nep-hea New Economics Papers
on Health Economics
Issue of 2018‒07‒30
27 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Positively Aware? Conflicting Expert Reviews and Demand for Medical Treatment By Jorge F. Balat; Nicholas W. Papageorge; Shaiza Qayyum
  2. Who benefits when inertia is reduced? Competition, quality and returns to skill in health care markets By Fleitas, Sebastián
  3. Paying for what kind of performance? Performance pay and multitasking in mission-oriented jobs By Daniel Jones; Mirco Tonin; Michael Vlassopoulos
  4. A Kink that Makes You Sick: The Effect of Sick Pay on Absence By Petri, Böckerman; Ohto, Kanninen; Ilpo, Suoniemi
  5. Violence while in Utero: The Impact of Assaults During Pregnancy on Birth Outcomes By Janet Currie; Michael Mueller-Smith; Maya Rossin-Slater
  6. Rationalizations and mistakes: optimal policy with normative ambiguity By Goldin, Jacob; Reck, Daniel
  7. Accounting for the Rise of Health Spending and Longevity By Raquel Fonseca; Pierre-Carl Michaud; Arie Kapteyn; Titus Galama
  8. A Structural Model of The Demand For Telecare By Kevin Momanyi
  9. Long Term Care Risk Misperceptions By M. Martin Boyer; Philippe De Donder; Claude Fluet; Marie-Louise Leroux; Pierre-Carl Michaud
  10. A Canadian Parlor Room-Type Approach to the Long-Term Care Insurance Puzzle By M. Martin Boyer; Philippe De Donder; Claude Fluet; Marie-Louise Leroux; Pierre-Carl Michaud
  11. Impact of acute health shocks on cigarette consumption By Antoine Marsaudon; Lise Rochaix
  12. Identifying Food Labeling Effects on Consumer Behavior By Sebastián Araya; Andrés Elberg; Carlos Noton; Daniel Schwartz
  13. Minimum Wages and Healthy Diet By Pohl, R. Vincent; Clark, Kathryn L.; Thomas, Ryan C.
  14. Seaweed as health and dietetic food - What target consumers ? IDEALG project By Morgane Marchand; Charline Comparini; Marie Lesueur
  15. Ambiguity preferences for health By Arthur E. Attema; Han Bleichrodt; Olivier L'Haridon
  16. Life satisfaction, QALYs, and the monetary value of health By Huang, Li; Frijters, Paul; Dalziel, Kim; Clarke, Philip
  17. The Effect of Education on Health: Evidence from National Compulsory Schooling Reforms By Raquel Fonseca; Pierre-Carl Michaud; Yuhui Zheng
  18. Immigration and the Health of Older Natives in Western Europe By Escarce, José J.; Rocco, Lorenzo
  19. Comparing the Education Gradient in Chronic Disease Incidence among the Elderly in Six OECD Countries By Aurélie Côté-Sergent; Raquel Fonseca; Erin Strumpf
  20. What matters the most to people?: Evidence from the OECD Better Life Index users’ responses By Carlotta Balestra; Romina Boarini; Elena Tosetto
  21. Private Health Investments under Competing Risks: Evidence from Malaria Control in Senegal By Pauline Rossi; Paola Villar
  22. Socioeconomic Inequality in Tobacco use in Kenya: A Concentration Analysis By Hermann Pythagore Pierre Donfouet; Shukri Mokamed; Éric Malin
  23. Inequalities in Life Expectancy and the Global Welfare Convergence By Hippolyte D'Albis; Florian Bonnet
  24. Maternal Mortality and Women's Political Participation By Bhalotra, Sonia R.; Clarke, Damian; Gomes, Joseph; Venkataramani, Atheendar
  25. The Effect of Transportation Benefits on Health and Consumption among the Elderly: Quasi-Experimental Evidence from Urban China By YIN Ting; YIN Zhigang; ZHANG Junchao
  26. A community based program promotes sanitation By María Laura Alzúa; Habiba Djebbari; Amy J. Pickering
  27. Use of multicriteria decision analysis for assessing the benefit and risk of over-the-counter analgesics By Moore, Andrew; Crossley, Anne; Ng, Bernard; Phillips, Lawrence D.; Sancak, Özgür; Rainsford, K.D.

  1. By: Jorge F. Balat; Nicholas W. Papageorge; Shaiza Qayyum
    Abstract: We study the impact of expert reviews on the demand for HIV treatments. A novel feature of our study is that we observe two reviews for each HIV drug and focus attention on consumer responses when experts disagree. Reviews are provided by both a doctor and an activist in the HIV lifestyle magazine Positively Aware, which we merge with detailed panel data on HIV-positive men’s treatment consumption and health outcomes. To establish a causal relationship between reviews and demand, we exploit the arrival of new drugs over time, which provides arguably random variation in reviews of existing drugs. We find that when doctors and activists agree, positive reviews increase demand for HIV drugs. However, doctors and activists frequently disagree, most often over treatments that are effective, but have harsh side effects, in which case they are given low ratings by the activist, but not by the doctor. In such cases, relatively healthy consumers favor drugs with higher activist reviews, which is consistent with a distaste for side effects. This pattern reverses for individuals who are in worse health and thus face stronger incentives to choose more effective medication despite side effects. Findings suggest that consumers demand information from experts whose review is more aligned to their preferences over health versus side effects, which can vary by health status.
    JEL: D12 D83 I12 L15 M3
    Date: 2018–07
  2. By: Fleitas, Sebastián
    Abstract: Increased competition may lead to incentives for firms to increase quality by incorporating higher quality inputs. This is particularly relevant in health care markets, since the supply of high quality physicians is relatively inelastic in the short run. Therefore, an increase in the relative demand for high-quality physicians could lead to an increase in their relative wages without increasing their total hours of work. Using a policy change in the Uruguayan health care system, I assess the effects of increased competition via lock-in reductions on a market for inputs. I leverage the facts that insurance companies, hospitals and physician services are completely vertically integrated in Uruguay and that in 2009 the government generated an exogenous change in the regulated mobility regime, increasing the competition in the market and providing incentives to increase quality. I combine administrative records on wages and hours of work in all hospitals for all specialists with data on the scores that specialists obtained in the test they must take to be admitted into the medical specialty graduate school, which I use as an exogenous measure of their quality. Consistent with the idea of an inelastic relative supply in the short run, I show that the increased competition shifted the relative demand for high-quality medical specialists, increasing the returns to skill. I do not find strong evidence of an increase in quality, approximated as relative hours of high-skill versus low-skill physicians
    Keywords: Medición de impacto, Salud,
    Date: 2018
  3. By: Daniel Jones (University of Pittsburgh, Graduate School of Public and International Affairs); Mirco Tonin (Free University of Bolzano‐Bozen, Faculty of Economics and Management); Michael Vlassopoulos (University of Southampton)
    Abstract: How does pay-for-performance (P4P) impact productivity, multitasking, and the composition of workers in mission-oriented jobs? These are central issues in sectors like education or healthcare. We conduct a laboratory experiment, manipulating compensation and mission, to answer these questions. We find that P4P has positive effects on productivity on the incentivized dimension of effort and negative effects on the non-incentivized dimension for workers in non-mission-oriented treatments. In mission-oriented treatments, P4P generates minimal change on either dimension. Participants in the non-mission sector – but not in the mission-oriented treatments – sort on ability, with lower ability workers opting out of the P4P scheme.
    Keywords: Prosocial motivation, Performance pay, Multitasking, Sorting
    JEL: C91 M52 J45
    Date: 2018–07
  4. By: Petri, Böckerman; Ohto, Kanninen; Ilpo, Suoniemi
    Abstract: We exploit a regression kink design to estimate the elasticity of the duration of sickness absence with respect to replacement rate. Elasticity is a central parameter in defining the optimal social insurance scheme compensating for lost earnings due to sickness. We use comprehensive administrative data and a kink in the policy rule near the median earnings. We find a statistically significant estimate of the elasticity of the order of one.
    Keywords: Sick pay, labor supply, sickness absence, regression kink design, social insurance
    JEL: H55 I13 J22
    Date: 2018–06–20
  5. By: Janet Currie; Michael Mueller-Smith; Maya Rossin-Slater
    Abstract: Causal evidence of the effects of violent crime on its victims is sparse. Yet such evidence is needed to determine the social cost of crime and to evaluate the cost-effectiveness of policy interventions in the justice system. This study presents new evidence on the effects of violent crime on pregnancy and infant health outcomes, using unique linked administrative data from New York City. We merge birth records with maternal residential addresses to the locations of reported crimes, and focus on mothers who lived in a home where an assault was reported during their pregnancies. We compare these mothers to women who lived in a home with an assault that took place shortly after the birth. We find that assaults in the 3rd trimester significantly increase rates of very low birth weight (less than 1,500 grams) and very pre-term (less than 34 weeks gestation) births, possibly through a higher likelihood of induced labor. We show that our results are robust to multiple choices of control groups and to using maternal fixed effects models. We calculate that these impacts translate into a social cost per assault during pregnancy of $41,771, and a total annual cost of over $4.25 billion when scaled by the national victimization rate. As infant health is a strong predictor of life-long well-being, and women of lower socioeconomic status are more likely to be victims of domestic abuse than their more advantaged counterparts, our results suggest that in utero subjection to violent crime is an important new channel for intergenerational transmission of inequality.
    JEL: I14 I31 J12 J13 K14
    Date: 2018–07
  6. By: Goldin, Jacob; Reck, Daniel
    Abstract: Behavior that appears to violate neoclassical assumptions can often be rationalized by incorporating an optimization cost into decision-makers' utility functions. Depending on the setting, these costs may reflect either an actual welfare loss for the decision-maker who incurs them or a convenient (but welfare irrelevant) modeling device. We consider how the resolution of this normative ambiguity shapes optimal policy in a number of contexts, including default options, inertia in health plan selection, take-up of social programs, programs that encourage moving to a new neighborhood, and tax salience.
    JEL: J1
    Date: 2018–05
  7. By: Raquel Fonseca; Pierre-Carl Michaud; Arie Kapteyn; Titus Galama
    Abstract: We estimate a stochastic life-cycle model of endogenous health spending, asset accumulation and retirement to investigate the causes behind the increase in health spending and longevity in the U.S. over the period 1965-2005. We estimate that technological change and the increase in the generosity of health insurance on their own may explain 36.3% of the rise in health spending (technology 31.5% and insurance 4.8%), while income explains only 4.4%. By simultaneously occurring over this period, these changes may have led to complementarity effects which explain an additional 59% increase in health spending. The estimates suggest that the elasticity of health spending with respect to changes in both income and insurance is larger with co-occurring improvements in technology. Technological change, taking the form of increased health-care productivity at an annual rate of 1.7%, explains almost all of the rise in life expectancy at age 25 over this period. Welfare gains are substantial and most of the gain appears to be due to technological change (47% out of a total gain of 67%).
    Keywords: health spending, longevity, life-cycle models, technological change
    JEL: I10 I38 J26
    Date: 2018
  8. By: Kevin Momanyi
    Abstract: In this paper, we formulate a structural model of the demand for telecare. We show how the Andersen's Behavioral Model of Health Services Use, the Almost Ideal Demand System and the Revealed Preference theory can be combined with microeconomic principles of health production to reason about individuals' utility maximizing behavior. We then estimate the model using a strategy that controls for the effects of both observable and unobservable factors, and later conduct a simulation exercise by way of a decomposition analysis.
    JEL: C32 C36 D13
    Date: 2018–07–20
  9. By: M. Martin Boyer; Philippe De Donder; Claude Fluet; Marie-Louise Leroux; Pierre-Carl Michaud
    Abstract: This paper reports survey evidence on long-term care (LTC) risk misperceptions and demand for long-term care insurance (LTCI) in Canada. LTC risk misperceptions is divided into three different risks: needing help for at least one activity of daily life, needing access to a nursing home, and living to be 85 years old. We contrast subjective (i.e. stated) probabilities with actual probabilities for these three dimensions. We first provide descriptive statistics of how objective and subjective probabilities differ and correlate to each other. Second, we study cross-correlations between different types of risks. We then study how risk misperceptions correlate with individual characteristics, and evaluate how misperceptions affect intentions and actual purchase of LTCI. Our conclusions are two-fold. First, we find that most subjects are not well informed about their individual LTC risks, making it difficult for them to take the correct LTCI decisions. Second, and even though misperceptions explain an individuals actual or his intentions to take-up LTCI, misperceptions are unlikely to explain the poor take-up rate of LTCI in our sample.
    Keywords: Long-term care insurance puzzle, disability, misperceptions, subjective probability
    JEL: D91 I13
    Date: 2018
  10. By: M. Martin Boyer; Philippe De Donder; Claude Fluet; Marie-Louise Leroux; Pierre-Carl Michaud
    Abstract: We examine the different hypotheses which have been put forward to explain the low demand for long-term care insurance using the results from a survey of 2000 Canadians that was conducted in the autumn of 2016. Defining the natural market of long-term care insurance buyers as the one catering to individuals aged between 50 and 70, we find that a remarkable proportion of this natural market has never been approached to purchase such protection. We estimate that approximately 60% of this natural market is currently under-served. After eliminating risk perception and demand side explanations for the low market penetration of long-term care insurance, we conclude that supply-side factors and the crowding-out by government programs are the most likely culprits in explaining the low proportion of Canadians that purchase LTC insurance from private providers.
    Keywords: Long-term care puzzle; Risk perceptions; Supply and demand of insurance, Government programs
    JEL: G02 G12 C14
    Date: 2018
  11. By: Antoine Marsaudon (PSE - Paris-Jourdan Sciences Economiques - 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, Hospinnomics (PSE – École d’Économie de Paris, Assistance Publique Hôpitaux de Paris – AP-HP) - PSE - Paris School of Economics, UP1 - Université Panthéon-Sorbonne); Lise Rochaix (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique, Hospinnomics (PSE – École d’Économie de Paris, Assistance Publique Hôpitaux de Paris – AP-HP) - PSE - Paris School of Economics, UP1 - Université Panthéon-Sorbonne)
    Abstract: This paper investigates the relationship between an acute health shock, namely the first onset of an accident requiring medical care, and cigarette consumption, using the French Gazel panel data. To identify the causal effect of such shocks, we use a difference-indifferences approach combined with a propensity score. Results suggest that there is a significant effect running from the shock to the number of cigarettes smoked with impact duration of eight years after the shock. Individuals subject to such a shock smoke, on average, 2 cigarettes less (per week) than those not exposed to such a shock. Further, the findings show heterogeneous effects among smokers: heavy smokers are more likely to reduce tobacco consumption than occasional smokers.
    Keywords: Cigarette consumption,propensity score matching,France,lifestyles,health shock,panel data
    Date: 2017–10
  12. By: Sebastián Araya; Andrés Elberg; Carlos Noton; Daniel Schwartz
    Abstract: We take advantage of the gradual implementation of a comprehensive mandatory food labeling regulation introduced in Chile to identify its effects on consumer behavior. Using individual-level scandata from transactions in a big-box supermarket, we estimate a demand model for differentiated products in which a food label indicator captures the warning label effect. We find sizable effects on juices and cereals, but no impact on chocolates & candies and cookies. Our results are consistent with the information disclosure being effective only when information is unexpected. Key words:
    Date: 2018
  13. By: Pohl, R. Vincent; Clark, Kathryn L.; Thomas, Ryan C.
    Abstract: A healthy diet is often unaffordable for low-income individuals, so income-lifting policies may play an important role in not only alleviating poverty but also in improving nutrition. We investigate if higher minimum wages can contribute to an improved diet by increasing consumption of fruits and vegetables. Exploiting recent minimum wage increases in the U.S. and using individual-level data from the Behavioral Risk Factor Surveillance System we identify the causal effect of minimum wage changes on fruit and vegetable intake among low-wage individuals in a triple-differences framework. Our results indicate that higher minimum wages contribute positively but moderately to improved nutrition.
    Keywords: minimum wages, nutrition, healthy diet, fruit and vegetable consumption, triple-differences
    JEL: I12 J38
    Date: 2017–07–28
  14. By: Morgane Marchand (Pôle halieutique - AGROCAMPUS OUEST); Charline Comparini (AGROCAMPUS OUEST); Marie Lesueur (AGROCAMPUS OUEST, Pôle halieutique - AGROCAMPUS OUEST)
    Abstract: The surveys conducted by AGROCAMPUS OUEST as part of the Idealg project iden"fied consumers interested in seaweed as a health food because of its nutri"onal and diete"c proper"es, work that resulted in the authors asking the following ques"on: " Is edible seaweed a health food product and is it suited to French ea"ng habits? " Diagram summing up the methods used Health is one of the main perceived a+ributes of edible seaweed in France. French consumers associate it with seafood as well as with a number of nutri"onal, diete"c and health benefits. When asked about the profile of seaweed consumers, both general public respondents and experts imagine a woman looking for natural, healthy and low-calorie products to help her eat be/er and watch her figure. This profile is indeed a historical one in edible seaweed consump"on; many French women, however, have never had access to such products and are therefore a poten"al target. Besides, despite the obvious link between edible seaweed and health, few processors and retailers are marke"ng seaweed as a health product in an appropriate selling environment. Only organic shops highlight this aspect. The panel of experts also confirmed how difficult it is for them to place seaweed in a specific product category. Context Macro-algae have been part of the human diet from "me immemorial and have long been used in Chinese, Japanese and Indian medical schools for their medicinal proper"es. In France, consuming seaweed as food is a rela"vely recent and minority prac"ce. Consump"on started in the 1970s, spurred on by vegetarians interested in its nutri"onal proper"es, and then a+racted a larger consumer base in the 2000s with the development of Japanese restaurants and the success of sushi.
    Date: 2017
  15. By: Arthur E. Attema (Erasmus School of Economics - Erasmus University Rotterdam); Han Bleichrodt (Erasmus School of Economics - Erasmus University Rotterdam); Olivier L'Haridon (CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR1 - Université de Rennes 1 - UNIV-RENNES - Université de Rennes - CNRS - Centre National de la Recherche Scientifique)
    Abstract: In most medical decisions probabilities are ambiguous and not objectively known.Empirical evidence suggests that people's preferences are affected by ambiguity. Health economic analyses generally ignore ambiguity preferences and assume that they are the same as preferences under risk. We show how health preferences can be measured under ambiguity and we compare them with health preferences under risk. We assume a general ambiguity model that includes many of the ambiguity models that have been proposed in the literature. For health gains, ambiguity preferences and risk preferences were indeed the same. For health losses they differed with subjects being more pessimistic in decision under ambiguity. Utility and loss aversion were the same for risk and ambiguity .
    Keywords: ambiguity, health
    Date: 2018
  16. By: Huang, Li; Frijters, Paul; Dalziel, Kim; Clarke, Philip
    Abstract: The monetary value of a quality-adjusted life-year (QALY) is frequently used to assess the benefits of health interventions and inform funding decisions. However, there is little consensus on methods for the estimation of this monetary value. In this study, we use life satisfaction as an indicator of ‘experienced utility’, and estimate the dollar equivalent value of a QALY using a fixed effect model with instrumental variable estimators. Using a nationally-representative longitudinal survey including 28,347 individuals followed during 2002–2015 in Australia, we estimate that individual's willingness to pay for one QALY is approximately A$42,000-A$67,000, and the willingness to pay for not having a long-term condition approximately A$2000 per year. As the estimates are derived using population-level data and a wellbeing measurement of life satisfaction, the approach has the advantage of being socially inclusive and recognizes the significant meaning of people's subjective valuations of health. The method could be particularly useful for nations where QALY thresholds are not yet validated or established.
    Keywords: Australia; Wellbeing; Life satisfaction; QALY; Value of health
    JEL: J1
    Date: 2018–08
  17. By: Raquel Fonseca; Pierre-Carl Michaud; Yuhui Zheng
    Abstract: This paper sheds light on the causal relationship between education and health outcomes. We combine three surveys (SHARE, HRS and ELSA) that include nationally representative samples of people aged 50 and over from fifteen OECD countries. We use variations in the timing of educational reforms across these countries as an instrument for education. Using IV-Probit models, we find causal evidence that more years of education lead to a lower probability of reporting poor health, less likely of having limitations in functional status (ADL and iADLs), and lower prevalence for diabetes. These effects are larger than those from the Probit that do not control for the endogeneity of education. The relationship between education and cancer is positive in both Probit and IV-Probit models. The causal impacts of education on other chronic conditions as well as functional status are not established using IV-Probit models.
    Keywords: education, health, causality, compulsory schooling laws
    JEL: I1 I2
    Date: 2018
  18. By: Escarce, José J.; Rocco, Lorenzo
    Abstract: Previous research has found that immigration benefits the health of working-age natives, an effect mediated through the labor market. We use the Study of Health, Ageing and Retirement in Europe (SHARE) to investigate whether immigration also affects the health of natives 65-80 years old. Immigration may increase the supply and lower the price of personal and household services, a term that refers to care services and non-care services such as cleaning, meal preparation, and domestic chores. Higher consumption of personal and household services by older natives may help maintain health through a variety of pathways. Using a shift-share IV, we find pervasive beneficial effects of immigration on the physical and mental health of older natives. We also find evidence for the hypothesized pathways, especially for an effect of immigration in increasing social integration (e.g., institutional connections, social participation). However, our ability to test mechanisms is limited in our data.
    Keywords: Health,immigration,aging,social determinants
    JEL: I12 I14 J61
    Date: 2018
  19. By: Aurélie Côté-Sergent; Raquel Fonseca; Erin Strumpf
    Abstract: Inequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we assess how rates of incident poor health, incident difficulties with activities of daily living, and incident chronic conditions vary by educational attainment across countries. We also examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health-education gradient within countries over time. We find systematic differences in disease incidence, as well as in the health-education gradients, across countries. We also demonstrate that while adjusting for confounders generally diminishes the health-education gradient, the impacts of these variables vary somewhat across countries.
    Keywords: disease incidence, older ages, education
    JEL: I1 I2
    Date: 2018
  20. By: Carlotta Balestra (OECD); Romina Boarini (OECD); Elena Tosetto (OECD)
    Abstract: The OECD Better Life Index is an interactive composite index that aggregates average measures of country’s well-being outcomes through weights defined by users. This paper studies these weights by analysing the responses given by close to 130 000 users since 2011 to date. The paper has three goals. First, to investigate the factors shaping users’ preferences over a set of 11 well-being dimensions. Second, to provide insights into users’ preferences for a large group of countries which differ in terms of culture and living conditions. Third, to test for the effects of users’ satisfaction with respect to a given well-being dimension on the weight they attach to it, across different population groups. Various empirical models are used to identify responses’ patterns and see whether they can be accounted for by respondents’ characteristics and their perceived well-being. The paper finds that health status, education and life satisfaction are the aspects that matter the most for BLI users in OECD countries. Men assign more importance to income than women, while women value community and work-life balance more than men. Health, safety, housing and civic engagement become more important with age, while life satisfaction, work-life balance, jobs, income and community are particularly important for youth. There are also clear regional patterns in the choices by BLI users; for instance education, jobs and civic engagement are particularly important in South America while personal safety and work-life balance matter a lot in Asia-Pacific. Analysis carried out on a subset of observations (i.e. BLI-users who completed an extended questionnaire) finds that, for several well-being dimensions (i.e. jobs, housing, community, health, education, civic engagement, personal safety, life satisfaction and work-life balance), there is a positive and linear relationship between individual preferences and self-reported satisfaction in the same dimension, with evidence of distinctly different patterns of association within the population in the case of income and education.
    Keywords: Better Life Index, composite index, preferences, users, well-being
    JEL: C43 I31 O1
    Date: 2018–07–24
  21. By: Pauline Rossi (UvA - University of Amsterdam [Amsterdam]); Paola Villar (INED - Institut national d'études démographiques, PSE - Paris School of Economics, 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)
    Abstract: This study exploits the introduction of high subsidies for anti-malaria products in Senegal in 2009 to investigate if malaria prevents parents to invest in child health. Building upon the seminal paper of Dow et al. (1999), we develop a simple model of health investments under competing mortality risks, in which people allocate expenses to equalize lifetime across all causes of death. We predict that private health investments to fight malaria as well as other diseases should increase in response to anti-malaria public interventions. To test this prediction, we use original panel data from a Senegalese household survey combined with geographical information on malaria prevalence. Our strategy is to compare the evolution of child health expenditures before and after anti-malaria interventions, between malarious and non-malarious regions of Senegal. We find that health expenditures in malarious regions catch up with non-malarious regions, at the extensive and intensive margins, and both in level and in composition. The same result holds for parental health-seeking behavior in case of other diseases like diarrhea. We provide evidence that these patterns cannot be explained by differential trends in total income or access to healthcare or child morbidity between malarious and non-malarious regions. Our results suggest that behavioral responses to anti-malaria campaigns magnify their impact on all-cause mortality for children.
    Keywords: Health expenses,Malaria,Africa,Human capital,Competing risks
    Date: 2017–11
  22. By: Hermann Pythagore Pierre Donfouet (African Population Health Research Centre, Nairobi, Kenya ; Univ Rennes, CNRS, CREM - UMR 6211, F-35000 Rennes, France); Shukri Mokamed (African Population Health Research Centre, Nairobi, Kenya); Éric Malin (Univ Rennes, CNRS, CREM - UMR 6211, F-35000 Rennes, France)
    Abstract: Tobacco use is one of the four major risk factors for non-communicable diseases and its effect on health is well documented. Despite several policies adopted to curb tobacco use, African countries are experiencing the highest growth of tobacco use amongst developing countries. There is ample evidence in the literature about the factors influencing tobacco use among adults and youths in Africa. However, in Africa there is yawning evidence gap on the socioeconomic inequalities in tobacco use. This paper attempts to fill this gap by assessing and exploring socioeconomic inequalities in tobacco use in Kenya. Using the theory of fundamental causes, a rich data set-Global Adult Tobacco Survey, and concentration index, we investigate the determinants of tobacco use in Kenya, and whether tobacco use evenly affect the poor and rich. Our results suggest that there is a strong link between tobacco use and socioeconomic inequality. Overall, the poorer households are more affected by tobacco use than richer households and this socioeconomic inequality is more evident among poorer Kenyan men, and poorer Kenyan households living in urban areas. The decomposition of the concentration index indicates that the overall socioeconomic inequality for current tobacco smokers is explained by 40.317% of the household income. This confinement of tobacco use among the poorest in Kenya could be reduced by increasing taxes on tobacco products.
    Keywords: Theory of fundamental causes, tobacco consumption, socioeconomic inequalities, concentration index
    JEL: D C2 L66
    Date: 2018–07
  23. By: Hippolyte D'Albis (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); Florian Bonnet (UP1 UFR02 - Université Panthéon-Sorbonne - UFR d'Économie - UP1 - Université Panthéon-Sorbonne, PSE - Paris School of Economics)
    Abstract: Becker, Philipson and Soares (2005) maintain that including life expectancy gains in a welfare indicator result in a reduction of inequality between 1960 and 2000 twice as great as when measured by per capita income. We discuss their methodology and show it determines the convergence result. We use an alternative methodology, based on Fleurbaey and Gaulier (2009), which monetizes differences in life expectancy between countries at each date rather than life expectancy gains. We show that including life expectancy has no effect on the evolution of world inequality.
    Keywords: World inequality,Well-being indicators,Life expectancy
    Date: 2018–01
  24. By: Bhalotra, Sonia R. (University of Essex); Clarke, Damian (Universidad de Santiago de Chile); Gomes, Joseph (University of Navarra); Venkataramani, Atheendar (Massachusetts General Hospital)
    Abstract: Raising women's political participation leads to faster maternal mortality decline. We estimate that the introduction of quotas for women in parliament results in a 9 to 12% decline in maternal mortality. In terms of mechanisms, it also leads to an 8 to 11% increase in skilled birth attendance and a 6 to 11% increase in prenatal care utilization. We find reinforcing evidence from the period in which the United States experienced rapid declines in maternal mortality. The historical decline made feasible by the introduction of antibiotics was significantly greater in states that had longer exposure to women's suffrage.
    Keywords: maternal mortality, women's political representation, gender, quotas, suffrage
    JEL: I14 I15 O15
    Date: 2018–06
  25. By: YIN Ting; YIN Zhigang; ZHANG Junchao
    Abstract: This study estimates the causal effect of transportation subsidies or similar benefits on the health of elderly people. We exploit a discontinuity in the probability of receiving transportation benefits induced by an age-based policy to take into account the endogeneity of treatment status. Our baseline IV results indicate that receiving public transportation benefits significantly improves elderly people's health condition by approximately 10 percentage points. The results are robust under different specifications and placebo tests. Further tests on possible channels show that the health effect is driven by increasing food consumption and health care utilization, but not by the amount of exercise done.
    Date: 2018–06
  26. By: María Laura Alzúa (CEDLAS-FCE-UNLP, CONICET.); Habiba Djebbari (Aix Marseille University (Aix Marseille School of Economics) EHESS & CNRS.); Amy J. Pickering (Civil and Environmental Engineering, Tufts University.)
    Abstract: Basic sanitation facilities are still lacking in large parts of the developing world, engendering serious environmental health risks. Interventions commonly deliver in-kind or cash subsidies to promote private toilet ownership. In this paper, we assess an intervention that provides information and behavioral incentives to encourage villagers in rural Mali to build and use basic latrines. Using an experimental research design and carefully measured indicators of use, we find a sizeable impact from this intervention: latrine ownership and use almost doubled in intervention villages, and open defecation was reduced by half. Our results partially attribute these effects to increased knowledge about cheap and locally available sanitation solutions. They are also associated with shifts in the social norm governing sanitation. Taken together, our findings, unlike previous evidence from other contexts, suggest that a progressive approach that starts with ending open defecation and targets whole communities at a time can help meet the new Sustainable Development Goal of ending open defecation.
    JEL: I12
    Date: 2018–05
  27. By: Moore, Andrew; Crossley, Anne; Ng, Bernard; Phillips, Lawrence D.; Sancak, Özgür; Rainsford, K.D.
    Abstract: Objectives : To test the ability of a multi-criteria decision analysis (MCDA) model to incorporate disparate data sources of varying quality along with clinical judgement in a benefit-risk assessment of six well-known pain-relief drugs. Methods: Six OTC analgesics were evaluated against three favourable effects and eight unfavourable effects by seven experts who specialise in the relief of pain, two in a two-day facilitated workshop whose input data and judgements were later peer-reviewed by five additional experts. Key findings: Ibuprofen salts & solubilised emerged with the best benefit-risk profile, followed by naproxen, ibuprofen acid, diclofenac, paracetamol, and aspirin. Conclusions: MCDA enabled participants to evaluate the OTC analgesics against a range of favourable and unfavourable effects in a group setting that enabled all issues to be openly aired and debated. The model was easily communicated and understood by the peer reviewers, so the model should be comprehensible to physicians, pharmacists, and other health professionals
    Keywords: OTC analgesics; MCDA; group judgements; decision conferencing; pain relief
    JEL: J50
    Date: 2017–07–13

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