nep-hea New Economics Papers
on Health Economics
Issue of 2019‒04‒01
thirteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Disability and Distress: The Effect of Disability Programs on Financial Outcomes By Manasi Deshpande; Tal Gross; Yalun Su
  2. Legacies of Loss: The intergenerational outcomes of slaveholder compensation in the British Cape Colony By Martins, Igor; Cilliers, Jeanne; Fourie, Johan
  3. Inexpensive Heating Reduces Winter Mortality By Janjala Chirakijja; Seema Jayachandran; Pinchuan Ong
  4. The Phenomenon of Summer Diarrhea and its Waning, 1910-1930 By D. Mark Anderson; Daniel I. Rees; Tianyi Wang
  5. Fair allocations for cooperation problems in vaccination By Westerink-Duijzer, L.E.; Schlicher, L.P.J.; Musegaas, M.
  6. Convenient Primary Care and Emergency Hospital Utilization By Pinchbeck, E.
  7. Effects of market structure and patient choice on hospital quality for planned patients By Giuseppe Moscelli; Hugh Gravelle; Luigi Siciliani
  8. The Intergenerational Transmission of Food Security: A Nonparametric Bounds Analysis By Gundersen, Craig; Kreider, Brent; Pepper, John V.
  9. The Effect of Maternal Education on Offspring's Mental Health By Daniel Graeber; Daniel D. Schnitzlein
  10. The Causal Effects of Adolescent School Bullying Victimisation on Later Life Outcomes By Emma Gorman; Colm Harmon; Silvia Mendolia; Anita Staneva; Ian Walker
  11. Wealth and health in South Africa By Julien Albertini; Anthony Terriau
  12. Early Life Exposure to Pollution: Eect of Seasonal Open Biomass Burning on Child Health in India By Singh, Prachi; Dey, Sagnik; Chowdhury, Sourangsu
  13. Affordability of fruits and vegetables in Ethiopia By Hirvonen, Kalle; Wolle, Abdulazize; Minten, Bart

  1. By: Manasi Deshpande (University of Chicago, Department of Economics); Tal Gross (Columbia University Mailman School of Public Health); Yalun Su (University of Chicago)
    Abstract: We provide the first evidence on the relationship between disability programs and markers of financial distress: bankruptcy, foreclosure, eviction, and home sale. Rates of these adverse financial events peak around the time of disability application and subsequently fall for both allowed and denied applicants. To estimate the causal effect of disability programs on these outcomes, we use variation induced by an age-based eligibility rule and find that disability allowance substantially reduces the likelihood of ad- verse financial events. Within three years of the decision, the likelihood of bankruptcy falls by 0.81 percentage point (30 percent), and the likelihood of foreclosure and home sale among homeowners falls by 1.7 percentage points (30 percent) and 2.5 percentage points (20 percent), respectively. We find suggestive evidence of reductions in eviction rates. Conversely, the likelihood of home purchases increases by 0.86 percentage point (20 percent) within three years. We present evidence that these changes reflect true reductions in financial distress. Considering these extreme events increases the optimal disability benefit amount and suggests a shorter optimal waiting time.
    Keywords: disability, bankruptcy, eviction
    JEL: D14 H50 I30
    Date: 2019–03
  2. By: Martins, Igor (Department of Economic History, Lund University); Cilliers, Jeanne (Department of Economic History, Lund University); Fourie, Johan (Stellenbosch University)
    Abstract: Can wealth shocks have intergenerational health consequences? We use the partial compensation slaveholders received after the 1834 slave emancipation in the British Cape Colony to measure the intergenerational effects of a wealth loss on longevity. Because the share of partial compensation received was uncorrelated to wealth, we can interpret the results as having a causal influence. We find that a greater loss of slave wealth shortened the lifespans of the generation of slaveholders that experienced the shock and those of their children, but not those of their grandchildren. We speculate on the mechanisms for this intergenerational persistence.
    Keywords: intergenerational health; intergenerational persistence; wealth shock; lifespan; longevity; slaveemancipation; Cape Colony
    JEL: D60 I19 J47 N37 N47 N97
    Date: 2019–03–20
  3. By: Janjala Chirakijja; Seema Jayachandran; Pinchuan Ong
    Abstract: This paper examines how the price of home heating affects mortality in the US. Exposure to cold is one reason that mortality peaks in winter, and a higher heating price increases exposure to cold by reducing heating use. It also raises energy bills, which could affect health by decreasing other health-promoting spending. Our empirical approach combines spatial variation in the energy source used for home heating and temporal variation in the national prices of natural gas versus electricity. We find that a lower heating price reduces winter mortality, driven mostly by cardiovascular and respiratory causes.
    JEL: I1 J14 Q41
    Date: 2019–03
  4. By: D. Mark Anderson; Daniel I. Rees; Tianyi Wang
    Abstract: During the first two decades of the 20th century, diarrheal deaths among American infants and children surged every summer. Although we still do not know what pathogen (or pathogens) caused this phenomenon, the consensus view is that it was eventually controlled through public health efforts at the municipal level. Using data from 26 major American cities for the period 1910-1930, we document the phenomenon of summer diarrhea and explore its dissipation. We find that water filtration is associated with a 15-17 percent reduction in diarrheal mortality among children under the age of two during the non-summer months, but does not seem to have had an effect on diarrheal mortality during the summer. In general, we find little evidence to suggest that public health interventions undertaken at the municipal level contributed to the dissipation of summer diarrhea. Our results are relevant for many parts of the developing world today, where climate change is expected to affect the length and intensity of seasons as well as the incidence of diarrheal diseases.
    JEL: I10 I18 N3 Q54
    Date: 2019–03
  5. By: Westerink-Duijzer, L.E.; Schlicher, L.P.J.; Musegaas, M.
    Abstract: Vaccination is a very effective measure to fight an outbreak of an infectious disease, but it often suffers from delayed deliveries and limited stockpiles. To use these limited amounts of vaccines effectively, health agencies can decide to cooperate and share their vaccines. In this paper, we analyze this type of cooperation. Typically cooperation leads to an increased total return, but cooperation is only plausible when this total return can be distributed among the agents in a fair way. Using cooperative game theory, we derive theoretical sufficient conditions under which cooperation is plausible and we show that the resources can be traded for a market price in those cases. We perform numerical analyses to generalize these findings and we derive analytical expressions for market prices that can be used in general for distributing the total return in a fair way. Our results demonstrate that cooperation is a delicate matter. Cooperation is most likely to be plausible when the total amount of resources is limited or very large. In those cases, trading resources for a market price often results in a fair allocation of the total return. We confirm these findings with a case study on the redistribution of influenza vaccines.
    Keywords: cooperative game theory, market allocations, core, S-shaped return functions, vaccination
    Date: 2019–03–08
  6. By: Pinchbeck, E.
    Abstract: Participation and utilization decisions lie at the heart of many public policy questions. I contribute new evidence by using hospital records to examine how access to primary care services affects utilization of hospital Emergency Departments in England. Using a natural experiment in the roll out of services, I first show that access to primary care reduces Emergency Departments visits. Additional strategies then allow me to separate descriptively four aspects of primary care access: proximity, opening hours, need to make an appointment, and eligibility. Convenience–oriented services divert three times as many patients from emergency visits, largely because patients can attend without appointments.
    Keywords: primary care; emergency care; access; utilization decisions
    Date: 2018–12–12
  7. By: Giuseppe Moscelli (Economics of Social and Health Care Research Unit, Centre for Health Economics,University of York, UK and School of Economics, University of Surrey, Guildford, UK.); Hugh Gravelle (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, UK); Luigi Siciliani (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, UK and Department of Economics and Related Studies, University of York, York, UK)
    Abstract: We investigate the change in the effect of market structure on planned hospital quality for three high-volume treatments, using a quasi difference in differences approach based on the relaxation of patient constraints on hospital choice in England. We employ control functions to allow for timevarying endogeneity from unobserved patient characteristics. We find that the choice reforms reduced quality for hip and knee replacement but not for coronary bypass. This is likely due to hospitals making a larger loss on hip and knee replacements, since robustness checks rule out changes in length of stay, new competitors’ entry and hospital-level mortality as possible confounders.
    Keywords: competition, quality, hospital, choice, endogeneity, difference in difference, control function.
    JEL: H51 I11 I18 L32 L33
    Date: 2019–03
  8. By: Gundersen, Craig; Kreider, Brent; Pepper, John V.
    Abstract: Using partial identification methods and data from the PSID, we analyze the causal transmission of food security across generations. Food security rates are positively correlated across generations; food security rates in 2015 are 20 points higher for respondents who grew up in households that were secure in 1999 than those growing up in food insecure households. Despite these strong associations, the intergenerational effect of growing up in a food secure household remains uncertain. . Assessing the degree of intergenerational transmission of food security is complicated by unobserved factors (e.g., human capital, health issues) that jointly influence whether a child resides in a food secure household and, subsequently, whether likely to be food secure as a young adult. Identifying causal transmission across generations requires addressing this important selection problem. In light of the ambiguities created by the selection problem, a number of alternative assumptions and estimates are presented. While under the weakest assumptions very little can be inferred, results derived under strong but plausible assumptions provide evidence that growing up in a food insecure household increases the probability of being food insecure as a young adult.
    Keywords: Food Security and Poverty
    Date: 2019–02
  9. By: Daniel Graeber; Daniel D. Schnitzlein
    Abstract: We estimate the causal effect of maternal education on the mental health of mother’s children in late adolescence and adulthood. Theoretical considerations are ambiguous about a causal effect of maternal education on children’s mental health. To identify the causal effect of maternal education, we exploit exogenous variation in maternal years of schooling, caused by a compulsory schooling law reform in West Germany. Based on data from the German Socio-Economic Panel, we find no evidence of a causal protective effect of maternal education on children’s mental health. Instead, our empirical results suggest a moderate negative effect of maternal education on the daughters’ mental health. We find no effects for the sons. Our investigation of potential mechanisms is consistent with the hypothesis that the negative effect of higher maternal labor supply outweighs the positive effect of an expansion in household resources.
    Keywords: Mental health, education, compulsory schooling reform, intergenerational mobility
    JEL: I10 I21 J62
    Date: 2019
  10. By: Emma Gorman (Lancaster University Management School); Colm Harmon (University of Sydney); Silvia Mendolia (University of Wollongong); Anita Staneva (The University of Sydney); Ian Walker (Lancaster University Management School)
    Abstract: We use rich data on a cohort of English adolescents to analyse the long-term effects of experiencing bullying victimisation in junior high school. The data contain self-reports of five types of bullying and their frequency, for three waves of the data, when the pupils were aged 13 to 16 years. Using a variety of estimation strategies - least squares, matching, inverse probability weighting, and instrumental variables - we assess the effects of bullying victimisation on short- and long-term outcomes, including educational achievements, earnings, and mental ill-health at age 25 years. We handle potential measurement error in the child self-reports of bullying type and frequency by instrumenting with corresponding parental cross-reports. Using a detailed longitudinal survey linked to administrative data, we control for many of the determinants of bullying victimisation and child outcomes identified in previous literature, paired with comprehensive sensitivity analyses to assess the potential role of unobserved variables. The pattern of results strongly suggests that there are important long run effects on victims - stronger than correlation analysis would otherwise suggest. In particular, we find that both type of bullying and its intensity matters for long run outcomes.
    Keywords: bullying, victimization, long-term outcomes
    JEL: I21 I24 J24
    Date: 2019–03
  11. By: Julien Albertini (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet [Saint-Étienne] - Université de Lyon - CNRS - Centre National de la Recherche Scientifique); Anthony Terriau (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet [Saint-Étienne] - Université de Lyon - CNRS - Centre National de la Recherche Scientifique)
    Abstract: In this paper, we investigate the impact of wealth on health in South Africa using the National Income Dynamics Study (NIDS). We estimate a two-stage probit model with inheritance as an instrumental variable for wealth. We find no significant effect of wealth on health at the individual level, consistent with most of the results found for developed countries. Alternative specifications to the health outcomes (self-reported health versus reported diseases) as well as the introduction of gifts as an additional instrumental variable delivers similar results. In addition, we decompose wealth into liquid and illiquid wealth. Despite the health effect being higher for liquid than for non-liquid wealth, none of these measures involve substantial or significant effects on health.
    Keywords: Wealth,Health,Inheritance,South Africa
    Date: 2019–03–20
  12. By: Singh, Prachi; Dey, Sagnik; Chowdhury, Sourangsu
    Abstract: This paper examines effect of outdoor air pollution on child health in India by combining satellite PM2.5 data with geo-coded Demographic and Health Survey of India(2016). Pollution levels vary due to seasonal open biomass burning events (like crop-burning and forest res) which are a common occurrence. Our identification strategy relies on spatial and temporal differences in these biomass burning events to identify the effect air pollution on child health. Our results indicate that children ex- posed to higher levels of PM2.5 during their first trimester and during the post-natal period of first three months after birth have lower Height-for-age and Weight-for-age; the effect is not limited to just rural areas, but prominent for Northern states of India which have higher incidence of such events.
    Keywords: Health Economics and Policy
    Date: 2019–02
  13. By: Hirvonen, Kalle; Wolle, Abdulazize; Minten, Bart
    Abstract: As in many other low-income countries, fruit and vegetable (FV) consumption is very low in Ethiopia. Consequently, micronutrient deficiencies, such as for Vitamin A, are widespread, and more than half of young Ethiopian children suffer from anemia. Efforts to increase FV consumption in Ethiopia have focused on improving consumer knowledge of the health benefits of FV and other nutritious foods. While these interventions have been successful in improving knowledge and ultimately improving dietary diversity, diets remain extremely monotonous across the country. Recent international research in this area suggest that high relative prices of FVs could be another important constraint. To shed more light on this issue, we assess the affordability of FVs in Ethiopia. Using expenditure and price data collected by the Central Statistical Agency of Ethiopia, we find that the average Ethiopian household would have to spend 11 percent of their income to meet the international recommendation of two servings of fruits and three servings of vegetables per person per day. This share is more than 2.5 times higher for households in the poorest quintile, indicating that meeting these guidelines is currently out of reach for the poorest households in Ethiopia. More investments and research attention to the production of fruits and vegetables is urgently needed to improve supplies and, hence, their affordability.
    Keywords: ETHIOPIA, EAST AFRICA, AFRICA SOUTH OF SAHARA, AFRICA,fruits; vegetables; food prices; nutrition; diet; trace elements; health; dietary guidelines; micronutrients
    Date: 2018

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