nep-hea New Economics Papers
on Health Economics
Issue of 2019‒05‒13
fourteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Effect of College Education on Health and Mortality: Evidence from Canada By Guy Lacroix; François Laliberté-Auger; Pierre-Carl Michaud; Daniel Parent
  2. Impact of later retirement on mortality: Evidence from France By Antoine Bozio; Clémentine Garrouste; Elsa Perdrix
  3. Increased Instruction Time and Stress-Related Health Problems among School Children By Jan Marcus; Simon Reif; Amelie Wuppermann; Amélie Rouche
  4. Battling Antibiotic Resistance: Can Machine Learning Improve Prescribing? By Michael A. Ribers; Hannes Ullrich
  5. Does higher Institutional Quality improve the Appropriateness of Healthcare Provision? By Giacomo De Luca; Domenico Lisi; Marco Martorana; Luigi Siciliani
  6. Do-It-Yourself medicine? The impact of light cannabis liberalization on prescription drugs By Carrieri,V.; Madio,L.; Principe, F.;
  7. Does Gentrification Displace Poor Children? New Evidence from New York City Medicaid Data By Kacie Dragan; Ingrid Ellen; Sherry A. Glied
  8. Health Insurance and Marriage Behavior: Will Marriage Lock Hold Under Healthcare Reform? By Tianxu Chen
  9. Health Insurance Coverage and Marriage Behavior: Is There Evidence of Marriage Lock? By Tianxu Chen
  10. On discrimination in health insurance By Thomas Boyer-Kassem; Sébastien Duchêne
  11. Demand and Welfare Analysis in Discrete Choice Models with Social Interactions By Bhattacharya, Debopam; Dupas, Pascaline; Kanaya, Shin
  12. Are local public services better delivered in more autonomous regions? Evidence from European regions using a dose-response approach By Filippetti, Andrea; Cerulli, Giovanni
  13. Multi-criteria decision analysis for health technology assessment: addressing methodological challenges to improve the state of the art By Oliveira, Mónica D.; Mataloto, Inês; Kanavos, Panos
  14. The impact of foreign aid on maternal mortality By Banchani Emmanuel; Swiss Liam

  1. 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 (4.1 years additional years at age 51), 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 (27.3% reduction in lifetime hospital stays, 19.7 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 longterm 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
  2. By: Antoine Bozio (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, PSE - Paris School of Economics, IPP - Institut des politiques publiques - PSE - Paris School of Economics); Clémentine Garrouste (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine, Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris-Dauphine); Elsa Perdrix (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, PSE - Paris School of Economics)
    Abstract: This paper investigates the impact of delaying retirement on mortality among the French population. We take advantage of the 1993 pension reform in the private sector to identify the causal effect of an increase in claiming age on mortality. We use administrative data which provide detailed information on career characteristics, dates of birth and death. Our results, precisely estimated, show that an exogenous increase of the claiming age has no significant impact on the probability to die between age 65 and 72, conversely we find that an increase of the retirement age of one year leads to an increase of 0.004 in the death rate between age 72 and 77. This effect is qualitatively small, and we discuss more generally the ability to estimate small effects in rare event data using minimal detectable effect procedure.
    Keywords: pension reform,health,mortality
    Date: 2019–02
  3. By: Jan Marcus; Simon Reif; Amelie Wuppermann; Amélie Rouche
    Abstract: While several studies suggest that stress-related mental health problems among school children are related to specific elements of schooling, empirical evidence on this causal relationship is scarce. We examine a German schooling reform that increased weekly instruction time and study its effects on stress-related outpatient diagnoses from the universe of health claims data of the German Social Health Insurance. Exploiting the differential timing in the reform implementation across states, we show that the reform slightly increased stress-related health problems among school children. While increasing instruction time might increase student performance, it might have adverse effects in terms of additional stress.
    Keywords: Stress, mental health, instruction time, G8 reform
    JEL: I18 I28
    Date: 2019
  4. By: Michael A. Ribers; Hannes Ullrich
    Abstract: Antibiotic resistance constitutes a major health threat. Predicting bacterial causes of infections is key to reducing antibiotic misuse, a leading cause of antibiotic resistance. We combine administrative and microbiological laboratory data from Denmark to train a machine learning algorithm predicting bacterial causes of urinary tract infections. Based on predictions, we develop policies to improve prescribing in primary care, highlighting the relevance of physician expertise and time-variant patient distributions for policy implementation. The proposed policies delay prescriptions for some patients until test results are known and give them instantly to others. We find that machine learning can reduce antibiotic use by 7.42 percent without reducing the number of treated bacterial infections. As Denmark is one of the most conservative countries in terms of antibiotic use, targeting a 30 percent reduction in prescribing by 2020, this result is likely to be a lower bound of what can be achieved elsewhere.
    Keywords: Antibiotic prescribing; prediction policy; machine learning; expert decision-making
    JEL: C10 I11 I18 L38 O38 Q28
    Date: 2019
  5. By: Giacomo De Luca; Domenico Lisi; Marco Martorana; Luigi Siciliani
    Abstract: We study the effect of institutional quality on the appropriateness of healthcare provision in Italian hospitals. We focus on cesarean section rates for first-time mothers, which is a common indicator of appropriateness in healthcare and is vulnerable to providers’ opportunistic behaviors. To identify the causal effect of institutional quality we rely on an IV strategy based on historical instruments, exploiting the idea that current differences in institutional quality across regions have been shaped by different cultural and political histories. We find that a standard deviation increase in our indicator of institutional quality leads to a decrease of about 10 percentage points in cesarean section rates, implying an annual saving of about € 50 million. Our results are robust to different measures of institutional quality and samples.
    Keywords: institutional quality, appropriateness, healthcare provision
    JEL: I11 D73 C26
    Date: 2019–05
  6. By: Carrieri,V.; Madio,L.; Principe, F.;
    Abstract: This paper provides the first analysis of “Do-it-Yourself Medicine†concerning marijuana consumption by studying the effects of the unintended liberalization of light cannabis that took place in Italy in 2016 on prescription drugs sales. Using a unique and high-frequency dataset on monthly sales of drugs and the location of light cannabis retailers and adopting a staggered DiD research design, we find that the local market accessibility of light cannabis led to a reduction in dispensed packets of opioids, anxiolytics, sedatives, anti-migraines, antiepileptics, anti-depressives and anti-psychotics. This calls for an effective regulation of the market and a proper evaluation of the use of light cannabis for medical purposes.
    Keywords: light cannabis; self-medication; marijuana; differences-in-differences; prescriptions;
    JEL: H51 H75 I18 K32 K42
    Date: 2019–04
  7. By: Kacie Dragan; Ingrid Ellen; Sherry A. Glied
    Abstract: The pace of gentrification has accelerated in cities across the country since 2000, and many observers fear it is displacing low-income populations from their homes and communities. We offer new evidence about the consequences of gentrification on mobility, building and neighborhood conditions, using longitudinal New York City Medicaid records from January 2009 to December 2015 to track the movement of a cohort of low-income children over seven years, during a period of rapid gentrification in the city. We leverage building-level data to examine children in market rate housing separately from those in subsidized housing. We find no evidence that gentrification is associated with meaningful changes in mobility rates over the seven-year period. It is associated with slightly longer distance moves. As for changes in neighborhood conditions, we find that children who start out in a gentrifying area experience larger improvements in some aspects of their residential environment than their counterparts who start out in persistently low-socioeconomic status areas. This effect is driven by families who stay in neighborhoods as they gentrify; we observe few differences in the characteristics of destination neighborhoods among families who move, though we find modest evidence that children moving from gentrifying areas move to lower-quality buildings.
    JEL: J6 R31 R52
    Date: 2019–05
  8. By: Tianxu Chen (University of Connecticut)
    Abstract: Spousal healthcare coverage can potentially cause “marriage lock” in which couples stay married for the sake of health insurance benefits. However, the “marriage lock” effect may change under healthcare reforms. In this paper, I examine the impact of the 2006 Massachusetts healthcare reform on marriage and divorce decisions. I hypothesis that the individual mandate make people stay/get married to get health insurance, while the exchange markets will the reduce people’s reliance on marriage to get health insurance. Using American Community Survey data, I find that the 2006 healthcare reform increased incentives for marriage in Massachusetts relative to neighboring states. Specifically, the reform appears to have reduced the divorce rate by 0.5 percentage point and increased the marriage rate by 1.4 percentage points. These findings provide evidence that the “marriage lock” effect exists and it changes under healthcare reforms.
    Keywords: Marriage Lock, Health Care Reform, Health Insurance Exchanges, Employer Sponsored Health Insurance, Marriage Behavior
    JEL: J I1 D1
    Date: 2019–05
  9. By: Tianxu Chen (University of Connecticut)
    Abstract: Premiums and eligibility for health insurance may cause “marriage lock,” in which couples stay married for the sake of maintaining health insurance coverage. By using the Health and Retirement Study for adults aged 60–70, I examine whether employer-based spousal health insurance coverage discourages divorce. Diverse difference-in-difference models provide evidence of a 7 percentage points increase in the number of divorces upon achieving Medicare eligibility at age 65 for people with spousal insurance coverage relative to those without it. The estimates thus provide evidence that marriage lock exists.
    Keywords: Marriage Lock, Medicare, Employer-sponsored Health Insurance, Marriage Behavior
    JEL: J I1 D1
    Date: 2019–05
  10. By: Thomas Boyer-Kassem (MAPP - Métaphysique allemande et philosophie pratique - Université de Poitiers); Sébastien Duchêne (CEE-M - Centre d'Economie de l'Environnement - Montpellier - FRE2010 - INRA - Institut National de la Recherche Agronomique - UM - Université de Montpellier - CNRS - Centre National de la Recherche Scientifique - Montpellier SupAgro - Institut national d’études supérieures agronomiques de Montpellier)
    Abstract: In many countries, private health insurance companies are allowed to vary their premiums based on some information on individuals. This practice is intuitively justified by the idea that people should pay the premium corresponding to their own known risk. However, one may consider this as a form of discrimination or wrongful differential treatment. Our goal in this paper is to assess whether profiling is ethically permissible in health insurance. We go beyond the existing literature in considering a wide range of parameters, be they genetic, non-genetic, or even non-medical such as age or place of living. Analyzing several ethical concerns, and tackling the difficult question of responsibility, we argue that profiling is generally unjust in health insurance
    Keywords: ethics,discrimination,responsibility,health profiling,health insurance
    Date: 2018
  11. By: Bhattacharya, Debopam; Dupas, Pascaline; Kanaya, Shin
    Abstract: Many real-life settings of consumer choice involve social interactions, causing targeted policies to have spillover effects. This paper develops novel empirical tools for analyzing demand and welfare effects of policy interventions in binary choice settings with social interactions. Examples include subsidies for health product adoption and vouchers for attending a high-achieving school. We establish the connection between econometrics of large games and Brock-Durlauf-type interaction models, under both I.I.D. and spatially correlated unobservables. We develop new convergence results for associated beliefs and estimates of preference parameters under increasing domain spatial asymptotics. Next, we show that even with fully parametric specifications and unique equilibrium, choice data, that are sufficient for counterfactual demand prediction under interactions, are insufficient for welfare calculations. This is because distinct underlying mechanisms producing the same interaction coefficient can imply different welfare effects and deadweight-loss from a policy intervention. Standard index-restrictions imply distribution-free bounds on welfare. We illustrate our results using experimental data on mosquito-net adoption in rural Kenya.
    Date: 2019–04
  12. By: Filippetti, Andrea; Cerulli, Giovanni
    Abstract: Does regional autonomy lead to better local public services? We investigate this issue using measures of public service performance and autonomy at the region level in 171 European regions. We introduce a novel dose-response approach which identifies the pattern of the effect of regional autonomy on the performance of public services. The relationship between the level of regional autonomy and the provision of local public services exhibits a u-shape: both low and high autonomy lead to better local public services. This speaks against the presence of one optimal level of autonomy and policy recommendations based on the view that more decentralisation is always desirable. It shows that different institutional settings can be economically viable and efficient.
    Keywords: decentralization; dose-response approach; European regions; quality of institutions; Quality of local public services; regional autonomy
    JEL: P48 R10 R50 H70
    Date: 2018–08–01
  13. By: Oliveira, Mónica D.; Mataloto, Inês; Kanavos, Panos
    Abstract: Background: Multi-criteria decision analysis (MCDA) concepts, models and tools have been used increasingly in health technology assessment (HTA), with several studies pointing out practical and theoretical issues related to its use. This study provides a critical review of published studies on MCDA in the context of HTA by assessing their methodological quality and summarising methodological challenges. Methods: A systematic review was conducted to identify studies discussing, developing or reviewing the use of MCDA in HTA using aggregation approaches. Studies were classified according to publication time and type, country of study, technology type and study type. The PROACTIVE-S approach was constructed and used to analyse methodological quality. Challenges and limitations reported in eligible studies were collected and summarised; this was followed by a critical discussion on research requirements to address the identified challenges. Results: 129 journal articles were eligible for review, 56% of which were published in 2015–2017; 42% focused on pharmaceuticals; 36, 26 and 18% reported model applications, issues regarding MCDA implementation analyses, and proposing frameworks, respectively. Poor compliance with good methodological practice (
    Keywords: health technology assessment; MCDA modelling; methodological challenges; methodological quality; multi-criteria decision analysis; systematic review
    JEL: I10 I18 C44 D80
    Date: 2019–04–20
  14. By: Banchani Emmanuel; Swiss Liam
    Abstract: In 2010, the G8 placed renewed focus on maternal health via the Muskoka Initiative by committing to spend an additional US$5 billion on maternal, newborn, and child health before 2015. Following the end of the Millennium Development Goals and the advent of the Sustainable Development Goals, maternal health issues have continued to feature prominently on the global health agenda.Despite substantial investments of foreign aid over the past decade, however, there is limited evidence on the effectiveness of foreign aid in reducing maternal mortality in low- and middle-income countries. Using data from the Organisation for Economic Co-operation and Development, the World Development Indicators, and the Institute for Health Metrics and Evaluation, this study analyses the effects of aid on maternal health in a sample of 130 low- and middle-income countries from 1996 through 2015.Our results show that the effects of total foreign aid on maternal mortality are limited, but that aid allocated to the reproductive health sector and directly at maternal health is associated with significant reductions in maternal mortality. Given these targeted effects, it is important to channel more donor assistance to the promotion of reproductive health and contraceptive use among women, as it serves as a tool towards the reduction of maternal mortality.
    Keywords: Maternal mortality,Muskoka Initiative,reproductive health,Family planning,Foreign aid
    Date: 2019

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