nep-hea New Economics Papers
on Health Economics
Issue of 2018‒07‒16
twenty-six papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Policy discontinuity and duration outcomes By Gerard Van Den Berg; Antoine Bozio; Monica Costa Dias
  2. Health, Longevity and Pension Reform By Laun, Tobias; Markussen, Simen; Vigtel, Trond Christian; Wallenius, Johanna
  3. Cost, context and decisions in Health Economics and cost-effectiveness analysis By Anthony J Culyer
  4. High on Crime? Exploring the Effects of Marijuana Dispensary Laws on Crime in California Counties By Hunt, Priscillia E; Pacula, Rosalie Liccardo; Weinberger, Gabriel
  5. Measuring Physicians' Response to Incentives: Evidence on Hours Worked and Multitasking By Shearer, Bruce S.; Somé, Nibene Habib; Fortin, Bernard
  6. Expectations, preferences and physicians' specialty choice By Jon Gibson; Dan Rigby; Matt Sutton; Sharon Spooner; Kath Checkland
  7. Impact of Diagnosis Related Group Refinement on the Choice Between Scheduled Caesarean Section and Normal Delivery: Recent Evidence from France By Aleksandr Proshin; Alexandre Cazenave-Lacroutz; Zeynep Or; Lise Rochaix
  8. Better off at home? Effects of a nursing home admission on costs, hospitalizations and survival By Pieter Bakx; Bram Wouterse; Eddy (E.K.A.) van Doorslaer; Albert Wong
  9. Economics of Innovative Payment Models Compared with Single Pricing of Pharmaceuticals By Cole, A.; Towse, A.; Lorgelly, P.; Sullivan, R.
  10. Power of personalized smoking cessation: A unified lifecycle framework for policy evaluation By Chen, Li-Shiun; Wang, Ping; Yao, Yao
  11. The impact of cuts to social care spending on the use of Accident and Emergency departments in England By Rowena Crawford; George Stoye; Ben Zaranko
  12. A Reconsideration of the Sugar Sweetened Beverage Tax in a Household Production Model By Di Xiang; Lue Zhan; Massimo Bordignon
  13. Mortality/longevity Risk-Minimization with or without securitization By Tahir Choulli; Catherine Daveloose; Mich\`ele Vanmaele
  14. Are rising house prices really good for your brain? House value and cognitive functioning among older Europeans By Bénédicte H. Apouey; Isabelle Chort
  15. Worth the Wait? Improving Predictions of Prolonged Work Disability By Kara Contreary; Yonatan Ben-Shalom; Brian Gifford
  16. The Effect of Religiosity on Adolescent Risky Behaviors By Mendolia, Silvia; Paloyo, Alfredo R.; Walker, Ian
  17. The disutility of commuting? The effect of gender and local labour markets By Luke Munford; Nigel Rice; Jennifer Roberts; Nikita Jacob
  18. Nudgital: Critique of Behavioral Political Economy By Julia M. Puaschunder
  19. Reported MPC and Unobserved Heterogeneity By Tullio Jappelli; Luigi Pistaferri
  20. Subjective expectations of survival and economic behaviour By Cormac O'Dea; David Sturrock
  21. New Evidence on predictable validity of grip strength on later outcomes in Japan By Midori Matsushima; Satoshi Shimizutani; Hiroyuki Yamada
  22. Persistence of suicides in G20 countries: SPSM approach to three generations of unit root tests By Gosego Mothuti; Nicolene Haaman; Andrew Phiri
  23. My Choice: Female Contraceptive Use Autonomy in Bangladesh By Blunch, Niels-Hugo
  24. Setting research priorities in Global Health:Appraising the value of evidence generation activities to support decision-making in health care By Beth Woods; Claire Rothery; Paul Revill; Timothy Hallett; Andrew Phillips; Karl Claxton.
  25. Sexual Exploitation of Trafficked Children: Evidence from Bangladesh By Masahiro Shoji; Kenmei Tsubota
  26. Combating domestic violence against women in Turkey. The role of women's economic empowerment By Aurélien Dasre; Angela Greulich; Inan Ceren

  1. By: Gerard Van Den Berg (Institute for Fiscal Studies and University of Mannheim); Antoine Bozio (Institute for Fiscal Studies and Institut des Politiques Publiques, Paris School of Economics); Monica Costa Dias (Institute for Fiscal Studies and Institute for Fiscal Studies)
    Abstract: Causal effects of a policy change on the hazard rates of a duration outcome variable are not identifi ed from a comparison of spells before and after the policy change when there is unobserved heterogeneity in the effects and no model structure is imposed. We develop a discontinuity approach that overcomes this by considering spells that include the moment of the policy change and by exploiting variation in the moment at which different cohorts are exposed to the policy change. We prove identi cation of average treatment effects on hazard rates without model structure. We estimate these effects by kernel hazard regression. We use the introduction of the NDYP program for young unemployed individuals in the UK to estimate average program participation effects on the exit rate to work as well as anticipation effects.
    Keywords: policy evaluation, hazard rate, identi fication, causality, regression discontinuity, selectivity, kernel hazard estimation, local linear regression, average treatment effect, job search assistance, youth unemployment
    Date: 2018–03–14
  2. By: Laun, Tobias (Department of Economics); Markussen, Simen (Ragnar Frisch Centre for Economic Research); Vigtel, Trond Christian (Ragnar Frisch Centre for Economic Research); Wallenius, Johanna (Department of Economics, Stockholm School of Economics,)
    Abstract: In this paper, we study alternative pension reforms designed to achieve fiscal sustainability in the face of demographic change. We are particularly interested in the heterogeneous effects across demographic groups, as improvements in health and longevity have not been uniform across the population. To this end, we develop a dynamic, structural life cycle model of heterogeneous agents who face health, mortality and income risk. We consider the following policy reform measures: (1) increasing the early access age to pensions, (2) raising income taxes, (3) lowering pension benefits and (4) lowering pension and disability benefits. We find that, of the considered policies, proportionally lowering pension and disability benefits results in the highest average welfare and the lowest degree of inequality. It is also successful at boosting employment, particularly among the less educated.
    Keywords: Life cycle; Retirement; Disability insurance; Health
    JEL: E24 J22 J26
    Date: 2018–05–08
  3. By: Anthony J Culyer (Centre for Health Economics, University of York, York, UK)
    Abstract: Cost in health economics is necessarily associated with a decision. It varies according to the context of that decision: whether about inputs or outputs, the alternatives, its timing, the nature of the commitment to following a decision, who the decision maker is, and the constraints and discretion limiting or liberating the decision maker. Distinctions between short/long runs and between fixed/variable inputs are matters of choice, not technology, and are similarly context-dependent. Costs are not harms or negative consequences. Whether ‘clinically unrelated’ future costs and benefits should be counted in current decisions also depends on context. The costs of entire health programmes are context-dependent, relating to planned rates of activity, volumes and timings. The implications for the methods of CEA and HTA are different in the contexts of low- and middleincome countries compared with high-income countries, and further differ contextually according to budget constraints (fixed or variable).
    Keywords: Opportunity cost, choice, decisions, context, short/long runs, fixed/variable costs, unrelated costs, LMICs.
    Date: 2018–06
  4. By: Hunt, Priscillia E (RAND); Pacula, Rosalie Liccardo (RAND); Weinberger, Gabriel (Pardee RAND Graduate School)
    Abstract: Regulated marijuana markets are more common today than outright prohibitions across the U.S. states. Advocates for policies that would legalize marijuana recreational markets frequently argue that such laws will eliminate crime associated with the black markets, which many argue is the only link between marijuana use and crime. Law enforcement, however, has consistently argued that marijuana medical dispensaries (regulated retail sale and a common method of medical marijuana distribution), create crime in neighborhoods with these store-fronts. This study offers new insight into the question by exploiting newly collected longitudinal data on local marijuana ordinances within California and thoroughly examining the extent to which counties that permit dispensaries experience changes in violent, property and marijuana use crimes using difference-in-difference methods. The results suggest no relationship between county laws that legally permit dispensaries and reported violent crime. We find a negative and significant relationship between dispensary allowances and property crime rates, although event studies indicate these effects may be a result of pre-existing trends. These results are consistent with some recent studies suggesting that dispensaries help reduce crime by reducing vacant buildings and putting more security in these areas. We also find a positive association between dispensary allowances and DUI arrests, suggesting marijuana use increases in conjunction with impaired driving in counties that adopt these ordinances, but these results are also not corroborated by an event study analysis.
    Keywords: crime, marijuana markets, local ordinances
    JEL: K14 K42 H75
    Date: 2018–05
  5. By: Shearer, Bruce S. (Université Laval); Somé, Nibene Habib (University of Western Ontario); Fortin, Bernard (Université Laval)
    Abstract: We measure the response of physicians to monetary incentives using matched administrative and time-use data on specialists from Québec (Canada). These physicians were paid fee-for-service contracts and supplied a number of different services. Our sample covers a period during which the Québec government changed the prices paid for clinical services. We apply these data to a multitasking model of physician labour supply, measuring two distinct responses. The first is the labour-supply response of physicians to broad-based fee increases. The second is the response to changes in the relative prices of individual services. Our results confirm that physicians respond to incentives in predictable ways. The own-price substitution effects of a relative price change are both economically and statistically significant. Income effects are present, but are overridden when prices are increased for individual services. They are more prominent in the presence of broad-based fee increases. In such cases, the income effect empirically dominates the substitution effect, which leads physicians to reduce their supply of clinical services.
    Keywords: physician labour supply, multitasking, incentive pay
    JEL: I10 J22 J33 J44
    Date: 2018–05
  6. By: Jon Gibson; Dan Rigby; Matt Sutton; Sharon Spooner; Kath Checkland
    Date: 2018
  7. By: Aleksandr Proshin; Alexandre Cazenave-Lacroutz; Zeynep Or (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Institut de la Recherche et Documentation en Economie de la Santé); Lise Rochaix (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics, Hospinomics - PSE - Paris School of Economics)
    Abstract: Studying quasi-experimental data from French hospitals from 2010 to 2013, we test the effects of a considerable diagnosis related group (DRG) refinement that occurred in 2012. As a result, the reform had a direct impact on hospital-level financial incentives but did not immediately concern individual providers. Using a difference-in-differences approach, controlling for multiple patient, hospital and regional characteristics and allowing for hospital and year effects, we show that introducing new severity levels and clinical factors into the reimbursement algorithm had no significant effect on the probability of a scheduled C-section being performed. The results are robust to multiple formulations of financial incentives, to restricting the sample to bigger (>15%) DRG tariff incentive changes and to analyzing policy effects for individual years following the reform. Our results suggest that the DRG refinement did not lead to a transmission of hospital-level stimuli to midwifes and obstetricians. Our paper is the first study that focuses on the consequences of DRG refinement in obstetrics and develops an approach suitable for measuring monetary incentives in this setting.
    Keywords: C-section,DRG,midwifes,obstetricians,refinement,tariffs,vaginal labor
    Date: 2018–06
  8. By: Pieter Bakx (Erasmus University Rotterdam); Bram Wouterse (CPB); Eddy (E.K.A.) van Doorslaer (Erasmus School of Economics Rotterdam); Albert Wong (RIVM)
    Abstract: Aging-in-place policies substitute home care for nursing home admissions (NHA). They appear to be a win-win by keeping public spending in check and being in line with personal preferences, but have hitherto not been evaluated. We study the impact of NHA eligibility using Dutch administrative data and exploiting variation between randomly assigned assessors in their tendency to grant admission. The impact on mortality is zero, but with considerable effect heterogeneity. Moreover, aging-in-place policies come at the cost of increased curative care, especially hospital admissions, and do not reduce total healthcare spending, suggesting they may not be a win-win after all.
    Keywords: long-term care; policy evaluation; instrumental variables
    JEL: C26 I10
    Date: 2018–07–06
  9. By: Cole, A.; Towse, A.; Lorgelly, P.; Sullivan, R.
    Abstract: The current system of a single price per medicine means that, for multi-indication medicines, the relationship between price and "value" can vary substantially. In this OHE Research paper, we consider - What are the economic implications of an alternative to single-price payments for pharmaceuticals? In particular, what are the implications for - payer budgets, patient access, and the incentives for innovation? Varying prices with the use of a drug offers the opportunity to better align payment with value, but the impact on patients, payers, and incentives for innovation are not clear cut. Two key papers offer competing perspectives. Bach (2014) described the potential for IBP to increase transparency and illustrated how IBP could lead to lower prices for lower value indications, while Chandra and Garthwaite (2017) argued that IBP would lead to higher prices overall. The key differences arose from assumptions as to where (single) prices are currently set, and the extent to which IBP could expand patient access by allowing further indications to be developed. In the short term theory suggests that indication-based pricing can improve overall welfare if it means greater patient access, but payers may face higher expenditure. However, the potential longer-term (dynamic) effects of IBP are sometimes neglected - optimising incentives for R&D means indications that can provide cost-effective treatment are likely to be developed, and there is the potential for increased price competition at the indication-level, which could lead to lower prices, so delivering better value to the health system. In order to explore the potential impact of competition, we identify two classes of cancer therapy - tyrosine-kinase inhibitors (TKIs) and PD-1/PD-L1 inhibitors and show how competing products and competing indications have developed over time. In the case of the PD-1/PD-L1 inhibitors additional indications are currently in development with more competing therapies expected to enter the market for several further cancer types. We illustrate how competition by indication in the PD-1/PD-L1 space could, in theory, reduce prices below the value-based price.
    Keywords: Economics of innovation; Judging value for money and improving decision making
    JEL: I1
    Date: 2018–07–01
  10. By: Chen, Li-Shiun; Wang, Ping; Yao, Yao
    Abstract: Cigarette smoking leads to large healthcare and morbidity costs, and mortality losses, and smoking cessation plays a key role in reducing health risk and economic costs. While medical evidence suggests that some smokers are more likely to respond to medication treatment than others depending on genetic markers, it remains unexplored whether pharmacogenetic testing is cost-effective in treating potential quitters of smoking. We address this knowledge gap by developing a lifecycle model in which individuals make smoking, health investment and consumption-savings decisions. Depending on an individual’s genotype and demographics, smoking may bring enjoyment but deteriorates one’s health, and the dynamic evolution of health capital determines life expectancy. We incorporate various aspects of behavioral considerations that justify policy intervention. We calibrate this model to fit key economic and medical observations in the U.S. We then propose three smoking cessation policies, two with standard treatments and one personalized depending on genetic markers, all under the same program costs. We construct two unified measures of effectiveness and subsequently compute the cost-effectiveness ratio. We find that personalized treatment is the most cost-effective: for each dollar of program cost, it generates $4:59 value in effectiveness, which is 22 43% higher than those under standard treatments. The result is robust to several variations to the benchmark setting, including most importantly second-hand smoking, incomplete health knowledge, and bounded rationality.
    Keywords: Smoking and Cessation behavior, Lifecycle Decision and Health Evolution, Cost-Effectivenss of Personalized Treatments, Cigarette Smoking,
    Date: 2018
  11. By: Rowena Crawford (Institute for Fiscal Studies and Institute for Fiscal Studies); George Stoye (Institute for Fiscal Studies and Institute for Fiscal Studies); Ben Zaranko (Institute for Fiscal Studies and Institute for Fiscal Studies)
    Abstract: Recent years have seen substantial reductions in public spending on social care for older people in England. This has not only led to large falls in the number of people over the age of 65 receiving publicly funded social care, but also to growing concern about the potential knock-on effects on other public services, and in particular the National Health Service (NHS). In this paper, we exploit regional variation in the reductions in public funding for social care to examine the impact on Accident and Emergency (A&E) departments in NHS hospitals. We find that reductions in social care spending on people aged 65 and above have led to increased use of A&E services, both in terms of the average number of visits per resident and the number of unique patients visiting A&E each year. We estimate that the average cut to social care spending for the older population over the period (£375) led to an increase of 0.09 visits per resident, compared to a mean of 0.37 visits in 2009. The effects are most pronounced among people aged 85 and above. This has also led to a modest increase in the cost of providing A&E care, increasing A&E costs by an additional £3 per resident for each £100 cut in social care funding.
    Keywords: health, social care, spillovers
    Date: 2018–06–14
  12. By: Di Xiang; Lue Zhan; Massimo Bordignon
    Abstract: We study the impact of a hypothetical tax on sugar - sweetened beverages (SSBs) on the US households’ nutrients purchase, welfare change, and health benefit. Differently from the traditional approach, Food at Home(FAH) is here defined as a “home” good instead than a market good and consumers’ demands derived under the assumption that households maximize utility subject to both a money and a time constraint. The model is estimated by using an incomplete approximate Exact Affine Stone Index (EASI) demand system on a data set built by merging the most recent waves of the US consumer expenditure and time use surveys. Results show that a SSB tax would be much more effective in decreasing household nutrients purchase than it would appear by estimating a model neglecting time costs in home food production. A tax induced increased in SSB price by 20% is predicted to decrease the per capita energy purchase by 29.17 kcal/day. The annual health benefits of the tax, measured only in terms of reduced household medical expenditure, would overcome estimated welfare losses by more than $400 million.
    Keywords: sugar-sweetened beverage tax, obesity, household production
    JEL: D12 D13 I18
    Date: 2018
  13. By: Tahir Choulli; Catherine Daveloose; Mich\`ele Vanmaele
    Abstract: This paper addresses the risk-minimization problem, with and without mortality securitization, \`a la F\"ollmer-Sondermann for a large class of equity-linked mortality contracts when no model for the death time is specified. This framework includes the situation where the correlation between the market model and the time of death is arbitrary general, and hence leads to the case of a market model where there are two levels of information. The public information which is generated by the financial assets, and a larger flow of information that contains additional knowledge about a death time of an insured. By enlarging the filtration, the death uncertainty and its entailed risk are fully considered without any mathematical restriction. Our key tool lies in our optional martingale representation that states that any martingale in the large filtration stopped at the death time can be decomposed into precise orthogonal local martingales. This allows us to derive the dynamics of the value processes of the mortality/longevity securities used for the securitization, and to decompose any mortality/longevity liability into the sum of orthogonal risks by means of a risk basis. The first main contribution of this paper resides in quantifying, as explicit as possible, the effect of mortality uncertainty on the risk-minimizing strategy by determining the optimal strategy in the enlarged filtration in terms of strategies in the smaller filtration. Our second main contribution consists of finding risk-minimizing strategies with insurance securitization by investing in stocks and one (or more) mortality/longevity derivatives such as longevity bonds. This generalizes the existing literature on risk-minimization using mortality securitization in many directions.
    Date: 2018–05
  14. By: Bénédicte H. Apouey (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique); Isabelle Chort (UPPA - Université de Pau et des Pays de l'Adour)
    Abstract: This study examines how house prices influence cognitive functioning for individuals aged 50+ in Europe. Using data from the Survey of Health, Ageing and Retirement (SHARE) between 2004 and 2015, we compute the median house price for each region-year, using individual self-reported house values. Cognitive scores capture either fluid intelligence (numeracy, memory) or a mix of fluid and crystallized intelligences (verbal fluency). Compared with the previous literature, we allow housing market fluctuations to have different effects during episodes of price increases and decreases, and we study owners with a mortgage, owners without a mortgage, and tenants separately. Findings indicate that house price booms do not systematically improve cognitive health outcomes: for outright owners and tenants, a rise in prices correlates with a decrease in fluid intelligence. For outright owners, this result is partly explained by increased alcohol consumption, and is also related to stronger feelings of guilt and irritability, consistent with aversion to advantageous inequality. Findings also show asymmetry in the effects of price booms and busts: indeed, for mortgaged owners, both price increase and decrease episodes have a positive impact on cognitive outcomes. We argue that during the crisis the beneficial impact of price busts may have been driven by the decline in interest rates, which reduced the debt burden of households with a variable rate mortgage.
    Keywords: Wealth,Cognitive functioning,Health,House prices,Older Europeans,SHARE,Europe
    Date: 2018–06
  15. By: Kara Contreary; Yonatan Ben-Shalom; Brian Gifford
    Abstract: We use a large database of short-term disability insurance claims to estimate models that predict who will exhaust short-term disability insurance and transfer to long-term disability insurance.
    Keywords: disability insurance, predictive analytics, early intervention
    JEL: I J
  16. By: Mendolia, Silvia (University of Wollongong); Paloyo, Alfredo R. (University of Wollongong); Walker, Ian (Lancaster University)
    Abstract: We investigate the relationship between religiosity and risky behaviors in adolescence using data from a large and detailed cohort study of 14 year olds who have been followed for seven years. We focus on the effect of the self-reported importance of religion and on the risk of youths having early sexual intercourse, drinking underage, trying cigarettes, trying cannabis, and being involved in fighting at ages 14–17. We use school and individual fixed effects, and we control for a rich set of adolescent, school, and family characteristics, including achievements in standardized test scores at age 11, parental employment, and marital status. We also control for information on personality traits, such as work ethic, self-esteem, and external locus of control. Our results show that individuals with low religiosity are more likely to engage in risky health behaviors, whatever their combination of personality traits. These effects are robust to separate estimations for boys and girls and to the control variables used. Moreover, the results are essentially unchanged when we use Inverse Probability Weighted Regression Adjustment estimation methods – which provide causal estimates conditional on selection on observables only.
    Keywords: health behaviors, religiosity, personality, fixed effects
    JEL: I10 I12
    Date: 2018–05
  17. By: Luke Munford (Manchester Centre for Health Economics, University of Manchester); Nigel Rice (Centre for Health Economics & Department of Economics and Related Studies, University of York); Jennifer Roberts (Department of Economics, University of Sheffield); Nikita Jacob (Centre for Health Economics, University of York)
    Abstract: Commuting is an extremely important modern phenomenon characterised by the spatial interaction of housing and labour markets. The average commuter in the UK spends nearly an hour a day travelling to and from employment. Standard economic theory postulates that commuting is a choice behaviour undertaken when compensated through either lower rents or greater amenities in the housing market or through greater wages in the labour market. By exploiting exogenous shocks to commuting time, this paper investigates the impact on wellbeing of increased commuting. Ceteris paribus, exogenous increases in commuting time are expected to lower wellbeing. We find this holds for women but not men. This phenomenon can be explained, in part, by the different labour markets in which women operate. Where local labour markets are thin, women report significantly lower wellbeing when faced with an increased commute. This does not hold for tight local labour markets. Further our findings reveal that it is full-time working women in the managerial and professional tier of the occupational hierarchy who are most affected.
    Keywords: commuting; exogenous shocks; well-being; panel data econometrics
    JEL: C1 I1
    Date: 2018–10
  18. By: Julia M. Puaschunder (The New School, Department of Economics)
    Abstract: Behavioral Economics revolutionized mainstream neo-classical economics. A wide range of psychological, economic and sociological laboratory and field experiments proved human beings deviating from rational choices as standard neo-classical profit maximization axioms failed to explain how human actually behave. Human beings rather use heuristics in their day-to-day decision making. These mental short cuts enable to cope with a complex world yet also often leave individuals biased and falling astray to decision making failures. What followed was the powerful extension of these behavioral insights for public administration and public policy making. Behavioral economists proposed to nudge and wink citizens to make better choices for them and the community. Many different applications of rational coordination followed ranging from improved organ donations, health, wealth and time management, to name a few. Yet completely undescribed remains that the implicit hidden persuasion opens a gate to deception and is an unprecedented social class division means. Social media forces are captures as unfolding a class dividing nudgital society, in which the provider of social communication tools can reap surplus value from the information shared of social media users. The social media provider is outlined as capitalist-industrialist, who benefits from the information shared by social media users, or so-called consumer-workers, who share private information in their wish to interact with friends and communicate to public.
    Keywords: Behavioral Economics, Behavioral Political Economy, Democratisation of information, Education, Exchange value, Governance, Libertarian Paternalism, Nudging
    Date: 2018–05
  19. By: Tullio Jappelli (Università di Napoli Federico II, CSEF and CEPR); Luigi Pistaferri (Stanford University, SIEPR, NBER and CEPR)
    Abstract: We use panel data on reported marginal propensity to consume (MPC) in the 2010 and 2016 Italy’s Survey of Household Income and Wealth. We uncover a strong negative relationship between cash-on-hand and MPC. This relation is attenuated by using regression methods that control for unobserved heterogeneity. The estimates are used to show that the effectiveness of revenue-neutral fiscal policies is much weaker relative to a case in which both observed and unobserved heterogeneity are not taken into account, particularly for policies that target the bottom part of the distribution of household resources.
    Keywords: Transitory Income Shocks; Marginal Propensity to Consume; Panel Data
    JEL: D12 D14 E21
    Date: 2018–06–29
  20. By: Cormac O'Dea (Institute for Fiscal Studies); David Sturrock (Institute for Fiscal Studies and Institute for Fiscal Studies)
    Abstract: This paper investigates individuals’ expectations about their own survival to older ages and compares these to projected and actual survival rates. The extent to which individuals have, on average, reasonable expectations about survival to older ages is important in a context of increasing personal responsibility for, and control over, the accumulation and use of retirement savings. We use data from the English Longitudinal Study of Ageing, which surveyed a representative sample of the English household population aged 50 and over between 2002­–03 and 2014–15, and the ONS 2014-based life tables for England and Wales. Subjective expectations of survival Modern surveys ask individuals about their probability of survival to specific older ages. In only a small proportion of cases is there clear evidence that these questions are not understood. 98% of individuals gave an answer to a question asking their chances of surviving to older ages and of these just 14% – i.e. fewer than one-in-six – showed clear evidence of misunderstanding (e.g. by reporting no chance of death in the coming 10-year period). Individuals’ stated beliefs about their probability of survival are correlated with known risk factors such as smoking and the age that their parents died. Those who currently smoke report on average 6–8 percentage points lower chance of surviving to an age 11–15 years ahead than do people who have never smoked. Those whose mother died at age 85 or older report on average 5-7 percentage points higher chance of surviving to an age 11–15 years ahead than do those whose mother died aged 60-64. Beliefs about probability of survival are also correlated with the individual’s actual age of death and respond to new diagnoses of health conditions. Those reporting a 10% or less chance of survival to an age 11–15 years ahead were more than twice as likely to die in the following 10 years than those who reported a 50% or greater chance of survival. A new cancer diagnosis was associated with a 5 percentage point reduction in the stated probability of surviving to an age 11–15 years ahead. Comparing subjective expectations with life table estimates and mortality data Relative to life tables, individuals from a range of ages and birth cohorts underestimate their chances of survival to ages 75, 80 and 85, on average. Those in their 50s and 60s underestimate their chances of survival to age 75 by around 20 percentage points and to 85 by around 5 to 10 percentage For example, men born in the 1940s who were interviewed at age 65 reported a 65% chance of making it to age 75, whereas the official estimate was 83%. For women, the equivalent figures were 65% and 89%. Individuals in their late 70s and 80s are, on average, optimistic about surviving to ages 90, 95 and above. This optimism becomes larger at older ages (10–15 percentage points when looking at age 95) and is larger for men than for women, amongst those born in the 1920s and 1930 For example, men born in the 1930s who were interviewed at age 80 reported a 32% chance of making it to age 95, whereas the official estimate was 17%. For women, the equivalent figures were 37% and 24%. Figure 1.1. Comparing subjective reports and “objective” life table estimates of survival probabilities (for men born 1930-39)
    Keywords: Survival expectations, savings, wealth accumulation, annuitisation
    JEL: D14 D84 D91 J14
    Date: 2018–04–16
  21. By: Midori Matsushima (Faculty of Public Affairs, Osaka University of Commerce); Satoshi Shimizutani (Nakasone Yasuhiro Peace Institute); Hiroyuki Yamada (Faculty of Economics, Keio University)
    Abstract: This study provides new evidence on predictable validity of grip strength on later life outcomes using a population based longitudinal survey for the middle and older generations in Japan. We show level of grip strength contains significant information on health outcome or mortality in subsequent years although the loss of grip strength does not. Moreover, we confirm that grip strength is associated with socio-economic status, particularly educational attainment.
    Keywords: grip strength, JSTAR, health outcome, mortality, Japan
    JEL: I14 I19
  22. By: Gosego Mothuti (Department of Economics, Nelson Mandela University); Nicolene Haaman (Department of Economics, Nelson Mandela University); Andrew Phiri (Department of Economics, Nelson Mandela University)
    Abstract: Suicides represent an encompassing measure of psychological well-being, emotional stability as well as life satisfaction and have been recently identified by the World Health Organization (WHO) as a major global health concern. The G20 countries represent the powerhouse of global economic governance and hence possess the ability to influence the direction of global suicide rates. In applying the sequential panel selection method (SPSM) to three generations of unit root testing procedures, the study investigates whether G20 countries should be concerned with possible persistence within suicide rates. The results obtained from all three generation of tests provide rigid evidence of persistence within the suicides for most member states of the G20 countries hence supporting the current strategic agenda pushed by the WHO in reducing suicides to a target rate of 10 percent. In addition, we further propose that such strategies should emulate from within G20 countries and spread globally thereafter.
    Keywords: Suicides, sequential panel selection method (SPSM), nonlinear unit root tests, Fourier form unit root tests, G20 countries
    JEL: C22 C32 C51 C52 I12
    Date: 2018–07
  23. By: Blunch, Niels-Hugo
    Abstract: Previous research has examined the incidence and correlates of contraceptive use and of several dimensions of female autonomy but only rarely the intersection of the two: female contraceptive use autonomy (CUA). Using a nationally representative household survey for two cohorts of married women, I examine female CUA incidence and correlates in Bangladesh focusing on the role of education. Female CUA is found to differ substantially across cohorts, with women from the younger cohort being far more likely to have complete autonomy over contraceptive use than women from the older cohort. Detailed decompositions reveal that the improvement in education across cohorts is the main correlate of the improved generational CUA gap. Health knowledge, especially knowledge that the use of condoms can help avoid contracting HIV/AIDS, is found to be part of the transmission mechanism between female education and female CUA but also to additionally exert its own, additional influence on CUA. I also discuss the implications of the analysis conducted here for the specification of spousal education variables and geographic fixed effects for future related research.
    Keywords: Contraceptive use,female autonomy,spousal education differentials,gender norms,decomposition analysis,Bangladesh
    JEL: D13 I12 I21
    Date: 2018
  24. By: Beth Woods (Centre for Health Economics, University of York, York, UK); Claire Rothery (Centre for Health Economics, University of York, York, UK); Paul Revill (Centre for Health Economics, University of York, York, UK); Timothy Hallett (The HIV Modelling Consortium, Department of Infectious Disease Epidemiology, Imperial College London, London, UK); Andrew Phillips (3Department of Infection & Population Health, University College London, London, UK); Karl Claxton. (Centre for Health Economics, University of York, York, UK)
    Abstract: The allocation of scarce resources among competing health care priorities is a key objective in all jurisdictions, whether in low- and middle-income countries (LMICs) or high-income countries. This involves allocating resources to ensure access to health care programmes, which can deliver improvements in health, but also to managing innovation in the development of new technologies, and investing in evidence generation activities to improve health for future generations. The allocation of health care resources among competing priorities requires an assessment of the expected health effects and costs of investing resources in the different activities and the opportunity costs of these expenditures, as well as an assessment of the uncertainty in health effects and costs. Uncertainty can lead to unintended adverse health consequences, e.g., when expected benefits of an activity are not realised when implemented in practice, or resources committed by an activity are transferred away from other health improving activities. The consequences of uncertainty can be reduced by investing in evidence generation activities that improve the information available to support future resource allocation decisions. An analytic framework is developed to assess the value of evidence generation activities to support international research funders, who have the responsibility for allocating funds among competing research priorities in Global Health. Within the framework, the costs and health benefits of evidence generation activities are assessed using the same principles as those employed when evaluating the cost-effectiveness of investments in service provision. Metrics of value, founded on an understanding of the health opportunity costs imposed by research expenditure, are used to quantify the scale of the potential global net health impact across all beneficiary populations (in net disability-adjusted life years averted), or the equivalent health care system resources required to deliver this net health impact, and research costs and their potential health opportunity costs. The framework can be applied to answer key questions such as: whether investment in research activities is worthwhile; which research activities should be prioritised; what type of research activity is necessary and what is the most appropriate design of the research; what are the opportunity costs associated with evidence generation; what is the optimal timing of research; and whether evidence generation activities should be prioritised over investments in service provision or new technology development. An illustrative example is used to demonstrate the application of the framework for informing research priorities in Global Health.
    Date: 2018–06
  25. By: Masahiro Shoji; Kenmei Tsubota
    Abstract: Although human trafficking is a serious humanitarian problem of global scale, there is very little knowledge about the issue. Using a nationally representative survey of child sex workers in Bangladesh, this study examines the extent to which trafficking victims are forced to expend more effort than non-trafficked sex workers. To control for endogeneity of trafficking victimization, we use frequency of natural disasters occurred in their hometown as an instrumental variable. We find that the victims face higher exposure to violence and drug use, and lower freedom to quit the job. They also trade sex with more clients at a lower wage. However, victimization is not associated with condom use or prevalence of sexually transmitted diseases. These results suggest that while owners commit violence to extract the victims’ efforts, some of them also maintain the victims’ productivity.
    Keywords: human trafficking, commercial sex worker, worst form of child labor, forced labor, Bangladesh
    Date: 2018–06–14
  26. By: Aurélien Dasre (CRESPPA - Centre de recherches sociologiques et politiques de Paris - UP8 - Université Paris 8 Vincennes-Saint-Denis - UPN - Université Paris Nanterre - CNRS - Centre National de la Recherche Scientifique, INED - Institut national d'études démographiques); Angela Greulich (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique, INED - Institut national d'études démographiques); Inan Ceren (SIES - Systèmes d'information et des Etudes Statistiques - French Ministry of Education and Research)
    Abstract: This paper identifies motors and barriers for combatting domestic violence against women in Turkey – a country where modernism and conservatism are in constant interplay. We combine information from the Demographic Health Surveys and the Turkish Domestic Violence Survey and distinguish between controlling behavior, physical and sexual violence. Our empirical analysis tests how far a woman's intra-household decision making power (as measured by her education, her activity status, her income etc.) bears the potential to reduce her risk of experiencing domestic violence in Turkey. The analysis takes into account contextual factors as well as partner and household characteristics. We find that women's participation in the labor market does not, on its' own, reduce women's risk of experiencing intimate partner violence, but an egalitarian share of economic resources between spouses in likely to protect women against domestic violence. This finding has two important implications: First, higher education enabling women to access formal wage employment allows women not only to gain economic independence, but also to freely choose their partner. Second, unstable economic conditions that harm earning opportunities for men are an important risk factor for couples to experience conflits that can result in domestic violence against women. Against the background of the recent economic crisis that comes hand in hand with a backlash of gender and family norms in Turkey, our results highlight the need of policy action in this field.
    Keywords: economics,Violence against women,gender
    Date: 2017–11

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