nep-hea New Economics Papers
on Health Economics
Issue of 2018‒09‒24
eleven papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. An Equilibrium Model of the African HIV/AIDS Epidemic By Jeremy Greenwood; Philipp Kircher; Cezar Santos; Michèle Tertilt
  2. Long-run improvements in human health: Steady but unequal By Abeliansky, Ana Lucia; Strulik, Holger
  3. Health Capital Taxation By Job Boerma; Ellen McGrattan
  4. Hazed and Confused: The Effect of Air Pollution on Dementia By Kelly C. Bishop; Jonathan D. Ketcham; Nicolai V. Kuminoff
  5. Spatial Discrete Choice Models: A Review Focused on Specification, Estimation and Health Economics applications By Giuseppe Arbia; Anna Gloria Billé
  6. Twin Birth and Maternal Condition By Bhalotra, Sonia R.; Clarke, Damian
  7. The within-month pattern of medical utilization among SNAP participants By Fayaz Farkhad, Bita; Meyerhoefer, Chad D.; Dearden, James A.
  8. Mortality shifts and mortality compression. The case of Norway, 1900-2060 By Nico Keilman; Dinh Q. Pham; Astri Syse
  9. Market Effects of Adverse Regulatory Events: Evidence from Drug Relabeling By Matthew J. Higgins; Xin Yan; Chirantan Chatterjee
  10. Conditional cash transfers, spillovers and informal health care: Evidence from Peru By Guerrero, Natalia; Molina, Oswaldo; Winkelried, Diego
  11. Orange Fanta vs orange fruit: A novel measure of nutrition knowledge and women’s diet quality in Malawi By Schneider, K.; Masters, W.A.

  1. By: Jeremy Greenwood; Philipp Kircher; Cezar Santos; Michèle Tertilt
    Abstract: Twelve percent of the Malawian population is HIV infected. Eighteen percent of sexual encounters are casual. A condom is used a third of the time. To analyze the Malawian epidemic, a choice-theoretic general equilibrium search model is constructed. In the developed framework, people select between different sexual practices while knowing the inherent risk. The calibrated model is used to study several policy interventions. The analysis suggests that the efficacy of public policy depends upon the induced behavioral changes and equilibrium effects. The framework thus complements the insights provided by epidemiological studies and small-scale field experiments.
    Keywords: ART, circumcision, condoms, disease transmission, epidemiological studies, HIV/AIDS, homo economicus, knowledge about HIV, Malawi, marriage, policy intervention, search, small field experiments, STDs, sex markets
    JEL: I18 J12 O11 O55
    Date: 2018
  2. By: Abeliansky, Ana Lucia; Strulik, Holger
    Abstract: There exists a steady trend at which later born cohorts, at the same age, are healthier than earlier born cohorts. We show this trend by computing a health deficit index for a panel of 14 European Countries and six waves of the Survey of Health, Aging, and Retirement in Europe (SHARE). We find that for each year of later birth, health deficits decline by on average 1.4 - 1.5 percent with insignificant differences between men and women, between countries, and over time. We argue that this trend approximates the rate of medical progress, broadly defined. The steady progress implies substantial delays of human aging. For example, the level of health deficits experienced at age 65 by individuals born 1920 is predicted to be experienced at age 85 by individuals born 1945. The potential health gains are not fully appropriated by individuals of low socio-economic status. Their health deficits decline at about the same rate but from a higher level, which means that we find long-run persistence of health inequality.
    Keywords: health,aging,health deficit index,medical progress,health inequality
    JEL: I10 I14 I15 I24
    Date: 2018
  3. By: Job Boerma (University of Minnesota); Ellen McGrattan (University of Minnesota)
    Abstract: This paper studies the design of health care and tax policies in a quantitative macroeconomic model. We theoretically and quantitatively characterize the optimal taxation on consumption, health investments, earnings and capital investments. Policies are constrained due to private information with respect to shocks to household labor productivity and health status. We compare the results to actual policies and household allocations in the Netherlands, a country with a single-payer system but vast differences in health expenditures and mortality rates across income groups.
    Date: 2018
  4. By: Kelly C. Bishop; Jonathan D. Ketcham; Nicolai V. Kuminoff
    Abstract: We test whether long-term exposure to air pollution degrades human capital by causing dementia. We link fifteen years of Medicare records for 6.9 million adults age 65 and older to the EPA’s air quality monitoring network and track the evolution of individuals’ health, onset of dementia, financial decisions, and cumulative residential exposure to fine-particulate air pollution (PM2.5). Our instrumental variables framework capitalizes on quasi-random variation in pollution exposure due to the EPA’s 2005 designation of nonattainment counties for PM2.5. We find that a 1 microgram-per-cubic-meter increase in average decadal exposure (9.1% of the mean) increases the probability of receiving a dementia diagnosis by 1.3 percentage points (6.7% of the mean). This finding is consistent with hypotheses from the medical literature. We conclude that regulation of air pollution has greater benefits than previously known, in part because dementia impairs financial decision making. We estimate that the dementia-related benefits of the EPA’s county nonattainment designations exceeded $150 billion. We also find that the effect of PM2.5 on dementia persists below current regulatory thresholds.
    JEL: I18 Q53
    Date: 2018–08
  5. By: Giuseppe Arbia (Catholic University of the Sacred Heart, Rome, Department of Statistical Science); Anna Gloria Billé (Free University of Bozen-Bolzano, Faculty of Economics and Management)
    Abstract: Modeling individual choices is one of the main aim in microeconometrics. Discrete choice models have been widely used to describe economic agents' utility functions, and most of them play a paramount role in applied health economics. On the other hand, spatial econometrics collects a series of econometric tools which are particularly useful when we deal with spatially-distributed data sets. It has been demonstrated that accounting for spatial dependence can avoid inconsistency problems of the commonly used estimators. However, the complex structure of spatial dependence in most of the nonlinear models still precludes a large diffusion of these spatial techniques. The purpose of this paper is then twofold. The former is to review the main methodological problems and their different solutions in spatial discrete choice modeling as they have appeared in the econometric literature. The latter is to review their applications to health issues, especially in the last few years, by highlighting at least two main reasons why spatial discrete neighboring effects should be considered and then suggesting possible future lines of the development of this emerging field.
    Keywords: Discrete Choice Modeling, Health Economics, Spatial Econometrics
    JEL: C31 C35 C51 I10
    Date: 2018–09
  6. By: Bhalotra, Sonia R. (University of Essex); Clarke, Damian (Universidad de Santiago de Chile)
    Abstract: Twin births are often construed as a natural experiment in the social and natural sciences on the premise that the occurrence of twins is quasi-random. We present new population-level evidence that challenges this premise. Using individual data for 17 million births in 72 countries, we demonstrate that indicators of mother's health and health-related behaviours are systematically positively associated with the probability of a twin birth. The estimated associations are sizeable, evident in richer and poorer countries, evident even among women who do not use IVF, and hold for numerous different measures of health. We discuss potential mechanisms, showing evidence that favours selective miscarriage. Positive selection of women into twinning implies that estimates of impacts of fertility on parental investments and on women's labour supply that use twin births to instrument fertility will tend to be downward biased. This is pertinent given the emerging consensus that these relationships are weak. Our findings also potentially challenge the external validity of studies that rely upon twin differences.
    Keywords: parental investment, fertility, miscarriage, maternal health, twins, women's labor supply
    JEL: J12 J13 C13 D13 I12
    Date: 2018–08
  7. By: Fayaz Farkhad, Bita; Meyerhoefer, Chad D.; Dearden, James A.
    Keywords: Agricultural and Food Policy, Food Security and Poverty, Food Consumption/Nutrition/Food Safety
    Date: 2017–07–03
  8. By: Nico Keilman; Dinh Q. Pham; Astri Syse (Statistics Norway)
    Abstract: Historically, official Norwegian mortality projections computed by Statistics Norway have consistently under-predicted life expectancy. The projected age distribution of deaths may be used to check if the official mortality projections are plausible. The aim of the paper is to verify whether the projections predict a continuation of the ongoing compression in mortality and of the steady upward shift in the ages at which people die. We use official period data on observed (1900-2015) and projected (2016- 2060) sex- and age-specific mortality to estimate the age distribution of life table deaths. We analyse trends in life expectancy at birth, modal and median ages at death, and standard deviation of the age distribution at ages > 30. The historical shifts towards longer longevity are projected to continue into the future. The projections suggest a steady increase in the modal and the median age at death for men and women towards values between 90 and 94 years in 2060. At present these ages are in the range 83-90 years. Simultaneously, deaths become more concentrated around the mean, as the standard deviation of the age distribution is projected to fall continuously. Statistics Norway’s projection methodology is capable of tracking ongoing processes of mortality shifts towards higher ages and a compression of mortality around the modal and mean ages. Mortality projections could potentially benefit from including assessments of the age distribution of deaths.
    Keywords: age distribution; life expectancy; median age; modal age; mortality compression; mortality delay; Norway; population projection
    JEL: C53 I10
    Date: 2018–09
  9. By: Matthew J. Higgins; Xin Yan; Chirantan Chatterjee
    Abstract: The FDA maintains post-approval safety surveillance programs to monitor the safety of drugs. As adverse events are reported, the FDA may choose to intervene and change the safety labeling associated with a drug. We provide causal evidence of the impact that these regulatory interventions have on aggregate demand for pharmaceuticals. We find that aggregate demand declines by 16.9 percent within two years of a relabeling event. After accounting for substitution patterns by physicians along with competitor actions, aggregate demand declines by 5.1 percent. Critically, this decline represents consumers that leave the market. The overall effect appears to be driven by ‘high-intensity’ markets or those with significant relabeling activity. Results control for the level of advertising and are robust to variation across types of relabeling, market sizes, levels of competition and degrees of cross-molecular substitution.
    JEL: I18 L51 L65
    Date: 2018–08
  10. By: Guerrero, Natalia; Molina, Oswaldo; Winkelried, Diego
    Abstract: The use of low-quality informal health-care providers (IHCPs) is still prominent in developing countries despite the efforts of their governments to expand institutional services. The use of conditional cash transfer (CCT) programs have become instrumental in encouraging the use of formal health services, but little is known about their direct effect on the use of IHCPs. We use a large survey of rural households and a regression discontinuity design to estimate the effects of the Peruvian CCT program on the demand for IHCP. We find a sizeable reduction in the use of IHCPs not only in targeted but also in non-targeted members of treated households. This finding indicates the existence of spillover effects within the household. We also provide evidence that beyond the direct increase in income, the availability of better information about institutional services is a potential mechanism that drives these effects. We also find a corresponding improvement in the self-perception of health status. Our results are robust to a number of sensitivity analyses.
    Keywords: Informal health-care providers, cash transfer program, regression discontinuity.
    JEL: C21 I18 O17
    Date: 2018–08–20
  11. By: Schneider, K.; Masters, W.A.
    Abstract: This paper uses a novel survey instrument to identify distinct components of nutrition knowledge, and test for links between knowledge and dietary choices in Southern Malawi. Our first aim is to distinguish respondents’ familiarity with recommended behaviors, such as when to start breastfeeding or introduce solid foods, from respondents’ factual knowledge about mechanisms, such as whether biscuits or papaya and orange fruit or orange Fanta contribute more to future health. We find knowledge of nutrition behaviors to be strongly associated with more schooling, older age and being female, while knowledge of mechanisms is associated only with training and employment as a health professional. We then test whether this expanded definition of nutrition knowledge is associated with dietary intake when controlling for other factors, and find only suggestive evidence for significant links interacting with age of respondents. These findings point to the need for knowledge surveys and public health behavior-change campaigns to address the kinds of information that might have the most influence on actual behavior, potentially including the mechanisms involved in food composition, food safety and disease transmission.
    Keywords: Agricultural and Food Policy, Food Consumption/Nutrition/Food Safety, International Relations/Trade
    Date: 2018–07

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