nep-hea New Economics Papers
on Health Economics
Issue of 2018‒09‒10
twenty-two papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Equilibrium Provider Networks: Bargaining and Exclusion in Health Care Markets By Ho, Katherine; Lee, Robin S.
  2. The Value of Health Insurance: A Household Job Search Approach By Conti, Gabriella; Ginja, Rita; Narita, Renata
  3. Supplemental Security Income and Child Outcomes: Evidence from Birth Weight Eligibility Cutoffs By Melanie Guldi; Amelia Hawkins; Jeffrey Hemmeter; Lucie Schmidt
  4. Feeling Useless: The Effect of Unemployment on Mental Health in the Great Recession By Farre, Lidia; Fasani, Francesco; Mueller, Hannes Felix
  5. Does social isolation affect medical doctor visits? New evidence among European older adults By David Cantarero-Prieto; Marta Pascual-Sáez; Carla Blázquez-Fernández
  6. The Human Side of Austerity: Health Spending and Outcomes During the Greek Crisis By Roberto Perotti
  7. Has the Economic Crisis Worsened the Work-Related Stress and Mental Health of Temporary Workers in Spain? By Bartoll, Xavier; Gil, Joan; Ramos, Raul
  8. The effect of bigger human bodies on future global calorie requirements By Depenbusch, Lutz; Klasen, Stephan
  9. Working Times and Overweight: Tight Schedules, Weaker Fitness? By Joan Costa-i-Font; Belen Saenz de Miera Juarez
  10. The (short-term) individual welfare consequences of an alcohol ban By Petilliot, René
  11. Socio-Economic Inequalities in Tobacco Consumption of the Older Adults in China: A Decomposition Method By Si, Yafei; Zhou, Zhongliang; Su, Min; Wang, Xiao; Li, Dan; Wang, Dan; He, Shuyi; Hong, Zihan; Chen, Xi
  12. Toxic Effects of Lead Disposal in Water: An Analysis of TRI Facility Releases By Patrick Koval
  13. Light Pollution, Sleep Deprivation, and Infant Health at Birth By Argys, Laura M.; Averett, Susan L.; Yang, Muzhe
  14. Commuting Time and Sick-Day Absence of US Workers By Gimenez-Nadal, J. Ignacio; Molina, José Alberto; Velilla, Jorge
  15. Paying for Efficiency: Incentivising same-day discharges in the English NHS By James Gaughan; Nils Gutacker; Katja Grasic; Noemi Kreif; Luigi Siciliani; Andrew Street
  16. An equilibrium search model of the French dual market for medical services By Besancenot, Damien; Vranceanu, Radu
  17. Shocks and Transitions from Career Jobs to Bridge Jobs and Retirement: A New Approach By John Ameriks; Joseph Briggs; Andrew Caplin; Minjoon Lee; Matthew D. Shapiro; Christopher Tonetti
  18. Is Envy Harmful to a Society’s Psychological Health and Wellbeing? A Longitudinal Study of 18,000 Adults By Mujcic, Redzo; Oswald, Andrew J.
  19. Mental Health and Reporting Bias: Analysis of the GHQ - 12 By Sarah Brown; Mark N. Harris; Preety Srivastava; Karl Taylor
  20. The Evolution of Longevity: Evidence from Canada By Kevin Milligan; Tammy Schirle
  21. Using Animation to Self-report Health: a Randomized Experiment with Children By Carla Guerriero; Abrines Jaume N.; Diaz-Ordaz K.; Brown K.; Wray J.; Ashworth J.; Abbiss M.; Cairns J.
  22. Taxing Highly Processed Foods: Impacts on Obesity and Underweight in Sub-Saharan Africa By Boysen, O.; Bradford, H.; Urban, K.; Balie, J.

  1. By: Ho, Katherine; Lee, Robin S.
    Abstract: We evaluate the consequences of narrow hospital networks in commercial health care markets. We develop a bargaining solution, Nash-in-Nash with Threat of Replacement, that captures insurers' incentives to exclude, and combine it with California data and estimates from Ho and Lee (2017) to simulate equilibrium outcomes under social, consumer, and insurer-optimal networks. Private incentives to exclude generally exceed social incentives, as the insurer bene fits from substantially lower negotiated hospital rates. Regulation prohibiting exclusion increases prices and premiums and lowers consumer welfare without significantly affecting social surplus. However, regulation may prevent harm to consumers living close to excluded hospitals.
    Date: 2018–07
  2. By: Conti, Gabriella (University College London); Ginja, Rita (University of Bergen); Narita, Renata (University of Sao Paulo)
    Abstract: Do households value access to free health insurance when making labor supply decisions? We answer this question using the introduction of universal health insurance in Mexico, the Seguro Popular (SP), in 2002. The SP targeted individuals not covered by Social Security and broke the link between access to health care and job contract. We start by using the rollout of SP across municipalities in a differences-indifferences approach, and find an increase in informality of 4% among low-educated families with children. We then develop and estimate a household search model that incorporates the pre-reform valuation of formal sector amenities relative to the alternatives (informal sector and non-employment) and the value of SP. The estimated value of the health insurance coverage provided by SP is below the government's cost of the program, and the corresponding utility gain is, at most, 0.56 per each peso spent.
    Keywords: search, household behavior, health insurance, informality, unemployment
    JEL: J64 D10 I13
    Date: 2018–07
  3. By: Melanie Guldi; Amelia Hawkins; Jeffrey Hemmeter; Lucie Schmidt
    Abstract: Low birth weight infants born to mothers with low educational attainment have a double hurdle to overcome in the production of human capital. We examine whether income transfers in the form of Supplemental Security Income (SSI) payments for children with disabilities can help close the gap in outcomes due to this initial health and environmental disadvantage. We exploit a discontinuity in SSI eligibility at 1200 grams and use a regression discontinuity approach to produce causal estimates of the effects of SSI eligibility. We find that eligibility increases disability benefit participation, improves child outcomes and parenting behaviors, and shifts maternal labor supply from full to part time.
    JEL: H51 H53 I38 J21
    Date: 2018–08
  4. By: Farre, Lidia; Fasani, Francesco; Mueller, Hannes Felix
    Abstract: This article documents a strong connection between unemployment and mental distress using data from the Spanish National Health Survey. We exploit the collapse of the construction sector to identify the causal effect of job losses in different segments of the Spanish labour market. Our results suggest that an increase of the unemployment rate by 10 percentage points due to the breakdown in construction raised reported poor health and mental disorders in the affected population by 3 percentage points, respectively. We argue that the size of this effect responds to the fact that the construction sector was at the centre of the economic recession. As a result, workers exposed to the negative labor demand shock faced very low chances of re-entering employment. We show that this led to long unemployment spells, stress, hopelessness and feelings of uselessness. These effects point towards a potential channel for unemployment hysteresis.
    Keywords: great recession; hysteresis; mental health; unemployment
    JEL: C26 I10 J60
    Date: 2018–08
  5. By: David Cantarero-Prieto; Marta Pascual-Sáez; Carla Blázquez-Fernández
    Abstract: We have used panel data (2004-2015) from the Survey of Health, Ageing and Retirement in Europe (SHARE) to examine the impact of social isolation on general practitioner health care use. Socio-demographic, health and social isolation measures are analysed. Differences by welfare regimes have been also considered. Using two definitions of social isolation (Alone and Help), we have found that a sizeable proportion of those aged 50 years and older in Europe reported social isolation. Differences by welfare regimes are highlighted. Our findings provide several implications in current debates on the sustainability of welfare states.
    Keywords: Europe; aging; social isolation; health care utilization; SHARE; count data models.
    JEL: I10 I19
    Date: 2018–08
  6. By: Roberto Perotti
    Abstract: The Greek crisis was the most severe in postwar Europe; its budget cuts were the deepest. Among the components of the budget, health spending was hit particularly hard, declining by more than one third in just five years. This paper has two goals: establish the facts about health inputs, outputs and outcomes during the Greek crisis, and explore the connection between budget cuts and health outcomes. Health spending and inputs were very high in Greece before the crisis: in several dimensions, even after the budget cuts were implemented health spending and inputs were still at or near the top of the European countries; in other cases they merely went back to the European average. Nevertheless, budget cuts so deep and so sudden are unlikely to merely cut into inefficiencies and overcapacities. I highlight several areas in which a comparative quantitative analysis suggests that budget cuts might have had an appreciable effects on the health of the population.
    JEL: E62 H51 I18
    Date: 2018–08
  7. By: Bartoll, Xavier (University of Barcelona); Gil, Joan (University of Barcelona); Ramos, Raul (University of Barcelona)
    Abstract: This paper analyses the causal effects of temporary employment on work-related stress and mental health before (2006/07) and during the economic crisis (2011/12) and examines whether the economic recession worsened these two health outcomes. To control for selection bias, propensity scores (PS) are computed separately for men and women using microdata from two cross-sectional surveys, considering temporary (treatment group) versus permanent employment (control group). Next, we use difference-in-differences estimators stratifying by age, education level, and regional unemployment differences using PS as weights. Our results indicate that a male salaried worker with a temporary labour contract tends to have lower levels of work-related stress in the pre-crisis period, but not for women. The stratification analysis shows lower work-related stress levels among older male adults, workers with a high education level, and employees in regions with high unemployment rates. The economic crisis is responsible for increasing stress only among older temporary workers and male university graduates, without affecting women. We also see evidence of a positive link between temporary employment and poor mental health in both periods, although only for men. We neither find significant impacts for our sample of men or women, nor for most of our population subgroups with the exception of male workers with a university degree.
    Keywords: temporary employment, economic crisis, work-related stress, mental health, propensity score weighting
    JEL: I10 J41 J28
    Date: 2018–07
  8. By: Depenbusch, Lutz; Klasen, Stephan
    Abstract: Global food demand will see a rapid increase over the coming decades. Existing studies on future calorie demand consider mainly population growth and rising incomes. We add to the literature by estimating the effect of increases in human weight caused by rising BMI and height on future calorie requirements. We produce projections that are solely based on human energy requirements for maintenance of weight. We develop four different scenarios that affect this value and show that increases in human height and BMI could lead to an increase in global calorie requirements by 18.73 percentage points between 2010 and 2100 compared to a world where the weight per age-sex group would stay the same. These increases will particularly affect countries which are already facing higher rises in calorie requirements due to high population growth. The region most affected by this pattern is Sub-Saharan Africa.
    Keywords: Agricultural and Food Policy, Demand and Price Analysis, Food Consumption/Nutrition/Food Safety
    Date: 2017–10–01
  9. By: Joan Costa-i-Font; Belen Saenz de Miera Juarez
    Abstract: Although the rise in obesity and overweight is related to time constraints influencing health investments (e.g., exercise, shopping and cooking time, etc.), there is limited causal evidence to substantiate such claims. This paper estimates the causal effect of a change in working times on overweight and obesity drawing from evidence from the Aubrey reform implemented in the beginning of the past decade in France. We use longitudinal data from GAZEL (INSERM) 1997-2006 that contains detailed information about health indicators, including measures of height and weight. Taking the Alsace-Mosselle department as a control group and a difference-in-differences strategy, we estimate the effect of a differential reduction in working times on body weight. Our results show evidence of 0.7% increase in average BMI an 8pp increase in the probability of overweight among blue collars exposed to the reform. In contrast, we find no effect among white collar workers. The effects are robust to different specifications and placebo tests.
    Keywords: obesity, overweight, working times, difference-in-differences, blue collar, white collar, Body Mass Index
    JEL: I13 J81
    Date: 2018
  10. By: Petilliot, René
    Abstract: This paper provides the first empirical analysis of the (short-term) welfare consequences of an alcohol ban. Using subjective well-being data to proxy individual welfare, I apply a regression discontinuity design where the date of the implementation of the ban in the German federal state of Baden-Wuerttemberg functions as discontinuity. I find that the ban reduces life satisfaction of the total population and the subpopulation of drinkers, while life satisfaction of nondrinkers is unaffected. My findings are well in line with the rational addiction model perspective.
    Keywords: Alcohol ban,Well-being,Life satisfaction,Welfare,Addiction,Regression discontinuity design
    JEL: D04 D60 H30 I31
    Date: 2018
  11. By: Si, Yafei (Xi’an Jiaotong University); Zhou, Zhongliang (Xi’an Jiaotong University); Su, Min (Xi’an Jiaotong University); Wang, Xiao (Xi’an Jiaotong Liverpool University); Li, Dan (Xi’an Jiaotong University); Wang, Dan (Xi’an Jiaotong University); He, Shuyi (Xi’an Jiaotong Liverpool University); Hong, Zihan (Xi’an Jiaotong Liverpool University); Chen, Xi (Yale University)
    Abstract: In China, tobacco consumption is a leading risk factor for non-communicable diseases, and understanding the pattern of socio-economic inequalities of tobacco consumption will, thus, help to develop targeted policies of public health control. Data came from the China Health and Retirement Longitudinal Study in 2013, involving 17,663 respondents aged 45 and above. Tobacco use prevalence and tobacco use quantities were defined for further analysis. Using the concentration index (CI) and its decomposition, socio-economic inequalities of tobacco consumption grouped by gender were estimated. The concentration index of tobacco use prevalence was 0.044 (men 0.041; women −0.039). The concentration index of tobacco use quantities among smokers was 0.039 (men 0.033; women 0.038). The majority of the inequality could be explained by educational attainment, age, area, and economic quantiles. Tobacco consumption was more common among richer compared to poorer people in China. Gender, educational attainments, age, areas, and economic quantiles were strong predictors of tobacco consumption in China. Public health policies need to be targeted towards men in higher economic quantiles with lower educational attainment, and divorced or widowed women, especially in urban areas of China.
    Keywords: tobacco consumption, inequality, concentration index, decomposition, China
    JEL: I12 I14 J14
    Date: 2018–07
  12. By: Patrick Koval (Department of Economics and Accounting, College of the Holy Cross)
    Abstract: Using county-level TRI data from 2003 to 2016, I find evidence that lead emissions in water adversely affect birth weights within the emitting county, especially with respect to the percentage of births considered low birth weight within that county (less than 2,500 grams). I find that a one percent increase in lead emissions per square mile increases the proportion of low birth weights by 0.27 percentage points. For a county with an average number of births in a particular year, this one percent increase in lead per square mile translates to an additional $475,000 in hospitalization costs from complications with delivery and perinatal care alone. My results show that lead emissions create a substantial negative externality even at relatively small quantities and may have more significant effects for those living in poverty.
    Keywords: health effects; nutrition; distributive justice
    JEL: I12 D63 Q51
    Date: 2018–08
  13. By: Argys, Laura M. (University of Colorado Denver); Averett, Susan L. (Lafayette College); Yang, Muzhe (Lehigh University)
    Abstract: This is the first study that uses a direct measure of skyglow, an important aspect of light pollution, to examine its impact on infant health at birth. We find evidence of reduced birth weight, shortened gestational length and even preterm births. Specifically, increased nighttime brightness, characterized by being able to see only one-third to one-fourth of the stars that are visible in the absence of artificial light, is associated with an increase in the likelihood of a preterm birth by as much as 12.8 percent, or an increase of approximately 45,000 preterm births nationwide annually. Our findings add to the literature on the impact of in utero and early-life exposure to pollution, which thus far has focused primarily on air pollution. The unique feature of our identification strategy to determine a causal effect is the application of Walker's Law in physics, which provides a scientific basis to estimate skyglow. We use estimated skyglow as an instrumental variable to address the endogeneity problem associated with the skyglow variable. In addition, our study shows that increased skyglow is associated with less sleep, indicating a likely biological mechanism that links sleep deprivation to light-pollution induced circadian disruption. This result, combined with the literature on the adverse effects of sleep disorders, completes the causal chain underlying our finding on the adverse health impact of skyglow. Our study has important policy implications for current installation of LED streetlights in many U.S. municipalities, highlighting the necessity of minimizing skyglow contributed by streetlights.
    Keywords: light pollution, skyglow, sleep deprivation, birth outcomes
    JEL: I10 I12 I18 Q59 R11
    Date: 2018–07
  14. By: Gimenez-Nadal, J. Ignacio (University of Zaragoza); Molina, José Alberto (University of Zaragoza); Velilla, Jorge (University of Zaragoza)
    Abstract: This paper analyzes the relationship between commuting time and sick-day absence of US workers. Using data from the Panel Study of Income Dynamics for the years 2011, 2013, and 2015, we find that a 1% increase in the daily commute of male workers is associated with an increase of around 0.018% in sick-day absences per year. In the case of women, the relationship is not significant. These results hold after controlling for individual fixed effects and socio-demographic characteristics, changes in jobs and places of residence, and differences in the self-reported health status of workers. By determining how commuting time is related to sickness absenteeism, we shed light on the relationship between commuting behavior and workers' health-related outcomes, measured by their labour supply.
    Keywords: commuting time, sickness absence, health-related outcomes, labour supply
    JEL: I10 J22 R2 R40
    Date: 2018–07
  15. By: James Gaughan (Centre for Health Economics, University of York, York, UK); Nils Gutacker (Centre for Health Economics, University of York, York, UK); Katja Grasic (Centre for Health Economics, University of York, York, UK); Noemi Kreif (Centre for Health Economics, University of York, York, UK); Luigi Siciliani (Department of Economics and Related Studies, University of York, York, UK); Andrew Street (Department of Health Policy, The London School of Economics and Political Science, UK)
    Abstract: We study a pay-for-efficiency scheme that encourages hospitals to admit and discharge patients on the same calendar day where clinically appropriate. Since 2010, hospitals in the English NHS receive a higher price for patients treated as same-day discharge than for overnight stays, despite the former being less costly. We analyse administrative data for patients treated for 191 conditions for which same-day discharge is clinically appropriate — of which 32 are incentivised — during 2006-2014. Using interrupted time series, differences-in-differences and synthetic control methods, we find that the policy generally had a positive effect on planned conditions with a statistically significant effect in about a third of conditions. The results are more mixed for emergency conditions. The median elasticity (across all 32 conditions) is 0.09 but above one for six conditions. Condition-specific design features explain some, but not all, of the differential responses.
    Keywords: Pay for Performance, Best Practice Tariff, day surgery, same-day discharge, policy evaluation
    JEL: D22 I11
    Date: 2018–08
  16. By: Besancenot, Damien (ESSEC Research Center, ESSEC Business School); Vranceanu, Radu (ESSEC Research Center, ESSEC Business School)
    Abstract: The French market for specialist physician care has a dual structure, including a sector 1 with regulated fees, and a sector 2 where physicians can freely choose fees. Patients who undergo a sequential search process for the best medical o¤er develop a reservation fee decision rule. We analyzed physicians decisions to work in sector 1 or in sector 2, and their choice of fee in sector 2. The model features several pure strategy equilibria that can be ordered with respect to patient welfare. Policy implications follow.
    Keywords: Equilibrium search; Medical fee dispersion; Dual market; Regulation
    JEL: D83 I11 I18
    Date: 2017–06–06
  17. By: John Ameriks (The Vanguard Group, Inc.); Joseph Briggs (Federal Reserve Board); Andrew Caplin (New York University and NBER); Minjoon Lee (Carleton University); Matthew D. Shapiro (University of Michigan and NBER); Christopher Tonetti (Stanford University and NBER)
    Abstract: This research provides new empirical evidence on late-life labor market activities of American households from a new survey implemented under the Vanguard Research Initiative. The survey features following innovations: It measures detailed job characteristics not only of a career job but also of post-career bridge jobs; it examines reasons of leaving a career job and whether households would have changed their decisions under counterfactual situations; it examines post-career job search behavior of households. The research finds that, even though a direct transition from a career job to full retirement is still the most common pattern, a significant fraction of older Americans reveal interest in working beyond the career job. Within this sample of older Americans with positive financial assets, 38% of had a post-career bridge job and another 7% of them looked for a post-career employment opportunity. Low health or bad business conditions were the not the main reason for leaving the career job. Yet, for the minority of those who did leave career jobs owing to low health or bad economic conditions, had they counterfactually had better health or economic conditions, they likely would have decided to work longer. Those who work longer on their career job or have a post-career bridge job tend to work fewer hours, have a flexible schedule, and receive lower hourly wages.
    Date: 2018–02
  18. By: Mujcic, Redzo; Oswald, Andrew J.
    Abstract: Nearly 100 years ago, the philosopher and mathematician Bertrand Russell warned of the social dangers of widespread envy. One view of modern society is that it is systematically developing a set of institutions -- such as social media and new forms of advertising -- that make people feel inadequate and envious of others. If so, how might that be influencing the psychological health of our citizens? This paper reports the first large-scale longitudinal research into envy and its possible repercussions. The paper studies 18,000 randomly selected individuals over the years 2005, 2009, and 2013. Using measures of SF-36 mental health and psychological well-being, four main conclusions emerge. First, the young are especially susceptible. Levels of envy fall as people grow older. This longitudinal finding is consistent with a cross-sectional pattern noted recently by Nicole E. Henniger and Christine R. Harris, and with the theory of socioemotional regulation suggested by scholars such as Laura L. Carstensen. Second, using fixed-effects equations and prospective analysis, the analysis reveals that envy today is a powerful predictor of worse SF-36 mental health and well-being in the future. A change from the lowest to the highest level of envy, for example, is associated with a worsening of SF-36 mental health by approximately half a standard deviation (p <0.001). Third, no evidence is found for the idea that envy acts as a useful motivator. Greater envy is associated with slower -- not higher -- growth of psychological well-being in the future. Nor is envy a predictor of later economic success. Fourth, the longitudinal decline of envy leaves unaltered a U-shaped age pattern of well-being from age 20 to age 70. These results are consistent with the idea that society should be concerned about institutions that stimulate large-scale envy.
    Keywords: Financial Economics
    Date: 2018–02–02
  19. By: Sarah Brown (Department of Economics, University of Sheffield); Mark N. Harris (School of Economics and Finance, Curtin University); Preety Srivastava (School of Economics, Finance and Marketing, Royal Melbourne Institute of Technology); Karl Taylor (Department of Economics, University of Sheffield)
    Abstract: Measures of mental wellbeing are heavily relied upon to identify at-risk individuals. However, self-reported mental health metrics might be unduly affected by mis-reporting (perhaps stemming from stigma effects). In this paper we consider this phenomenon using data from the British Household Panel Survey (BHPS) and its successor, Understanding Society, the UK Household Longitudinal Study (UKHLS) over the period 1991 to 2016. In particular, in separate analyses of males and females we focus on the GHQ-12 measure, and specifically its sub-components, and how inaccurate reporting can adversely affect the distribution of the index. The results suggest that individuals typically over-report pyschological wellbeing and that reporting bias is greater for males. The results are then used to adjust the composite GHQ- 12 score to take such mis-reporting behaviours into account. To further illustrate the importance of this, we compare the effects of the adjusted and unadjusted GHQ-12 index when modelling a number of economic transitions. The results reveal that using the original GHQ-12 score generally leads to an underestimate of the effect of psychological distress on transitions into improved economic states, such as unemployment into employment.
    Keywords: GHQ-12 index, inflated outcomes, mental health and mis-reporting
    JEL: C3 D1 I1
    Date: 2018–09
  20. By: Kevin Milligan; Tammy Schirle
    Abstract: We find a steep earnings-longevity gradient using fifty years of administrative data from Canada, with men in the top ventile of earnings living eight years (11 percent) longer than those in the bottom ventile. For women, the difference is 3.6 years. Unlike the United States, this longevity gradient in Canada has shifted uniformly through time, with approximately equal gains across the earnings distribution. We compare our results using cross-sectional and cohort-based methods, finding similar trends but a steeper gradient when using cohorts. For middle-aged men, we find a cessation of mortality improvements in recent years, comparable to changes observed in the United States. Changes in income do not explain cross-time or cross-country differences.
    JEL: I14 J11 J14
    Date: 2018–08
  21. By: Carla Guerriero (Università di Napoli Federico II and CSEF); Abrines Jaume N. (Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.); Diaz-Ordaz K. (London School of Hygiene and Tropical Medicine, London, UK a); Brown K. (Institute of Cardiovascular Science, University College London, London, UK); Wray J. (London School of Hygiene and Tropical Medicine, London, UK.); Ashworth J. (Animation, Royal College of Art, London, UK.); Abbiss M. (Animation, Royal College of Art, London, UK.); Cairns J. (Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.)
    Abstract: The Child Health Utility-9D (CHU-9D) is the only generic preference based measure specifically developed to elicit health-related quality of life directly from children aged 7 to 11 years. The aim of this study was to investigate whether the use of animation on a touch screen device (tablet) is a better way of collecting health status information from children aged 4 to 14 years compared to a traditional paper questionnaire. The specific research questions were firstly, do young children (4 to 7 years) find an animated questionnaire easier to understand; secondly, independent of the child’s age, is completion of an animated questionnaire easier for sick children in hospital settings; and thirdly, do children’s preferences for the different versions of the questionnaire vary by the age of the child. Using a balanced cross-over trial we administered different versions of the CHU-9D to 221 healthy children in a school setting and 217 children with health problems in a hospital setting. The study tested five versions of the CHU-9D questionnaire: paper text, tablet text, tablet image, paper image and tablet animation. Our results indicate that the majority of the youngest children aged 4-7 years found the CHU-9D questions easy to answer independent of the type of questionnaire administered. Amongst children aged 7-14 with health problems the type of questionnaire was found to influence understanding. Children aged 7 to 11 years found tablet image and animation easier compared to text questionnaires while the oldest children in hospital found text based questionnaires easier compared to image and animation. Children in all three age groups preferred animation on a tablet to other methods of assessment. Our results highlight the potential for using an Animated Preference Based Measure to the health of children as young as 4 years.
    Keywords: Children health valuation; Animation; self-reported health state measure; CHU-9D
    JEL: I10 I12 I31
    Date: 2018–09–02
  22. By: Boysen, O.; Bradford, H.; Urban, K.; Balie, J.
    Abstract: The consumption of highly processed food has been singled out as one of the factors responsible for the rapidly increasing obesity prevalence and its associated non-communicable diseases and costs. While obesity prevalence is still comparatively low in the lower income Sub-Saharan Africa (SSA), its development prospects render its markets especially interesting for these foods whose consumption is already growing at higher rates than in developed countries. This might be reflected in the massive rise in obesity prevalence growth rates in SSA over the past decade. Nevertheless, many of these countries are simultaneously struggling with high undernutrition prevalence. With a focus on SSA, this study econometrically investigates the effect of higher import tariffs on highly processed vis-a-vis less processed foods with respect to their impacts on obesity and underweight prevalence utilizing a newly constructed cross-country panel dataset. The effects of the tariff differences found are significant and substantial in cases differentiated by income level of the country as well as gender. The results more generally show that policies affecting the consumer price differential between the two food groups are effective for influencing obesity and underweight prevalence and that these two issues cannot be treated as being separate.
    Keywords: Agricultural and Food Policy, Food Consumption/Nutrition/Food Safety, International Development
    Date: 2018–07

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