nep-hea New Economics Papers
on Health Economics
Issue of 2018‒10‒29
twelve papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Pauvreté, Egalité, Mortalité: Mortality (In)Equality in France and the United States By Janet CURRIE; Hannes SCHWANDT; Josselin THUILLIEZ
  2. Genes, Education, and Labor Market Outcomes: Evidence from the Health and Retirement Study By Nicholas W. Papageorge; Kevin Thom
  3. Understanding Joint Retirement By Pierre-Carl Michaud; Arthur Van Soest; Luc Bissonnette
  4. Discounting Health and Money: New Evidence Using A More Robust Method By Arthur E. Attema; Han Bleichrodt; Olivier L’haridon; Patrick Peretti-Watel; Valérie Seror
  5. Reference Pricing Systems on the Pharmaceutical Market By Unsorg, Maximiliane
  6. Measuring Physicians’ Response to Incentives: Evidence on Hours Worked and Multitasking By Bruce Shearer; Nibene Habib Somé; Bernard Fortin
  7. Womb at work: the missing impact of maternal employment on newborn health By Caroline Chuard
  8. Quiet please! Adverse effects of noise on child development By Makles, Anna; Schneider, Kerstin
  9. Home is where the health is: Housing and adult height from the late 19th to the mid-20th centuries By Carolin Schmidt
  10. Factors affecting women’s choice in selecting confinement centre By Amalina Azmi; Raja Nurul Aini Aziz; Zufara Arneeda B. Zulfakar
  11. Aging Population and Healthcare REITs: A comparative study of Japan and Singapore By Seow Eng Ong; Masanori Kobayashi
  12. Priorities and challenges accessing health care among female migrants By Lattof, Samantha R.; Coast, Ernestina; Leone, Tiziana

  1. By: Janet CURRIE (FERDI); Hannes SCHWANDT (FERDI); Josselin THUILLIEZ (Centre d'Economie de la Sorbonne - Université de Paris I)
    Abstract: We develop a method to compare levels and trends in inequality in mortality in the United States and France in a similar framework. The comparison shows that while income inequality has increased in both the United States and France, inequality in mortality in France remained remarkably low and stable. In the United States, inequality in mortality increased for older groups (especially women) while it decreased for children and young adults. These patterns highlight the fact that despite the strong cross-sectional relationship between income and health, there is no necessary connection between changes in income inequality and changes in health inequality.
    Date: 2018–05
  2. By: Nicholas W. Papageorge (John Hopkins University); Kevin Thom (New York University)
    Abstract: Recent advances have led to the discovery of specific genetic variants that predict educational attainment. We study how these variants, summarized as a linear index — known as a polygenic score — are associated with human capital accumulation and labor market outcomes in the Health and Retirement Study (HRS). We present two main sets of results. First, we find evidence that the genetic factors measured by this score interact strongly with childhood socioeconomic status in determining educational outcomes. In particular, while the polygenic score predicts higher rates of college graduation on average, this relationship is substantially stronger for individuals who grew up in households with higher socioeconomic status relative to those who grew up in poorer households. Second, the polygenic score predicts labor earnings even after adjusting for completed education, with larger returns in more recent decades. These patterns suggest that the genetic traits that promote education might allow workers to better accommodate ongoing skill biased technological change. Consistent with this interpretation, we find a positive association between the polygenic score and non-routine analytic tasks that have benefited from the introduction of new technologies. Nonetheless, the college premium remains the dominant determinant of earnings differences at all levels of the polygenic score. Given the role of childhood SES in predicting college attainment, this raises concerns about wasted potential arising from limited household resources.
    Keywords: human capital, Inequality, education, genes
    JEL: I24 J24
    Date: 2018–10
  3. By: Pierre-Carl Michaud; Arthur Van Soest; Luc Bissonnette
    Abstract: Evidence from different sources shows that spouses' retirement decisions are correlated. Retirement policies affecting individuals in couples are therefore also likely to affect behavior of their spouses. It is therefore important to account for joint features in modeling retirement. This paper studies a structural collective model of labor supply and retirement of both partners in a couple with interdependent preferences, imperfect knowledge of preferences of the spouse, and subjective expectations about the future. We propose a novel method to estimate preferences and the intra-household bargaining process, which relies on stated preferences data collected in the Health and Retirement Study. Respondents were asked to choose between hypothetical retirement trajectories describing the retirement ages and replacement rates of both spouses from three perspectives: considering their own preferences only, the preferences of their spouse only, or the most likely decision for the household. With these data, all model parameters are identified and potential sources of joint retirement can be disentangled. We find that males misperceive their wives' preferences, overestimating their disutility of work. Our estimates correct for this bias. They suggest that correlation in unobserved heterogeneity components of the partners' marginal utility of leisure explains a large share of joint retirement decisions. We also find significant positive complementarities in leisure, but this explains a much smaller part of joint retirement.
    Keywords: Collective models, Leisure complementarity, Stated choices, Identification.
    JEL: D13 J26 C81
    Date: 2018
  4. By: Arthur E. Attema (Erasmus School of Economics - Erasmus University Rotterdam, iBMG - Erasmus University Rotterdam); Han Bleichrodt (Erasmus School of Economics - Erasmus University Rotterdam); Olivier L’haridon (CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR1 - Université de Rennes 1 - UNIV-RENNES - Université de Rennes - CNRS - Centre National de la Recherche Scientifique); Patrick Peretti-Watel (SESSTIM - U1252 INSERM - AMU - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale); Valérie Seror (SESSTIM - U1252 INSERM - AMU - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale)
    Abstract: This study compares discounting for money and health in a field study. We applied the direct method, which measures discounting independent of utility, in a representative French sample, interviewed at home by professional interviewers. We found more discounting for money than for health. The median discount rates (6.5% for money and 2.2 % for health) were close to market interest rates suggesting that the direct method solves the puzzle of unrealistically high discount rates typically observed in applied economics. Constant discounting fitted the data better than hyperbolic discounting. The substantial individual heterogeneity in discounting could be explained by age and occupation.
    Keywords: Hyperbolic discounting,Constant discounting,Health versus money,Time preference,Direct method,Field study
    Date: 2018–05–09
  5. By: Unsorg, Maximiliane
    Abstract: Constantly rising expenditures for pharmaceuticals and uninformed consumers require government intervention in firms’ pricing strategies. To this end, reference pricing systems are frequently employed as regulatory mechanisms. This paper considers a duopoly market with vertically differentiated firms: a brand-name firm and a firm producing a generic version or a branded copy (depending on competition type). It can be proven that the introduction of a reference price leads to lower equilibrium prices for both firms and that it can induce fiercer competition between brand-name and generic/branded copy firms. Additionally, it can be shown that reference pricing promotes generic usage under sequential price competition. When implementing a reference pricing system, an increased market coverage and, hence, an improved provision of medical supply can be achieved due to the lower prices and the stimulated demand for drugs. Even under a higher supply the consumers’ expenditures decrease under reference pricing. Finally, the model proves the superiority of reference prices over price caps and therefore indicates that reference pricing systems should be preferred.
    Keywords: reference pricing,pharmaceutical market,copayment,price cap,price competition,consumer expenditure
    JEL: I11 I18 L51
    Date: 2018
  6. By: Bruce Shearer; Nibene Habib Somé; Bernard Fortin
    Abstract: We measure the response of physicians to monetary incentives using matched administrative and time-use data on specialists from Québec (Canada). These physicians were paid fee-for-service contracts and supplied a number of different services. Our sample covers a period during which the Québec government changed the prices paid for clinical services. We apply these data to a multitasking model of physician labour supply, measuring two distinct responses. The first is the labour-supply response of physicians to broad-based fee increases. The second is the response to changes in the relative prices of individual services. Our results confirm that physicians respond to incentives in predictable ways. The own-price substitution effects of a relative price change are both economically and statistically significant. Income effects are present, but are overridden when prices are increased for individual services. They are more prominent in the presence of broad-based fee increases. In such cases, the income effect empirically dominates the substitution effet, which leads physicians to reduce their supply of clinical services.
    Keywords: Physician labour supply, multitasking, incentive pay.
    JEL: I10 J22 J33 J44
    Date: 2018
  7. By: Caroline Chuard
    Abstract: Parental leave policies across the globe have become much more generous than they used to be. This is also true for prenatal maternal leave. While this may be costly in the short run, little is known about the effect of maternal employment during pregnancy on newborn health. In this paper, I exploit three sharp policy changes on the duration of paid parental leave in Austria that strongly affected the share of mothers who work up to the 32nd week of pregnancy. I use administrative data from Austria on the working history of women linked to the full Austrian birth register and coupled with a regression discontinuity framework to identify the effect of prenatal employment on their offspring. Maternal employment during pregnancy with the second child reacts strongly to these policy changes. The share of employed mothers sharply declined in 1990 by 19.1 percentage points, increased in 1996 by 7.2 percentage points and declined again by 6.4 percentage points in 2000. None of these changes in prenatal employment translated into effects on newborn health measured via birth weight, gestational length, and Apgar scores. This result holds true for mothers of different socioeconomic backgrounds and across industries. The effect is precisely estimated, which suggests that prenatal employment prior to the 32nd week of pregnancy does not causally affect the fetus for measures visible at birth.
    Keywords: Newborn health, maternal employment, pregnancy conditions, maternal leave
    JEL: I10 J13 J16
    Date: 2018–10
  8. By: Makles, Anna; Schneider, Kerstin
    Abstract: Noise pollution is detrimental to health and to the cognitive development of children. This is not only true for extreme levels of noise in the neighborhood of an airport but also for traffic noise in urban areas. Using a census of preschool children, we show that children exposed to intensive traffic noise significantly fall behind in terms of school readiness. Being exposed to an additional 10 dB(A) counteracts the benefits to school readiness from about 3 months of kindergarten. We contribute to the literature and the policy debate on noise reduction by working with administrative data and focusing on everyday exposure to noise. The proposed method is easily applied to other regions. We assess the public costs of different abatement instruments and perform a cost-benefit analysis accordingly. It turns out that the commonly used abatement measures—e.g., quiet pavement or noise protection walls in densely populated areas of about 3,000 to 5,000 inhabitants per km2—are potentially cost efficient, even under a conservative assessment of the benefits.
    Keywords: Noise,child development,early education,abatement,abatement costs
    JEL: Q53 I18 H23 H54
    Date: 2018
  9. By: Carolin Schmidt
    Abstract: Poor sanitation and overcrowding have severe impact on the disease environment. This study analyzes the impact of housing prices on physical health, proxied by adult height, during the late 19th and the first half of the 20th centuries. Using panel data on 14 advanced economies, the empirical results suggest that improved housing quality significantly contributed to human stature by reducing overcrowding and creating better hygienic standards. To be precise, a one standard deviation increase in real house prices translated to 1--1.2 cm taller adult heights---an amount which at that time was associated with 1.2 to 2.1 years of additional life expectancy on average. Also, 15 percent of the average height increase of 10 cm across all countries can be attributed to housing quality. These findings are robust even when income is controlled for.
    Keywords: Biological standard of living; Disease environment; Economic history; Health; Housing
    JEL: R3
    Date: 2018–01–01
  10. By: Amalina Azmi; Raja Nurul Aini Aziz; Zufara Arneeda B. Zulfakar
    Abstract: Pregnancy is another stage of life after marriage. Normal pregnancy takes 38 to 42 weeks which results in the birth of an infant. After the delivery, postnatal care is practiced to restore mother’s balance and health and to avoid illnesses in future. Support, assistance, health care, right nutrition’s and knowledge sharing are very important to the new mother during the postnatal care. Besides, postnatal care has been a trend due to changes in economic and financial position, high fatality rate among women and new born, high postpartum cases as well as demographic changes. In Malaysia, there are various confinement centre that was set up to take care of the new mother and new-born baby. Thus, this paper discussed the factors influencing the choice of confinement centre among women in Klang Valley. 100 sets of questionnaires have been distributed to the female respondents in Klang Valley, aged between 18-50 years old. The finding can be used a reference for a business operator to retain the customer loyalty and becomes more competitive in the confinement centre business market.
    JEL: R3
    Date: 2018–01–01
  11. By: Seow Eng Ong; Masanori Kobayashi
    Abstract: The aging population phenomenon has garnered much attention in recent years, with far reaching implications for the economy, industry and capital markets. This paper focuses on how the aging population affects healthcare REITs in Japan and Singapore by way of a detailed comparative study. Healthcare REITs focus their investments in various medical facilities such as hospitals, medical centers, nursing homes and retirement facilities. Their success is connected to the evolution of the healthcare system and REITs structure. This study focuses on the business model for healthcare REITs, acquisition and distribution implications as well as the stock return performance over time.
    Keywords: acquisition; aging population; Healthcare; Real Estate Investment Trusts; REITs; stock performance
    JEL: R3
    Date: 2018–01–01
  12. By: Lattof, Samantha R.; Coast, Ernestina; Leone, Tiziana
    Abstract: Women’s ability to access health care requires access to and control of resources as well as the ability to make personal health decisions. Female migrants may experience additional challenges in accessing health care due to marginalization and vulnerability resulting from both their gender and their migrant status. Rural-to-urban migrant women working in the informal sector, such as Ghana’s head porters (kayayei), experience exclusion from the health system, risk of being uninsured, and poor health outcomes. Kayeyei’s survival needs (e.g., food, water) and a need to provide for their families can mean that migrant kayayei avoid health care expenses for illnesses or injuries. To ensure equal access to health care for migrant and non-migrant populations, health insurance is crucial. Yet, improving access to health care and service uptake requires more than health insurance. Incorporating culturally-appropriate care into the provision of health services, or even developing specific migrant-friendly health services, could improve health service uptake and health awareness among migrants. Public health systems should also take account of migrants’ financial situations and priorities in the design and delivery of health services
    Keywords: Health insurance; health care-seeking behavior; determinants; perceptions; poverty; access; urban health; gender; informal sector; population movement; migration; Ghana
    JEL: N0
    Date: 2018–09–13

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