nep-hea New Economics Papers
on Health Economics
Issue of 2018‒10‒08
twenty papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Forward-looking moral hazard in social insurance: evidence from a natural experiment By Eliason, Marcus; Johansson, Per; Nilsson, Martin
  2. Labor Market Effects of U.S. Sick Pay Mandates. By Stefan Pichler; Nicolas Ziebarth
  3. Strategic Ignorance of Health Risk: Its Causes and Policy Consequences By Jonas Nordström; Linda Thunström; Klaas van ’t Veld; Jason F. Shogren; Mariah Ehmke
  4. Physician Density and Infant Mortality: A Semiparametric Analysis of the Returns to Health Care Provision By Helge Liebert; Beatrice Mäder
  5. Can a shift of neighborhoods affect mental health? Evidence from a quasi-random allocation of applicants in the public social housing system. By Boje-Kovacs, Bence; Greve, Jane; Weatherall, Cecilie Dohlmann
  6. Infant Feeding Practices: The Impact of WIC Policy Changes on Rural and Urban Participants By Di, Hongyang; Ishdorj, Ariun; McKyer, Lisako
  7. Factors Affecting Spatial Differences in Health Outcomes By Poku-Agyemang, Kwadwo; Fannin, J. Matthew
  8. "London fog: A century of pollution and mortality, 1866-1965" By Walker Hanlon
  9. Well-being and intended early retirement among older European workers: does job satisfaction matter? A 6-Wave follow-up By Cantarero-Prieto, David; Pascual-Sáez, Marta; Blázquez-Fernández, Carla
  10. Neighborhoods and youth health: Everybody needs good neighbors? By Björkegren, Evelina
  11. What Drives the Distribution of Rural Doctors? By Dudensing, Rebekka; Carpenter, Craig W.; Liu, Jyh C.
  12. Projecting Demand for the Services of Primary Care Doctors: Working Paper 2017-03 By Congressional Budget Office
  13. The Impact of New Medicines in the NHS: 70 Years of Innovation By Sampson, C.; O'Neill, P.; Lorgelly, P.
  14. The French Health Care System at a Juncture: Stakeholder Analysis, Networks and Idiosyncratic Reforms By Daniel Simonet
  15. On the Scaling Patterns of Infectious Disease Incidence in Cities By Andres Gomez-Lievano; Oscar Patterson-Lomba
  16. Global Alcohol Markets: Evolving Consumption Patterns, Regulations and Industrial Organizations By Kym Anderson; Giulia Meloni; Johan Swinnen
  17. Soda Consumption in the Tropics: The Trade-Off between Obesity and Diarrhea in Developing Countries By Patricia I. Ritter
  18. A fleet of packages for inputting United Kingdom primary care data By Roger Newson
  19. Econometrics with Weak Instruments By Marmer, Vadim
  20. Analysing time-to-event data in the presence of competing risks within the flexible parametric modelling framework. What tools are available in Stata, which one to use and when? By Sarwar Islam Mozumder

  1. By: Eliason, Marcus (IFAU - Institute for Evaluation of Labour Market and Education Policy); Johansson, Per (IFAU - Institute for Evaluation of Labour Market and Education Policy); Nilsson, Martin (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: This study tests for forward-looking moral hazard in the social insurance system by exploiting a 1991 reform in Sweden. The replacement rate was reduced for short absences but not for long absences, which introduced a potential future cost of returning to work. Using this exogenous variation in the replacement rate and controlling for dynamic selection, we find that the potential future cost of returning to work decreased the outflow from absence by 10 percent. This finding suggests that long-term sickness absentees are forward-looking, and highlights the importance of taking forward-looking behavior into account when designing and evaluating social insurance programs.
    Keywords: disability Insurance; dynamic Incentives; forward-looking behavior; moral hazard; natural experiment; sickness absence; sickness insurance
    JEL: H55 I12 I13 J22
    Date: 2018–09–05
  2. By: Stefan Pichler (ETH Zurich); Nicolas Ziebarth (Cornell University)
    Abstract: This paper exploits temporal and spatial variation in the implementation of nine-city- and four state-level U.S. sick pay mandates to assess their labor market consequences. We use the synthetic control group method and traditional difference-in-differences models along with the Quarterly Census of Employment and Wages to estimate the causal effects of mandated sick pay on employment and wages. We do not find much evidence that employment or wages were significantly affected by the mandates that typically allow employees to earn one hour of paid sick leave per work week, up to seven days per year. Employment decreases of 2 percent lie outside the 92 percent confidence interval and wage decreases of 3 percent lie outside the 95 percent confidence interval.
    Keywords: sick pay mandates, sick leave, medical leave, employer mandates, employment, wages, synthetic control group method (SCGM), Quarterly Census of Employment and Wages (QCEW), United States (U.S.)
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2018–09
  3. By: Jonas Nordström (Department of Food and Resource Economics, University of Copenhagen; Lund University School of Economics and Management); Linda Thunström (Department of Economics, University of Wyoming); Klaas van ’t Veld (Department of Economics, University of Wyoming); Jason F. Shogren (Department of Economics, University of Wyoming); Mariah Ehmke (Department of Agricultural and Applied Economics, University of Wyoming)
    Abstract: We examine the causes and policy consequences of strategic (willful) ignorance of risk as an excuse to overengage in risky health behavior. In an experiment on Copenhagen adults, we allow subjects to choose whether to learn the calorie content of a meal before consuming it, and measure their subsequent calorie intake. We find strong evidence of strategic ignorance: 46% of subjects choose to ignore calorie information, and these subjects subsequently consume more calories on average than they would have had they been informed. We find that strategically ignorant subjects downplay the health risk of their preferred meal being high-calorie, which we formally show is consistent with the theory of optimal expectations about risk. Further, we find that the prevalence of strategic ignorance largely negates the effectiveness of calorie information provision: on average, subjects who have the option to ignore calorie information consume about the same number of calories as subjects who are provided no information.
    Keywords: strategic ignorance, willful ignorance, risk perception, optimal expectations, calories, information.
    JEL: D11 D12 D81 D83 D91 I12
    Date: 2018–09
  4. By: Helge Liebert; Beatrice Mäder
    Abstract: This paper investigates the effect of physicians on infant mortality, stillbirths and the incidence of common childhood diseases. We construct a new panel data set covering German municipalities from 1928 to 1936 based on historical sources. The endogeneity of health care supply is addressed by using the expulsion of Jewish physicians from health insurance schemes by the Nazi government in 1933 as a source of exogenous variation in regional physician density. The results indicate substantial mortality effects due to changes in physician density. One additional physician per 1,000 of population reduces infant mortality by 23% and stillbirths by 16%. We find similar negative effects for gastrointestinal diseases and the incidence of measles, influenza and bronchitis. To investigate diminishing returns to health care provision, we develop a semiparametric control function approach. Our results indicate that the marginal returns to physicians are highly nonlinear and decreasing.
    Keywords: infant mortality, physicians, health care supply, childhood diseases, semiparametric IV
    JEL: I10 I18 N34
    Date: 2018
  5. By: Boje-Kovacs, Bence; Greve, Jane; Weatherall, Cecilie Dohlmann
    Abstract: Mental health problems generate vast pecuniary and non-pecuniary costs for the individual, for relatives, and for society. Living in deprived neighborhoods has been shown to influence, among other things, labor market outcomes and crime. Therefore, we explore how living in a deprived neighborhood with different characteristics influences the mental health of the residents. We utilize a quasi-random allocation of applicants into different neighborhoods through the public social housing (PSH) office to estimate the effect on mental health of living in a deprived neighborhood. The applicants entitled to PSH are lower-income residents with both an urgent housing problem and social problems. Our results suggest that being exposed to a deprived neighborhood as an adult has a significant negative impact on mental health among vulnerable men. We find that besides the usual characteristics of a deprived neighborhood—i.e., high shares of people without employment and with low income—the share of people with mental health problems is an important characteristic of the neighborhood that has a negative impact on mental health among men.
    Keywords: Deprived neighborhood, mental health, prescription of psychiatric medication, quasi-random allocation, administrative registry panel data, intention-to-treat, treatment on the treated, neighborhood characteristics
    JEL: I12 I14 R23
    Date: 2018–07–09
  6. By: Di, Hongyang; Ishdorj, Ariun; McKyer, Lisako
    Abstract: The 2009 WIC Program policy changes were designed to improve breastfeeding rates and health outcomes of WIC participants. Existing research in this area found that participants shifted towards healthier eating behavior after the changes in WIC food packages. However, little is known about the effect of these changes on the rural participants. Using the data from the National Food and Nutrition Survey (NATFAN), we examined the effects of the revised WIC food packages on breastfeeding among WIC participants in rural and non-rural areas, and food deserts. Our findings show that WIC participants were more likely to choose fully breastfeeding package after the revisions in WIC. Furthermore, we found that participants who were Hispanic, with lower degrees of education, living in the Southern region of the United States were less likely to choose full breastfeeding package. Overall, a greater proportion of rural participants utilized full breastfeeding package than non-rural participants.
    Keywords: Food Consumption/Nutrition/Food Safety, Health Economics and Policy
    Date: 2018–01–17
  7. By: Poku-Agyemang, Kwadwo; Fannin, J. Matthew
    Abstract: This study sought to understand the disparities between non-core/micropolitan communities and metropolitan communities on life expectancy. The study also assessed the impact of individual behavioral choices and certain social variables and state and county level policies that affect the life expectancy in a county. A descriptive comparison analysis was employed to establish the differences in life expectancy across the various levels of the urban hierarchy in 1559 counties in the United States. An ordinary least squares model was used to tease out the relationship between specific individual choice factors -- smoking habits, obesity and exercise habits -- and several socio-economic variables on life expectancy. This study also estimated the effects of each correlate at the various levels of the urban hierarchy. The study concluded that the effects of both individual choice factors differed greatly across the various levels of rurality but less differences existed between the functional relationships of socioeconomic characteristics and life expectancy across the urban hierarchy.
    Keywords: Community/Rural/Urban Development, Health Economics and Policy
    Date: 2018–01–17
  8. By: Walker Hanlon (NYU Stern School of Business)
    Abstract: "This study provides new evidence on the impact of air pollution in London over the century from 1866-1965. To identify weeks with elevated pollution levels I use new data tracking the timing of London’s famous fog events, which trapped emissions in the city. These events are compared to detailed new weekly mortality data. My results show that acute pollution exposure due to fog events accounted for at least one out of every 200 deaths in London during this century. I provide evidence that the presence of infectious diseases of the respiratory system, such as measles and tuberculosis, increased the mortality effects of pollution. As a result, success in reducing the infectious diseases burden in London in the 20th century reduced the impact of pollution exposure and shifted the distribution of pollution effects across age groups."
    JEL: N00
    Date: 2018–04
  9. By: Cantarero-Prieto, David; Pascual-Sáez, Marta; Blázquez-Fernández, Carla
    Abstract: In recent years, population aging has received great attention in developed countries given the social challenges that it entails. At this regard, it is well documented that this collective is associated with fewer resources (both physical and economic). Furthermore, ageing societies incite an increase in the inactive population and so, threaten the financial viability of the social protection systems. This study investigates the effects of different factors on early retirement intentions among European workers aged 50-65 using the latest available data (waves 1-6: 2004-2015) from the Survey of Health, Ageing and Retirement in Europe (SHARE). We shed new light on this causal relationship controlling for job characteristics and well-being indicators. Our empirical results based on logistics regressions suggest that people that is satisfied with their jobs (OR = 0.61; 95 % C.I. 0.53, 0.71), with very high appreciation of their quality of life (OR = 0.56; 95 % C.I. 0.49, 0.64) or with good health (OR = 0.55; 95 % C.I. 0.47, 0.65) would have less intentions of early retirement, that is, decreased odds of work exit. Besides, social-environment would matter.
    Keywords: Early retirement intentions; Job satisfaction; Quality of life; Health; SHARE; Panel.
    JEL: I10 J26 J28
    Date: 2018
  10. By: Björkegren, Evelina (Uppsala University)
    Abstract: There are large differences in health across neighborhoods in Sweden. To try to answer if there is a causal link between neighborhood conditions in childhood and youth health, I apply two different empirical strategies. First, I use population wide data on families living in different areas in Sweden, and estimate the effects of childhood neighborhood on youth health using data on families that move across the country. Since the choice of moving and where to live is endogenous, I exploit the timing of moves and estimate the effect of siblings’ different exposure time to neighborhoods. The second approach utilizes a governmental policy that assigned refugees to their initial neighborhood in Sweden, potentially offering exogenous variation in neighborhoods and allowing me to study the effect of different neighborhoods on youth health. The findings from the two strategies together imply that there are significant neighborhoods effects on youth health, but that the effects are contemporaneous and there is no evidence of exposure time effects.
    Keywords: Health; Inequality; Neighborhoods; Childhood
    JEL: I14 J62 R00
    Date: 2018–06–10
  11. By: Dudensing, Rebekka; Carpenter, Craig W.; Liu, Jyh C.
    Abstract: A number of media stories document a “shortage” of doctors in rural communities. The distribution of primary care physicians (PCP) is remarkably similar to the distribution of other services, including grocery stores, suggesting the role of regional economic factors in determining doctor location. This national study examines variables associated with the number of PCP per 100,000 people at the county level. Demographic factors significantly associated with the PCP rate include population density, the share of the population living outside urban cluster or urbanized areas, and the share of Hispanic residents. Economic factors include post-secondary education, out-commuting, the share of the workforce in agriculture and natural resource industries, employer law establishments per 100,000 people, and the presence of broadband. Being located in a Medicaid expansion state was the only significant insurance-related variable, but significance was sensitive to how expansion status was determined. Results suggest that decision makers should be cognizant of the role of economic changes in affecting, as well as reflecting, changes in the healthcare sector.
    Keywords: Community/Rural/Urban Development, Health Economics and Policy
    Date: 2018–01–17
  12. By: Congressional Budget Office
    Abstract: Policymakers and other observers have raised concerns that demand for primary care services will exceed supply, which could adversely affect people’s health and might also increase total spending on health care. Defining demand as the amount of primary care that people received, we estimate that the general U.S. population demanded about $70 billion worth of services from primary care doctors in 2013. After being adjusted for general price inflation, that represents a 15.5 percent increase since 2003—when demand totaled about $61 billion (in 2013 dollars). We defined demand
    JEL: I11 I18 J11
    Date: 2017–05–26
  13. By: Sampson, C.; O'Neill, P.; Lorgelly, P.
    Abstract: The NHS in England and Wales came into existence on the 5th July 1948. It provided coverage for a range of approved medical and pharmaceutical interventions. This resulted in rapid growth in the use of medicines and improved public health with its associated improvements in economic growth and development. This OHE Consulting Report demonstrates the contribution and impact of medicines to the health economy in the UK throughout the 70 year history of the NHS. Through interviews with experts we identified a shortlist of the most important medicines to have been brought to market, and from a review of the literature and evidence base we attempt to quantify the benefits of these key medicines in terms of health and economic outcomes. We additionally consider the broader impact of medicines and drug development to the health care environment. Our interviews with experts identified a shortlist of ten important new medicines introduced in the NHS in the last 70 years. These were selected from a longer list of 37 on the basis of the frequency that they were cited by interviewees and the strength of feeling about the magnitude of their positive impact in the NHS. Our evidence search identified a variety of benefits encompassing improvement in clinical outcomes, survival benefits, quality of life improvement, greater health service efficiency, and wider societal impacts. Our analysis of the interviews identified seven themes, each representing a factor that has played an important role in determining the impact of new medicines. These themes highlight a variety of ways in which policymakers can facilitate positive impact from new medicines. Their role should be considered in the use of medicines in the NHS over the next 70 years and for new medicines currently in the development pipeline.
    Keywords: Economics of innovation
    JEL: I1
    Date: 2018–08–01
  14. By: Daniel Simonet (American University of Sharjah)
    Abstract: The French health system was at a juncture in the 2000s. Policy makers faced multiple conflicting expectations from a variety of stakeholders. Our aim is to investigate two critical stakeholders: patients, whose sovereignty was weakened, and physicians, whose values have shifted. The provision of health services took a different shape. The emphasis is now on territorial networks.Our approach consists of a literature review that investigated the critical elements of French health care reforms. As such, the article will trace the evolution of health care stakeholders, , the impact of reforms on patient sovereignty and on physician?s professional values. In retrospect, it appears that the invasion of norms led to a democratic recess that reinstated the French Jacobinist tradition at the expense of citizen engagement and patient sovereignty. As for physicians who remained the last gatekeeper of ethics, they developed new coping and anchoring strategies.The article gives a critical appraisal of the prevailing administrative principles contained in the French administrative apparatus, and how these were translated into practice with respect to the uniformisation of services and the concentration of power within a newly-formed Welfare elite.France adopted an idiosyncratic market model that contrast with Anglo-Saxon Public Private Partnerships and consumer-driven approach. Verticalization of the chain of command and concentration of decision-making power became salient characteristics of French reforms that contrast with Anglo-Saxon de-amalgamation strategies.
    Keywords: Health Care, Participation, Citizen Engagement, New Public Management, France
    JEL: H83
    Date: 2018–07
  15. By: Andres Gomez-Lievano (Center for International Development at Harvard University); Oscar Patterson-Lomba (Harvard T.H. Chan School of Public Health)
    Abstract: Urban areas with larger and more connected populations offer an auspicious environment for contagion processes such as the spread of pathogens. Empirical evidence reveals a systematic increase in the rates of certain sexually transmitted diseases (STDs) with larger urban population size. However, the main drivers of these systemic infection patterns are still not well understood, and rampant urbanization rates worldwide makes it critical to advance our understanding on this front. Using confirmed-cases data for three STDs in US metropolitan areas, we investigate the scaling patterns of infectious disease incidence in urban areas. The most salient features of these patterns are that, on average, the incidence of infectious diseases that transmit with less ease– either because of a lower inherent transmissibility or due to a less suitable environment for transmission– scale more steeply with population size, are less predictable across time and more variable across cities of similar size. These features are explained, first, using a simple mathematical model of contagion, and then through the lens of a new theory of urban scaling. These frameworks help us reveal the links between the factors that determine the transmissibility of infectious diseases and the properties of their scaling patterns across cities.
    Keywords: cities, infectious diseases
    Date: 2018–09
  16. By: Kym Anderson; Giulia Meloni; Johan Swinnen
    Abstract: For millennia alcoholic drinks have played an important role in food security and health (both positive and negative), but consumption patterns of beer, wine and spirits have altered substantially over the past two centuries. So too have their production technologies and industrial organization. Globalization and economic growth have contributed to considerable convergence in national alcohol consumption patterns. The industrial revolution contributed to excess consumption by stimulating demand and lowering the cost of alcohol. It also led to concentration in some alcohol industries, expecially brewing. In recent years the emergence of craft producers has countered firm concentration and the homogenization of alcoholic beverages. Meanwhile, governments have intervened extensively in alcohol markets to reduce excessive consumption, raise taxes, protect domestic industries and/or ensure competition. These regulations have contributed to, and been affected by, evolving patterns of consumption and changing structures of alcohol industries.
    Keywords: Globalization of preferences; Convergence of national beverage consumption mix; Alcohol and health; Restrictions on alcohol consumption and production; Beverage firm concentration
    Date: 2018
  17. By: Patricia I. Ritter (University of Connecticut)
    Abstract: Increases in soda consumption mirror the increase in obesity rates in many countries of the world. This association, however, might be explained by third factors that are correlated with both trends. This paper exploits a natural experiment in Peru and finds that households without running water at home are especially responsive to changes in the price of soda, which generates not only an important increase in obesity rates but also a reduction in diarrhea prevalence. If the soda companies reach populations before the government can supply clean water, diarrhea prevalence might decrease, but at the cost of increasing obesity prevalence.
    Keywords: Obesity, diarrhea, soft drinks, clean water
    JEL: I12 I18 H41 O12
    Date: 2018–10
  18. By: Roger Newson (Department of Primary Care and Public Health, Imperial College London)
    Abstract: The Clinical Practice Research Datalink (CPRD) is a centrally-managed data warehouse, storing data provided by the primary-care sector of the United Kingdom (UK) National Health Service (NHS). Medical researchers request retrievals from this database, which take the form of a collection of text datasets, whose format can be complicated. I have written a flagship package cprdutil, with multiple modules to input into Stata the many text dataset types provided in a CPRD retrieval. These text datasets may be converted either to Stata value labels or to Stata datasets, which can be created complete with value labels, variable labels, and numeric Stata dates. I have also written a fleet of satellite packages, to input into Stata the text datasets for retrievals of linked data, in which data are provided from non-CPRD sources, with CPRD identifier variables as a foreign key to allow data linkage. The modules of cprdutil are introduced. A demonstration example is given, in which a minimal CPRD database is produced in Stata, using cprdutil, and some principles of sensible programming practice for creating large databases are illustrated.
    Date: 2018–10–15
  19. By: Marmer, Vadim
    Abstract: Lecture notes on weak instruments
    Keywords: Weak Instruments
    JEL: C12 C36
    Date: 2018–09–09
  20. By: Sarwar Islam Mozumder (Biostatistics Research Group, Department of Health Sciences, University of Leicester)
    Abstract: In a typical survival analysis, the time to an event of interest is studied. For example, in cancer studies, researchers often wish to analyse a patient’s time to death since diagnosis. Similar applications also exist in economics and engineering. In any case, the event of interest is often not distinguished between different causes. Although this may sometimes be useful, in many situations, this will not paint the entire picture and restricts analysis. More commonly, the event may occur due to different causes, which better reflects real- world scenarios. For instance, if the event of interest is death due to cancer, it is also possible for the patient to die due to other causes. This means that the time at which the patient would have died due to cancer is never observed. These are known as competing causes of death, or competing risks. In a competing risks analysis, interest lies in the cause-specific cumulative incidence function (CIF). This can be calculated by either (1) transforming on (all) cause-specific hazards, or (2) using a direct relationship with the subdistribution hazards. Obtaining cause-specific CIFs within the flexible parametric modelling framework by adopting approach (1) is possible by using the stpm2 post-estimation command, stpm2cif. Alternatively, since competing risks is a special case of a multi-state model, an equivalent model can be fitted using the multistate package. To estimate cause-specific CIFs using approach (2), stpm2 can be used by applying time-dependent censoring weights which are calculated on restructured data using stcrprep. The above methods involve some form of data augmentation. Instead, estimation on individual-level data may be preferred due to computational advantages. This is possible using either approach, (1) or (2), with stpm2cr. In this talk, an overview of these various tools are provided followed by some discussion on which of these to use and when.
    Date: 2018–10–15

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.
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