nep-hea New Economics Papers
on Health Economics
Issue of 2019‒04‒08
nineteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Mums Go Online: Is the Internet Changing the Demand for Healthcare? By Amaral Garcia, Sofia; Nardotto, Mattia; Propper, Carol; Valletti, Tommaso
  2. Capacity Constraints and the Provision of Public Services: The Case of Workers in Public Health Clinics By Matthew C. Harris; Yinan Liu; Ian McCarthy
  3. Birds of a Feather: Estimating the Value of Statistical Life from Dual-Earner Families By Joseph E. Aldy
  4. Information shocks and provider responsiveness: evidence from interventional cardiology By Avdic, Daniel; Propper, Carol; von Hinke, Stephanie
  5. Individual Discount Rates: A Meta-Analysis of Experimental Evidence By Matousek, Jindrich; Havranek, Tomas; Irsova, Zuzana
  6. Historical Analysis of National Subjective Wellbeing using Millions of Digitized Books By Hills, Thomas; Illushka Seresinhe, Chanuki; Proto, Eugenio; Sgroi, Daniel
  7. Intergenerational Health Mobility: Evidence from Danish Registers By Carsten Andersen
  8. Growing in the Womb: The Effect of Seismic Activity on Fetal Growth By Álvarez-Aranda, Rocío; Chirkova, Serafima; Romero, José Gabriel
  9. Coming out in America: AIDS, Politics, and Cultural Change By Raquel Fernández; Sahar Parsa; Martina Viarengo
  10. Global Alcohol Markets: Evolving Consumption Patterns, Regulations and Industrial Organizations By Kym Anderson; Giulia Meloni; Johan Swinnen
  11. How BLUE is the Sky? Estimating the Air Quality Data in Beijing During the Blue Sky Day Period (2008-2012) by the Bayesian LSTM Approach By Han, Y.; Li, V.; Lam, J., Pollitt, M.; Pollitt, M.
  12. Environment, Health and Labor Market By Xavier Pautrel
  13. Harder, better, faster... yet stronger? Working conditions and self-declaration of chronic diseases By Éric Defebvre
  14. The Effect of Immigration on the Well-Being of Native Populations: Evidence from the United Kingdom By Papageorgiou, Athanasios
  15. The Causal Effects of Adolescent School Bullying Victimisation on Later Life Outcomes By Gorman, Emma; Harmon, Colm; Mendolia, Silvia; Staneva, Anita; Walker, Ian
  16. Factor-Analysis-Based Directional Distance Function: The case of New Zealand hospitals By Nan Jiang; Zhongqi Deng; Ruizhi Pang
  17. The Health Issues of the Homeless and the Homeless Issues of the Ill-Health By Dai, Li; Zhou, Peng
  18. The Income Elasticity for Nutrition: Evidence from Unconditional Cash Transfers in Kenya By Ingvild Almås; Johannes Haushofer; Jeremy P. Shapiro
  19. Health insurance and self-employment transitions in Vietnam By Le, Nga; Groot, Wim; Tomini, Sonila M.; Tomini, Florian

  1. By: Amaral Garcia, Sofia; Nardotto, Mattia; Propper, Carol; Valletti, Tommaso
    Abstract: We study the effect of internet diffusion on childbirth procedures performed in England between 2000 and 2011. We exploit an identification strategy based on geographical discontinuities in internet access generated by technological factors. We show that broadband internet access increased Cesarean-sections: mothers living in areas with better internet access are 2.3 percent more likely to have a C-section than mothers living in areas with worse internet access. The effect is driven by first-time mothers who are 6.1 percent more likely to obtain an elective C-section. The increased C-section rate is not accompanied by changes in health care outcomes of mothers and newborns. Health care costs increased with no corresponding medical benefits for patients. Heterogeneity analysis shows that mothers with low income and low education are those more affected: thanks to the internet, they progressively close the C-section gap with mothers with higher income and education. We show evidence documenting the growing importance of the internet as a source of health related information, and we argue that patient's access to online information is changing the relationship between health care providers and patients.
    Keywords: c-sections; Information; internet
    Date: 2019–03
  2. By: Matthew C. Harris; Yinan Liu; Ian McCarthy
    Abstract: Unlike in the production of most goods, changes in capacity for labor-intensive services only affect outcomes of interest insofar as service providers change the way they allocate their time in response to those capacity changes. In this paper, we examine how public sector service providers respond to unexpected capacity constraints in the specific context of public health clinics. We exploit an exogenous reduction in public health clinic capacity to quantify nurses' trade-off between patients treated and time spent with each patient, which we treat as a proxy for a quality v. quantity decision. We provide evidence that these small and generally insignificant effects on nurse time favor public sector employees prioritizing quality of each interaction over clearing the patient queue.
    JEL: D24 I18 J22
    Date: 2019–03
  3. By: Joseph E. Aldy
    Abstract: Economists have long employed hedonic wage analysis to estimate income-fatality risk trade-offs, but some scholars have raised concerns about systematic measurement error and omitted variable bias in the empirical applications of this model. Recent studies have employed panel methods to remove time-invariant individual-specific characteristics that could induce bias in estimation. In an analogous manner, this paper proposes to exploit assortative matching on risk attitudes within married couples to control for worker characteristics that are unobserved to the econometrician. I develop and implement a modified hedonic wage estimator based on a within-coupled differenced wage equation for full-time working married couples with the Current Population Survey Merged Outgoing Rotation Group over 1996-2002. The key assumption builds on the findings in the assortative matching literature that individuals often marry those who have common traits across many dimensions, including those that may influence worker wages and are correlated with observed occupational fatality risks. This estimator identifies the compensating differential for occupation fatality risk by using within-couple differencing to remove unobserved determinants of risk attitudes and risk-mitigation ability, on which couples match, from the error term. I find that the value of statistical life (VSL) varies from $9 to $13 million (2016$). The within-couple differenced VSL estimates are stable and more robust to variation in specification of the hedonic wage model than conventional, cross-sectional hedonic wage models. I also find that the value of statistical life takes an inverted-U shape with respect to age.
    JEL: J12 J17 J31 Q51
    Date: 2019–03
  4. By: Avdic, Daniel; Propper, Carol; von Hinke, Stephanie
    Abstract: We examine physician responses to global information shocks and the impact on patient outcomes. We exploit an international "firestorm" over the safety of an innovation in healthcare, drug-eluting stents. We use rich micro-data on interventional cardiologists' use of stents to de- fine and measure responsiveness to news shocks. We find substantial heterogeneity in responsiveness to both good and bad news and an association between speed of response to news and patient outcomes. Patients treated by cardiologists who respond slowly to news shocks have fewer adverse outcomes. These results cannot be attributed to financial incentives, patient-physician sorting or heterogeneity in skill.
    Keywords: Practice style; Quality of care; response to news
    JEL: H51 I11 I18 J24 O33
    Date: 2019–03
  5. By: Matousek, Jindrich; Havranek, Tomas; Irsova, Zuzana
    Abstract: A key parameter estimated by lab and field experiments in economics is the individual discount rate---and the results vary widely. We examine the extent to which this variance can be attributed to observable differences in methods, subject pools, and potential publication bias. To address the model uncertainty inherent to such an exercise, we employ Bayesian model averaging. We find occasional but widespread publication bias against unintuitive results: in consequence, the mean reported discount rate is inflated twofold. Our results suggest that estimates decrease with the time horizon, a finding consistent with hyperbolic discounting. Discount rates are similar for money and health questions, but people tend to be less patient in exotic contexts (e.g., when offered a kiss from a movie star). Africans are less patient than people from other continents. Finally, the results of lab and field experiments differ systematically, and it also matters whether the experiment relies on students or uses broader samples of the population.
    Keywords: Discount rate,experiment,publication bias,meta-analysis,Bayesian model averaging
    JEL: D01 C83 C90
    Date: 2019
  6. By: Hills, Thomas; Illushka Seresinhe, Chanuki; Proto, Eugenio; Sgroi, Daniel
    Abstract: In addition to improving quality of life, higher subjective wellbeing leads to fewer health problems, higher productivity, and better incomes. For these reasons subjective wellbeing has become a key focal issue among scientific researchers and governments. Yet no scientific investigator knows how happy humans were in previous centuries. Here we show that a new method based on quantitative analysis of digitized text from millions of books published over the past 200 years captures reliable trends in historical subjective wellbeing across four nations. This method uses psychological valence norms for thousands of words to compute the relative proportion of positive and negative language, indicating relative happiness during national and international wars, financial crises, and in comparison to historical trends in longevity and GDP. We validate our method using Eurobarometer survey data from the 1970s onwards and in comparison with economic, medical, and political events since 1820 and also use a set of words with stable historical meanings to support our findings. Finally we show that our results are robust to the use of diverse corpora (including text derived from newspapers) and different word norms.
    Date: 2019–03
  7. By: Carsten Andersen (Department of Economics and Business Economics, Aarhus University, Denmark)
    Abstract: To what extent status depends on family background has been of great interest in the social sciences and the general public for centuries. The transmission of income, earnings and educational attainment is often studied, while equality of opportunity with respect to health outcomes has received far less attention. This paper is the first to investigate intergenerational health mobility using high-quality administrative data from Denmark. The attractiveness of this approach lies in objective health measures and large sample sizes allowing twin analyses. I operationalise health mobility by a variety of statistics: rank-rank slopes, intergenerational correlations and sibling and identical twin correlations. Mobility in health is found to be relatively high for men, both when compared to similar US-based studies, and when contrasted with outcomes such as educational attainment and income. For Danish women, health-related dependence on family background is on par with similar statistics for income and earnings for other Scandinavian countries. Mobility is thus, perhaps somewhat nonintuitively, higher in health than in income. Contrasting sibling and identical twin correlations with parent-child associations confirm earlier findings in the literature on equality of opportunity, namely that sibling correlations capture far more variation than traditional intergenerational correlations. 14-38 percent of the variation in individual health outcomes can be ascribed to family background and genes, factors which the individual cannot be held accountable for. Only a negligible share of this variation can be explained by parental health, which suggests that other family-specific characteristics may play an important role for health mobility.
    Keywords: Health, inequality, intergenerational mobility, sibling correlations, family background
    JEL: I1 I14 J62 D30
    Date: 2019–04–02
  8. By: Álvarez-Aranda, Rocío; Chirkova, Serafima; Romero, José Gabriel
    Abstract: We study how prenatal maternal stress, caused by sustained seismic activity, affects birth outcomes in Chile during the period 2011-2015. A mother-fixed-effect model together with the spatiotemporal variation of earthquakes in Chile allow us to deal with identification issues that have obscured previous estimates. Our findings show that prenatal maternal stress seems to affect fetal growth, because infants born to mothers exposed to earth tremors in early and/or mid gestation are more likely to be large for gestational age. The estimates suggest that relatively poorer Chilean mothers are more vulnerable to earthquakes, because their babies seem to drive the reported impacts on fetal growth. We discuss and provide evidence that suggests a possible mechanism that explains the varying results across socioeconomic status. Mothers with diabetes and/or hypertension are more likely to have large-for-gestational-age babies. Exposure to earth tremors seems to increase the incidence of these afflictions among the affected population, with the observed impact on diabetes being relatively higher among women with lower socio-economic status.
    Keywords: Health Economics and Policy
    Date: 2019–01–14
  9. By: Raquel Fernández; Sahar Parsa; Martina Viarengo
    Abstract: The last few decades witnessed a dramatic change in public opinion towards gay people. This paper uses a difference-in-difference empirical strategy to investigate the hypothesis that the AIDS epidemic and the ensuing endogenous political process led to this transformation. We show that the process of change was discontinuous over time and show suggestive evidence that the '92 presidential election followed by the “don't ask, don't tell” debate led to a change in attitudes. In accordance with our hypothesis, this change was greater in states with high-AIDS rate. Our analysis suggests that if individuals in low-AIDS states had experienced the same average AIDS rate as a high-AIDS state, the change in their approval rate from the '70s to the '90s would have been 50 percent greater.
    JEL: J15 P16 Z13
    Date: 2019–03
  10. By: Kym Anderson; Giulia Meloni; Johan Swinnen
    Abstract: For millennia alcoholic drinks have played an important role in food security and health (both positive and negative), but consumption patterns of beer, wine and spirits have altered substantially over the past two centuries. So too have their production technologies and industrial organization. Globalization and economic growth have contributed to considerable convergence in national alcohol consumption patterns. The industrial revolution contributed to excess consumption by stimulating demand and lowering the cost of alcohol. It also led to concentration in some alcohol industries, expecially brewing. In recent years the emergence of craft producers has countered firm concentration and the homogenization of alcoholic beverages. Meanwhile, governments have intervened extensively in alcohol markets to reduce excessive consumption, raise taxes, protect domestic industries and/or ensure competition. These regulations have contributed to, and been affected by, evolving patterns of consumption and changing structures of alcohol industries.
    Keywords: Globalization of preferences; Convergence of national beverage consumption mix; Alcohol and health; Restrictions on alcohol consumption and production; Beverage firm concentration
    Date: 2018
  11. By: Han, Y.; Li, V.; Lam, J., Pollitt, M.; Pollitt, M.
    Abstract: Over the last three decades, air pollution has become a major environmental challenge in many of the fast growing cities in China, including Beijing. Given that any long-term exposure to high-levels of air pollution has devastating health consequences, accurately monitoring and reporting air pollution information to the public is critical for ensuring public health and safety and facilitating rigorous air pollution and health-related scientific research. Recent statistical research examining China’s air quality data has posed questions regarding data accuracy, especially data reported during the Blue Sky Day (BSD) period (2000 – 2012), though the accuracy of publicly available air quality data in China has improved gradually over the recent years (2013 – 2017). To the best of our understanding, no attempt has been made to re-estimate the air quality data during the BSD period. In this paper, we put forward a machine-learning model to re-estimate the official air quality data during the BSD period of 2008 – 2012, based on the PM2.5 data of the Beijing US Embassy, and the proxy data covering Aerosol Optical Depth (AOD) and meteorology. Results have shown that the average re-estimated daily air quality values are respectively 64% and 61% higher than the official values, for air quality index (AQI) and AQI equivalent PM2.5, during the BSD period of 2008 to 2012. Moreover, the re-estimated BSD air quality data exhibit reduced statistical discontinuity and irregularity, based on our validation tests. The results suggest that the proposed data re-estimation methodology has the potential to provide more justifiable historical air quality data for evidence-based environmental decision-making in China.
    Keywords: Blue Sky Day (BSD), Air Quality, Beijing, Data Irregularity, Bayesian LSTM, Data Estimation
    JEL: C53 C63 Q53
    Date: 2019–03–21
  12. By: Xavier Pautrel
    Abstract: We re-examine the impact of environmental taxation on health and output, in the presence of labor market frictions. Our main findings are that matching process and wage bargaining introduce new channels of transmission of environmental taxation on the economy such that assuming perfect labor market leads to over-estimate the positive impact of environmental taxation on health. We also demonstrate that rising abatement expenditures as a way of tightening the environmental policy would be better for health than increasing environmental tax in the presence of market labor imperfections.
    Keywords: Environmental Economics and Policy
    Date: 2017–09–11
  13. By: Éric Defebvre (TEPP - Travail, Emploi et Politiques Publiques - UPEM - Université Paris-Est Marne-la-Vallée - CNRS - Centre National de la Recherche Scientifique, ERUDITE - Equipe de Recherche sur l’Utilisation des Données Individuelles en lien avec la Théorie Economique - UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12 - UPEM - Université Paris-Est Marne-la-Vallée)
    Abstract: The role of working conditions on workers' health status has been widely acknowledged in the literature in general but has received less attention in economics, due to the inherent statistical biases and the lack of data available to determine the role of simultaneous and chronic exposures. This study aims at estimating the causal impact of detrimental working conditions on the self-declaration of chronic diseases in France. Using a rebuilt retrospective lifelong panel and defining indicators for physical and psychosocial strains, we implement a mixed econometric strategy relying on difference-in-differences and matching methods taking into account for selection biases as well as unobserved heterogeneity. For men and women, we find deleterious effects of both types of working conditions on the declaration of chronic diseases after exposure, with varying patterns of impacts according to the strains' nature and magnitude. These results bring insights on the debate linked to legal age retirement postponement and plead for policies happening early in individuals' careers in order to prevent subsequent, mid-career health repercussions as well as schemes more focused on psychosocial risk factors.
    Keywords: Working conditions,Chronic diseases,Difference-in-differences,Matching
    Date: 2019–03–17
  14. By: Papageorgiou, Athanasios
    Abstract: Immigration has long been a controversial topic in the political landscape of the United Kingdom. Public scepticism over the adverse effects of immigration has largely determined the outcome of the recent referendum on the UK’s membership in the EU. This is especially the case for certain demographic groups, such as older people who tend to be more opposed to immigration. The aim of this study is to explore the relationship between migrant inflows and the subjective well-being of natives in the United Kingdom. The empirical analysis relies on a combined dataset from the British Household Panel Survey (BHPS) and the UK Household Longitudinal Study (UKHLS) for the entire UK covering the period 2004-2016, while subjective well-being is captured by life satisfaction and general happiness. Using respondents’ geographic identifiers allows us to map net migration at the local authority level. Our results suggest that immigration has only a minor effect on the subjective well-being of natives. We also examine how our estimates vary across socio-demographic groups and conclude that there is some degree of heterogeneity in terms of gender, age, marital and job status, although our results are not statistically significant. To account for endogeneity and reverse causality we apply the instrumental variable (IV) approach. The IV results suggest a positive effect of immigration on natives’ well-being, however the magnitude of the estimated coefficient appears to be quite small. Furthermore, we perform several additional tests to ensure the robustness of our estimates. Finally, we suggest that labour market and health outcomes may be two possible channels through which migrant inflows affect the subjective well-being of British natives.
    Keywords: Subjective well-being; Immigration; Fixed effects; Local authority district; UK
    JEL: C23 F22 I31 R23
    Date: 2018–09
  15. By: Gorman, Emma; Harmon, Colm; Mendolia, Silvia; Staneva, Anita; Walker, Ian
    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 selfreports 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
    Date: 2019–03
  16. By: Nan Jiang (School of Economics, Auckland University of Technology); Zhongqi Deng (School of Economics, Sichuan University, China); Ruizhi Pang (College of Economics and Social Development, Nankai University, China)
    Abstract: This paper develops a new factor-analysis-based (FAB) approach for choosing the optimal direction in a directional distance function (DDF) analysis. It has the combined merits of factor analysis and slacks-based measure (SBM) and incorporates the relative ease with which various input-output could be adjusted. This development relieves the dependency of price information that is normally unavailable in the provision of public goods. This new FAB-DDF model has been applied on a dataset containing all public hospitals in New Zealand (NZ) observed during 2011-2017. The empirical results indicate that the average reduction across different labor is in the range of 3-10 percent, and the corresponding figure for capital input is 25.7 percent. The case-adjusted inpatient-discharge and price-adjusted outpatient-visit are used as measures of desirable output, the average efficiencies are 92.7 percent and 99 percent respectively. Hospital readmission within 28 days of discharge is used as a measure for undesirable output, and the average efficiency score is 90 percent. These evidence support the suspicion that perverse incentives might exist under the National Health Targets abolished in 2018, which was a set of six indicators used in the last decade to evaluate the performance of local District Health Boards.
    Keywords: factor-analysis-based measure, directional distance function, NZ hospital efficiency, hospital readmission
    JEL: C61 D24 I11 I18
    Date: 2019–01
  17. By: Dai, Li (School of Economics and Trade, Hunan University); Zhou, Peng (Cardiff Business School)
    Abstract: In public policy planning and budgeting, the health issues and homeless issues tend to be in-terrelated and reinforced by each other, but this mutual causality is usually ignored in the ex-isting literature. This paper provides an unbiased estimate of a structural equation model taking endogeneity into account. A questionnaire is designed based on the health-related quality of life (EQ-5D) framework and is given to 322 homeless individuals. Evidence shows that, with-out timely support, the homeless state and health state will fast deteriorate and reinforce each other. It is therefore arguable to broaden the definition of statutory homelessness, and the "pre-ventative approach" can save, rather than increase, the public resources spent on the homeless.
    Keywords: Socio-Economic Policy; Health Needs; Homeless; Structural Equation Model
    Date: 2019–04
  18. By: Ingvild Almås; Johannes Haushofer; Jeremy P. Shapiro
    Abstract: We use a randomized controlled trial to study the effect of large income changes, through unconditional cash transfers, on the food share of expenditures and consumption of calories among poor households in rural Kenya. Our preferred estimate of the food elasticity following USD 709 transfers is 0.78 for expenditure, 0.60 for calories, and 1.29 for protein. Experimental elasticities are lower than cross-sectional estimates. These estimates are unaffected by spillovers or price changes at the village level: results are similar with vs. without an almost ideal demand system, and with a control group in treatment vs. control villages.
    JEL: C93 D12 D13 D14 O12
    Date: 2019–03
  19. By: Le, Nga (UNU-MERIT); Groot, Wim (UNU-MERIT, TIER and CAPHRI School for Public Health and Primary Care, Maastricht University); Tomini, Sonila M. (UNU-MERIT); Tomini, Florian (Centre for Primary Care and Public Health Queen Mary University, London,)
    Abstract: Health insurance can have important effects on self-employment and self- employment transitions. However, there is a literature gap on the relationship between health insurance and self-employment in low and middle income countries, especially in the context of rapid expansion of health insurance in these countries. This paper examines this relationship in Vietnam with a focus on the comparison between the voluntary scheme for the informal sector (mostly self-employed workers) and the compulsory insurance for the formal sector (mostly wage workers). We employ a Probit model with selection on a panel from the Vietnamese Household Living Standards Surveys 2010-2014 to investigate the association between health insurance and self-employment entry and exit. We show that those with compulsory health insurance in Vietnam, the formal workers, are 10 percentage points less likely to enter self-employment compared to those having voluntary insurance. Regarding self-employment exit, people with compulsory insurance are more likely to exit self-employment compared to those covered by voluntary insurance. However, the effect size is relatively small.
    Keywords: health insurance, self-employment, Vietnam, self-employment entry, self-employment exit
    JEL: I13 J22
    Date: 2019–03–22

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