nep-hea New Economics Papers
on Health Economics
Issue of 2018‒12‒17
24 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. End-of-Life Medical Expenses By French, Eric; Jones, John Bailey; Kelly, Elaine; McCauley, Jeremy
  2. Broadband Internet, Digital Temptations, and Sleep By Francesco Billari; Osea Giuntella; Luca Stella
  3. Social Security Programs and Retirement Around the World: Reforms and Retirement Incentives – Introduction and Summary By Axel H. Börsch-Supan; Courtney Coile
  4. Spatial Inequality in Mortality in France over the Past Two Centuries By Florian Bonnet; Hippolyte D'Albis
  5. Effect of measles outbreak on vaccination uptake By Thomas Schober
  6. Learning by Suffering? Patterns in Flu Shot Take-up By Ginger Zhe Jin; Thomas G. Koch
  7. Fertility and labor market responses to reductions in mortality By Bhalotra, Sonia; Venkataramani, Atheendar; Walther, Selma
  8. The Impact of Unemployment on Child Maltreatment in the United States By Dan Brown; Elisabetta De Cao
  9. On the importance of the upside down test in absolute socioeconomic health inequality comparisons By Mohamad Khaled; Paul Makdissi; Myra Yazbeck
  10. The Value of a Statistical Life Under Changes in Ambiguity By Han Bleichrodt; Christophe Courbage; Béatrice Rey
  11. Comparing latent inequality with ordinal data By David M. Kaplan; Longhao Zhuo
  12. Health and the Wage: Cause, Effect, Both, or Neither? New Evidence on an Old Question By Daniel Dench; Michael Grossman
  13. Health care utilization of refugees By Thomas Schober; Katrin Zocher
  14. The Long-Term Economic Costs of the Great London Smog By Alastair Ball
  15. The effect of reinsuring a deductible on pharmaceutical spending: A Dutch case study on low-income people By Marielle Non; Rudy Douven; Richard van Kleef; Onno van der Galiën
  16. Paying for what kind of performance? Performance pay and multitasking in mission-oriented jobs By Daniel Jones; Mirco Tonin; Michael Vlassopoulos
  17. The Effects of Capping Co-Insurance Payments By Westerhout, Ed; Folmer, Kees
  18. Public health, healthcare, health and inequality in health in the Nordic countries By Christiansen, Terkel; Lauridsen, Jørgen T.; Kifmann, Mathias; Lyttkens, Carl Hampus; Ólafsdóttir, Thorhildur; Valtonen, Hannu
  19. The growing American health penalty: International trends in the employment of older workers with poor health By Ben Baumberg Geiger; René Böheim; Thomas Leoni
  20. Adolescents’ risk perception on health of drug use: a European comparative analysis By Nicoletta Balbo; Andrea Bonanomi; Francesca Luppi
  21. Do We Know What We Are Doing? An Exploratory Study on Swedish Health Economists and the EQ-5D By Lyttkens, Carl Hampus; Gerdtham, Ulf-G.; Tinghög, Gustav
  22. Investigating The Dynamic Effect of Healthcare Expenditure and Education Expenditure On Economic Growth in Organisation of Islamic Countries (OIC) By Abdul Wahab, Abdul Azeez Oluwanisola; Kefeli, Zurina; Hashim, Nurhazirah
  23. Selection and Treatment Effects of Health Insurance Subsidies in the Long Run: Evidence from a Randomized Control Trial in Ghana By Patrick Asuming; Hyuncheol Bryant Kim; Armand Sim
  24. Leveraging Patients' Social Networks to Overcome Tuberculosis Underdetection: A Field Experiment in India By Jessica Goldberg; Mario Macis; Pradeep Chintagunta

  1. By: French, Eric (University College London, IFS, and CEPR); Jones, John Bailey (Federal Reserve Bank of Richmond); Kelly, Elaine (Institute for Fiscal Studies and the Health Foundation); McCauley, Jeremy (University College London)
    Abstract: In this review, we document end-of-life medical spending: its level, composition, funding, and contribution to aggregate medical spending. We discuss how end-of-life expenses affect household behavior and economic evidence on the efficacy of medical spending at the end of life. Finally, we document recent trends in health and chronic disease at older ages and discuss what they might imply for end-of-life spending and medical spending in the aggregate.
    Keywords: medical spending; household behavior
    Date: 2018–12–04
  2. By: Francesco Billari; Osea Giuntella; Luca Stella
    Abstract: There is a growing concern that the widespread use of computers, mobile phones and other digital devices before bedtime disrupts our sleep with detrimental effects on our health and cognitive performance. High-speed Internet promotes the use of electronic devices, video games and Internet addiction (e.g., online games and cyberloafing). Exposure to artificial light from tablets and PCs can alterate individuals’ sleep patterns. However, there is little empirical evidence on the causal relationship between technology use near bedtime and sleep. This paper studies the causal effects of access to high-speed Internet on sleep. We first show that playing video games, using PC or smartphones, watching TV or movies are correlated with shorter sleep duration. Second, we exploit historical differences in pre-existing telephone infrastructure that affected the deployment of high-speed Internet across Germany (see Falck et al., 2014) to identify a source of plausibly exogenous variation in access to Broadband. Using this instrumental variable strategy, we find that DSL access reduces sleep duration and sleep satisfaction.
    Keywords: Internet, Sleep Duration, Time use
    Date: 2017–10
  3. By: Axel H. Börsch-Supan; Courtney Coile
    Abstract: This is the introduction and summary to the ninth phase of an ongoing project on Social Security Programs and Retirement Around the World. This project, which compares the experiences of a dozen developed countries, was launched in the mid 1990s, following decades of decline in the labor force participation rate of older men. The first several phases of the project document that social security program provisions can create powerful incentives for retirement that are strongly correlated with the labor force behavior of older workers. Subsequent phases have explored how disability program provisions affect retirement, whether there is a link between older employment and youth unemployment, and whether older individuals are healthy enough to work longer. In the two decades since the project began, the dramatic decline in men’s labor force participation has been replaced by sharply rising participation rates. Older women’s participation has increased dramatically as well. Over this same period, countries have undertaken numerous reforms of their social security programs, disability programs, and other public benefit programs available to older workers. In this ninth phase of the project, we explore how the financial incentive to work at older ages has evolved from 1980 to the present. We highlight the important role of reforms in these changing incentives and examine how changing incentives may have affected retirement behavior.
    JEL: J14 J26
    Date: 2018–11
  4. By: Florian Bonnet (UP1 UFR02 - Université Panthéon-Sorbonne - UFR d'Économie - UP1 - Université Panthéon-Sorbonne, PSE - Paris School of Economics); Hippolyte D'Albis (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique)
    Abstract: This article analyzes the evolution of spatial inequalities in mortality across 90 French territorial units since 1806. Using a new database, we identify a period from 1881 to 1980 when inequalities rapidly shrank while life expectancy rose. This century of convergence across territories was mainly due to the fall in infant mortality. Since 1980, spatial inequalities have levelled out or occasionally widened, due mainly to differences in life expectancy among the elderly. The geography of mortality also changed radically during the century of convergence. Whereas in the 19th century high mortality occurred mainly in larger cities and along a line from North-west to South-east France, it is now concentrated in the North, and Paris and Lyon currently enjoy an urban advantage.
    Date: 2018–11
  5. By: Thomas Schober
    Abstract: This paper explores the effects of a measles outbreak on vaccination uptake in Austria, using administrative data with individual-level information on childhood vaccinations. I define a treatment group of children affected by the outbreak, and compare them with a control group of earlier-born children who are unaffected. Twelve months after the outbreak, the vaccination rate of the treatment group is 2.5 (first dose of the measles, mumps and rubella vaccine) and 4 (second dose) percentage points higher than the corresponding rates of the control group. The results do not indicate that families at increased risk respond more strongly, suggesting that the outbreak changed the perceived value of vaccinations across the whole population. Findings also reveal heterogeneity in the response of families based on the parents’ level of education, indicating that parents with higher education levels absorb new information more rapidly.
    Keywords: vaccination, measles outbreak, health behaviour
    JEL: I12 I18 H42 H51
    Date: 2018–11
  6. By: Ginger Zhe Jin; Thomas G. Koch
    Abstract: An annual flu shot is one of the least controversial and most widely-recommended preventative health measures. In spite of such advice, only a fraction of those who are suggested to get a flu shot actually receive it. We focus on past personal outcomes to understand how individual learning in influences patterns over time using medical claims for a 5% panel sample of Medicare FFS beneficiaries. We find that individuals learn from personal suffering from flu and such learning is conditional on whether they have taken a flu shot in the same flu season. If they did not take a flu shot, having the flu later on encourages them to get the flu shot next year. But if they had the flu shot and still got the flu, their likelihood of getting a flu shot next year is significantly reduced. The 2009 outbreak of bird flu does not break the qualitative pattern of “learning by suffering” but it does change the strength of learning.
    JEL: D12 D18 I12 I18
    Date: 2018–11
  7. By: Bhalotra, Sonia; Venkataramani, Atheendar; Walther, Selma
    Abstract: We investigate womenÂ’s fertility, labor, and marriage market responses to large declines in child mortality in the U.S. Fertility declined on the intensive margin as expected. However, despite the increasing value of having at least one child, a larger share of women remained childless. We explain these fiÂ…ndings with a new theory of fertility that includes fertility timing and labor force participation as choices. Consistent with the modelÂ’s predictions, we fiÂ…nd that reductions in child mortality led women to delay childbearing, increase their labor force participation, improve their occupational status, and to be less likely to have ever married.
    Date: 2018–12–03
  8. By: Dan Brown; Elisabetta De Cao
    Abstract: In this paper, we show that unemployment increases child neglect in the United States during the period from 2004 to 2012. A one percentage point increase in the unemployment rate leads to a 20 percent increase in neglect. We identify this effect by instrumenting for the county-level unemployment rate with a Bartik instrument, which we create as the weighted average of the national-level unemployment rates across each of twenty industries, where the weights are the county-level fraction of the employed working-age population in each industry at the start of the sample period. An important mechanism behind this effect is that parents lack social and private safety nets. The effect on neglect is smaller in states that introduce longer extensions to unemployment benefits, and is greater in counties where an initially larger fraction of children are not covered by health insurance. We find no evidence that the effect is driven by alcohol consumption or divorce.
    Keywords: child abuse and neglect, unemployment rate, recession, safety net, unemployment insurance
    Date: 2017–09
  9. By: Mohamad Khaled; Paul Makdissi; Myra Yazbeck
    Abstract: This paper shows that it is impossible to obtain a robust ranking of absolute socioeconomic health inequality if one only imposes Bleichrodt and van Doorslaer's (2006) principle of income-related health transfer. This means that for any comparison, some indices obeying this ethical principle will always contradict the ranking produced by other indices obeying the same ethical principle. This results points to the need to impose more ethical structure on indices when one wants to identify robust rankings of absolute socioeconomic health inequality. We show that imposing Erreygers, Clarke and Van Ourti's (2012) upside down test allows for the identification of robust orderings of absolute health inequality. We also show that alternatively one can increase inequality aversion and impose higher order pro-poor principles of income-related health transfer sensitivity. In order to make the identification of all robust orderings implementable using survey data, the paper also discusses statistical inference for these positional dominance tests. To illustrate the empirical relevance of the proposed approach, we compare joint distributions of income and a health-related behavior in the United States in 1997 and 2014.
    Keywords: Generalized health concentration curves, generalized health range curves, absolute socioeconomic health inequality, stochastic dominance, inference
    JEL: D63 I10
    Date: 2018–11
  10. By: Han Bleichrodt (Erasmus School of Economics, PO Box 1738, 3000 DR Rotterdam; Research School of Economics, Australian National University, Canberra, Australia); Christophe Courbage (Haute Ecole de Gestion de Genève, University of Applied Sciences Western Switzerland (HES-SO)); Béatrice Rey (Univ Lyon, Université Lumière Lyon 2, GATE UMR 5824, F-69130 Ecully, France)
    Abstract: The value of a statistical life (VSL) is a key parameter in the analysis of government policy. Most policy decisions are made under ambiguity. This paper studies the effect of changes in ambiguity perception on the value of a statistical life (VSL). We propose a definition of increases in ambiguity perception based on Ekern’s (1980) definition of increases in risk. Ambiguity aversion alone is not sufficient to lead to an increase in the VSL when the decision maker perceives more ambiguity. Our results highlight the importance of higher order ambiguity attitudes, particularly ambiguity prudence.
    Keywords: Value of a statistical life, ambiguity, prudence, smooth ambiguity model, neoadditive preferences
    JEL: D81 I18 Q51
    Date: 2018
  11. By: David M. Kaplan (Department of Economics, University of Missouri); Longhao Zhuo (University of Missouri)
    Abstract: Using health as an example, we consider comparing two latent distributions when only ordinal data are available. Distinct from the literature, we assume a continuous latent distribution but not a parametric model. Primarily, we contribute (partial) identification results: given two known ordinal distributions, what can be learned about the relationship between the two corresponding latent distributions? Secondarily, we discuss Bayesian and frequentist inference on the relevant ordinal relationships, which are combinations of moment inequalities. Simulations and empirical examples illustrate our contributions.
    Keywords: health; nonparametric inference; partial identification; partial ordering; shape restrictions
    JEL: C25 D30 I14
    Date: 2018–12–03
  12. By: Daniel Dench; Michael Grossman
    Abstract: We investigate two-way causality between health and the hourly wage by employing insights from the human capital and compensating wage differential models, a panel formed from the National Longitudinal Survey of Youth 1997, and dynamic panel estimation methods in this investigation. We uncover a causal relationship between two of five measures of health and the wage in which a reduction in health leads to an increase in the wage rate but find no evidence of a causal relationship running from the wage rate to health. The former result is consistent with a framework in which a large amount of effort in one period is required to obtain promotions and the wage increases that accompany them in subsequent periods. That effort may cause reductions in health and result in a negative effect of health in the previous period on the current period wage. The finding also is consistent with a model in which investments in career advancement compete with investments in health for time—the ultimate scarce resource. The lack of a causal effect of the wage on health may suggest that forces that go in opposite directions in the human capital and compensating wage differential models offset each other.
    JEL: I20 J24
    Date: 2018–11
  13. By: Thomas Schober; Katrin Zocher (JKU, Austria)
    Abstract: European countries experienced significant inflows of migrants in the past decade, including many refugees coming from regions engaged in armed conflicts. While previous research on migrant health largely focused on economic migration, empirical evidence on the health of refugees is sparse. We use administrative data from Austria to differentiate between economic migrants and refugees and analyze their health care expenditures in comparison to natives. The results distinctly show different expenditure patterns. Unlike economic migrants, we find substantially higher expenditures for refugees, most pronounced in the first year upon arrival. The difference is not explained by specific diseases or individual refugee groups, indicating a, generally, inferior health status. Further, by using the quasi-random placement of refugees as a natural experiment, we show that characteristics of the local health care sector do not have a significant effect on expenditure levels.
    Date: 2018–11
  14. By: Alastair Ball (Birkbeck, University of London)
    Abstract: This paper studies the long-term economic effects of early exposure to the Great London Smog of 1952. Cohorts born in London are tracked for up to sixty years using the Office of National Statistics Longitudinal Study. Exposure to the four day smog reduced the size of the surviving cohort by 2% and caused lasting damage to human capital accumulation, employment, hours of work, and propensity to develop cancer.
    JEL: Q53 I12 I18
    Date: 2018–12
  15. By: Marielle Non (CPB Netherlands Bureau for Economic Policy Analysis); Rudy Douven (CPB Netherlands Bureau for Economic Policy Analysis); Richard van Kleef (EUR); Onno van der Galiën (Achmea)
    Abstract: The basic health insurance in the Netherlands includes a mandatory deductible of currently 385 euros per adult per year. Several municipalities offer a group contract for low-income people in which the deductible is reinsured, meaning that out-of-pocket spending under the deductible is covered by supplementary insurance. This study examines to what extent such reinsurance leads to higher pharmaceutical spending. We use a unique dataset from a Dutch health insurer with anonymized individual insurance claims for the period 2014-2017. We run a difference-in-difference regression to estimate the effect of reinsurance on pharmaceutical spending. The treatment group consists of enrollees from three municipalities that implemented reinsurance on January 1st 2017. The control group includes enrollees from three municipalities that didn’t implement reinsurance. We find that the introduction of reinsurance led to a statistically significant increase in pharmaceutical spending of 16% in the first quarter of 2017 and 7% in the second quarter. For the second half of 2017 the effect is small and not statistically significant. Conditional on people with low expected spending we find a statistically significant increase in pharmaceutical spending in all four quarters of 2017 varying from 22% to 30% per quarter.
    JEL: I12 I13 C23 D12
    Date: 2018–11
  16. By: Daniel Jones; Mirco Tonin; Michael Vlassopoulos
    Abstract: How does pay-for-performance (P4P) impact productivity, multitasking, and the composition of workers in mission-oriented jobs? These are central issues in sectors like education or healthcare. We conduct a laboratory experiment, manipulating compensation and mission, to answer these questions. We find that P4P has positive effects on productivity on the incentivized dimension of effort and negative effects on the non-incentivized dimension for workers in non-mission-oriented treatments. In mission-oriented treatments, P4P generates minimal change on either dimension. Participants in the non-mission sector – but not in the mission-oriented treatments – sort on ability, with lower ability workers opting out of the P4P scheme.
    Date: 2018–07
  17. By: Westerhout, Ed (Tilburg University, Center For Economic Research); Folmer, Kees
    Abstract: It is common to limit the cost sharing in health insurance schemes by a cap on co-insurance payments. This paper derives the economic and welfare effects of such a cap, adopting a model of which two features are crucial. First, health care demand is price-elastic. Second, demand is less elastic the worser the consumer’s health status. The paper derives that a cap induces optimizing health insurers to raise the co-insurance rate. This raises welfare in the aggregate, but part of the consumers do not share in this welfare gain. In particular, those with health spending close to the level at which co-insurance payments reach their maximum level suffer large welfare losses. We adopt a 3- state model to derive our results and a continuous-state model for a numerical illustration.
    Keywords: coinsurance; health insurance; cap on coinsurance payments; moral hazard
    JEL: D60 H21 I18
    Date: 2018
  18. By: Christiansen, Terkel (University of Southern Denmark, COHERE - Centre of Health Economics Research); Lauridsen, Jørgen T. (University of Southern Denmark, COHERE - Centre of Health Economics Research); Kifmann, Mathias (Hamburg Center for Health Economics); Lyttkens, Carl Hampus (Department of Economis); Ólafsdóttir, Thorhildur (Faculty of Business Administration); Valtonen, Hannu (Department of Social and Health Management)
    Abstract: All five Nordic countries emphasize equal and easy access to healthcare, assuming that increased access to healthcare leads to increased health. It is the purpose of the present study to explore to which extent the populations of these countries have reached good health and a high degree of socio-economic equality in health. Each of the five countries has established extensive public health programmes, although with somewhat different measures to increase health of the populations. We compare these countries to the UK and Germany by using data from the European Social Survey for 2002 and 2012 in addition to OECD statistics for the same years. Health is measured by self-assessed health in five categories, which is transformed to a cardinal scale using Swedish time trade-off (TTO) weights. As socio-economic measures we use household income and length of education. Socio-economic inequality in health is elicited in two ways. First, we show social gradients by comparing the percentage of respondents in the lower income group reporting good or very good health to the corresponding rates in the upper income group. Second, we show concentration indices of socio-economic related inequality in health. Everything else kept equal, good health and the size of the concentration index are negatively associated by definition. In 2012, mean health, based on Swedish weights applied to all countries, is above 0.93 in all the Nordic countries and the UK, but lower in Germany. Each of the Nordic countries have introduced centrally initiated comprehensive public health programmes to increase health and reduce socio-economic inequalities in health. In general, the Nordic countries have achieved good health for their populations as well as a high degree of socioeconomic equality in health. Improvements in life-style related determinants of health are possible, however.
    Keywords: International comparison of health systems; health status; inequality in health
    JEL: I11 I14 I19
    Date: 2018–03–01
  19. By: Ben Baumberg Geiger; René Böheim; Thomas Leoni
    Abstract: Many countries have reduced the generosity of disability benefits while making them more activating – yet few studies have examined how employment rates have subsequently changed. We present estimates of how the employment rates of older workers with poor health in 13 high-income countries changed between 2004-7 and 2012-15 using HRS/SHARE/ELSA data. We find that those in poor health in the USA have experienced a unique deterioration: they have not only seen a widening gap to the employment rates of those with good health, but their employment rates fell per se. We find only for Sweden (and possibly England) signs that the health employment gap shrank. We then examine possible explanations for the development in the USA: we find no evidence it links to labour market trends, but possible links to the USA’s lack of disability benefit reform – which should be considered alongside the wider challenges of our findings for policymakers.
    Keywords: disability benefits; older workers; poor health; HRS/ SHARE/ELSA data
    JEL: H51 I12 I18 J14 J22
    Date: 2018–08
  20. By: Nicoletta Balbo; Andrea Bonanomi; Francesca Luppi
    Abstract: The general decline in alcohol and tobacco consumption among teenagers in recent years has been interpreted as a success of the European governments campaigns to increase adolescents’ awareness about the risk associated to drug use. At the same time, polydrug users – those who make use of more than one substance – are becoming a prevalent group among adolescent substance users. This evidence raises the question of whether the traditional approach to study risk perception related to substance use could be improved. Research in this field always deals with substance-specific risk perception indicators, while it lacks of a composite and synthetic measure of risk perception related to the overall attitudes towards substances use. This study explores whether there is a unique overall perception of risk associated with different legal and illegal substances use. Specifically, by making use of ESPAD data, we explore whether it is possible to derive an overall measure of attitude toward drugs consumption, by combining a set of indicators of risk perception regarding different types of substances (i.e. alcohol, tobacco, cannabis and other illegal drugs) and different frequencies of use (i.e. sporadic versus regular). Factor analysis results provide evidence of the existence of three indexes of perceived risk associated, respectively, to the use of legal drugs, the sporadic use of illegal drugs and the regular use of illegal drugs.
    Keywords: adolescents, drugs, Europe, perceived risk, polydrug
    Date: 2017–12
  21. By: Lyttkens, Carl Hampus (Department of Economics, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University); Tinghög, Gustav (Division of Economics, Department of Management and Engineering, Linköping University)
    Abstract: The UK tariff for quality of life associated with the health states in the EQ-5D is probably not consistent with the preferences of Swedish health economists. This is worrying in view of the widespread use of the tariff values and the fact that health economists likely are better able than ordinary citizens to report their preferences for health states in a valid and reliable manner. We suggest this result is taken into account when the EQ-5D instrument is used, and that researchers should be cautious in using the UK (or any other) value sets. Our results also indicate that the variation across citizens in preferences for health may be a more complex issue than previously observed and deserves further study. An intriguing question for the future is to what extent health economists use methods and instruments that they themselves do not believe in.
    Keywords: health-related quality of life; EQ-5D; valid; respondents; health economist
    JEL: I10 I14 I18
    Date: 2018–12–10
  22. By: Abdul Wahab, Abdul Azeez Oluwanisola; Kefeli, Zurina; Hashim, Nurhazirah
    Abstract: The socio-economic development level of any country has been significantly attached to the state of healthcare and well-being of its people. Moreover, it is unequivocal that healthy people have substantial influences on economic advancement of a country because when they live longer there is tendency that they will be more productive. On the other hand, the standpoint of education on economic growth cannot be underscored as it serves as method of evolution and progression of personalities and an essential indicator of broad production of the national income. Nevertheless, this paper examines the dynamic effect of healthcare expenditure and education expenditure on economic growth using evidence from Organization of Islamic Cooperation (OIC) countries. The study applied Pool Mean Group (PMG) method by using 1990 to 2015 data. The study reveals a robust long-run co-integrating relationship between healthcare expenditure, education expenditure, research and development and the economic growths of OIC countries. Besides, the short-run effects indicates that, healthcare expenditure per capita significantly impact economic growth of OIC countries, while the education expenditure and research and development (technology) were insignificantly impact economic growth of OIC countries in the short-run. Albeit, the findings of the study short-run specific-effects concluded that, there is existence of a co-integrating relationship between the healthcare, education, technology and economic growth in 36 out of the 56 OIC countries, while 20 other countries have no co-integrating relationship with the economic growths. However, the study suggests that healthcare and education are device to further attain economic growth and development in OIC countries if well managed and administered.
    Keywords: Economic growth; healthcare expenditure; education expenditure; OIC countries
    JEL: H51 H52 O47 O57
    Date: 2018–10–10
  23. By: Patrick Asuming; Hyuncheol Bryant Kim; Armand Sim
    Abstract: We study long-run selection and treatment effects of a health insurance subsidy in Ghana, where mandates are not enforceable. We randomly provide different levels of subsidy (1/3, 2/3, and full), with follow-up surveys seven months and three years after the initial intervention. We find that a one-time subsidy promotes and sustains insurance enrollment for all treatment groups, but long-run health care service utilization increases only for the partial subsidy (1/3 and 2/3) groups. We find evidence that selection explains this pattern: those who were enrolled due to the subsidy, especially the partial subsidy, are more ill and have greater health care utilization.
    Date: 2018–11
  24. By: Jessica Goldberg; Mario Macis; Pradeep Chintagunta
    Abstract: Peer referrals are a common strategy for addressing asymmetric information in contexts such as the labor market. They could be especially valuable for increasing testing and treatment of infectious diseases, where peers may have advantages over health workers in both identifying new patients and providing them credible information, but they are rare in that context. In an experiment with 3,182 patients at 128 tuberculosis (TB) treatment centers in India, we find peers are indeed more effective than health workers in bringing in new suspects for testing, and low-cost incentives of about $US 3 per referral considerably increase the probability that current patients make referrals that result in the testing of new symptomatics and the identification of new TB cases. Peer outreach identifies new TB cases at 25%-35% of the cost of outreach by health workers and can be a valuable tool in combating infectious disease.
    JEL: I1 O1
    Date: 2018–11

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