nep-hea New Economics Papers
on Health Economics
Issue of 2018‒11‒26
twenty papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Genome-wide association analyses of risk tolerance and risky behaviors in over one million individuals identify hundreds of loci and shared genetic influences By Richard Karlsson Linnér; Pietro Biroli; Edward Kong; S. Fleur W. Meddens; Robee Wedow; Mark Alan Fontana; Maël Lebreton; Abdel Abdellaoui; Anke R. Hammerschlag; Michel G. Nivard; Aysu Okbay; Cornelius A. Rietveld; Pascal N. Timshel; Stephen P. Tino; Maciej Trzaskowski; Ronald de Vlaming; Christian L. Zünd; Yanchun Bao; Laura Buzdugan; Ann H. Caplin; Chia-Yen Chen; Peter Eibich; Pierre Fontanillas; Juan R. Gonzalez; Peter K. Joshi; Ville Karhunen; Aaron Kleinman; Remy Z. Levin; Christina M. Lill; Gerardus A. Meddens; Gerard Muntané; Sandra Sanchez-Roige; Frank J. van Rooji; Erdogan Taskesen; Yang Wu; Futao Zhang; 23andMe Research Team; eQTLgen Consortium; International Cannabis Consortium; Psychiatric Genomics Consortium; Social Science Genetic Association Consortium; Adam Auton; Jason D. Boardman; David W. Clark; Andrew Conlin; Conor C. Dolan; Urs Fischbacher; Patrick J. F. Groenen; Kathleen Mullan Harris; Gregor Hasler; Albert Hofman; Mohammad A. Ikram; Sonia Jain; Robert Karlsson; Ronald C. Kessler; Maarten Kooyman; James MacKillop; Minna Männikkö; Carlos Morcillo-Suarez; Matthew B. McQueen; Klaus M. Schmidt; Melissa C. Smart; Matthias Sutter; A. Roy Thurik; Andre G. Uitterlinden; Jon White; Harriet de Wit; Jian Yang; Lars Bertram; Dorret Boomsma; Tõnu Esko; Ernst Fehr; David A. Hinds; Magnus Johannesson; Meena Kumari; David Laibson; Patrik K. E. Magnusson; Michelle N. Meyer; Arcadi Navarro; Abraham A. Palmer; Tune H. Pers; Danielle Posthuma; Daniel Schunk; Murray B. Stein; Rauli Svento; Henning Tiemeier; Paul R. H. J. Timmers; Patrick Turley; Robert J. Ursano; Gert G. Wagner; James F. Wilson; Jacob Gratten; James J. Lee; David Cesarini; Daniel Benjamin; Philipp Koellinger; Jonathan Beauchamp
  2. Health Seeking Behavior among Rural Left-behind Children: Evidence from a Randomized Controlled Trial in China By Wang, H.; Guan, H.; Boswell, M.
  3. What's Behind Her Smile? Looks, Self-Esteem, and Labor Market Outcomes By Francisco Gallego; Cristian Larroulet; Andrea Repetto
  4. The Twin Instrument: Fertility and Human Capital Investment By Bhalotra, Sonia R.; Clarke, Damian
  5. Abortion Laws and Women's Health By Clarke, Damian; Mühlrad, Hanna
  6. Exit, Voice or Loyalty? An Investigation into Mandated Portability of Front-Loaded Private Health Plans By Juan Pablo Atal; Hanming Fang; Martin Karlsson; Nicolas Ziebarth
  7. Physician workload and treatment choice: the case of primary care By Alkalay, Adi; Eizenberg, Alon; Lahad, Amnon; Shurtz, Ity
  8. Acculturation in Food Choices among U.S. Immigrants By Rickertsen, K.; Gustavsen, G.W.; Nayga, R.M.; Dong, D.
  9. Family Income and Health: Evidence from Food Consumption in China By Li, H.; Wang, X.; Ren, Y.
  10. Stress on the Sidewalk: Mental health costs of close proximity crime By Panka Bencsik
  11. Distributional analysis of the role of breadth and persistence of multiple deprivation in the health gradient measured by biomarkers By Sinha, Kompal; Davillas, Apostolos; Jones, Andrew M.; Sharma, Anurag
  12. Economic incentives, disability insurance and labor supply By Hjellset Alne, Ragnar
  13. Do Potential Future Health Shocks Keep Older Americans from Using Their Housing Equity? By Tim Murray
  14. The Effect of Physical and Cognitive Decline at Older Ages on Job Mismatch and Retirement By Péter Hudomiet; Michael D. Hurd; Susann Rohwedder; Robert J. Willis
  15. Inequality in Life Expectancies across Europe By Bohacek, Radim; Bueren, Jesus; Crespo, Laura; Mira, Pedro Solbes; Pijoan-Mas, Josep
  16. Exposure-Adjusted Road Fatality Rates for Cycling and Walking in European Countries By Alberto Castro; Sonja Kahlmeier; Thomas Gotschi
  17. The cost-effectiveness of biological therapy cycles in the management of Crohn’s disease By Bolin, Kristian; Hertervig, Erik; Louis, Edouard
  18. Too much care? Private health care sector and surgical interventions during childbirth in India By Surana, Mitul; Dongre, Ambrish
  19. The Effect of Health Insurance Reform: Evidence from China By He, Huajing; Nolen, Patrick J.
  20. Water, sanitation and child health: Evidence from subnational panel data in 59 countries By Headey, Derek D.; Palloni, Giordano

  1. By: Richard Karlsson Linnér (University Amsterdam); Pietro Biroli (University of Zurich); Edward Kong (Harvard University); S. Fleur W. Meddens (University Amsterdam); Robee Wedow (University of Colorado, Boulder); Mark Alan Fontana (Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery); Maël Lebreton (University of Amsterdam); Abdel Abdellaoui (Vrije Universiteit Amsterdam); Anke R. Hammerschlag (University Amsterdam); Michel G. Nivard (Vrije Universiteit Amsterdam); Aysu Okbay (Vrije Universiteit Amsterdam); Cornelius A. Rietveld (Erasmus University); Pascal N. Timshel (University of Copenhagen); Stephen P. Tino (University of Toronto); Maciej Trzaskowski (University of Queensland); Ronald de Vlaming (Vrije Universiteit Amsterdam); Christian L. Zünd (University of Zurich); Yanchun Bao (University of Essex); Laura Buzdugan (ETH Zurich); Ann H. Caplin (Stuyvesant High School); Chia-Yen Chen (Massachusetts General Hospital); Peter Eibich (University of Oxford); Pierre Fontanillas (23andMe); Juan R. Gonzalez (Barcelona Institute for Global Health); Peter K. Joshi (University of Edinburgh); Ville Karhunen (University of Oulu,); Aaron Kleinman (23andMe); Remy Z. Levin (University of California San Diego); Christina M. Lill (University of Lübeck); Gerardus A. Meddens (Team Loyalty BV); Gerard Muntané (Universitat Pompeu Fabra); Sandra Sanchez-Roige (University of California San Diego); Frank J. van Rooji (Erasmus University); Erdogan Taskesen (Vrije Universiteit Amsterdam); Yang Wu (University of Queensland); Futao Zhang (University of Queensland); 23andMe Research Team (23andMe); eQTLgen Consortium (eQTLgen Consortium); International Cannabis Consortium (International Cannabis Consortium); Psychiatric Genomics Consortium (Psychiatric Genomics Consortium); Social Science Genetic Association Consortium (Social Science Genetic Association Consortium); Adam Auton (23andMe); Jason D. Boardman (University of Colorado Boulder); David W. Clark (University of Edinburgh); Andrew Conlin (Oulu Business School); Conor C. Dolan (Vrije Universiteit Amsterdam); Urs Fischbacher (University of Konstanz); Patrick J. F. Groenen (Erasmus University); Kathleen Mullan Harris (University of North Carolina at Chapel Hill); Gregor Hasler (University of Bern); Albert Hofman (Erasmus Medical Center); Mohammad A. Ikram (Erasmus Medical Center); Sonia Jain (University of California San Diego); Robert Karlsson (Karolinska Institutet); Ronald C. Kessler (Harvard Medical School); Maarten Kooyman (SURFsara); James MacKillop (McMaster University); Minna Männikkö (University of Oulu); Carlos Morcillo-Suarez (Universitat Pompeu Fabra); Matthew B. McQueen (University of Colorado Boulder); Klaus M. Schmidt (University of Munich); Melissa C. Smart (University of Essex); Matthias Sutter (University of Cologne); A. Roy Thurik (Erasmus University); Andre G. Uitterlinden (Erasmus Medical Center); Jon White (University College London); Harriet de Wit (University of Chicago); Jian Yang (University of Queensland); Lars Bertram (University of Lübeck); Dorret Boomsma (Vrije Universiteit Amsterdam); Tõnu Esko (University of Tartu); Ernst Fehr (University of Zurich); David A. Hinds (23andMe); Magnus Johannesson (Stockholm School of Economics); Meena Kumari (University of Essex); David Laibson (Harvard University); Patrik K. E. Magnusson (Karolinska Institutet); Michelle N. Meyer (Geisinger Health System); Arcadi Navarro (Universitat Pompeu Fabra); Abraham A. Palmer (University of California San Diego); Tune H. Pers (University of Copenhagen); Danielle Posthuma (Vrije Universiteit Amsterdam); Daniel Schunk (Johannes Gutenberg University); Murray B. Stein (University of California San Diego); Rauli Svento (University of Oulu); Henning Tiemeier (Erasmus Medical Center); Paul R. H. J. Timmers (University of Edinburgh); Patrick Turley (Massachusetts General Hospital); Robert J. Ursano (University Health Science); Gert G. Wagner (Max Planck Institute for Human Development); James F. Wilson (University of Edinburgh); Jacob Gratten (University of Queensland); James J. Lee (University of Minnesota Twin Cities); David Cesarini (New York University); Daniel Benjamin (University of Southern California); Philipp Koellinger (University of Amsterdam); Jonathan Beauchamp (University of Toronto)
    Abstract: Humans vary substantially in their willingness to take risks. In a combined sample of over one million individuals, we conducted genome-wide association studies (GWAS) of general risk tolerance, adventurousness, and risky behaviors in the driving, drinking, smoking, and sexual domains. We identified 611 approximately independent genetic loci associated with at least one of our phenotypes, including 124 with general risk tolerance. We report evidence of substantial shared genetic influences across general risk tolerance and risky behaviors: 72 of the 124 general risk tolerance loci contain a lead SNP for at least one of our other GWAS, and general risk tolerance is moderately to strongly genetically correlated with a range of risky behaviors. Bioinformatics analyses imply that genes near general-risk-tolerance-associated SNPs are highly expressed in brain tissues and point to a role for glutamatergic and GABAergic neurotransmission. We find no evidence of enrichment for genes previously hypothesized to relate to risk tolerance.
    Keywords: GWAS, genome-wide association studies, risk taking, risk tolerance
    JEL: D81 I14
    Date: 2018–11
  2. By: Wang, H.; Guan, H.; Boswell, M.
    Abstract: More than 60 million children in rural China are left-behind both parents live and work far from rural homes and leave behind their children. This paper explores the variations in how left-behind and non-left-behind families seek health remediation in China's vast but understudied rural areas. We examine this question in the context of a program to provide vision health care to myopic rural students, using data from a randomized controlled trial of 13,100 students in two provinces in China. We find that without a subsidy, uptake of health care services is low, even if individuals are provided with evidence of a potential problem (an eyeglasses prescription). Uptake rises two to three times when this information is paired with a subsidy voucher redeemable for a free pair of prescription eyeglasses. Left-behind children who receive an eyeglasses voucher are not only more likely to redeem it, but also more likely to use the eyeglasses. In other words, in terms of uptake of care and compliance with treatment, the voucher program benefitted left-behind students more than non-left-behind students. The results provide a scientific understanding of differential impacts for guiding effective implementation of health policy to all groups in need in developing countries. Acknowledgement :
    Keywords: Health Economics and Policy
    Date: 2018–07
  3. By: Francisco Gallego; Cristian Larroulet; Andrea Repetto
    Abstract: We explore how improving dental health affects economic, social, and psychological outcomes. Using a randomized intervention whereby an impoverished group in Chile received free dental care, including access to prostheses, we find that the treatment in the short-run: (i) significantly improved dental health of both men and women, (ii) had a significant and positive effect on women's selfesteem, and (iii) positively impacted both employment rates and earnings among women. In the medium run, the effects on dental health and self-esteem persist but the treatment effects on labor market outcomes become statistically non-significant, although still economically relevant among women with low levels of self-esteem and among women missing at least one front tooth at baseline. We also find treatment effects on spending on appearance-related items, and improvements in the quality of relationships with partners including a reduction in verbal violence. The employment effects come mostly from the informal sector. Using several pieces of evidence, we document that the employment effects are consistent with a combination of increases in productivity and labor supply jointly with a possibly much smaller response of labor demand in the formal sector.
    Keywords: Dental Health, Labor Markets, Self-Esteem, Women.
    JEL: I10 J16 J20 O15
    Date: 2018–11–15
  4. By: Bhalotra, Sonia R. (University of Essex); Clarke, Damian (Universidad de Santiago de Chile)
    Abstract: Twin births are often used to instrument fertility to address (negative) selection of women into fertility. However recent work shows positive selection of women into twin birth. Thus, while OLS estimates will tend to be downward biased, twin-IV estimates will tend to be upward biased. This is pertinent given the emerging consensus that fertility has limited impacts on women's labour supply, or on investments in children. Using data for developing countries and the United States, we demonstrate the nature and size of the bias in the twin-IV estimator of the quantity-quality trade-off and estimate bounds on the true parameter.
    Keywords: twins, fertility, maternal health, quantity-quality trade-off, parental investment, bounds, IV
    JEL: J12 J13 C13 D13 I12
    Date: 2018–10
  5. By: Clarke, Damian (Universidad de Santiago de Chile); Mühlrad, Hanna (Lund University)
    Abstract: We examine the impact of progressive and regressive abortion legislation on women's health and survival in Mexico. Following a 2007 reform in the Federal District of Mexico which decriminalised and subsidised early-term elective abortion, multiple other Mexican states increased sanctions on illegal abortion. We observe that the original progressive policy resulted in a sharp decline in maternal morbidity, particularly maternal morbidity due to haemorrhage early in pregnancy. We observe small or null impacts on women's health from increasing sanctions on illegal abortion. We find some evidence to suggest that these impacts were also observed when considering maternal mortality, though effects are less precisely estimated.
    Keywords: abortion, maternal morbidity, maternal mortality, political economy, legislative reform
    JEL: I18 J13 H75
    Date: 2018–10
  6. By: Juan Pablo Atal (Department of Economics, University of Pennsylvania); Hanming Fang (Department of Economics, University of Pennsylvania); Martin Karlsson (Department of Economics, University of Duisburg-Essen); Nicolas Ziebarth (Department of Economics, Cornell University)
    Abstract: We study theoretically and empirically how consumers in an individual private long-term health insurance market with front-loaded contracts respond to newly mandated portability requirements of their old-age provisions. To foster competition, effective 2009, German legislature made the portability of standardized old-age provisions mandatory. Our theoretical model predicts that the portability reform will increase internal plan switching. However, under plausible assumptions, it will not increase external insurer switching. Moreover, the portability reform will enable unhealthier enrollees to reoptimize their plans. We find confirmatory evidence for the theoretical predictions using claims panel data from a big private insurer.
    Keywords: individual private health insurance, portability, old-age provisions, health plan switching, switching costs, health policy reform, consumer bargaining, retention
    JEL: G22 I11 I18
    Date: 2017–05–23
  7. By: Alkalay, Adi; Eizenberg, Alon; Lahad, Amnon; Shurtz, Ity
    Abstract: Primary care is a notable example of a service industry where capacity-constrained suppliers face fluctuating demand levels. Unable to adjust prices, such providers may degrade service quality when faced with high demand levels. Little is known, however, on the nature of such adjustments in the primary care context. We study how physicians trade off one key input --- their time with patients --- with other inputs, such as prescriptions, lab tests and referrals. Employing detailed administrative data from eleven clinics of a large Israeli HMO, we use the absence of colleagues as a source of exogenous variation in physician workload. We find no evidence that physicians' workload affects the intensity with which they prescribe painkillers, or refer patients to the Emergency Room, and very little evidence for an effect on the prescription of antibiotics. We do find, however, that physician time and the use of diagnostic inputs are complements: a one minute decrease in the (daily) average visit length causes a 9 percent decrease in referrals to specialists, and a 3.8 percent decrease in referrals to lab tests. Following recent literature, we complement the traditional use of an exclusion restriction within a linear model by estimating non-parametric bounds on Average Treatment Effects using alternative assumptions. Such alternative estimators rule out the possibility that physician time and the use of diagnostic tools are substitutes in an economically-meaningful fashion, while still leaving a broad scope for the possibility that those are complements. Taken together, the results indicate that the shadow cost of physician capacity is not reflected in poor treatment decisions, but may instead be manifested in the underprovision of tests and referrals to specialists --- fundamental aspects of long-term preventive care.
    Keywords: capacity constraints; Partial identification; Physician workload
    Date: 2018–09
  8. By: Rickertsen, K.; Gustavsen, G.W.; Nayga, R.M.; Dong, D.
    Abstract: Immigration has made the U.S. more racially and ethnically diverse. With this diversity comes heterogeneity in dietary behaviors and health disparities. We used the food and nutrient database from the U.S. Department of Agriculture (USDA) and estimated econometric models explaining the daily consumption of milk, meat, processed meat, fruits, and vegetables among immigrants and people born in the U.S. Tests for differences in consumption between immigrants with different race and ethnicity and their U.S. born counterparts were performed. In addition, we simulated the effects of time of residency on food consumption among the different immigrant groups. The results show that immigrants tend to have lower consumption of meat but higher consumption of fruits and vegetables than their U.S. born counterparts, but the differences begin to disappear after being in the U.S. for five years. The findings may help policymakers to craft food assistance programs aimed at reducing obesity and related health problems among different racial and ethnic groups in the U.S. Acknowledgement : The findings and conclusions in this presentation are those of the authors and do not represent the views of the Economic Research Service of the U.S. Department of Agriculture. The Research Council of Norway (BION R), Grant no 233800 provided financial support for this research.
    Keywords: Livestock Production/Industries
    Date: 2018–07
  9. By: Li, H.; Wang, X.; Ren, Y.
    Abstract: With the substantial increase in family income, the prevalence of overweight has risen and become a serious threat to individual health and major health challenges in many developing countries. From the perspective of food consumption, this study attempts to shed light on the effect of family income on adults health outcomes of BMI and being overweight through three potential channels of nutrition intakes, dietary knowledge, and health insurance. Using data from the China Health and Nutrition Survey (CHNS), the empirical estimations show adults BMI and the propensity of being overweight tend to increase with rising income in China. After identifying significant correlations between family income and potential channels considered, we conclude that approximately 34.14% and 33.75% of income effect on BMI and overweight could be explained by these three channels, especially, nutrition intakes taking the largest proportion is responsible for 26.96% and 28.08% of income effect on BMI and overweight, respectively. Additionally, we observe that there exists a significant heterogeneity in income-BMI gradients across various income quantiles and sub-samples, showing that income has higher effect on adults health for male and urban samples but it is not responsible for female sample. Acknowledgement : The authors acknowledge funding supports provided by National Natural Sciences of China (71742002; 71673008).
    Keywords: Health Economics and Policy
    Date: 2018–07
  10. By: Panka Bencsik
    Abstract: I apply novel, extremely micro-level datasets to provide new evidence on crime's impact on mental health. I find that each reported violent and sexual crime significantly increases the stress levels of those in the vicinity for three days after the crime was committed. The temporal aspect of the effect is specifically driven by violent and sexual crimes committed two days earlier, a lag which suggests the presence of a mediator of the information--word of mouth or the media. To measure that, I scrape news data and observe significant increases in nationwide stress levels in response to the number of articles published on the topic of crime in the domestic news section of multiple daily newspapers. I measure crime's effect on stress by merging a unique daily response panel dataset that has over 75,000 responses from 2010 to 2017 in the Thames Valley region of England with secure access data containing every reported crime in the same region with exact location, time, and event characteristics. The result that violent and sexual crimes increase stress holds with extensive controls for individual fixed effects, circumstantial characteristics, and spatial fixed effects, including fixed effects for the smallest level of census geography in England that contain only an average of 250 people.
    JEL: I1 K4 H4
    Date: 2018–11–12
  11. By: Sinha, Kompal; Davillas, Apostolos; Jones, Andrew M.; Sharma, Anurag
    Abstract: This paper analyses the relationship between health and socioeconomic status ac- counting for the role of breadth and persistence of multiple deprivation. Adopting a holistic approach to multidimensional deprivation, we construct measures of absolute and relative deprivation and use these measures along with a range of nurse measured and blood-based biomarkers for a distributional analysis of the relationship between so- cioeconomic status and health. Using data from the British Household Panel Survey and Understanding Society, our analysis finds the presence of systematic multidimensional deprivation gradient across the distribution of most of our biomarkers (BMI, waist cir- cumference, heart rate, C-reactive protein and HbA1c) beyond income, with the size of this gradient to be substantially larger at higher tails of the biomarker distribution. De- composition analysis of the contribution of components of deprivation to health suggests breadth of deprivation to dominate the contribution over persistence. Health policy pri- oritising health of people enduring deprivation across multiple domains, i.e., people who experience dual burden of deprivation across several domains and poor health, may be particularly effective at reducing the risk of falling into a health-deprivation trap.
    Date: 2018–11–15
  12. By: Hjellset Alne, Ragnar (University of Bergen, Department of Economics)
    Abstract: Using a difference-in-difference model on full population data, I estimate the labor market response to a 2015 Norwegian disability insurance (DI) reform. The reform introduced an incentive program to encourage DI beneficiaries to increase their labor supply, and I find that the program significantly increased the average working hours and modestly affected the labor market participation of DI beneficiaries. There is significant heterogeneity in the estimated effects; young beneficiaries respond positively along the extensive and the intensive labor supply margins. The analysis accentuates the importance of analyzing both labor supply margins when evaluating the effects of DI reforms.
    Keywords: Disability insurance reform; labor supply; economic incentives; difference-in-difference; labor economics
    JEL: D60 H53 I38 J08 J22
    Date: 2018–06–14
  13. By: Tim Murray
    Abstract: Many retirees retain their housing equity until they die and do not utilize it to help finance spending on consumption. In this paper, I examine how older Americans (age 55+) may use their house as a form of precautionary savings in the event they face an increase in out-of-pocket medical expenses due to a health shock. I find that households are 12-percentage points more likely to own a home in their late retirement years if they might face an unexpected increase in medical bills, indicating that many of such households prefer not to own but choose to knowing they may get sick and face an increase in out-of-pocket medical expenses. Accordingly, I propose an insurance policy that would cover any out-of-pocket medical expenses not covered by Medicaid. When the price of the insurance policy is between 0.15%-0.50% of each householdâs house value, 12.8% of households purchase the insurance policy. In the presence of an insurance policy and health shocks, the homeownership and moving rates look like an economy without health shocks, thus correcting a possible market failure that causes households to use their house as a form of precautionary savings.
    JEL: D14 E13 R21
    Date: 2018–11–13
  14. By: Péter Hudomiet; Michael D. Hurd; Susann Rohwedder; Robert J. Willis
    Abstract: Physical and cognitive abilities of older workers decline with age, which can cause a mismatch between abilities and job demands, potentially leading to early retirement. We link longitudinal Health and Retirement Study data to O*NET occupational characteristics to estimate to what extent changes in workers’ physical and cognitive resources change their work-limiting health problems, mental health, subjective probabilities of retirement, and labor market status. While we find that physical and cognitive decline strongly predict all outcomes, only the interaction between large-muscle resources and job demands is statistically significant, implying a strong mismatch at older ages in jobs requiring large-muscle strength. The effects of declines in fine motor skills and cognition are not statistically different across differing occupational job demands.
    JEL: J26 J81
    Date: 2018–11
  15. By: Bohacek, Radim; Bueren, Jesus; Crespo, Laura; Mira, Pedro Solbes; Pijoan-Mas, Josep
    Abstract: We use harmonized household panel data from 10 European countries (SHARE) plus US (HRS) and England (ELSA) to provide novel and comparable measurements of education and gender differences in life expectancy and disability-free life expectancy, as well as in the underlying multi-state life tables. Common across countries we find significant interactions between socio-economic status and gender: (a) the education advantage in life expectancy is larger for males, (b) the female advantage in life expectancy is larger among the low educated, (c) education reduces disability years and this added advantage is larger for females, and (d) females suffer more disability years but this disadvantage is hardly present for the high educated. Common across countries we also find that the education advantage in disability years is due to better health transitions by the highly-educated, and that the female disadvantage in disability years is due to better survival in ill-health by females. Looking at the differences across countries, we find that inequalities are largest in Eastern Europe, lowest in Scandinavia, and that the education gradient in life expectancy for males correlates positively with income inequality and negatively with public health spending across countries
    Keywords: education gradient; Gender Gap; healthy life expectancy; Life Expectancy
    JEL: I14 I24 J14 J16
    Date: 2018–09
  16. By: Alberto Castro (University of Zurich); Sonja Kahlmeier (University of Zurich); Thomas Gotschi (University of Zurich)
    Abstract: This paper presents fatality rates for walking and cycling in European Countries used in the World Health Organization’s Health Economic Assessment Tool (HEAT). It evaluates and ranks the quality of data sources and gives fatality rates adjusted by exposure (i.e. distance travelled). It also discusses the different methodologies applied for national exposure data, as well as the proposed solutions to make these figures comparable across countries.
    Date: 2018–09–25
  17. By: Bolin, Kristian (Department of Economics, School of Business, Economics and Law, Göteborg University); Hertervig, Erik; Louis, Edouard
    Abstract: Objectives: to examine the cost-effectiveness of continued treatment for patients with moderate-severe Crohn’s disease in clinical remission, with a combination of anti-TNFα (infliximab) and immunosuppressant therapy compared to two different withdrawal strategies (1) withdrawal of the anti-TNFα therapy, and (2) withdrawal of the immunosuppressant therapy, respectively. Material and methods: A decision-tree model (Markov type) was constructed mimicking three treatment arms: (1) continued combination therapy with infliximab and antimetabolites, (2) withdrawal of infliximab, or (3) withdrawal of the immunosuppressant. Relapses in each arm are managed with treatment intensification. State dependent relapse risks, remission probabilities and quality of life weights were collected from previous published studies. Results: Combination therapy was less costly and more efficient than the withdrawal of the immunosuppressant, and more costly and more efficient than withdrawal of infliximab. The incremental cost-effectiveness ratio for the combination therapy compared with withdrawal of infliximab was estimated at SEK 755 449 per additional QALY. This is well above the informal willingness-to-pay threshold in Sweden (500 000 SEK/QALY). The estimated cost-effectiveness of the combination therapy was found highly sensitive to the unit cost of infliximab; at a 36% lower unit cost of infliximab, the combination treatment would become cost-effective. The qualitative content of these results were quite robust to changes in the clinical effectiveness and the quality-of-life figures adopted in the calculations. The qualitative content of these results were quite robust to changes in the clinical effectiveness and quality-of-life values. Conclusions: Combination therapy using a combination of anti-TNFα (infliximab) and immunosuppressant is cost effective in the treatment of Crohn’s disease compared to treatment cycles in which the immunosuppressant is withdrawn. Combination treatment is not cost effective compared to treatment cycles in which infliximab is withdrawn, at current pharmaceutical prices.
    Keywords: infliximab; immunosuppressant; de-escalation; cost-effectiveness
    JEL: I10
    Date: 2018–11
  18. By: Surana, Mitul; Dongre, Ambrish
    Abstract: This paper evaluates the role of the private sector in performing one of the common surgical interventions, i.e. caesarean sections during childbirth in India. We use the latest round of National Family Health Survey to estimate the differential probability of C-section in private medical facilities relative to government facilities. We employ two estimation techniques, Household Fixed Effects and Coarsened Exact Matching, to reduce the extent of selection bias in the choice of delivery location. We also take advantage of a new question introduced in the survey which allows identification of planned C-sections which are more likely to be the result of either demand for C-section or unobservable (in the data) medical risks. We find that the probability of an unplanned C-section is 13.5-14 percentage points higher in the private sector. Given that some of the planned C-sections could be a result of supplier-induced demand, this is a very conservative estimate. Our results suggest that there were potentially 0.9 million preventable C-sections in the private sector in 2016. These results therefore call for a critical assessment of the role of private sector in healthcare in the context of inadequate public provision, expanding private provision and weak governance structures.
    Date: 2018–11–20
  19. By: He, Huajing (University of Essex); Nolen, Patrick J. (University of Essex)
    Abstract: This paper estimates the impact of a health insurance reform on health outcomes in urban China. Using the China Health and Nutrition Survey we find that this reform increases the rate of health insurance coverage significantly among workers in Non-State Owned Enterprises. The double difference (DD) estimations show that the reform also leads to better health outcomes: workers are less likely to get sick and more likely to use preventive care. Using an instrumental variable (IV) approach to look at the causal effect of health insurance, we find those with health insurance use more preventive care but do not report significantly better health outcomes, an increase in health care utilisation, or an increase in out-of-pocket medical expenditure.
    Keywords: health insurance reform, health outcomes, China
    JEL: H51 H43 O2
    Date: 2018–10
  20. By: Headey, Derek D.; Palloni, Giordano
    Abstract: Water, sanitation and hygiene (WASH) investments are widely seen as essential for improving health in early childhood. However, the experimental literature on WASH interventions identifies inconsistent impacts on child health outcomes, with relatively robust impacts on diarrhea and other symptoms of infection, but weak and varying impacts on child nutrition. In contrast, observational research exploiting cross-sectional variation in water and sanitation access is much more sanguine, finding strong associations with diarrhea prevalence, mortality and stunting. In practice, both literatures suffer from significant methodological limitations. Experimental WASH evaluations are often subject to poor compliance, rural bias, and short duration of exposure, while cross-sectional observational evidence may be highly vulnerable to omitted variables bias. To overcome some of the limitations of both literatures, we construct a panel of 442 subnational regions in 59 countries with multiple Demographic Health Surveys. This large subnational panel is used to implement difference-in-difference regressions that allow us to examine whether longer term changes in water and sanitation at the subnational level predict improvements in child morbidity, mortality and nutrition. We find results that are partially consistent with both literatures. Improved water access is statistically insignificantly associated with most outcomes, although water piped into the dwelling predicts reductions in child stunting. Improvements in sanitation predict large reductions in diarrhea prevalence and child mortality, but are not associated with changes in stunting or wasting. We estimate that sanitation improvements can account for just under 10% of the decline in child mortality from 1990-2015.
    Keywords: public health; hygiene; children; mortality; water; child nutrition; improved water,sanitation and hygiene (WASH)
    Date: 2018

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