nep-hea New Economics Papers
on Health Economics
Issue of 2018‒08‒13
eighteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Later Pension, Poorer Health? Evidence from the New State Pension Age in the UK By Carrino, Ludovico; Glaser, Karen; Avendano, Mauricio
  2. The Intergenerational Transmission of Welfare Dependency By Monique De Haan; Ragnhild C. Schreiner
  3. Health Plan Enrollees with Disability Informing Primary Care Practices and Providers about Their Quality of Care: A Randomized Trial By Lisa I. Iezzoni; Yuchiao Chang; Holly Matulewicz; Dennis Heaphy; Kimberley S. Warsett; Karen Donelan
  4. Biomarkers as precursors of disability By Davillas, Apostolos; Pudney, Stephen
  5. Work-Related Overpayments of Social Security Disability Insurance Beneficiaries: Prevalence and Descriptive Statistics By Denise Hoffman; Benjamin Fischer; John Jones; Andrew McGuirk; Miriam Loewenberg
  6. Paying for what kind of Performance? Performance Pay and Multitasking in Mission-Oriented Jobs By Daniel Jones; Mirco Tonin; Michael Vlassopoulos
  7. Spatial competition and quality: evidence from the English family doctor market By Gravelle, H; Liu, D; Propper, C; Santos, R
  8. The closer the better: does better access to outpatient care prevent hospitalization? By Peter Elek; Tamas Molnar; Balazs Varadi
  9. Primary care availability affects antibiotic consumption – Evidence using unfilled positions in Hungary By Aniko Biro; Peter Elek
  10. Cancer Risk Messages: A Light Bulb Model By Ka C. Chan; Ruth F. G. Williams; Christopher T. Lenard; Terence M. Mills
  11. Adolescents on the Road: A Case Study of Determinants of Risky Behaviors By Filippo Elba; Fiammetta Cosci; Anna Pettini; Federico M. Stefanini
  12. Catastrophic health spending in Europe: equity and policy implications of different calculation methods By Cylus, Jonathan; Thomson, Sarah; Evetovits, Tamás
  13. Optimal Investment in Health when Lifetime is Stochastic, or, Rational Agents do not Often Follow Health Agency Recommendations By Bolin, Kristian; Caputo, Michael R.
  14. The system-wide impact of healthy eating: assessing emissions and economic impacts at the regional level By Grant Allan; David Comerford; Peter McGregor
  15. Examining an "Experimental" Food Security Status Classification Method for Households with Children By Coleman-Jensen, Alisha; Rabbitt, Matthew P.; Gregory, Christian A.
  16. Globalisation and national trends in nutrition and health -a grouped fixed-effects approach to inter-country heterogeneity By Lisa Oberländer; Anne-Célia Disdier; Fabrice Etilé
  17. Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013 By Baker, Peter; Hone, Thomas; Reeves, Aaron; Avendano, Mauricio; Millett, Christopher
  18. Age-Profile Estimates of the Relationship Between Economic Growth and Child Health By Joseph Cummins; Anaka Aiyar

  1. By: Carrino, Ludovico; Glaser, Karen; Avendano, Mauricio
    Abstract: This paper examines the health impact of UK pension reforms that increased women’s State Pension age for up to six years since 2010. Exploiting an 11% increase in employment caused by the reforms, we show that rising the State Pension age reduces physical and mental health among women from routine-manual occupations. We show robust evidence that a larger increase in the State Pension age leads to larger negative health effects, resulting in a widening gap in health between women from different occupations. Our results are consistent with a 27% fall in individual incomes for women in routine-manual occupations.
    Keywords: Social Security, Public Pensions, Economics of ageing, Public Health; Understanding Society
    JEL: H75 I14 I18 J26
    Date: 2018–04–15
  2. By: Monique De Haan; Ragnhild C. Schreiner
    Abstract: There is a strong intergenerational correlation in welfare participation, but this does not imply that parental welfare receipt induces child receipt. While there are a few quasi-experimental studies that provide estimates of the causal effect of parental welfare participation for children from marginal welfare participants, we know very little about intergenerational spillovers of welfare participation onto the children of average welfare participants. By combining rich administrative data from Norway with weak mean-monotonicity assumptions, we estimate nonparametric bounds around the average causal effect of parental welfare participation on children’s welfare participation in the general population, as well as the average causal effect for children growing up in welfare-dependent families. We find that these average causal effects are considerably lower than the intergenerational correlation in welfare participation, and substantially below available local average treatment effect estimates in the literature. We further find important differences between intergenerational spillovers of disability insurance and intergenerational spillovers of financial assistance, a traditional means-tested welfare program.
    Keywords: welfare dependency, intergenerational spillovers, disability insurance, financial assistance, partial identification
    JEL: H55 I38 J62
    Date: 2018
  3. By: Lisa I. Iezzoni; Yuchiao Chang; Holly Matulewicz; Dennis Heaphy; Kimberley S. Warsett; Karen Donelan
    Abstract: Disability advocates conducting YESHealth reported substantial difficulties contacting practices and engaging PCPs. With few exceptions, no differences were found across the three study arms in enrollee-reported outcomes.
    Keywords: physical disability, serious mental illness, quality assessment, consumer engagement, randomized trial
    JEL: I J
  4. By: Davillas, Apostolos; Pudney, Stephen
    Abstract: Some social surveys now collect physical measurements and markers derived from biological samples, in addition to self-reported health assessments. This information is expensive to collect; its value in medical epidemiology has been clearly established, but its potential contribution to social science research is less certain. We focused on disability, which results from biological processes but is defined in terms of its implications for social functioning and wellbeing. Using data from waves 2 and 3 of the UK Understanding Society panel survey as our baseline, we estimated predictive models for disability 2-4 years ahead, using a wide range of biomarkers in addition to self-assessed health (SAH) and other socio-economic covariates. We found a quantitatively and statistically significant predictive role for a large set of nurse-collected and blood-based biomarkers, over and above the strong predictive power of self-assessed health. We also applied a latent variable model accounting for the longitudinal nature of observed disability outcomes and measurement error in in SAH and biomarkers. Although SAH performed well as a summary measure, it has shortcomings as a leading indicator of disability, since we found it to be biased in the sense of over- or under-sensitivity to certain biological pathways.
    Date: 2018–07–30
  5. By: Denise Hoffman; Benjamin Fischer; John Jones; Andrew McGuirk; Miriam Loewenberg
    Abstract: This study quantifies the beneficiary-level prevalence, duration, and size of work-related overpayments. Among other notable findings, the results establish the high prevalence of overpayments among beneficiaries who engage in substantial gainful activity: more than 7 in 10 were overpaid.
    Keywords: Disability, SSDI, work, overpayment
    JEL: I J
  6. By: Daniel Jones; Mirco Tonin; Michael Vlassopoulos
    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
  7. By: Gravelle, H; Liu, D; Propper, C; Santos, R
    Abstract: We examine whether family doctor firms in England respond to local competition by increasing their quality. We measure quality in terms of clinical performance and patient-reported satisfaction to capture its multi-dimensional nature. We use a panel covering 8 years for over 8000 English general practices, allowing us to control for unobserved local area effects. We measure competition by the number of rival doctors within a small distance. We find that increases in local competition are associated with increases in clinical quality and patient satisfaction, particularly for firms with lower quality. However, the magnitude of the effect is small.
    Date: 2018–02–28
  8. By: Peter Elek (Department of Economics, Eörvös Loránd University (ELTE), Budapest, Hungary); Tamas Molnar (Budapest Institute for Policy Analysis, Budapest, Hungary); Balazs Varadi (Budapest Institute for Policy Analysis, Budapest, Hungary Department of Economics, ELTE)
    Abstract: In 2010-2012 new outpatient service locations were established in poor Hungarian microregions. We exploit this quasi-experiment to estimate the extent of substitution between outpatient and inpatient care. Fixed-effects Poisson models on individual-level panel data for years 2008-2015 show that the number of outpatient visits increased by 19% and the number of inpatient stays decreased by 1.6% as a result, driven by a marked reduction of potentially avoidable hospitalization (PAH) (5%). In our dynamic specification, PAH effects occur in the year after the treatment, whereas non-PAH only decreases with a multi-year lag. The instrumental variable estimates suggest that a one euro increase in outpatient care expenditures produces a 0.6 euro decrease in inpatient care expenditures. Our results (1) strengthen the claim that bringing outpatient care closer to a previously underserved population yields considerable health benefits, and (2) suggest that there is a strong substitution element between outpatient and inpatient care.
    Keywords: Administrative panel data, Inpatient care, Outpatient care, Potentially avoidable hospitalization, Quasi-experiment, Substitution effect
    JEL: C23 C26 I10
    Date: 2018–04
  9. By: Aniko Biro (Institute of Economics, Centre for Economic and Regional Studies, Hungarian Academy of Sciences); Peter Elek (Department of Economics, Eörvös Loránd University (ELTE), Budapest, Hungary)
    Abstract: Using administrative data from Hungary, we analyse the effect of general practitioner (GP) care availability on the consumption of antibiotics. We exploit the geographical and time variation in unfilled GP positions as a source of exogenous variation in the availability of primary care. According to our estimates from fixed effects panel regressions, if the single GP position of a village becomes unfilled, the days of therapy (DOT) as well as public expenditures on antibiotics decrease by 3.2-4.1%. The negative effect on antibiotic consumption is stronger in smaller settlements, in settlements where secondary care is less available, and where antibiotics were previously overprescribed. The quality of prescribing behaviour measured by the ratio of narrow-spectrum to broad-spectrum antibiotics deteriorates significantly as a consequence of worse primary care availability. The number of GP consultations decreases by 9.8%, but prescribed antibiotic DOT per GP visit goes up by 7.2%.
    Keywords: Administrative panel data, Antibiotics, Primary care availability, Quality of antibiotic prescription, Unfilled general practices
    JEL: C23 I10 I11
    Date: 2018–06
  10. By: Ka C. Chan; Ruth F. G. Williams; Christopher T. Lenard; Terence M. Mills
    Abstract: The meaning of public messages such as "One in x people gets cancer" or "One in y people gets cancer by age z" can be improved. One assumption commonly invoked is that there is no other cause of death, a confusing assumption. We develop a light bulb model to clarify cumulative risk and we use Markov chain modeling, incorporating the assumption widely in place, to evaluate transition probabilities. Age-progression in the cancer risk is then reported on Australian data. Future modelling can elicit realistic assumptions.
    Date: 2018–07
  11. By: Filippo Elba; Fiammetta Cosci; Anna Pettini; Federico M. Stefanini
    Abstract: The 2016 report of the European Transport Safety Council claims that EU safety progress has come to a standstill. This study aims at deepening the knowledge of factors that influence adolescents’ risky behavior on the road. Bayesian Networks offer a promising new way to looking at the issue. In the analysis of a dataset collected in Tuscany, Italy, called EDIT, we found evidence that the use of alcohol and illegal substances explain only part of the probability of having an accident, and that other observable variables, like the level of distress or the type of school attended are significantly related to the probability of incurring in a road crash. New and close attention should be given to a systemic approach and to a plethora of environmental and individual variables that may rise the probability of road accidents for very young drivers.
    Keywords: Bayesian Networks, structural learning, road accidents, distress factors, risky behavior, adolescence, youth, novice drivers
    JEL: C11 D91 I11
    Date: 2018
  12. By: Cylus, Jonathan; Thomson, Sarah; Evetovits, Tamás
    Abstract: Objective To investigate the equity and policy implications of different methods of calculating catastrophic health spending. Methods We used routinely collected data from recent household budget surveys in 14 European countries. We calculated the incidence of catastrophic health spending and its distribution across consumption quintiles using four methods. We compared the budget share method, which is used to monitor universal health coverage (UHC) in the sustainable development goals (SDGs), with three other well established methods: actual food spending; partial normative food spending; and normative spending on food, housing and utilities. Findings Country estimates of the incidence of catastrophic health spending were generally similar using the normative spending on food, housing and utilities method and the budget share method at the 10% threshold of a household’s ability to pay. The former method found that catastrophic spending was concentrated in the poorest quintile in all countries, whereas with the budget share method catastrophic spending was largely experienced by richer households. This is because the threshold for catastrophic health spending in the budget share method is the same for all households, while the other methods generated effective thresholds that varied across households. The normative spending on food, housing and utilities method was the only one that produced an effective threshold that rose smoothly with total household expenditure. Conclusion The budget share method used in the SDGs overestimates financial hardship among rich households and underestimates hardship among poor households. This raises concerns about the ability of the SDG process to generate appropriate guidance for policy on UHC.
    JEL: J1
    Date: 2018–09
  13. By: Bolin, Kristian (Department of Economics, School of Business, Economics and Law, Göteborg University); Caputo, Michael R. (Department of Economics University of Central Florida)
    Abstract: A health-capital model is contemplated which accounts for the consumption of many goods, a stock of health and investment in it, as well as an agent’s random lifetime and accumulation of wealth. It is shown that if an agent maximizes the expected discounted value of lifetime utility, or if an agent maximizes the expected value of their lifetime, then an agent does not follow the health-investment policy that minimizes the conditional probability of dying at each point in time, in general. What is more, simple and intuitive sufficient, and necessary and sufficient, conditions are identified whereby such agents investment more or less in their health than said policy.
    Keywords: health capital; health investment; optimal control; random lifetime
    JEL: C61 D11 I12
    Date: 2018–08
  14. By: Grant Allan (University of Strathclyde); David Comerford (University of Strathclyde); Peter McGregor (University of Strathclyde)
    Abstract: Encouraging consumers to shift their diets towards to a lower meat/lower calorie alternative has been the focus of food and health policies across the world. The economic impact on regions has been less widely examined, but is likely to be significant, where agricultural and food activities are important for the host region. In this study we use a multi-sectoral modelling framework to examine the environmental and economic impacts of a dietary change, and illustrate this using a detailed model for Scotland. We find that if household food and drink consumption follows healthy eating guidelines, it would reduce both Scotland’s “footprint†and “territorial†emissions, and yet may be associated with positive economic impacts, generating a “double dividend†for both the environment and the economy. Furthermore, the likely benefits to health suggest the potential for a “triple dividend†. The economic impact however depends critically upon how households use the income previously spent on higher calorie diets.
    Keywords: Diet, emissions, economic impact, Scotland
    JEL: Q11 Q18 R11
    Date: 2018–07
  15. By: Coleman-Jensen, Alisha; Rabbitt, Matthew P.; Gregory, Christian A.
    Abstract: Food security, which USDA has measured and tracked since 1995, has become a key national measure of well-being; therefore, it is important that the measure is accurate. Since the food security measure was developed, USDA, Economic Research Service (ERS) has conducted ongoing research on the statistical properties of the measure. ERS researchers have developed an alternative “experimental” classification method for classifying food security status in households with children. This alternative approach reduces statistical biases inherent in the current classification approach and improves fit to the Rasch measurement model and its assumptions. Here, ERS evaluates how well the food security-status categories correlate with other food inadequacy and nutritional indicators. The researchers examine whether the experimental classification or the current classification is more consistent with indicators of “food inadequacy,” defined here as food insufficiency, unmet food needs, and use of a food pantry. ERS also examines the association between each of the two food-security-classification methods and dietary quality. Results show that the current classification is more consistent with indicators of food inadequacy. The report includes guidance for researchers using USDA’s food security measure.
    Keywords: Agricultural and Food Policy, Food Security and Poverty, Health Economics and Policy, Research Methods/ Statistical Methods
    Date: 2017–09–27
  16. By: Lisa Oberländer (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); Anne-Célia Disdier (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); Fabrice Etilé (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: Using a panel dataset of 70 countries spanning 42 years (1970-2011), we investigate the distinct effects of social globalisation and trade openness on national trends in markers of diet quality (supplies of animal proteins, free fats and sugar, average body mass index – BMI – and diabetes prevalence). Our key methodological contribution is the application of a grouped fixed-effects (GFE) estimator, which extends linear fixed-effects models. The GFE estimator partitions our sample into distinct groups of countries in order to control for time-varying unobserved heterogeneity that follows a group-specific pattern. We find that increasing social globalisation has a significant impact on the supplies of animal protein and sugar available for human consumption, as well as on mean BMI. Specific components of social globalisation such as information flows (via television and the Internet) drive these results. Trade openness has no effect on dietary outcomes or health. These findings suggest that the social and cultural aspects of globalisation should receive greater attention in research on the nutrition transition.
    Keywords: trade openness,grouped fixedeffects,nutrition transition,obesity,social globalisation,panel data
    Date: 2017–05
  17. By: Baker, Peter; Hone, Thomas; Reeves, Aaron; Avendano, Mauricio; Millett, Christopher
    Abstract: Inequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of −2.468 [95% confidence intervals (CIs): −4.190, −0.746] and RII of −0.026 (95% CIs: −0.048, −0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.
    JEL: J1
    Date: 2018–06–27
  18. By: Joseph Cummins (Department of Economics, University of California Riverside); Anaka Aiyar
    Abstract: Based largely on the analysis of the same underlying data, recently published papers have presented estimates that the association between economic growth and child undernutrition in developing countries is either strong and robust, or weak to nonexistent. We provide clarity on both the magnitude of the association and the underlying econometric problem. Focusing on child growth faltering as a process that unfolds over the first several years of life, we provide new evidence tracing out the relationship between macroeconomic trends and the trajectory of child growth through age 5. Using two novel regression models that each harness different kinds of within- and between-country variation, and data on over 600,000 children from 38 countries over more than 20 years, our estimates of the association are small but precise, and are consistent across both estimators. We estimate that a $10\%$ increase in GDP around the time of a child's birth is associated with a decrease in the rate of loss of HAZ of about 0.002sd per month over the first two years of life. This generates a cumulative effect of around 0.04sd by a child's third birthday and the magnitude of the correlation largely persists through age 5. Our models are derived from both economic and biological theory and provide a new empirical framework for researchers interested in investigating the ecological-level determinants of child growth.
    Keywords: anthropometrics; child health; economic growth;
    JEL: I15 J13 O15
    Date: 2017–10

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