Ivets, Maryna (University of Duisburg-Essen); Karlsson, Martin (University of Duisburg-Essen); Nilsson, Therese (Research Institute of Industrial Economics (IFN))
    Abstract: This paper studies the effect of the 1918–19 influenza pandemic on fertility using a historical dataset from Sweden. Our results suggest an immediate reduction in fertility driven by morbidity, and additional behavioral effects driven by mortality. We find some evidence of community rebuilding and replacement fertility, but the net long-term effect is fertility reduction. In districts highly affected by the flu there is also an improvement in parental quality: we observe a relative increase in births to married women and better-off city dwellers. Our findings help understand the link between mortality and fertility, one of the central relations in demography, and show that several factors – including disruptions to marriage and labor markets – contribute to fertility reduction in the long term. Our results are consistent with studies that find a positive fertility response following natural disasters, but with high-quality historical data we show that this effect is short-lived.
    Keywords: 1918–19 influenza pandemic; Influenza and pneumonia mortality; Fertility; Difference-in-Differences
    JEL: I12 J11 J13
    Date: 2017–08–31
  7. By: Cappelen, Alexander W (The Choice Lab); Charness, Gary (University of California); Ekström, Mathias (The Choice Lab); Gneezy, Uri (University of California); Tungodden, Bertil (The Choice Lab)
    Abstract: We report the results of a randomized controlled trial testing whether incentivizing physical exercise improves the academic performance of college students. As expected, the intervention increases physical activity. The main result is that it generates a strong and significant improvement in academic performance, particularly for students who struggled at the baseline in terms of lifestyle habits. We also provide evidence on the underlying mechanisms: Students who were incentivized to exercise have a healthier life style and improved self-control. Overall, the study demonstrates that incentivizing students to exercise can be an important tool in improving educational achievements.
    Keywords: C93; I12; I18; I21; Z20
    JEL: C93 I12 I18 I21
    Date: 2017–09–08
  8. By: Jillian Oderkirk (OECD)
    Abstract: All countries are investing in the development of electronic health (clinical) records, but only some countries are moving forward the possibility of data extraction for research, statistics and other uses that serve the public interest. This study reports on the development and use of data from electronic health records in twenty-eight countries. It reports on the prevalence of technical and operational factors that support countries in the development of health information and research programmes from data held within electronic health record systems, such as data coverage, interoperability and standardisation. It examines data quality challenges and how some countries are addressing them and it explores the governance of electronic health record systems and data, including examples of national statistical and research uses of data. The report provides an overall assessment of the readiness of countries to further develop health information from data within electronic health record systems and describes the outlook for the future. Ten countries are identified as having high readiness that enables them to develop world-class health information systems supporting health system quality, efficiency and performance and creates a firm foundation for scientific research and discovery.
    JEL: I1 O3 O5
    Date: 2017–12–04
  9. By: Isabel Correia Dias (Universidade do Minho, NIMA); Priscila Ferreira (Universidade do Minho, NIMA); Lígia Costa Pinto (Universidade do Minho, NIMA); Marieta Valente (Universidade do Minho, NIMA); Paula Veiga (Universidade do Minho, NIMA)
    Abstract: In this study we provide evidence on the health status and the role of gender and socioeconomic inequality in self-reported health and morbidity status amongst the elderly in Portugal. We find a negative self-perception of health status amongst the elderly; high prevalence of chronic diseases since an earlier age; high level of depression problems reported by women; and high levels of disability amongst the oldest old. There are, nonetheless, substantial differences in health status between age groups that suggest a potential for health gains in the future. The prevalence of chronic diseases, mental problems and high disability requires an adequate (re)organization of healthcare delivery to the elderly. Moreover, the evidence presented clearly calls for a gendered perspective on health policy, particularly in mental health policy.
    Keywords: ageing, health status, inequality
    JEL: I1 I14 I18
    Date: 2017–11
  10. By: Sergi Jimenez-Martin; Catia Nicodemo; Stuart Redding
    Abstract: The Department of Health of the Basque Government launched in 2010 a new strategy to tackle the challenge of chronicity which aimed to re-orient the health system towards an integrated care model. In this paper we evaluate this strategy through a retrospective observational study with a historical control group based on data from the clinical and administrative databases of the Basque Health Service
    Date: 2017–09
  11. By: Hebe Nicholson (School of Geography and Sustainable Development, University of St. Andrews); Nick Hanley (School of Geography and Sustainable Development, University of St. Andrews); Laure Kuhfuss (School of Geography and Sustainable Development, University of St. Andrews); Allan Findlay (School of Geography and Sustainable Development, University of St. Andrews)
    Abstract: This paper analyses the role of income, income inequality and geography in explaining recent time trends in global hazards from natural disasters such as floods and hurricanes. We seek to explain a pattern in the data which shows a decline in such disasters from the early 2000s across 73 countries, despite increasing pressures from climate change. Using a zero-inflated negative binomial model and a generalized least squared regression model, we show that income and income inequality both have significant effects on the number of disasters and on deaths from natural hazards; but that geographical factors also play an important role. It seems from the data as if countries can reduce expected deaths from natural disasters by increasing average incomes and by improving the fairness with which such income is distributed. However, results for the geographical variables suggest that this “escape route” is not equally open to all countries.
    Keywords: Natural disasters, natural hazards, income growth, income inequality, self-protection, zero inflated negative binomial models
    JEL: Q54 Q56
    Date: 2017–11
  12. By: BARONE, Adriana (CELPE - Centre of Labour Economics and Economic Policy, University of Salerno - Italy); NESE, Annamaria (CELPE - Centre of Labour Economics and Economic Policy, University of Salerno - Italy)
    Abstract: This study reports new evidence on the association between educational outcomes for young adults in Italy (in terms of both schooling levels and type of education) and selected health behaviours (simultaneously taken). The results indicate the following: i) individuals who decide to stay at school longer also do things that improve their own health, such as not smoking, practicing physical activity, maintaining a normal body weight and low consumption of unhealthy food (snacks, cakes, etc.), thereby confirming complementarities between investment in education and health (Fuchs, 2004, Becker 2007); and ii) particularly for females, a positive association is observed between the choice of Sciences vs. Humanities, a normal body weight and the adoption of healthy behaviours (not smoking, practising physical activity, and consuming healthy food).
    Keywords: Human capital; Education; Health Behaviour; Gender; Microeconometrics
    JEL: C25 I12 I21 J16 J24
    Date: 2017–10–26
  13. By: Osea Giuntella (University of Pittsburgh, IZA); Fabrizio Mazzonna (Universita’ della Svizzera Italiana, MEA); Catia Nicodemo (University of Oxford, CHSEO, IZA); Carlos Vargas Silva (University of Oxford, Centre on Migration, Policy and Society (COMPAS))
    Abstract: This paper studies the effects of immigration on the allocation of occupational physical burden and work injury risks. Using data for England and Wales from the Labour Force Survey (2003-2013), we find that, on average, immigration leads to a reallocation of UK-born workers towards jobs characterized by lower physical burden and injury risk. The results also show important differences across skill groups. Immigration reduces the average physical burden of UK-born workers with medium levels of education, but has no significant effect on those with low levels. These findings, together with the evidence that immigrants report lower injury rates than natives, suggest that the reallocation of tasks could reduce overall health care costs and the human and financial costs typically associated with workplace injuries.
    Keywords: Immigration, labor-market, physical burden, work-related injuries, health
    JEL: J61 I10
    Date: 2017–12
  14. By: Munford, L.A.; Fichera, E.; Sutton, M.;
    Abstract: Little is known about the causal effects of home ownership on health. We exploit the 'Right to Buy' policy in England as a source of exogenous variation in the ownership decision. The policy gave secure long-term tenants of publicly rented housing a discount in order to encourage them to buy their home. We assess the health and well-being impacts of this ownership decision by considering a macro and micro level analysis. In both analyses, home ownership is associated with higher levels of health and well-being. At the macro-level, local authorities with higher ownership rates had lower rates of people reporting having a longstanding health condition and also lower average counts of the number of health conditions reported by individuals. At the micro-level, becoming a homeowner reduced the number of self-reported health conditions by 0.65, increased self-assessed health by 0.19 points on a ve-point scale, and increased General Health Questionnaire scores by 1.46 points on a 37-point scale. These results are robust to a number of assumptions. Further models suggest that the mechanisms through which home ownership aects health may operate via the labour markets with new job opportunities, extra time saved travelling and resources available for healthy leisure activities.
    Keywords: Home ownership; Health and Well-being; Right to Buy;
    JEL: H70 I10 I31 I38
    Date: 2017–11
  15. By: Osea Giuntella (University of Pittsburgh, IZA); Catia Nicodemo (University of Oxford, CHSEO, IZA); Carlos Vargas Silva (University of Oxford, Centre on Migration, Policy and Society (COMPAS))
    Abstract: This paper analyzes the effects of immigration on waiting times for the National Health Service (NHS) in England. Linking administrative records from Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in accident and emergency departments (A&E) and elective care. The reduction in outpatient waiting times can be explained by the fact that immigration increases natives’ internal mobility and that immigrants tend to be healthier than natives who move to different areas. Conversely, we observe higher outpatient waiting times in places to which native internal migrants have moved. Finally, we find evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside of London. The increase in average waiting times in more deprived areas is concentrated in the years immediately following the 2004 EU enlargement and disappears in the medium term (e.g., 3 to 4 years).
    Keywords: Immigration, waiting times, NHS, access to health care, welfare
    JEL: J61 I10
    Date: 2017–12
  16. By: Sahara Graf; Michele Cecchini (OECD)
    Abstract: Prevalence of non-communicable diseases has increased in past decades in the OECD. These conditions have many risk factors, including poor quality diet, insufficient physical activity, and excess sedentarism. These behaviours are also at the root of overweight and obesity, which are themselves risk factors leading to non-communicable diseases. Using the most recent data available from individual-level national health surveys and health interviews, this paper paints a picture of the situation in terms of diet and physical activity in eleven OECD countries. Fruit and vegetable consumption remains low in all countries, as daily consumption of five fruit and vegetables per day rarely reaches 40%; diet quality can also be improved, although it is higher in some countries. Physical activity levels are more encouraging, with over 50% of the population reporting to reach the World Health Organization target in all countries, and excess sedentarism is high in two of the seven countries studied. Disparities by level of education and socio-economic status are visible for all health behaviours: overall, those with higher socio-economic characteristics consume a healthier diet and are more physically active, but also more sedentary. Inequalities and gender gaps vary by country and by health indicator. A latent class analysis was run to classify individuals into different groups, depending on their various health behaviours (adherence to national diet guidelines, sufficient physical activity, and low sedentarism). This approach demonstrated that these behaviours are linked, and allowed to determine the traits (demographic, health) of individuals in each class. This analysis allows policy-makers to specifically target these populations with interventions aiming to improve their health. Globally, men with higher socio-economic characteristics were more likely to be in the groups displaying less healthy behaviours.
    JEL: D12 I12 I14 I18
    Date: 2017–12–11

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