nep-hea New Economics Papers
on Health Economics
Issue of 2018‒08‒27
27 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Impact of Information Disclosure on Consumer Behavior: Evidence from a Randomized Field Experiment of Calorie Labels on Restaurant Menus By John Cawley; Alex Susskind; Barton Willage
  2. Local Food Prices, SNAP Purchasing Power, and Child Health By Erin T. Bronchetti; Garret S. Christensen; Hilary W. Hoynes
  3. Benefits of a modified traffic light labelling system for food products By Burggraf, Christine; Volkhardt, Ina; Meier, Toni
  4. The Health Effects of Smoking Bans: Evidence from German Hospitalization Data By Kvasnicka, Michael; Siedler, Thomas; Ziebarth, Nicolas R.
  5. The impact of smoking during pregnancy on children's body weight By Kabir Dasgupta; Keshar M. Ghimire; Gail Pacheco
  6. Physician-Industry Interactions: Persuasion and Welfare By Matthew Grennan; Kyle Myers; Ashley Swanson; Aaron Chatterji
  7. Financial incentives and physician prescription behavior.Evidence from dispensing regulations By Burkhard, D.;; Schmid, C.P.R.;; Wüthrich, K.;
  8. Pay less, consume more? Estimating the price elasticity of demand for home care services of the disabled elderly By Quitterie Roquebert; Marianne Tenand
  9. The effect of co-payments in Long Term Care on the distribution of payments,consumption, and risk. By Wouterse, B.;; Hussem, A.;; Wong, A.;
  10. The Effect of Disenrollment from Medicaid on Employment, Insurance Coverage, Health and Health Care Utilization By Thomas DeLeire
  11. Workload, staff composition, and sickness absence. Findings from employees in child care centers By Trude Gunnes; Nina Drange; Kjetil Telle
  12. A Reevaluation of the Effects of State and Federal Dependent Coverage Mandates on Health Insurance Coverage By Barkowski, Scott; McLaughlin, Joanne Song; Ray, Alex
  13. Impacts of Shifting Responsibility for High-Cost Individuals on Health Insurance Exchange Plan Premiums and Cost-Sharing Provisions By Mukhopadhyay, Sankar; Wendel, Jeanne; Zou, Miaomiao
  14. Health Shocks, Human Capital, and Labor Market Outcomes. By Francisco Parro; R. Vincent Pohl
  15. Medicaid, What happens when the insurer can say no? Assessing prior authorization as a tool to prevent high-risk prescriptions and to lower costs By Marcus Dillender
  16. Fetal Shock or Selection? The 1918 Influenza Pandemic and Human Capital Development By Brian Beach; Joseph P. Ferrie; Martin H. Saavedra
  17. Testing for Peer Effects Using Genetic Data By Cawley, J.;; Han, E.;; Kim, J.;; Norton, E.C.;
  18. Pension Reform: Disentangling Retirement and Savings Responses By Lindeboom, Maarten; Montizaan, Raymond
  19. Are Health Care Services Shoppable? Evidence from the Consumption of Lower-Limb MRI Scans By Michael Chernew; Zack Cooper; Eugene Larsen-Hallock; Fiona Scott Morton
  20. Objective vs. Subjective Fuel Poverty and Self-Assessed Health By Llorca, M.; Rodriguez-Alvarez, A.; Jamasb, T.
  21. Shocks, vulnerability and income generating capacity of rural households: Evidence from Southeast Asia By Buehler, Dorothee; Cunningham, Wendy
  22. Every crisis has a silver lining? Unravelling the pro-cyclical pattern of health inequalities by income By Max Coveney; Pilar (P.) Garcia-Gomez; Eddy (E.K.A.) van Doorslaer; Tom (T.G.M.) van Ourti
  23. Heat, Humidity, and Infant Mortality in the Developing World By Michael Geruso; Dean Spears
  24. Does democracy reduce the HIV epidemic? Evidence from Kenya By Antoine Marsaudon; Josselin Thuilliez
  25. Bismarck's Health Insurance and the Mortality Decline By Bauernschuster, Stefan; Driva, Anastasia; Hornung, Erik
  26. XX>XY?: The Changing Female Advantage in Life Expectancy By Claudia Goldin; Adriana Lleras-Muney
  27. Why Is the Practice of Levirate Marriage Disappearing in Africa? HIV/AIDS as an Agent of Institutional Change By Kudo, Yuya

  1. By: John Cawley; Alex Susskind; Barton Willage
    Abstract: The impact of information on consumer behavior is a classic topic in economics, and there has recently been particular interest in whether providing nutritional information leads consumers to choose healthier diets. For example, a nationwide requirement of calorie counts on the menus of chain restaurants took effect in the U.S. in May, 2018, and the results of such information disclosure are not well known. To estimate the impact of menu labeling, we conducted a randomized controlled field experiment in two full-service restaurants, in which the control group received the usual menus and the treatment group received the same menus but with calorie counts. We estimate that the labels resulted in a 3.0% reduction in calories ordered, with the reduction occurring in appetizers and entrees but not drinks or desserts. Exposure to the information also increases consumers’ support for requiring calorie labels by 9.6%. These results are informative about the impact of the new nationwide menu label requirement, and more generally contribute to the literature on the impact of information disclosure on consumer behavior.
    JEL: D8 I12 I18
    Date: 2018–08
  2. By: Erin T. Bronchetti; Garret S. Christensen; Hilary W. Hoynes
    Abstract: The Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) is one of the most important elements of the social safety net. Unlike most other safety net programs, SNAP varies little across states and over time, which creates challenges for quasi-experimental evaluation. Notably, SNAP benefits are fixed across 48 states; but local food prices vary, leading to geographic variation in the real value – or purchasing power – of SNAP benefits. In this study, we provide the first estimates that leverage variation in SNAP purchasing power across markets to examine effects of SNAP on child health. We link panel data on regional food prices to National Health Interview Survey data and use a fixed effects framework to estimate the relationship between local purchasing power of SNAP and children’s health and health care utilization. We find that lower SNAP purchasing power leads to lower utilization of preventive health care and more days of school missed due to illness. We find no effect on reported health status.
    JEL: H53 I12 I38
    Date: 2018–06
  3. By: Burggraf, Christine; Volkhardt, Ina; Meier, Toni
    Abstract: The prevalence of cardiovascular diseases, type 2 diabetes melitus, and other diet-related chronic diseases is increasing worldwide due to the global rise in overweight and obesity. Numerous ways to communicate nutritional information to consumers can be considered to effectively improve eating habits, thereby counteracting this development. Traffic light labels have been discussed in Germany as a possible tool to communicate easy-to-understand information about the nutritional value of food products. However, the design of traffic light labels discussed to-date is aimed only at reducing the intake of fat, saturated fatty acids, sugar, and salt. The aspect of consuming adequate amounts of vitamins, minerals, and dietary fibre has been neglected so far. Traffic light labelling including information on this aspect of a healthy diet would significantly improve the potential for promoting healthier diets.
    Keywords: Food Consumption/Nutrition/Food Safety, Health Economics and Policy
    Date: 2017–12–11
  4. By: Kvasnicka, Michael (Otto-von-Guericke University Magdeburg); Siedler, Thomas (University of Hamburg); Ziebarth, Nicolas R. (Cornell University)
    Abstract: This paper studies the short-term impact of public smoking bans on hospitalizations in Germany. It exploits the staggered implementation of smoking bans over time and across the 16 federal states along with the universe of hospitalizations from 2000-2008 and daily county-level weather and pollution data. Smoking bans in bars and restaurants have been effective in preventing 1.9 hospital admissions (-2.1%) due to cardiovascular diseases per day, per 1 million population. We also find a decrease by 0.5 admissions (-6.5%) due to asthma per day, per 1 million population. The health prevention effects are more pronounced on sunny days and days with higher ambient pollution levels.
    Keywords: smoking bans, health effects, hospital admissions, second-hand smoke
    JEL: D12 H19 I12 I18
    Date: 2018–06
  5. By: Kabir Dasgupta (New Zealand Work Research Institute, Faculty of Business, Economics and Law, Auckland University of Technology); Keshar M. Ghimire (Business and Economics Department, University of Cincinnati - Blue ASh, United States); Gail Pacheco (New Zealand Work Research Institute, Faculty of Business, Economics and Law, Auckland University of Technology)
    Abstract: We study the effect of mothers' smoking during pregnancy on children's body weight outcomes during pre-school ages using a nationally representative sample of children surveyed in NLSY79 Children and Young Adults. Exploiting ‘within mother and across pregnancies’ variation in smoking behavior, we find that maternal smoking during pregnancy has a negative effect on weight outcomes at birth but the children of mothers who smoked during pregnancy catch up with the children of non-smokers, usually within their first-year post birth. We also find evidence to suggest that children of smokers in later pre-school ages (3 to 5 years old) are likely to have higher weight outcomes relative to children of non-smokers when their mother reported higher intensity levels of smoking (greater than one pack per day).
    Keywords: Maternal smoking, Children's health outcomes, child weight, child BMI
    Date: 2018–04
  6. By: Matthew Grennan; Kyle Myers; Ashley Swanson; Aaron Chatterji
    Abstract: In markets where consumers seek expert advice regarding purchases, firms seek to influence experts, raising concerns about biased advice. Assessing firm-expert interactions requires identifying their causal impact on demand, amidst frictions like market power. We study pharmaceutical firms' payments to physicians, leveraging instrumental variables based on regional spillovers from hospitals' conflict-of-interest policies and market shocks due to patent expiration. We find that the average payment increases prescribing of the focal drug by 73 percent. Our structural model estimates indicate that payments decrease total surplus, unless payments are sufficiently correlated with information (vs. persuasion) or clinical gains not captured in demand.
    JEL: I1 L0
    Date: 2018–07
  7. By: Burkhard, D.;; Schmid, C.P.R.;; Wüthrich, K.;
    Abstract: In many healthcare markets, physicians can respond to changes in reimbursement schemes by changing the volume (volume response) and the composition of services provided (substitution response). We examine the relative importance of these two behavioral responses in the context of physician drug dispensing in Switzerland. We find that dispensing increases drug costs by 52% for general practitioners and 56% for specialists. This increase is mainly due to a volume increase. The substitution response is negative on average, but not significantly different from zero for large parts of the distribution. In addition, our results reveal substantial effect heterogeneity.
    Keywords: physician agency; drug expenditures; volume response; substitution response; physician dispensing;
    JEL: I11 I18
    Date: 2018–08
  8. By: Quitterie Roquebert (UP1 - Université Paris 1, Panthéon-Sorbonne - Université Paris I - Panthéon-Sorbonne - Pres Hesam); Marianne Tenand (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, PSE - Paris School of Economics)
    Abstract: Although the consumption of home care is increasing with population ageing, little is known about its price sensitivity. This paper estimates the price elasticity of the demand for home care of the disabled elderly, using the French home care subsidy program ("APA"). We use an original dataset collected from a French District Council with administrative records of APA out-of-pocket payments and home care consumption. Identification primarily relies on inter-individual variations in producer prices. We use the unequal spatial distribution of producers to address the potential price endogeneity arising from non-random selection into a producer. Our results point to a price elasticity around -0.4: a 10% increase in the out-of-pocket price is predicted to lower consumption by 4%, or 37 minutes per month for the median consumer. Copayment rates thus matter for allocative and dynamic efficiencies, while the generosity of home care subsidies also entails redistributive effects.
    Keywords: Long-term Care,Price elasticity,Public policies,Disabled elderly,Censored regression,Dépendance chez la personne âgée,Elasticité-prix,Politiques publiques,Régression censurée
    Date: 2016–08
  9. By: Wouterse, B.;; Hussem, A.;; Wong, A.;
    Abstract: Population aging leads to concerns about the financial sustainability of collective long term care insurance systems. One way to keep public spending in check is by increasing the role of co-payments. An interesting feature of the copayments that have been introduced in the Netherlands is that they are income and wealth dependent. This dependency allows the fine-tuning of effects across income groups, but can also distort consumption decisions of the elderly. Modeling long term care expenditures over the lifecycle is challenging because of their very uneven distribution, with a small proportion of elderly experiencing very high costs. We use a flexible semi-parametric nearest-neighbor approach to estimate lifecycle paths of long term care spending. We apply this approach to an extensive administrative data set for the entire Dutch elderly population. The estimated paths are then used as inputs in a stochastic lifecycle decision model for singles at the retirement age. We analyze the effects of different co-payment schemes on the distribution of LTC payments, consumption and risk across income groups. We find that, compared to a flat-rate co-payment, income- and especially wealth-dependent copayments lead to much lower welfare costs for groups with low financial means. At the same time, the welfare costs of the groups with the highest means increase only slightly. Excluding a bequest motive leads to lower, and including healthstate dependent utility to higher welfare losses due to co-payments compared to full insurance.
    Date: 2018–08
  10. By: Thomas DeLeire
    Abstract: This study examines the effect of a Medicaid disenrollment on employment, sources of health insurance coverage, health, and health care utilization of childless adults using longitudinal data from the 2004 Panel of the Survey of Income and Program Participation. From July through September 2005, TennCare, the Tennessee Medicaid program, disenrolled approximately 170,000 adults following a change in eligibility rules. Following this eligibility change, the fraction of adults in Tennessee covered by Medicaid fell by over 5 percentage points while uninsured rates increased by almost 5 percentage points relative to adults in other Southern states. There is no evidence of an increase in employment rates in Tennessee following the disenrollment. Self-reported health and access to medical care worsened as hospitalization rates, doctor visits, and dentist visits all declined while the use of free or public clinics increased. The Tennessee experience suggests that undoing the expansion of Medicaid eligibility to adults that occurred under the Affordable Care Act likely would reduce health insurance coverage, reduce health care access, and worsen health but would not lead to increases in employment.
    JEL: I11 I13 I18 J22
    Date: 2018–08
  11. By: Trude Gunnes; Nina Drange; Kjetil Telle (Statistics Norway)
    Abstract: Persistently high workload may raise sickness absence with associated costs to firms and society. We proxy workload by the number of adults per child in Norwegian child care centers, but do not find that centers with many adults per child have lower sickness absence than other centers. However, we do find that more college-educated teachers per child are associated with lower sickness absence, whereas more assistants (with low or no education) per child are associated with higher sickness absence, suggesting that the observed variation in sickness absence at the center level is mainly driven by compositional differences of the employees rather than workload. The importance of compositional effects is supported by findings from individual fixed effects models and a regression discontinuity approach relying on results from municipal elections.
    Keywords: Workload; sickness absence; child care centers; teachers per child; education level
    JEL: I1 I2
    Date: 2018–08
  12. By: Barkowski, Scott; McLaughlin, Joanne Song; Ray, Alex
    Abstract: State governments have been passing laws mandating insurers to allow young adults to stay on their parents' health insurance plans past the age of 19 since the 1970s. These laws were intended to increase coverage, but research has been inconclusive on whether they were successful. We reconsider the issue with an improved approach featuring three key elements: a new, accurate dataset on state mandates; recognition that effects could differ greatly by age due to take up rate differences; and avoidance of endogenous characteristics when identifying mandate eligible young adults. We find the impact of the state mandates was concentrated among the 19 to 22 age group, for which dependent coverage increased sharply by about 6 percentage points. Overall coverage increased by almost 3 percentage points, with the difference explained by crowd out of public insurance. Crowd out of coverage through young adults own jobs was negligible. For those above age 22, we find little evidence of changes in coverage. We incorporate these insights into analysis of the Affordable Care Act (ACA) dependent coverage mandate, showing its effects were focused among those whom were previously ineligible for state mandates, or were eligible but older than 22. We argue the ACA's impact was broader because it had fewer eligibility conditions that implied parental dependence; young adults could be on their parents' insurance but still be relatively independent.
    Keywords: Health Insurance; Dependent Coverage Mandates; Affordable Care Act
    JEL: H11 H75 I13 I18
    Date: 2018–07–27
  13. By: Mukhopadhyay, Sankar (University of Nevada, Reno); Wendel, Jeanne (University of Nevada, Reno); Zou, Miaomiao (Nanjing University)
    Abstract: States with Section 1332 Waivers to operate high-risk pools (HRPs) or reinsurance programs can receive federal pass through funds equal to reductions in federal expenditures generated by the Waiver. Shifting financial responsibility for high-cost individuals out of the Health Insurance Exchange (HIX) markets is expected to reduce federal expenditures for Advanced Premium Tax Credits, by reducing HIX plan premiums. Simulation models predict that a new HRP or reinsurance program would trigger premium reductions ranging from 7% to 23%. These models assume that insurers do not adjust plan cost-sharing requirements or plan generosity. However, federal requirements specifying the Medical Loss Ratio and plan Actuarial Values give insurers incentives to make multidimensional adjustments. We use plan level fixed effects to generate difference-in-difference estimates of insurer responses to closures of state-operated HRPs during 2014-2016. Silver plan premiums increased 7.7%, deductibles increased 41%, and Maximum-Out-Of-Pocket (MOOPs) expenditures increased 24% following closure of a state HRP.
    Keywords: high risk pools, insurance premium, health insurance exchanges, cost-sharing
    JEL: I11 I13 I18
    Date: 2018–06
  14. By: Francisco Parro (Universidad Adolfo Ibáñez); R. Vincent Pohl (University of Georgia)
    Abstract: Health, human capital, and labor market outcomes are linked though complex connections that are not fully understood. We explore these links by estimating a flexible yet tractable dynamic model of human capital accumulation in the presence of health shocks using administrative data from Chile. We find that (i) human capital mitigates the negative labor market effects of health events, (ii) these alleviating effects operate through channels involving occupational choice, the frequency of exposure to health events, and access to health care, and (iii) the effect of health shocks on labor market outcomes is heterogeneous across industries and types of diagnoses.
    Keywords: health shocks, hospitalizations, labor market outcomes, earnings, human capital
    JEL: I10 J22 J24
    Date: 2018–06
  15. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research)
    Keywords: Prior authorization, Prescription drug abuse, Workers' compensation, Health care spending, Prescribing behavior
    JEL: J28 I13 I18
  16. By: Brian Beach; Joseph P. Ferrie; Martin H. Saavedra
    Abstract: Almond (2006) argues that in utero exposure to the 1918 influenza pandemic lowered socioeconomic status in adulthood, whereas Brown and Thomas (2016) find that the effect disappears after controlling for parental characteristics of the 1919 birth cohort. We link microdata from the 1920 and 1930 censuses to WWII enlistment records and city-level influenza data. The result is a data set with much more precisely measured influenza exposure and parental characteristics. Results indicate that in the absence of the pandemic, the 1919 birth cohort would have been more likely to graduate from high school and would have obtained more years of schooling. The impact on high school graduation is largely unaffected by including parental controls and city-specific time trends. Adding household fixed effects (and thus exploiting variation among brothers) yields similar but somewhat larger results.
    JEL: I1 J0 N12
    Date: 2018–06
  17. By: Cawley, J.;; Han, E.;; Kim, J.;; Norton, E.C.;
    Abstract: This paper tests for peer effects in obesity in a novel way. It addresses the reflection problem by using the alter’s genetic risk score for obesity, which is a significant predictor of obesity, is determined prior to birth, and cannot be affected by the behavior of others. It addresses the endogeneity of peer group formation by examining peers who are not self-selected: full siblings. We find evidence of positive peer effects in weight and obesity; having a sibling with a high genetic predisposition to obesity raises one’s risk of obesity, even controlling for one’s own genetic predisposition to obesity.
    Keywords: peer effects; obesity; genetics;
    JEL: I1 I12 I18 D1 J1 Z18
    Date: 2018–08
  18. By: Lindeboom, Maarten (Vrije Universiteit Amsterdam); Montizaan, Raymond (ROA, Maastricht University)
    Abstract: In January 2006, the Dutch government implemented a pension reform that substantially reduced the public pension wealth of workers born in 1950 or later. At the same time, a tax-facilitated savings plan was introduced that substantially reduced the saving costs of all workers, irrespective of birth year. This paper uses linked administrative and survey data to assess the effect of the reform on the savings and retirement expectations and realizations of two virtually identical male cohorts that differ only in treatment status, the treated having been born in 1950 and the controls having been born in 1949. We show that retirement expectations are in line with realizations and that the reform had the intended effect on the labor supply for the larger part of the workers, namely, those without sufficient means to substantially increase private savings to counter the effect of the reform. These workers, who are generally in worse health, have zero substitution rates between private and public wealth. On the other hand, there is a group of mostly high-wage workers who participate in the tax-facilitated Life Course Savings Scheme and who increase private savings to fully counter the impact of the drop in public wealth. A further, unintended side effect of the introduction of the tax-facilitated savings plan is that high wage earners who are not affected by the drop in pension wealth retire even sooner than initially planned.
    Keywords: natural experiment, regression discontinuity, retirement, private wealth, public wealth, crowding out, substitution rate
    JEL: J26 H55 J14
    Date: 2018–06
  19. By: Michael Chernew; Zack Cooper; Eugene Larsen-Hallock; Fiona Scott Morton
    Abstract: We study how individuals with private health insurance choose providers for lower-limb MRI scans. Lower-limb MRI scans are a fairly undifferentiated service and providers' prices routinely vary by a factor of five or more across providers within hospital referral regions. We observe that despite significant out-of-pocket cost exposure, patients often received care in high-priced locations when lower priced options were available. Fewer than 1 percent of individuals used a price transparency tool to search for the price of their services in advance of care. The choice of provider is such that, on average, individuals bypassed 6 lower-priced providers between their home and the location where they received their scan. Referring physicians heavily influence where their patients receive care. The influence of referring physicians is dramatically greater than the effect of patient cost-sharing. As a result, in order to lower out-of-pocket costs and reduce total MRI spending, patients must diverge from the established referral pathways of their referring physicians. We also observe that patients with vertically integrated (i.e. hospital-owned) referring physicians are more likely to have hospital-based (and more costly) MRI scans.
    JEL: I1 I11
    Date: 2018–07
  20. By: Llorca, M.; Rodriguez-Alvarez, A.; Jamasb, T.
    Abstract: Policies towards fuel poverty often use relative or absolute measures. The effectiveness of the official indicators in identifying fuel poor households and assessing its impact on health is an emerging social policy issue. In this paper we analyse objective and perceived fuel poverty as determinants of self-assessed health in Spain. In 2014, 5.1 million of her population could not afford to heat their homes to an adequate temperature. We propose a latent class ordered probit model to analyse the influence of fuel poverty on self-reported health in a sample of 25,000 individuals in 11,000 households for the 2011-2014 period. This original approach allows us to include a ‘subjective’ measure of fuel poverty in the class membership probabilities and purge the influence of the ‘objective’ measure of fuel poverty on self-assessed health. The results show that poor housing conditions, fuel poverty, and material deprivation have a negative impact on health. Also, individuals who rate themselves as fuel poor tend to report poorer health status. The effect of objective fuel poverty on health is stronger when unobserved heterogeneity of individuals is controlled for. Since objective measures alone may not fully capture the adverse effect of fuel poverty on health, we advocate the use of approaches that allow a combination of objective and subjective measures and its application by policy-makers. Moreover, it is important that policies to tackle fuel poverty take into account the different energy vectors and the prospects of a future smart and integrated energy system.
    Keywords: Fuel poverty in Spain; self-assessed health; latent class ordered probit model.
    JEL: C01 C25 I14 I32 Q43
    Date: 2018–08–16
  21. By: Buehler, Dorothee; Cunningham, Wendy
    Abstract: Against the background of rising weather risks this paper seeks to understand how risks impact the income generating capacity of rural households in Southeast Asia. In this study, we use assets to predict households' income generating capacity and examine the role of different shock categories on asset accumulation. In addition, we detect region, country and income group specific patterns. We use panel data from Cambodia, Laos, Thailand, and Vietnam covering 5,200 rural households. Households' income generating capacity is estimated in a fixed-effects regression based on assets owned or accessed by the household. The findings suggest that shocks decrease the asset accumulation rate of rural households by 1.4 percentage points across all four countries. While health shocks decrease households' asset accumulation rate by 1.2 to 1.4 percentage points, the effect of drought and flood shocks is twice as high. At the country level, the effect of flood shocks on asset growth are strongest in Vietnam while drought shocks disproportionately affect Laotian households. Households are largely able to anticipate the occurrence of health shocks, while droughts and floods are less predictable and thus, have a more detrimental effect on asset growth. The effects of shocks differ across income quartiles. While households in the richest quartile are able cope with weather shocks, health shocks affect their asset accumulation disproportionately. Poor households are strongest affected by drought shocks.
    Keywords: Shocks, Asset-based approach, Economic development, Poverty, Regional analysis, Southeast Asia
    JEL: I32 O18 Q1
    Date: 2018–08
  22. By: Max Coveney (Erasmus University Rotterdam); Pilar (P.) Garcia-Gomez (Erasmus University Rotterdam); Eddy (E.K.A.) van Doorslaer (Erasmus University Rotterdam); Tom (T.G.M.) van Ourti (Erasmus University Rotterdam)
    Abstract: It is well known that income and health are positively associated. Much less is known about the strength of this association in times of growth and recession. We develop a novel decomposition method that focuses on isolating the roles played by government transfers versus market transfers on changes in income-related health inequality (IRHI) in Europe. Using European Union Survey of Income and Living Conditions (EU-SILC) panel data for 7 EU countries from 2004 to 2013, we decompose the changes in IRHI while focusing on possible effects of the 2008 financial crisis. We find that such inequalities rise in good economic times and fall in bad economic times. This pattern can largely be explained by the relative stickiness of old age pension benefits compared to the market incomes of younger groups. Austerity measures are associated with a weakening of the IRHI reducing effect of government transfers.
    Keywords: Crisis; inequalities; health; income; decomposition
    JEL: D30 D63 I14 I15
    Date: 2018–08–17
  23. By: Michael Geruso; Dean Spears
    Abstract: We study how extreme weather exposure impacts infant survival in the developing world. Our analysis overcomes the absence of vital registration systems in many poor countries by extracting birth histories from household surveys. Studying 53 developing countries that span five continents, we find impacts of hot days on infant morality that are an order of magnitude larger than corresponding estimates from rich country studies, with humidity playing an important role. The size and implied geographic distribution of harms documented here have the potential to significantly alter assessments of optimal climate policy.
    JEL: H23 I1 J1 O1 Q5 Q54 Q56
    Date: 2018–07
  24. By: Antoine Marsaudon (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); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Does democracy help Kenyan citizens to struggle against the HIV epidemic? Yet, very little attention has been devoted to establish whether political regimes react differently to the HIV infection. Using an electoral definition of democracy makes a contribution in understanding which aspects of political rules matter to manage the disease. Using a difference-in-difference design that draws upon pre-existing variations in HIV intensity and cohort's exposure to democracy, we find that a person living under democracy is less likely to have a HIV infection. Further, we present some evidence of ethnic favoritism and gender disparities during periods of non-democracy.
    Keywords: Institution,Democracy,HIV,Health,Kenya
    Date: 2016–11
  25. By: Bauernschuster, Stefan (University of Passau); Driva, Anastasia (Ludwig-Maximilians-Universität München); Hornung, Erik (University of Cologne)
    Abstract: We study the impact of social health insurance on mortality. Using the introduction of compulsory health insurance in the German Empire in 1884 as a natural experiment, we estimate flexible difference-in-differences models exploiting variation in eligibility for insurance across occupations. Our findings suggest that Bismarck's health insurance generated a significant mortality reduction. Despite the absence of antibiotics and most vaccines, we find the results to be largely driven by a decline of deaths from infectious diseases. We present evidence suggesting that the decline is associated with access to health services but not sick pay. This finding may be explained by insurance fund physicians transmitting new knowledge on infectious disease prevention.
    Keywords: health insurance, mortality, demographic transition, Prussia
    JEL: I13 I18 N33 J11
    Date: 2018–06
  26. By: Claudia Goldin; Adriana Lleras-Muney
    Abstract: Females live longer than males in most parts of the world today. Among OECD nations in recent years, the difference in life expectancy at birth is around four to six years (seven in Japan). But have women always lived so much longer than men? The answer is that they have not. We ask when and why the female advantage emerged. We show that reductions in maternal mortality and fertility are not the reasons. Rather, we argue that the sharp reduction in infectious disease in the early twentieth century played a role. The primary reason is that those who survive most infectious diseases carry a health burden that affects organs, such as the heart, as well as impacting general well-being. We use new data from Massachusetts containing information on causes of death from 1887 to show that infectious diseases disproportionately affected females between the ages of 5 and 25. Increased longevity of women, therefore, occurred as the burden of infectious disease fell for all. Our explanation does not tell us why women live longer than men, but it does help understand the timing of the increase.
    JEL: J1 J16 N0
    Date: 2018–06
  27. By: Kudo, Yuya
    Abstract: Levirate marriage, whereby a widow is inherited by male relatives of her deceased husband, has anecdotally been viewed as an informal safety net for widows who have limited property rights. This study investigates why this widespread practice in sub-Saharan Africa has recently been disappearing. A developed game-theoretic analysis reveals that levirate marriage arises as a pure strategy subgame perfect equilibrium when a husband's clan desires to keep children of the deceased within its extended family and widows have limited independent livelihood means. Female empowerment renders levirate marriage redundant because it increases widows' reservation utility. HIV/AIDS also discourages a husband's clan from inheriting a widow who loses her husband to HIV/AIDS, reducing her remarriage prospects and thus, reservation utility because she is likely to be HIV positive. Consequently, widows' welfare tends to decline (resp., increase) in step with the deterioration of levirate marriage driven by HIV/AIDS (female empowerment). By exploiting long-term household panel data drawn from rural Tanzania and testing multiple theoretical predictions relevant to widows' welfare and women's fertility, this study finds that HIV/AIDS is primarily responsible for the deterioration of levirate marriage. Young widows in Africa may need some form of social protection against the influence of HIV/AIDS.
    Keywords: cultural institution, female empowerment, HIV/AIDS, safety net, levirate marriage, widowhood protection
    JEL: J12 J13 J16 K11 Z13
    Date: 2018–08–08

This nep-hea issue is ©2018 by Nicolas R. Ziebarth. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.