nep-hea New Economics Papers
on Health Economics
Issue of 2018‒03‒05
sixteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. An Expanded Decomposition of the Luenberger Productivity Indicator with an Application to the Chinese Healthcare Sector By Jean-Philippe Boussemart; Gary D. Ferrier; Hervé Leleu; Zhiyang Shen
  2. Intergenerational Health Mobility in the US By Halliday, Toby; Mazumder, Bhashkar; Wong, Ashley
  3. The Effect of Community Engagement on Healthcare Utilization and Health Insurance Enrolment in Ghana Results from a Randomized Experiment By Stephen K.O. Duku; Edward Nketiah-Amponsahd; Christine J. Fenenga; Daniel K. Arhinful; Wendy (W.) Janssens; Menno (M.) Pradhan
  4. Social Assistance and Mental Health: Evidence from Longitudinal Data on Pharmaceutical Consumption By Dackehag, Margareta; Ellegård, Lina Maria; Gerdtham, Ulf-G; Nilsson, Therese
  5. Effects of Water Quality, Sanitation, Handwashing, and Nutritional Interventions on Diarrhoea and Child Growth in Rural Kenya: A Cluster-Randomised Controlled Trial By Clair Null; Christine P. Stewart; Amy J. Pickering; Holly N. Dentz; Benjamin F. Arnold; Charles D. Arnold; Jade Benjamin-Chung; Thomas Clasen; Kathryn G. Dewey; Lia C. H. Fernald; Alan E. Hubbard; Patricia Kariger; Audrie Lin; Stephen P. Luby; Andrew Mertens; Sammy M. Njenga; Geoffrey Nyambane; Pavani K. Ram; John M. Colford; Jr.
  6. Death by Pokémon GO: The Economic and Human Cost of Using Apps While Driving By Mara Faccio; John J. McConnell
  7. How Do Prescription Drugs Affect the Use of Other Health Services? By Gal Wettstein
  8. Physical Activity after Commitment Lotteries : Examining Long-Term Results in a Cluster Randomized Trial By van der Swaluw, Koen; Lambooij, M.; Mathijssen, Jolanda; Schipper, M.; Zeelenberg, Marcel; Berkhout, S.; Polder, Johan; Prast, Henriette
  9. Gender differentiation in intergenerational care-giving and migration choices By Stark, Oded; Curkowska-Torzewska, Ewa
  10. Parametric models for biomarkers based on flexible size distributions By Davillas, A.; Jones, A.M.
  11. Emotional Responses to Behavioral Economic Incentives for Health Behavior Change By van der Swaluw, Koen; Lambooij, Mattijs S; Mathijssen, Jolanda; Zeelenberg, Marcel; Polder, Johan; Prast, Henriette
  12. Body Weight and Hypertension Risk in a Developing Country By Dang, Thang
  13. Status of Maternal and Child Health (MCH) in Telangana By Motkuri, Venkatanarayana; Hansda, Lakhiram
  14. Quantity and Quality of Human Resources in Health Care: Shortage of Health Workers in India By Motkuri, Venkatanarayana; Vardhan, T Sundara; Ahmad, Shakeel
  15. Smoking Inequality across Genders and Socio-economic Classes. Evidence from Longitudinal Italian Data By Cinzi Di Novi; Rowena Jacobs; Matteo Migheli
  16. The Smoking Epidemic across Generations, Gender and Educational Groups: A Matter of Diffusion of Innovations By Cinzi Di Novi; Anna Marenzi

  1. By: Jean-Philippe Boussemart (University of Lille 3 and IÉSEG School of Management (LEM 9221-CNRS)); Gary D. Ferrier (University of Arkansas); Hervé Leleu (CNRS-LEM 9221 and IÉSEG School of Management); Zhiyang Shen (Eximbank, Anhui University of Finance and Economics)
    Abstract: Productivity growth is an important determinant of the economic well-being of producers, consumers, and society overall. Given its importance, economists have long measured productivity growth, often decomposing the overall measure into constituent pieces to isolate and better understand the sources of productivity change. Typically, productivity change is analyzed at a single level of analysis—e.g., a firm or a country. The objective of this research is to combine productivity analysis at the “firm-level” and the “industry-level” so that a novel, fuller decomposition of the sources of productivity change can be undertaken. Specifically, our decomposition allows us to capture changes in productivity due to the reallocation of inputs or outputs across productive units. In practice, such reallocation might take place across plants operated by the same firm, across regions within a country, or via mergers and acquisitions. By shedding light on more dimensions of productivity growth, this expanded decomposition may facilitate policy development and other efforts to improve productivity. The expanded decomposition begins with a standard decomposition of the aggregate Luenberger productivity indicator into its technical progress and efficiency change components. The efficiency change component is then further decomposed into technical, mix, and scale efficiency effects. The decomposition yielding the mix and scale efficiency changes uses both aggregated and disaggregated data, which allows for productivity effects of reallocations of inputs and outputs across members of a group to be measured. The new decomposition of the aggregate Luenberger productivity indicator is illustrated using data at both the provincial and regional levels for China’s healthcare sector over the period 2009-2014. Given the rapid growth in the Chinese healthcare sector in recent years and the various healthcare reforms initiated by the government, a deeper understanding of productivity in this traditionally low-productivity sector is warranted. Our results indicate that the growth of the aggregate Luenberger productivity indicator varied across both time and regions; the annual average growth rates were 0.73%, 0.53%, and 0.18% for China’s Central, Eastern, and Western regions, respectively. We find that China’s regional productivity growth in healthcare was primarily driven by technological progress; the contributions of the efficiency related elements of productivity change were smaller and more varied across regions.
    Keywords: Luenberger Productivity Indicator; Chinese Healthcare; Structural Efficiency; Scale Efficiency; Mix Efficiency
    Date: 2017–11
  2. By: Halliday, Toby (University of Hawaii, Manoa and IZA); Mazumder, Bhashkar (Federal Reserve Bank of Chicago); Wong, Ashley (Northwestern University)
    Abstract: Studies of intergenerational mobility have largely ignored health despite the central importance of health to welfare. We present the first estimates of intergenerational health mobility in the US by using repeated measures of self-reported health status (SRH) during adulthood from the PSID. Our main finding is that there is substantially greater health mobility than income mobility in the US. A possible explanation is that social institutions and policies are more effective at disrupting intergenerational health transmission than income transmission. We further show that health and income each capture a distinct dimension of social mobility. We also characterize heterogeneity in health mobility by child gender, parent gender, race, education, geography and health insurance coverage in childhood. We find some important differences in the patterns of health mobility compared with income mobility and also find some evidence that there has been a notable decline in health mobility for more recent cohorts. We use a rich set of background characteristics to highlight potential mechanisms leading to intergenerational health persistence.
    Keywords: Health; inequality; mobility; intergenerational
    JEL: I1 I14
    Date: 2018–01–31
  3. By: Stephen K.O. Duku (University of Ghana, Ghana); Edward Nketiah-Amponsahd (University of Ghana, Legon, Ghana); Christine J. Fenenga (Amsterdam Institute for Global Health and Development, the Netherlands); Daniel K. Arhinful (University of Ghana, Ghana); Wendy (W.) Janssens (Vrije Universiteit Amsterdam); Menno (M.) Pradhan (Amsterdam)
    Abstract: Background: Health insurance enrolment in many Sub-Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. This paper evaluates the impact of a community engagement intervention implemented in Ghana with the aim of improving clients’ perceptions on service quality and subsequently improving healthcare utilization and health insurance enrolment. Method: We used a panel data of 6,937 individuals from a cluster randomized controlled trial conducted in 64 communities in two regions in Ghana. A random half of communities received the intervention after a baseline survey in April 2012; the remaining communities served as controls. A follow-up survey was conducted in March 2014 to evaluate the intervention. Ordinary Least Squares regression estimations were used to measure the intervention’s impact on quality perceptions, and on healthcare utilization and health insurance enrolment for the full and balanced samples of all household members as well as the uninsured at baseline. Results: In the short term (12 months) the intervention did not produce any significant impact on perceptions of service quality, healthcare utilization or health insurance enrolment in the targeted population. It however reduced the frequency of illness by 13.8 percentage points, suggesting an overall improvement in health status. It also resulted in a 7.2 percentage points increase in insurance enrolment for the uninsured. Conclusion: Community engagement has the potential to motivate service providers to improve quality of care. However, this may not lead to improved perception of service quality, and increased healthcare utilization in the short term. Still, engaging clients in community discussions on quality improvements can effectively enhance health insurance uptake among those who were previously uninsured. Further long-term intervention is necessary to investigate its long-term effects.
    Keywords: health insurance; Ghana; randomized experiment; community participation
    Date: 2018–02–28
  4. By: Dackehag, Margareta (Department of Economics, Lund University); Ellegård, Lina Maria (Department of Economics, Lund University); Gerdtham, Ulf-G (Department of Economics, Lund University); Nilsson, Therese (Department of Economics, Lund University)
    Abstract: This paper examines the short-term effect between take-up of Social Assistance Benefit (SAB) and mental health. Using a panel dataset including rich yearly register data on e.g. income, income sources, unemployment and types of pharmaceutical consumption for over 140,000 Swedes 2006-2012, we quantify the importance of the psychosocial dimensions (e.g. shame and guilt) of the socioeconomic status – mental health nexus. Our main independent variable is an indicator for SAB, which is the means-tested last-resort option for individuals with no other means to cover necessary living expenses, received by six per cent of all Swedish households annually. Mental ill-health is measured by data on prescribed antidepressants, anxiolytics, or hypnotics. While SAB strongly associates with psychopharmaca consumption in a cross-section of observations, the association largely disappear once we introduce individual fixed effects. These results indicate that other mechanisms than shame or guilt related to the SAB experience are more important for mental health in the short term.
    Keywords: mental health; socio-economic status; social assistance; shame; guilt; individual fixed effect
    JEL: I12 I14 I18
    Date: 2018–02–15
  5. By: Clair Null; Christine P. Stewart; Amy J. Pickering; Holly N. Dentz; Benjamin F. Arnold; Charles D. Arnold; Jade Benjamin-Chung; Thomas Clasen; Kathryn G. Dewey; Lia C. H. Fernald; Alan E. Hubbard; Patricia Kariger; Audrie Lin; Stephen P. Luby; Andrew Mertens; Sammy M. Njenga; Geoffrey Nyambane; Pavani K. Ram; John M. Colford; Jr.
    Abstract: Poor nutrition and exposure to faecal contamination are associated with diarrhoea and growth faltering, both of which have long-term consequences for child health.
    Keywords: Water quality, sanitation, handwashing, Kenya
    JEL: F Z
  6. By: Mara Faccio; John J. McConnell
    Abstract: Using police accident reports for Tippecanoe County, Indiana, and exploiting the introduction of the augmented reality game Pokémon GO as a natural experiment, we document a disproportionate increase in crashes and associated vehicular damage, injuries, and fatalities in the vicinity of locations where users can play the game while driving. We estimate the incremental county-wide cost of users playing Pokémon GO while driving to be in the range of $5.2 to $25.5 million over the 148 days following the introduction of the game. Extrapolating these estimates to nation-wide levels yields a total ranging from $2.0 to $7.3 billion.
    JEL: O33 R40
    Date: 2018–02
  7. By: Gal Wettstein
    Abstract: Over the past decade, the availability of prescription drugs has increased, particularly for the elderly. Medicare Part D expanded coverage to include prescription drugs, and the Affordable Care Act (ACA) enhanced Part D’s coverage. While lowering the cost of prescription drugs would obviously encourage more use of medications, the implications of such changes for the rest of the health care market are less clear. The answer depends on whether drugs are “substitutes” for other care or “complements.” Drugs could be substitutes if they prevent deterioration in health conditions that would otherwise require more intensive care, such as surgery. However, in many ways, drugs may be complements to other care, adding value to other tools in the clinician’s toolbox. To explore this issue, this brief examines the use of health services before and after the introduction of Part D. The discussion proceeds as follows. The first section provides background on Part D and summarizes previous reesearch on how it affects the use of other health services. The second section explains the data and methodology used in this study. The third section shows the main results. The final section concludes that broadening the availability of drugs increases the use of office-based health care, with a possible decline in the use of inpatient facilities.
    Date: 2018–02
  8. By: van der Swaluw, Koen (Tilburg University, Center For Economic Research); Lambooij, M.; Mathijssen, Jolanda (Tilburg University, Center For Economic Research); Schipper, M.; Zeelenberg, Marcel (Tilburg University, Center For Economic Research); Berkhout, S.; Polder, Johan (Tilburg University, Center For Economic Research); Prast, Henriette (Tilburg University, Center For Economic Research)
    Abstract: To overcome self-control difficulties, people can commit to their health goals by voluntarily accepting deadlines with consequences. In a commitment lottery, the winners are drawn from all participants, but can only claim their prize if they also attained their gym-attendance goals. In a 52-week, three-arm trial across six company gyms, we tested if commitment lotteries with behavioral economic underpinnings would promote physical activity among overweight adults. In previous work, we presented an effective 26-week intervention. In the present paper we analyzed maintenance of goal attainment at 52-week follow-up and the development of weight over time. We compared weight and goal attainment (gym attendance ≥ 2 per week) between three arms that –in the intervention period- consisted of (I) weekly short-term lotteries for 13 weeks; (II) the same short-term lotteries in combination with an additional long-term lottery after 26 weeks; and (III) a control arm without lottery-deadlines. After a successful 26-week intervention, goal attainment declined between weeks 27 and 52 in the long-term lottery arm, but remained higher than in the control group. Goal attainment did not differ between the short-term lottery arm and control arm. Weight declined slightly in all arms in the first 13 weeks of the trial and remained stable from there on. Commitment lotteries can support regular gym attendance up to 52 weeks, but more research is needed to achieve higher levels of maintenance and weight loss.
    Keywords: Behavior Change; Physical Activity; prevention; Commitment Devices; Behavioral Economics; Deadlines
    JEL: I12 D91 C93
    Date: 2018
  9. By: Stark, Oded; Curkowska-Torzewska, Ewa
    Abstract: We weave together care-giving, gender, and migration. We hypothesize that daughters who are mothers have a stronger incentive than sons who are fathers to demonstrate to their children the appropriate way of caring for one's parents. The reason underlying this hypothesis is that women on average live longer than men, they tend to marry men who are older than they are and, thus, they are more likely than men to spend their last years without a spouse. Because it is more effective and less costly to care for parents if they live nearby, daughters with children do not move as far away from the parental home as sons with children or childless offspring. Data on the distance between the children's location and the parents' location extracted from the Survey of Health, Ageing and Retirement in Europe (SHARE), in conjunction with data on selected demographic characteristics and institutional indicators taken from Eurostat, the OECD, and the World Bank, lend support to our hypothesis: compared to childless daughters, childless sons, and sons who are fathers, daughters who are mothers choose to live closer to their parents' home.
    Keywords: Demonstration of care-giving across generations,Gender differentiation,Migration distance from the parental home
    JEL: D10 D64 J13 J14 J16
    Date: 2018
  10. By: Davillas, A.; Jones, A.M.
    Abstract: Recent advances in social-science surveys include collection of biological samples. Although biomarkers offer a large potential for social-science and economic research, they impose a number of statistical challenges, often being distributed asymmetrically with heavy tails. Using data from the UK Household Panel Survey (UKHLS), we illustrate the comparative performance of a set of flexible parametric distributions, which allow for a wide range of skewness and kurtosis: the four-parameter generalized beta of the second kind (GB2), the three-parameter generalized gamma (GG) and their three-, two- or oneparameter nested and limiting cases. Commonly used blood-based biomarkers for inflammation, diabetes, cholesterol and stress-related hormones are modelled. Although some of the three-parameter distributions nested within the GB2 outperform the latter for most of the biomarkers considered, the GB2 can be used as a guide for choosing among competing parametric distributions for biomarkers. Going beyond the mean to estimate tail probabilities, we find that GB2 performs fairly well with some disparities at the very high levels of HbA1c and Fibrinogen. Commonly used OLS models are shown to perform worse than almost all the flexible distributions.
    Keywords: biomarkers; generalised beta of second kind; heavy tails; tail probabilities;
    JEL: C18 C52 I14
    Date: 2018–02
  11. By: van der Swaluw, Koen (Tilburg University, Center For Economic Research); Lambooij, Mattijs S; Mathijssen, Jolanda (Tilburg University, Center For Economic Research); Zeelenberg, Marcel (Tilburg University, Center For Economic Research); Polder, Johan (Tilburg University, Center For Economic Research); Prast, Henriette (Tilburg University, Center For Economic Research)
    Abstract: Many people aim to change their lifestyle, but have trouble acting on their intentions. Behavioral economic incentives and related emotions can support commitment to personal health goals, but the related emotions remain unexplored. In a regret lottery, winners who do not attain their health goals do not get their prize but receive feedback on what their forgone earnings would have been. This counterfactual feedback should provoke anticipated regret and increase commitment to health goals. We explored which emotions were actually expected upon missing out on a prize due to unsuccessful weight loss and which incentive-characteristics influence their likelihood and intensity. Participants reported their expected emotional response after missing out on a prize in one of 12 randomly presented incentive-scenarios, which varied in incentive type, incentive size and deadline distance. Participants primarily reported feeling disappointment, followed by regret. Regret was expected most when losing a lottery prize (vs. a fixed incentive) and intensified with prize size. Multiple features of the participant and the lottery incentive increase the occurrence and intensity of regret. As such, our findings can be helpful in designing behavioral economic incentives that leverage emotions to support health behavior change.
    Keywords: incentives; emotions; behavioral economics; health behavior; weight loss
    JEL: D91 I12
    Date: 2018
  12. By: Dang, Thang
    Abstract: This study provides a first causal inference of the link between body weight and the risk of hypertension among adults in a developing country, Vietnam. The study uses biological offspring’s body weight as an instrument for exogenous changes in parents’ body weight to address the potential problem of endogeneity and applies the instrumental variable approach to estimate the relationship of interest. The paper finds that on average an addition BMI unit causally increases the likelihood of being hypertensive by about 5.1–7.3% points for men and 5.6–8.2% points for women. The paper also shows that the impacts of body weight on the risk of hypertension are different with various age intervals. Furthermore, overweight or obesity causally enlarges the risk of hypertension compared to underweight or normal weight.
    Keywords: Body weight; Hypertension; Causal effect; Vietnam
    JEL: I1 I14 I18
    Date: 2017–12–06
  13. By: Motkuri, Venkatanarayana; Hansda, Lakhiram
    Abstract: The present note is about the status of Maternal and Child Health (MCH) in the undivided Andhra Pradesh and separate Telangana. It is bring out the performance of the state of Telangana in continuum from the levels inherited from the undivided Andhra Pradesh. The analysis above indicates that the achievement of Telangana state in respect of maternal and child health is falling far short of ideal situation or required health outcomes. The only solace is that its performance is relatively much better than all India average and performing no less than residual state of Andhra Pradesh. The associative factors one could observe for the relatively better performance of Telangana state in this regard is perhaps its relative advantage in respect of infrastructure particularly that of the availability of health workers.
    Keywords: Maternal Health, Child Health, Maternal and Child Health, Telangana
    JEL: I1 I10 I12 I14 I18
    Date: 2017–12
  14. By: Motkuri, Venkatanarayana; Vardhan, T Sundara; Ahmad, Shakeel
    Abstract: The analysis made in this paper is illustriously indicate that the shortage of human resources for health care services especially the skilled health professionals and workers in India is at considerable level and thereby it is a great deal of concern.
    Keywords: Health, Health Workers, Human Resources, Human Resources in Health, India
    JEL: I1 I18
    Date: 2017–10
  15. By: Cinzi Di Novi (Department of Economics and Management, University of Pavia); Rowena Jacobs (Centre for Health Economics, University of York); Matteo Migheli (University of Turin, Collegio Carlo Alberto)
    Abstract: There has been a dearth of literature on smoking inequalities, in spite of its contribution to health inequalities. We exploit longitudinal Italian individual-level data to identify the main socio-demographic characteristics that determine smoking inequalities. We use the Erreygers Concentration Index to identify in which groups smoking is relatively more prevalent. We find that, among men, pro-poor prevalence is driven by members of the lower socio-economic classes, while we observe the opposite for women. We encourage policymakers to address the issue of smoking inequalities, which the current policies have largely disregarded.
    Keywords: smoking inequality, Italy, gender, social classes
    JEL: I14 I18 J16
    Date: 2018–02
  16. By: Cinzi Di Novi (Department of Economics and Management, University of Pavia); Anna Marenzi (Department of Economics, Ca’ Foscari University of Venice)
    Abstract: This study examines whether the temporal variations in smoking habits across generations and gender and among groups with differing levels of education fit the pattern proposed by the theory of the diffusion of innovations (TDI) (Rogers, 2003). We focus on the Italian case and employ a pseudo-panel derived from repeated cross-sections of the annual household survey, “Aspects of Daily Life,” that is part of the Multipurpose Survey carried out by the Italian National Statistical Office (ISTAT) for the period 1997 to 2012. The results confirm Rogers’ TDI and show that smoking prevalence has declined over time and across age cohorts: younger men of all educational levels and women with higher education are less likely to smoke than are those in other cohorts. On the other side, less-educated women, who entered the smoking-diffusion process later that others are more likely to smoke. Hence, socio-economic differences in smoking continue to persist, especially for women. According to Rogers’ TDI, smoking prevalence is expected to decline further, particularly among little-educated women.
    Keywords: Smoking habit, theory of diffusion, generations.
    JEL: J1 I1
    Date: 2018–02

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