nep-hea New Economics Papers
on Health Economics
Issue of 2019‒05‒27
fifteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Regressive Sin Taxes, With an Application to the Optimal Soda Tax By Hunt Allcott; Benjamin Lockwood; Dmitry Taubinsky
  2. Should We Tax Sugar-Sweetened Beverages? An Overview of Theory and Evidence By Hunt Allcott; Benjamin Lockwood; Dmitry Taubinsky
  3. Targeting Disability Insurance Applications with Screening By Mathilde Godard; Pierre Koning; Maarten Lindeboom
  4. Heat Stress: Ambient Temperature and Workplace Accidents in the US By Lucy Page; Stephen Sheppard
  5. The Effects of Mass Layoffs on Mental Health By Christine Le Clainche; Pascale Lengagne
  6. Gender Differences in the Influence of Mental Health on Job Retention By Thomas Barnay; Éric Defebvre
  7. Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines By Chelsea J. Richwine; Avi Dor; Ali Moghtaderi
  8. Physician Bias and Racial Disparities in Health: Evidence from Veterans' Pensions By Shari Eli; Trevon D. Logan; Boriana Miloucheva
  9. Nursing without caring? A discrete choice experiment about job characteristics of German surgical technologist trainees By Katharina Saunders; Christian Hagist; Alistair McGuire; Christian Schlereth
  10. Modelling the Dynamic Effects of Elective Hospital Admissions on Emergency Levels in England By Jimenez-Martin, Sergi; Nicodemo, Catia; Redding, Stuart
  11. Assessing the impact of tourism on hospitals’ performance in a coastal destination By Ezza, Alberto; Marinò, Ludovico; Giovanelli, Lucia
  12. A Stochastic Economic Growth Model with Health Capital and State-Dependent Probabilities. By La Torre, Davide; Marsiglio, Simone; Mendivil, Franklin; Privileggi, Fabio
  13. The Effect of Education on Health: Evidence from the 1997 Compulsory Schooling Reform in Turkey By Baltagi, Badi H.; Flores-Lagunes, Alfonso; Karatas, Haci M.
  14. Gender gaps in wages and mortality rates during industrialization: the case of Alcoy, Spain, 1860-1914 By Pilar Beneito; José Joaquin García-Gómez
  15. Socioeconomic inequality in life expectancy in India By Asaria, Miqdad; Mazumdar, Sumit; Chowdhury, Samir; Mazumdar, Papiya; Mukhopadhyay, Abhiroop; Gupta, Indrani

  1. By: Hunt Allcott; Benjamin Lockwood; Dmitry Taubinsky
    Abstract: A common objection to “sin taxes”—corrective taxes on goods that are thought to be overconsumed, such as cigarettes, alcohol, and sugary drinks—is that they often fall disproportionately on low-income consumers. This paper studies the interaction between corrective and redistributive motives in a general optimal taxation framework and delivers empirically implementable sufficient statistics formulas for the optimal commodity tax. The optimal sin tax is increasing in the price elasticity of demand, increasing in the degree to which lower-income consumers are more biased or more elastic to the tax, decreasing in the extent to which consumption is concentrated among the poor, and decreasing in income effects, because income effects imply that commodity taxes create labor supply distortions. Contrary to common intuitions, stronger preferences for redistribution can increase the optimal sin tax, if lower-income consumers are more responsive to taxes or are more biased. As an application, we estimate the optimal nationwide tax on sugar-sweetened beverages in our model, using Nielsen Homescan data and a specially designed survey measuring nutrition knowledge and self-control. Holding federal income tax rates constant, we find an optimal federal sugar-sweetened beverage tax of 1 to 2.1 cents per ounce in our model, although optimal city-level taxes could be as much as 60% lower due to cross-border shopping.
    JEL: D9 H0 I1
    Date: 2019–05
  2. By: Hunt Allcott; Benjamin Lockwood; Dmitry Taubinsky
    Abstract: Taxes on sugar-sweetened beverages are growing in popularity and have generated an active public debate. Are they a good idea? If so, how high should they be? Are such taxes regressive? People in the U.S. and some other countries consume remarkable quantities of sugar-sweetened beverages, and the evidence suggests that this generates significant health costs. Building on recent work by Allcott, Lockwood, and Taubinsky (Forthcoming) and others, we review the basic economic principles that determine the socially optimal SSB tax. The optimal tax depends on (1) externalities: uninternalized health system costs from diseases caused by sugary drink consumption; (2) internalities: costs consumers impose on themselves by consuming too many sugary drinks due to poor nutrition knowledge or lack of self-control; and (3) regressivity: how much the financial burden and the internality benefits from the tax fall on the poor. We summarize the empirical evidence about the key parameters affect how large the tax should be. In the theoretical framework of Allcott, Lockwood, and Taubinsky (Forthcoming), our calculations imply that sugar-sweetened beverage taxes are welfare enhancing, and indeed that the optimal nationwide SSB tax rate may be higher than the one cent per ounce rate most commonly used in U.S. cities. Using our theoretical framework, we end by deriving seven concrete implications for optimal SSB tax structure.
    JEL: D00 D6 D9 H0
    Date: 2019–05
  3. By: Mathilde Godard (University of Lyon); Pierre Koning (Vrije Universiteit Amsterdam); Maarten Lindeboom (Vrije Universiteit Amsterdam)
    Abstract: We examine the targeting effects of increased scrutiny in the screening of Disability Insurance (DI) applications using exogenous variation in screening induced by a policy reform. The reform raised DI application costs and revealed more information about the true disability status of applicants at the point of the award decision. We use administrative data on DI claims and awards and merge these with other administrative data on hospitalization, mortality and labor market outcomes. Regression Discontinuity in Time (RDiT) regressions show substantial declines in DI application rates and changes in the composition of the pool of applicants. We find that the health of those who are not discouraged from applying is worse than those who are. This suggests that the pool of applicants becomes more deserving. At the same time, compared with those who did not apply under the old system of more lax screening, those who are discouraged from applying are in worse health, have substantially lower earnings and are more often unemployed. This indicates that there are spillovers of the DI reform to other social insurance programs. As we do not find additional screening effects on health at the point of the award decision, we conclude that changes in the health condition of the pool of awarded applicants are fully driven by self-screening of (potential) applicants.
    Keywords: Disability Insurance, Screening, Composition effects, Targeting efficiency
    JEL: H2 I3
    Date: 2019–05–17
  4. By: Lucy Page (MIT Department of Economics); Stephen Sheppard (Williams College)
    Abstract: Combining records for 71,225 severe accidents from the Occupational Safety and Health Administration with a panel of county-level weather data for 1990 to 2010, we find that heat shocks significantly increase accident rates across the United States, while cold shocks significantly reduce them. We find that heat shocks increase accidents both in plausibly temperature-sensitive industries, like construction and agriculture, and among industries that are not obviously sensitive to weather. While we find suggestive evidence of short-term adaptation to heat shocks over summer months, we find no evidence that the impacts of heat shocks have fallen over our 21-year panel.
    JEL: Q54 I18
    Date: 2019–04–06
  5. By: Christine Le Clainche (Lille University, Lille Économie Management, UMR CNRS 9221); Pascale Lengagne (IRDES Institut de recherche et documentation en économie de la santé)
    Abstract: This article assesses the effects of mass layoffs on the mental health of workers remaining in plants after layoffs, using a French survey merged with administrative health insurance data covering the period 2010–2013. We rely on the consumption of psychotropic drugs prescribed by doctors as an indicator of mental health. Results show that mass layoffs induce a sizeable rise in the use of psychotropic drugs amongst job stayers: we measure an increase of 41% in psychotropic drug consumption rates amongst them after displacement, as compared with the pre-displacement period. We find evidence for a social gradient whereby employees belonging to the lowest socio-economic are more affected by the adverse effect of mass layoffs on their mental health, leading to psychotropic drug consumption, than those in the highest socio­-economic groups.
    Keywords: Mass layoffs, Downsizing, Mental health, Psychotropic drug prescriptions
    JEL: J6 I10
    Date: 2019–05
  6. By: Thomas Barnay (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, TEPP - Travail, Emploi et Politiques Publiques - UPEM - Université Paris-Est Marne-la-Vallée - CNRS - Centre National de la Recherche Scientifique); Éric Defebvre (TEPP - Travail, Emploi et Politiques Publiques - UPEM - Université Paris-Est Marne-la-Vallée - CNRS - Centre National de la Recherche Scientifique, CES - Centre d'économie de la Sorbonne - CNRS - Centre National de la Recherche Scientifique - UP1 - Université Panthéon-Sorbonne)
    Abstract: We measure gender differences in the causal impact of the 2006 self-assessed mental health status (anxiety disorders and depressive episodes) on job retention in 2010. We use data from the French Health and Professional Career Path survey. To control for endogeneity biases, we use bivariate probit models to simultaneously explain employment status and mental health. Anxiety disorders reduce men's job retention capacity by up to 12 percentage points (pp). Depressive episodes affect both genders almost equally (around 11pp). More severe cases of both mental health conditions are relevant in determining the capacity of individuals to remain in employment.
    Keywords: Mental health,Employment,Instrumental variables,Gender differences,France
    Date: 2019
  7. By: Chelsea J. Richwine; Avi Dor; Ali Moghtaderi
    Abstract: Nonmedical exemptions are widely shown to be associated with outbreaks of vaccine-preventable disease. In response to a recent measles outbreak in 2015, California acted to increase immunization coverage by removing all nonmedical exemptions effective in 2016. Employing a unique dataset of county-level vaccination and exemption rates at Kindergarten entry, we exploit the recent policy change in California to estimate the impact of the repeal of nonmedical exemptions on immunization coverage for school-mandated vaccines. Relative to a diverse group of control states, our findings indicate that vaccination coverage increased for all required vaccines following the repeal, ranging from 2.5% for MMR to 5% for Polio. We also find a significant 3.4 percentage-point decline in nonmedical exemptions, accompanied by a 2.1 percentage-point increase in medical exemptions in counties that previously had high rates of nonmedical waivers. Our findings indicate that the repeal of nonmedical exemptions in California was only partially effective in improving vaccination coverage, and may have led parents to substitute between medical and nonmedical exemptions, leading to a net decline in total exemptions of just 1 percentage-point.
    JEL: I10 I12 I18
    Date: 2019–05
  8. By: Shari Eli; Trevon D. Logan; Boriana Miloucheva
    Abstract: We estimate racial differences in longevity using records from cohorts of Union Army veterans. Since veterans received pensions based on proof of disability at medical exams, estimates of the causal effect of income on mortality may be biased, as sicker veterans received larger pensions. To circumvent endogeneity bias, we propose an exogenous source of variation in pension income: the judgment of the doctors who certified disability. We find that doctors appeared to discriminate against black veterans. The discrimination we observe is acute—we would not observe any racial mortality differences had physicians not been racially biased in determining pension awards. The effect of income on health was indeed large enough to close the black-white mortality gap in the period. Our work emphasizes that the large effects of physicians’ attitudes on racial differentials in health, which persist today amongst both veterans and the civilian population, were equally prominent in the past.
    JEL: I14 I3 N11
    Date: 2019–05
  9. By: Katharina Saunders; Christian Hagist; Alistair McGuire; Christian Schlereth
    Abstract: We know that existing professions in the health care sector value work environment and job conditions to a great extent. However, we are also witnessing an expansion of new roles into the health care sector, many of which substitutie the tasks of existing professions. This may be efficient, in that it releases professionals’ time. However, there is little understanding of what motivates these new professions in entering or remaining in these newly created roles. This study tries to evaluate the preference structure of one of these new staff groups, surgical technologist, through examining the preferences of trainees, defined over a number of attributes, in this group. The DCE study covers 80% of the target population. The results show a vigorous disfavour towards any perceived nursing job characteristics such as caring activities, hierarchical work environment or shift types. The results inform policy makers and hospital manager about the importance to focus not only on the nursing profession but also to take into account the existence of a group of people who is willing to work within the health care system however, associated with strong preferences against nursing activities, especially caring. Implementing and further development of new and specialised profession through reallocating former nursing tasks- should be considered while coping with labour shortage.
    Keywords: UDCE, labour shortage, specialised health care profession, job preferences
    JEL: I18 J08 J30 C93 C90
    Date: 2019–05–22
  10. By: Jimenez-Martin, Sergi (Universitat Pompeu Fabra); Nicodemo, Catia (University of Oxford); Redding, Stuart (University of Oxford)
    Abstract: In England as elsewhere, policy makers are trying to reduce the pressure on costs due to rising hospital admissions by encouraging GPs to refer fewer patients to hospital specialists. This could have an impact on elective treatment levels, particularly procedures for conditions which are not life-threatening and can be delayed or perhaps withheld entirely. This study attempts to determine whether cost savings in one area of publicly funded health care may lead to cost increases in another and therefore have unintended consequences by offsetting the cost-saving benefits anticipated by policy makers. Using administrative data from Hospital Episode Statistics (HES) in England we estimate dynamic fixed effects panel data models for emergency admissions at Primary Care Trust and Hospital Trust levels for the years 2004–13, controlling for a group of area-specific characteristics and other secondary care variables. We find a negative link between current levels of elective care and future levels of emergency treatment. This observation comes from a time of growing admissions and there is no guarantee that the link between emergency and elective activity will persist if policy is effective in reducing levels of elective treatment, but our results suggest that the cost-saving benefits to the NHS from reducing elective treatment are reduced by between 5.6 per cent and 15.5 per cent in aggregate as a consequence of increased emergency activity.
    Keywords: emergency, hospital admissions, elective, NHS
    JEL: I10 I14 C10 B12
    Date: 2019–05
  11. By: Ezza, Alberto; Marinò, Ludovico; Giovanelli, Lucia
    Abstract: Tourism represents one the most relevant industries in promoting the development of a destination, but tourism and its seasonality can produce negative outcomes. The additional demand caused by tourism can strongly affect public service providers which cannot adapt their supply to seasonal variations as a result of organisational, financial and institutional limitations. This work focuses on hospital services in an Italian coastal destination and it aims to explain the impact tourism and its related seasonality have on the performance of hospitals in a coastal destination. The activity of three hospitals located in Gallura, a region in the north-east of Sardinia, Italy, has been analysed. The analysis has been carried out using data on hospitals admission from 2014 and 2015.The study highlights the critical impact tourism can have on the activity of healthcare providers in a coastal destination, identifying the reduction of hospital performance and a potential cause of bed crises.
    Keywords: impact of tourism; hospital admission; host communities; seasonality; bed crisis
    JEL: L32 L83 M19
    Date: 2019–04–15
  12. By: La Torre, Davide; Marsiglio, Simone; Mendivil, Franklin; Privileggi, Fabio (University of Turin)
    Abstract: We analyze a simple stochastic model of economic growth in which physical and health capital accumulation jointly contribute to determine long run economic growth. Health capital is subject to random shocks via the effects of behavioral changes: unpredictable changes in individuals’ attitude toward healthy behaviors may reduce the effectiveness of health services provision; this in turn, by reducing the production of new health capital, lowers economic production activities negatively affecting economic growth. Unlike the extant literature, we assume that the probability with which such random shocks occur is not constant but state-dependent. Specifically, the probability that behavioral changes will negatively impact on health capital and economic growth depends on the level of economic development, proxied by the relative abundance of health capital with respect to physical capital. We show that our model’s dynamics can be converted into an iterated function system with state-dependent probabilities which converges to an invariant self-similar measure supported on a (possibly fractal) compact attractor. We develop a numerical method to approximate the invariant distribution to illustrate its features in specific model’s parametrizations, exemplifying thus the effects of state-dependent probabilities on the model’s steady state.
    Date: 2019–04
  13. By: Baltagi, Badi H. (Syracuse University); Flores-Lagunes, Alfonso (Syracuse University); Karatas, Haci M. (Giresun University)
    Abstract: This paper analyzes the relationship between education and health outcomes using a natural experiment in Turkey. The compulsory schooling increased from 5 to 8 years in 1997. This increase was accompanied by a massive construction of classrooms and recruitment of teachers in a differential rate across regions. As in previous studies, we confirm that the 1997 reform substantially increased education in Turkey. Using the number of new middle school class openings per 1000 children as an intensity measure for the 1997 reform, we find that, on average, one additional middle school class increases the probability of completion of 8 years or more of schooling by about 7.1 percentage points. We use this exogenous increase in the educational attainment to investigate the impact of education on body mass index, obesity, smoking behavior, and self-rated health, as well as the effect of maternal education on the infant's well-being. Using ordinary least squares, we find that there is a statistically significant favorable effect of education on health outcomes and behavior. However, this relationship becomes insignificant when we account for the endogeneity of education and health by instrumenting education with exogenous variations generated by the 1997 reform and the accompanying middle school class openings. The insignificance of the health effect may be due to lack of statistical power in our data, or to the fact that this policy affects only relatively low levels of schooling and the health effects of education need to be examined at higher levels of schooling.
    Keywords: health, education, compulsory schooling, body mass index, obesity, smoking, selfrated health, maternal education, infant's well-being, Turkey
    JEL: C26 I12 I21 I28
    Date: 2019–05
  14. By: Pilar Beneito (University of Valencia. ERI-CES); José Joaquin García-Gómez (University of Almeria)
    Abstract: What role did women play during industrialization? Interpretations of this key period of our history have been largely based on analyses of male work. In this paper, we offer evidence of the effects of women's involvement in the industrialization process that took place in Alcoy, Spain, over the period 1860-1914. Using data drawn from historical sources, we analyse labour-force participation rates and wage series for women and men in the textile industry and three other sectors of activity (education, health and low-skill services). We then connect the gender pay gaps with life expectancy indicators. Our results suggest that women's contribution to household income might have favoured the female life-expectancy advantage, an effect that seems to have been channelled through a reduction in the relative mortality rates of female infants and girls, at the expense of a higher mortality rate of working-age women.
    Keywords: Industrialization, gender wage gap, female mortality advantage
    JEL: J16 J31 N33 O14
    Date: 2019–05
  15. By: Asaria, Miqdad; Mazumdar, Sumit; Chowdhury, Samir; Mazumdar, Papiya; Mukhopadhyay, Abhiroop; Gupta, Indrani
    Abstract: Introduction Concern for health inequalities is an important driver of health policy in India; however, much of the empirical evidence regarding health inequalities in the country is piecemeal focusing only on specific diseases or on access to particular treatments. This study estimates inequalities in health across the whole life course for the entire Indian population. These estimates are used to calculate the socioeconomic disparities in life expectancy at birth in the population. Methods Population mortality data from the Indian Sample Registration System were combined with data on mortality rates by wealth quintile from the National Family Health Survey to calculate wealth quintile specific mortality rates. Results were calculated separately for males and females as well as for urban and rural populations. Life tables were constructed for each subpopulation and used to calculate distributions of life expectancy at birth by wealth quintile. Absolute gap and relative gap indices of inequality were used to quantify the health disparity in terms of life expectancy at birth between the richest and poorest fifths of households. results Life expectancy at birth was 65.1 years for the poorest fifth of households in India as compared with 72.7 years for the richest fifth of households. This constituted an absolute gap of 7.6 years and a relative gap of 11.7 %. Women had both higher life expectancy at birth and narrower wealth-related disparities in life expectancy than men. Life expectancy at birth was higher across the wealth distribution in urban households as compared with rural households with inequalities in life expectancy widest for men living in urban areas and narrowest for women living in urban areas. Conclusion As India progresses towards Universal Health Coverage, the baseline social distributions of health estimated in this study will allow policy makers to target and monitor the health equity impacts of health policies introduced.
    JEL: N0
    Date: 2019–05–09

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