nep-hea New Economics Papers
on Health Economics
Issue of 2019‒01‒14
nine papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Rational Self-Medication By Michael E. Darden; Nicholas W. Papageorge
  2. Substance Use Disorder Treatment Centers and Property Values By Brady P. Horn; Aakrit Joshi; Johanna Catherine Maclean
  3. The Effect of College Education on Health and Mortality: Evidence from Canada By Guy Lacroix; François Laliberté-Auger; Pierre-Carl Michaud; Daniel Parent
  4. To Pill or not to Pill? Access to Emergency Contraception and Contraceptive Behaviour By Ana Nuevo-Chiquero; Francisco J. Pino
  5. The Disability Option: Labor Market Dynamics with Macroeconomic and Health Risks By Amanda Michaud; David Wiczer
  6. The impact of NFL kickoff rule changes on player injuries: Forgoing excitement to reduce injuries? By Richardson, Zachary; Lindrooth, Richard
  7. For Good Measure: Advancing Research on Well-Being Metrics Beyond GDP By Joseph Stiglitz; Jean-Paul Fitoussi; Martine Durand
  8. Pre – Birth Exposure to Ramadan, Height, and the Length of Gastation By Seyed Mohammad Karimi
  9. The Impact of a Conditional Cash Transfer Program on Households' Well-Being By Daniela Del Boca; Chiara Pronzato; Giuseppe Sorrenti

  1. By: Michael E. Darden; Nicholas W. Papageorge
    Abstract: We develop a theory of rational self-medication. The idea is that forward-looking individuals, lacking access to better treatment options, attempt to manage the symptoms of mental and physical pain outside of formal medical care. They use substances that relieve symptoms in the short run but that may be harmful in the long run. For example, heavy drinking could alleviate current symptoms of depression but could also exacerbate future depression or lead to alcoholism. Rational self-medication suggests that, when presented with a safer, more effective treatment, individuals will substitute towards it. To investigate, we use forty years of longitudinal data from the Framingham Heart Study and leverage the exogenous introduction of selective serotonin reuptake inhibitors (SSRIs). We demonstrate an economically meaningful reduction in heavy alcohol consumption for men when SSRIs became available. Additionally, we show that addiction to alcohol inhibits substitution. Our results suggest a role for rational self-medication in understanding the origin of substance abuse. Furthermore, our work suggests that punitive policies targeting substance abuse may backfire, leading to substitution towards even more harmful substances to self-medicate. In contrast, policies promoting medical innovation that provide safer treatment options could obviate the need to self-medicate with dangerous or addictive substances.
    JEL: I10 I12
    Date: 2018–12
  2. By: Brady P. Horn; Aakrit Joshi; Johanna Catherine Maclean
    Abstract: Substance use disorders (SUDs) are a major social concern in the United States and other developed countries. There is an extensive economic literature estimating the social costs associated with SUDs in terms of healthcare, labor market outcomes, crime, traffic accidents, and so forth. However, beyond anecdotal claims that SUD treatment centers (SUDTCs), settings in which patients receive care for their SUDs, have a negative effect on property values, there is scant empirical work on this question. In this paper, we investigate the effect of SUDTCs on residential property values using data from Seattle, Washington, and SUDTC location, entry, and exit information. To mitigate bias from the potential endogeneity of SUDTC location choices, we apply a spatial differences-in-differences (SDD) model, which uses property and SUDTC location to construct treatment and comparison groups. Our findings suggest that SUDTCs endogenously locate in lower value areas, and naïve models imply that the entry of an SUDTC leads to a 3.4% to 4.6% reduction in property values. When an SDD model is applied, we find no evidence that SUDTCs affect property values. Overall, our findings suggest anecdotal claims that SUDTCs reduce property values are potentially overstated.
    JEL: H0 I1 R3
    Date: 2019–01
  3. By: Guy Lacroix; François Laliberté-Auger; Pierre-Carl Michaud; Daniel Parent
    Abstract: We investigate the returns to college attendance in Canada in terms of health and mortality reduction. To do so, we first use a dynamic health microsimulation model to document how interventions which incentivize college attendance among high school graduates may impact their health trajectory, health care consumption and life expectancy. We find large returns both in terms of longevity (4.2 years additional years at age 50), reduction in the prevalence of various health conditions (10-15 percentage points reduction in diabetes and 5 percentage points for stroke) and health care consumption (28.4% reduction in lifetime hospital stays, 19.8 for specialists). We find that education impacts mortality mostly by delaying the incidence of health conditions as well as providing a survival advantage conditional on having diseases. Second, we provide quasi-experimental evidence on the impact of college attendance on long-term health outcomes by exploiting the Canadian Veteran’s Rehabilitation Act, a program targeted towards returning WW-II veterans and which incentivized college attendance. The impact on mortality are found to be larger than those estimated from the health microsimulation model (hazard ratio of 0.216 compared to 0.6 in the simulation model) which suggest substantial returns to college education in terms of healthy life extension which we estimate around one million canadian dollars.
    Keywords: mortality,education,microsimulation,quasi-experimental,instrumental variables,veterans,
    JEL: I14
    Date: 2018–12–24
  4. By: Ana Nuevo-Chiquero; Francisco J. Pino
    Abstract: We examine the effects of free-of-charge availability of emergency contraception on contraceptive behaviour in Chile. Using a survey of individuals 15 to 29, we exploit variation in availability at the municipality level as a consequence of legal and judicial decisions in the late 2000s. We find an increase in the use of emergency contraception in municipalities in which it was available through the public health system, but also an increase in the use of other methods of hormonal, pre-coital contraception, and a decrease of more traditional contraceptive methods. This effect is concentrated among groups with a low starting use of contraceptives, who may benefit from the contact with the health services. Unlike previous results for developed countries, our results indicate that there is scope for an effect of emergency contraception in settings with low starting levels of contraceptive use, and a significant potential for policies to increase adoption of regular contraception.
    Date: 2019–01
  5. By: Amanda Michaud; David Wiczer
    Abstract: We evaluate the contribution of changing macroeconomic conditions and demographics to the increase in Social Security Disability Insurance (SSDI) over recent decades. Within our quantitative framework, multiple sectors differentially expose workers to health and economic risks, both of which affect individuals' decisions to apply for SSDI. Over the transition, falling wages at the bottom of the distribution increased awards by 27% in the 1980s and 90s and aging demographics rose in importance thereafter. The model also implies two-thirds of the decline in working-age male employment from 1985 to 2013, three-fourths of which eventually goes on SSDI.
    Date: 2018
  6. By: Richardson, Zachary; Lindrooth, Richard
    Abstract: Recognizing the increased danger during kickoff returns, the National Football League and National Collegiate Athletic Association changed rules aimed to reduce player injuries. Using a two-stage model, we examined the impact of rule changes on kickoff returns to the rate of player injuries. We estimated the impact of the changes on the number of kickoff returns using a difference-in-difference approach; from these estimates we created an instrumental variable measuring the local average treatment effect of the NFL rule change on player injuries. Our findings suggest that moving the kickoff location decreased both the likelihood of kickoff returns and player injuries.
    Keywords: NFL; NCAA; Football; Policy Analysis; Health Economics; Health Services Research; Rule Changes; Concussions; Injuries; Player Injuries
    JEL: I1 I10
    Date: 2018–12
  7. By: Joseph Stiglitz (Columbia Business School); Jean-Paul Fitoussi (Département d'économie); Martine Durand (Organisation de Coopération et de Développement Économiques (OCDE))
    Abstract: The 2009 Commission on the Measurement of Economic Performance and Social Progress (“Stiglitz-Sen-Fitoussi” Commission) concluded that we should move away from over-reliance on GDP when assessing a country’s health, towards a broader dashboard of indicators that would reflect concerns such as the distribution of well-being and sustainability in all of its dimensions. This book includes contributions from members of the OECD-hosted High Level Expert Group on the Measurement of Economic Performance and Social Progress, the successor of the Stiglitz-Sen-Fitoussi Commission, and their co-authors on the latest research in this field. These contributions look at key issues raised by the 2009 Commission that deserved more attention, such as how to better include the environment and sustainability in our measurement system, and how to improve the measurement of different types of inequalities, of economic insecurity, of subjective well-being and of trust. A companion volume Beyond GDP: Measuring What Counts for Economic and Social Performance presents an overview by the co-chairs of the High Level Expert Group, Joseph E. Stiglitz, Jean-Paul Fitoussi and Martine Durand of the progress accomplished since the 2009 report, of the work conducted by the Group over the past five years, and of what still needs to be done.
    Date: 2018–11
  8. By: Seyed Mohammad Karimi (University of Washington Tacoma)
    Abstract: The effect of pre-birth exposure to Ramadan, the Muslim month of fasting, on children’s height and an array of pregnancy, delivery, and postpartum outcomes— namely birthweight, neonatal mortality, breastfeeding initiation and duration, and a series of maternal pregnancy and delivery complications— was measured. Since the birth and postpartum outcomes correlate with the length of gestation, they can provide evidence on the effect of exposure to Ramadan on the length of gestation. I used data from 98 demographic and health surveys from 37 low and lower-middle income countries and found that pre-birth exposure to Ramadan decreases a Muslim male child’s height by as much as 12.2 mm on average. The examinations of the other outcomes did not provide strong evidence on the impact of exposure to Ramadan on gestation length.
    Date: 2018–10–10
  9. By: Daniela Del Boca (University of Turin and Collegio Carlo Alberto); Chiara Pronzato (University of Turin, CHILD and Collegio Carlo Alberto); Giuseppe Sorrenti (University of Zurich)
    Abstract: We evaluate the impact of a conditional cash transfer (CCT) program that we designed on family well-being among low-income families with young children. Although most CCTs have been implemented in low-income countries, our research is in the context of a high-income country, Italy, where the recent economic crises have worsened the conditions of families with children, especially among immigrants. Our objective is to evaluate the introduction of conditionality (attendance of courses) into a pre-existing unconditional cash transfer program. Using a randomized controlled trial, we find that CCT families search more actively for work, and they work more hours and more regularity than the cash transfer and control groups. CCT families also are able to save more money and eat healthier foods. The CCT intervention appears to be more effective than cash transfer alone in changing households' behavior in several dimensions of well-being. Our findings add to the accumulating evidence on the impact of conditional cash transfers versus unconditional ones and to the literature concerning multidimensional incentive programs.
    Keywords: conditional cash transfers, poverty, use of money, Labor Supply, parenting
    JEL: I10 I20 J24 I31
    Date: 2018–12

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