nep-hea New Economics Papers
on Health Economics
Issue of 2019‒06‒17
seventeen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Impact of Car Pollution on Infant and Child Health: Evidence from Emissions Cheating By Alexander, Diane; Schwandt, Hannes
  2. From Local to Global: External Validity in a Fertility Natural Experiment By Rajeev Dehejia; Cristian Pop-Eleches; Cyrus Samii
  3. The effect of widowhood on mortality in polygamous marriages: evidence from the Utah Population Database By Kieron J. Barclay; Robyn Donrovich Thorén; Heidi A. Hanson; Ken R. Smith
  4. Education and gender differences in mortality rates By Cristina Bellés-Obrero; Sergi Jiménez-Martín; Judit Vall Castello
  5. Paid Sick Leave and Employee Absenteeism By Annalisa Scognamiglio
  6. "Increasing Cigarette Taxes is Unfair to the Poor? Evidence from Argentina" By Martin Gonzalez-Rozada
  7. The Effect of Prenatal Exposure to Radiation on Birth Outcomes: Exploiting a Natural Experiment in Taiwan By Tsou, Meng-Wen; Liu, Jin-Tan; Hammitt, James K.; Lu, Chyi-Horng; Kao, Szu-Yu Zoe
  8. The Economic Consequences of Hospitalizations for Older Workers across Countries By Mommaerts, Corina; Raza, Syed Hassan; Zheng, Yu
  9. New Evidence on the Effect of Economic Shocks on Retirement Plan Withdrawals By Teresa Ghilarducci; Siavash Radpour; Anthony Webb
  10. Old age or dependence. Which social insurance? By Yukihiro Nishimura; Pierre Pestieau
  11. R&D and market size: who benefits from orphan drug regulation? By Simona Gamba; Laura Magazzini; Paolo Pertile
  12. Wasted windfalls: Inefficiencies in health care spending in oil rich countries By Michael Keller
  13. Human Development in the Age of Globalisation By Leandro Prados de la Escosura
  14. Health systems characteristics: A survey of 21 Latin America and Caribbean countries By Luca Lorenzoni; Diana Pinto; Frederico Guanais; Tomas Plaza Reneses; Frederic Daniel; Ane Auraaen
  15. Current and past trends in physical activity in four OECD countries: Empirical results from time use surveys in Canada, France, Germany and the United States By Sahara Graf; Michele Cecchini
  16. Valuing Mortality Risk in China: Comparing Stated-Preference Estimates from 2005 and 2016 By Hammitt, James K.; Geng, Fangli; Guo, Xiaoqi; Nielsen, Chris P.
  17. Assessing the population-wide exposure to lead pollution in Kabwe, Zambia : blood lead level estimation based on survey data By Hiwatari, Masato; Yamada, Daichi; Hangoma, Peter; Narita, Daiju; Mphuka, Chrispin; Chitah, Bona; Yabe, John; Nakayama, Shouta MM; Nakata, Hokuto; Choongo, Kennedy; Ishizuka, Mayumi

  1. By: Alexander, Diane (Federal Reserve Bank of Chicago); Schwandt, Hannes
    Abstract: Car exhaust is a major source of air pollution, but little is known about its impacts on population health. We exploit the dispersion of emissions-cheating diesel cars across the United States from 2008–2015 as a natural experiment to measure the health impact of car pollution—each cheating diesel car secretly polluted up to 150 times as much as gasoline cars. Using the universe of vehicle registrations, we demonstrate that a 10 percent cheating-induced increase in car exhaust increases fine particulate matter by 2 percent and rates of low birth weight and acute asthma attacks among children by 1.9 and 8.0 percent, respectively. These health impacts occur at all pollution levels and across the entire socioeconomic spectrum.
    Keywords: car pollution, health, emissions-cheating
    JEL: I10 I14 K32 J13
    Date: 2019–06
  2. By: Rajeev Dehejia; Cristian Pop-Eleches; Cyrus Samii
    Abstract: We study issues related to external validity for treatment effects using over 100 replications of the Angrist and Evans (1998) natural experiment on the effects of sibling sex composition on fertility and labor supply. The replications are based on census data from around the world going back to 1960. We decompose sources of error in predicting treatment effects in external contexts in terms of macro and micro sources of variation. In our empirical setting, we find that macro covariates dominate over micro covariates for reducing errors in predicting treatments, an issue that past studies of external validity have been unable to evaluate. We develop methods for two applications to evidence-based decision-making, including determining where to locate an experiment and whether policy-makers should commission new experiments or rely on an existing evidence base for making a policy decision.
    Date: 2019–06
  3. By: Kieron J. Barclay (Max Planck Institute for Demographic Research, Rostock, Germany); Robyn Donrovich Thorén; Heidi A. Hanson; Ken R. Smith
    Abstract: Although the increase in mortality following widowhood has been widely studied, much less is known about how this pattern varies across less common household structures. Polygamous marriages are still prevalent across much of the world, but whether and how mortality varies following the death of a partner has not been studied in polygamous relationships. In this study we use data from the Utah Population Database to examine the relationship between marital status and mortality in polygamous marriages in 19th century Utah. With data on 110,952 women and 106,898 men, we particularly focus on whether the widowhood mortality effect varies between monogamous and polygamous marriages. We examine how the number of wife deaths affects male mortality in polygamous marriages, how the death of a sister wife, meaning other women with whom they share a husband, affects female mortality relative to the death of a husband, as well as how marriage order amongst sister wives affects the mortality of women in polygamous marriages. For women we find that the death of a husband in polygamous marriages increases mortality to a similar extent as in monogamous marriages, while the death of a sister wife does not have a qualitatively different effect on mortality than the death of the husband. Marriage order does not play a role in the mortality of women in polygamous marriages in this historical context. For men we find that the death of one wife in a polygamous marriage increases mortality to a lesser extent than it does for men in monogamous marriages. For men there is a dose-response effect to losing additional wives. We discuss these findings in relation to theories regarding the mechanisms driving the widowhood mortality effect.
    Keywords: Utah, adult mortality, polygamy, widowhood
    JEL: J1 Z0
    Date: 2019–06
  4. By: Cristina Bellés-Obrero; Sergi Jiménez-Martín; Judit Vall Castello
    Abstract: We examine the gender asymmetries in the health benefits of acquiring further education at a time of increasing gender equality and women’s greater access to economic opportunities. A labor market reform in Spain in 1980 raised the minimum legal working age from 14 to 16, while the school-leaving age remained at 14. We apply a difference-in-difference strategy to identify the reform’s within-cohort effects, where treated and control individuals differ only in their month of birth. Although the reform improved the educational attainment of both women and men, the long-term effects over mortality differ by gender. We find that the reform decreased mortality at young ages (14-29) by 6.3% among men and by 8.9% among women. This was driven by a decrease (12.2% for men, 14.7% for women) in the probability of dying from external causes of death (accidents). However, we also find that the child labor reform increased mortality for prime-age women (30-45) by 6.3%. This effect is driven by increases in HIV mortality (11.6%), as well as by diseases of the nervous and circulatory system (8.7%). This pattern helps explain the narrowing age gap in life expectancy between women and men in Spain.
    Keywords: minimum working age, education, mortality, gender
    JEL: I12 I20 J10
    Date: 2019–06
  5. By: Annalisa Scognamiglio (CSEF, Università di Napoli)
    Abstract: This paper studies the response of sickness absences to changes in the replacement rate for sick leave. In June 2008 a national law modified both the strength of monitoring and the monetary cost of sick leaves for public sector employees in Italy. This paper focuses on the National Health Service, which accounts for about 21% of the total number of workers employed in the Italian public administration. Using administrative data I show that absenteeism largely decreased following the reform. I identify the effects of an increase in the monetary cost of an absence using a difference-in-differences strategy that exploits variation in changes to the replacement rate for sick leave. Under the assumption that changes in monitoring had the same proportional impact on absenteeism within the same institutions, I estimate that a 1 percentage point decrease in the replacement rate reduces absenteeism by 1%. JEL Classification: J88, J08.
    Keywords: Public sector absenteeism, paid sick leave, incentives.
    Date: 2019–06–06
  6. By: Martin Gonzalez-Rozada
    Abstract: Raising cigarette taxes is an important public policy to reduce the use of tobacco. The appeal of increasing cigarette taxes is obvious. Since smoking is bad for one’s health and for that of others as well, increasing prices, via taxes, will induce people to quit or cut back smoking improving their health. However, increasing cigarette taxes could also have bad consequences: they can be regressive. Increasing taxes could result in poor people paying a higher percentage of their income in taxes than do the rich. How much the increment in taxes reduces consumption and if it’s regressive are empirical questions. This paper investigates those issues for Argentina estimating total demand price elasticity for the whole sample and by income groups and then simulating an increase in cigarette taxes. The main results are, (1) total demand price elasticity estimation is around -0.28 implying that increasing prices by 10 percent, via taxes, induce a reduction of consumption of about 2.8 percent; (2) demand price elasticity estimations by income groups suggest that richer individuals are more price sensitive, in absolute value, than poorer ones with respect to consumption but they are less price sensitive with respect to prevalence; (3) increasing taxes on tobacco consumption is unfair to the poor since their welfare loss, measured by the change in consumer surplus, is 61 percent larger than the loss experienced by the richer individuals in the sample; (4) overall, the main policy recommendation is that the increment in taxes should be complemented with public health policies targeted towards the poor.
    Keywords: Tobacco taxes, consumption of cigarettes, demand price elasticity of cigarettes consumption, regresivity.
    JEL: C25 C26 H23 I18
    Date: 2019–06
  7. By: Tsou, Meng-Wen; Liu, Jin-Tan; Hammitt, James K.; Lu, Chyi-Horng; Kao, Szu-Yu Zoe
    Abstract: We estimate the effect of prenatal exposure to radiation on infant health. By exploiting the 1983 Taiwanese radiation-contaminated buildings (RCBs) accident as a natural experiment, we compare birth outcomes between siblings and cousins exposed to different radiation levels. Given the 1983 accident was unanticipated and exposed cohorts were unaware of the risk until 1992, our design isolates the effect of radiation exposure during pregnancy from other effects. We provide the first evidence that prenatal exposure to a continuous low-level dose of radiation significantly reduces gestational length and increases the probabilities of prematurity and low birth weight.
    JEL: I10 I18 J13
    Date: 2019–06
  8. By: Mommaerts, Corina; Raza, Syed Hassan; Zheng, Yu
    Abstract: This paper estimates the effect of hospital admissions among older workers on economic outcomes across countries. We use harmonized longitudinal survey data from the United States, China, and 13 countries in Europe, and follow the event study design of Dobkin, Finkelstein, Kluender and Notowidigdo (2018) to estimate dynamic effects of a hospitalization on out-of-pocket health expenditures, labor market outcomes, social insurance payments, and household income. We find distinctly different patterns across countries. In contrast to the United States, where hospitalizations lead to large health expenditures and decreases in earnings, individuals in Northern and Southern Europe are largely protected from negative economic outcomes. Hospitalizations in China lead to even larger out-of-pocket expenditures as a percent of prior income, but do not negatively affect labor market outcomes. Our results largely align with the differences in generosity across countries in social protection institutions that include health systems, social security programs and labor market regulations.
    Keywords: cross-country differences; Health shocks; healthcare system; labor market protection; medical spending; social insurance program
    JEL: E21 H53 I13 I18
    Date: 2019–05
  9. By: Teresa Ghilarducci; Siavash Radpour; Anthony Webb (Schwartz Center for Economic Policy Analysis (SCEPA))
    Abstract: Using data from the Survey for Income and Program Participation (SIPP), this study investigates the relationship between withdrawals from 401(k) and IRA accounts and household level economic shocks such as job-loss, job change, divorce, and the onset of poor health. Workers in low-wage households are more likely to withdraw from their accounts than those in middle and high income households, in part because they experience more shocks, and are more likely to withdraw, conditional on experiencing a shock. The above shocks are associated with about a fifth of all retirement account withdrawals and exacerbate pre-existing inequalities in financial preparation for retirement.
    Keywords: retirement savings, retirement, retirement wealth, economic shocks
    JEL: J26 J32 J11
    Date: 2018–11
  10. By: Yukihiro Nishimura (Graduate School of Economics, Osaka University); Pierre Pestieau (CREPP, Universite de Li`ege, CORE)
    Abstract: We consider a society where individuals differ according to their productivity and their risk of mortality and dependency. We show that ac-cording to the most reasonable estimates of correlations among these threecharacteristics, if one had to choose between a public pension system anda long-term care social insurance, the latter should be chosen by a utili-tarian social planner. With a Rawlsian planner, the balance between thetwo schemes does depend on the comparison between the probabilities ofthe worst off individual and the probabilities of the rest of society.
    Keywords: long term care, pension, mortality risk, optimal taxation,liquidity constraints
    JEL: H2 H5
    Date: 2019–04
  11. By: Simona Gamba (Department of Economics (University of Verona)); Laura Magazzini (Department of Economics (University of Verona)); Paolo Pertile (Department of Economics (University of Verona))
    Abstract: Since the early 80s, orphan drug regulations have been introduced to stimulate R&D for rare diseases. We develop a theoretical model to study the heterogeneous impact on optimal R&D decisions of the incentives for diseases with different levels of prevalence. We show the mechanisms through which the type of incentives deployed by orphan drug regulations may stimulate R&D more for orphan diseases with comparatively high prevalence, thus increasing inequality within the class of orphan diseases. Using data from the Food and Drug Administration on the number of orphan designations, our empirical analysis shows that, while R&D has increased over time for all orphan diseases, the increase has been much greater for the less rare. According to our baseline specification, the difference between the predicted number of orphan designations for a disease belonging to the highest and the lowest class of prevalence is 5.6 times larger after 2008 than it was in 1983. Our findings support the idea that the type of incentives in place may be responsible for this increase in inequality within orphan diseases.
    Keywords: pharmaceuticals, innovation, orphan regulations, market size, inequality
    JEL: I14 I18 O31 O38 C35
    Date: 2019–06
  12. By: Michael Keller (Department of Economics, University of Sussex, Brighton, UK)
    Abstract: This paper uses Stochastic Frontier Analysis (SFA) to determine whether oil rents drive inefficiency in the healthcare sector. SFA simultaneously estimates a production function for health outputs and the determinants of inefficiency in production. Using a sample of 119 countries covering the period 2000 to 2015, unexpectedly high oil revenues are shown to increase inefficiency. Oil rents hinder countries in reaching their potential life expectancy. Exploiting exogenous variation in the international oil price reveals that causality runs from oil rents to inefficiency. The effect varies with institutions, sex and age. The effect is more pronounced in democracies, and women and children are affected more. Transparency and inequality are potential mechanisms.
    Keywords: Oil windfalls, health expenditure, stochastic frontier analysis
    JEL: H51 I15 Q33 Q38
    Date: 2019–06
  13. By: Leandro Prados de la Escosura (Universidad Carlos III, CEPR, Groningen)
    Abstract: This paper provides a long run view of human development as a capabilities measure of well-being for the last one-and-a-half centuries on the basis of an augmented historical human development index [AHHDI] that combines achievements in health, education, living standard, plus liberal democracy, and provides an alternative to the UN Human Development Index, HDI. The AHHDI shows substantial gains in world human development since 1870, especially during 1913-1970, but much room for improvement exists. Life expectancy has been the leading force behind its progress, especially until 1970. Human development spread unevenly. The absolute gap between western Europe and its offshoots plus Japan -the OECD- and the Rest of the world deepened over time, though fell in relative terms, with catching-up driven by longevity during the epidemiological transition and by democratization thereafter. This result compares favourably with the growing income gap. Economic growth and human development do not always go hand-in-hand.
    Keywords: Human Development, Well-being, Capabilities, Life Expectancy, Health Transition, Schooling, Income, Liberal Democracy
    JEL: I00 N30 O15
    Date: 2019–06
  14. By: Luca Lorenzoni (OECD); Diana Pinto (Inter-American Development Bank); Frederico Guanais (OECD); Tomas Plaza Reneses (Inter-American Development Bank); Frederic Daniel (OECD); Ane Auraaen (OECD)
    Abstract: In 2018, the Inter-American Development Bank and the OECD launched a survey to collect information on key health systems characteristics in Latin American and Caribbean (LAC) countries. This paper presents the information provided by 21 of these countries. It describes country-specific arrangements to organise the population coverage against health risks and the financing of health spending. It depicts the organisation of health care delivery, focusing on the public/private mix of health care provision, provider payment schemes, user choice and competition among providers, as well as the regulation of health care supply and prices. Finally, this document provides information on governance and resource allocation in health systems (decentralisation in decision-making, nature of budget constraints and priority setting).
    JEL: I10 I18
    Date: 2019–06–19
  15. By: Sahara Graf (OECD); Michele Cecchini (OECD)
    Abstract: Physical inactivity and sedentary behaviours have been rising throughout the OECD in recent decades. Lack of physical activity and excessive sedentary behaviour are well-known risk factors for non-communicable diseases, such as heart diseases, stroke, diabetes, and osteoporosis. As such, reducing physical inactivity and sedentary behaviours and increasing daily physical activity has become a crucial public health issue. Using nationally representative time use surveys, this paper presents the trends in physical activity (PA) and sedentary behaviours over time, in Canada, France, Germany and the United States. A particular focus of this analysis is placed on sport activities. Men and women spend between 80 and 105 minutes daily in physical activities, with women spending more time in domestic physical activity, and men more time in sports. Participation in sport activities has been increasing over time, but no global trend for time spent in sports is visible; additionally, women are consistently less likely than men to report engagement in sport activities. Meanwhile, participation in active travel has been decreasing, displaying no overall trend for duration either. Education-based inequalities for sports participation are higher in men than in women, while income-based inequalities for sports are higher in women than in men. Men and women with a low level of income are more likely to report active travel in all countries. Additional MET (metabolic equivalent) hours spent in sports and non-sports leisure PA, domestic PA, and active travel are all associated with an increase in total PA, while work-related PA as well as other activities are associated with a decrease in total PA. At the individual level, an increase in time spent in all previously mentioned activities is associated with a decrease in total time spent in sedentary behaviours.
    JEL: I1 C02 D1
    Date: 2019–06–19
  16. By: Hammitt, James K.; Geng, Fangli; Guo, Xiaoqi; Nielsen, Chris P.
    Abstract: We estimate the marginal rate of substitution of income for reduction in current annual mortality risk (the “value per statistical life” or VSL) using stated-preference surveys administered to independent samples of the general population of Chengdu China in 2005 and 2016. We evaluate the quality of estimates by the theoretical criterion that WTP for risk reduction should be strictly positive and nearly proportional to the magnitude of the risk reduction (evaluated by comparing answers between respondents). We test the effect of excluding respondents whose answers violate these validity criteria. For subsamples of respondents that satisfy the criteria, point estimates of the sensitivity of WTP to risk reduction are consistent with theory and yield estimates of VSL that are two to three times larger than estimated using the full samples. Between 2005 and 2016, estimated VSL increased sharply, from about 22,000 USD in 2005 to 550,000 USD in 2016. Income also increased substantially over this period. Attributing the change in VSL solely to the change in income implies an income elasticity of about 2.5.
    Keywords: value per statistical life; stated preference; willingness to pay
    JEL: D61 H43 I18 Q51
    Date: 2019–06–14
  17. By: Hiwatari, Masato; Yamada, Daichi; Hangoma, Peter; Narita, Daiju; Mphuka, Chrispin; Chitah, Bona; Yabe, John; Nakayama, Shouta MM; Nakata, Hokuto; Choongo, Kennedy; Ishizuka, Mayumi
    Abstract: In this study, we aim to quantitatively assess the population-wide exposure to lead pollution in Kabwe, Zambia. While Kabwe is known as one of the most significant cases of environmental pollution in the world, the available information does not provide a representative figure on residents’ lead poisoning conditions. To obtain a representative figure, we estimate blood lead level (BLL) of the representative sample of Kabwe by combining two datasets: BLL data collected based on residents’ voluntary participation to blood sampling and socioeconomic data collected for approximately 900, randomly chosen households that represent Kabwe population. The results show that the representative mean BLL is slightly lower than the one observed in previous studies but a few times higher than the recent standard BLL of 5μg/dL above which health risks become significant.
    Date: 2019–05

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