nep-hea New Economics Papers
on Health Economics
Issue of 2019‒07‒29
eleven papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Is Great Information Good Enough? Evidence from Physicians as Patients By Michael D. Frakes; Jonathan Gruber; Anupam Jena
  2. The Effects of Stepwise Minimum Legal Drinking Age Legislation on Mortality: Evidence from Germany By Kamalow, Raffael; Siedler, Thomas
  3. Adverse childhood experiences and outcomes later in life: Evidence from SHARE countries By Agar Brugiavini; Raluca Elena Buia; Matija Kovacic; Cristina Elisa Orso
  4. Self-control: Determinants, life outcomes and intergenerational implications By Cobb-Clark, Deborah A.; Dahmann, Sarah Christina; Kamhöfer, Daniel A.; Schildberg-Hörisch, Hannah
  5. Strategic Sorting: The Role of Ordeals in Health Care By Richard J. Zeckhauser
  6. Education, Taxation and the Perceived Effects of Sin Good Consumption By Annamaria Menichini; Giovanni Immordino; Maria Grazia Romano
  7. Pathways to Good Healthcare Services and Patient Satisfaction: An Evolutionary Game Theoretical Approach By Zainab Alalawi; The Anh Han; Yifeng Zeng; Aiman Elragig
  8. Regional inequalities in premature mortality in Great Britain By Plümper, Thomas; Laroze, Denise; Neumayer, Eric
  9. Your money and your life: risk attitudes over gains and losses By Oliver, Adam
  10. Voting Up? The Effects of Democracy and Franchise Extension on Human Stature By Alberto Batinti; Joan Costa-i-Font; Timothy J. Hatton
  11. Economic impact of third-wave cognitive behavioral therapies: a systematic review and quality assessment of economic evaluations in randomized controlled trials By Feliu-Soler, Albert; Cebolla, Ausias; McCracken, Lance M.; D'Amico, Francesco; Knapp, Martin; López-Montoyo, Alba; García-Campayo, Javier; Soler, Joaquim; Baños, Rosa M.; Pérez-Aranda, Adrián; Andrés-Rodriguez, Laura; Rubio-Valera, Maria; Luciano, Juan V.

  1. By: Michael D. Frakes; Jonathan Gruber; Anupam Jena
    Abstract: Stemming from the belief that the key barrier to achieving high-quality and low-cost health care is the deficiency of information and medical knowledge among patients, an enormous number of health policies are focused on patient education. In this paper, we attempt to place an upper bound on the improvements to health care quality that may emanate from such information campaigns. To do so, we compare the care received by a group of patients that should have the best possible information on health care service efficacy—i.e., physicians as patients—with a comparable group of non-physician patients, taking various steps to account for unobservable differences between the two groups. Our results suggest that physicians do only slightly better in adhering to both low- and high-value care guidelines than non-physicians – but not by much and not always.
    JEL: H51 I11
    Date: 2019–07
  2. By: Kamalow, Raffael (University of Hamburg); Siedler, Thomas (University of Hamburg)
    Abstract: This study investigates the short-term mortality effects of two age-based restrictions on legal access to alcohol in Germany. We exploit sharp differences in legal access to alcohol at 16 and 18 years by implementing a regression discontinuity design. We find discontinuous increases in deaths at both age cutoffs, which are mainly driven by a "novice driver effect", whereas legal access to alcohol plays a marginal role at most. Overall, our results indicate that a stepwise introduction to alcohol has, at most, a minor impact on drunk driving and mortality at age 16 and 18 years. This study thus provides fresh impetus to the ongoing debate on the "optimal" MLDA legislation.
    Keywords: mortality, motor vehicle fatalities, minimum legal drinking age, regression discontinuity design
    JEL: I10 I18 C26 C31
    Date: 2019–06
  3. By: Agar Brugiavini (Department of Economics, University Of Venice Cà Foscari); Raluca Elena Buia (Department of Economics, University Of Venice Cà Foscari); Matija Kovacic (Department of Economics, University Of Venice Cà Foscari); Cristina Elisa Orso (Department of Economics, University Of Verona)
    Abstract: In this paper, we investigate whether exposure to adverse experiences during childhood such as physical and emotional abuse affects a set of health and socio-economic outcomes across the lifespan using recent European data from SHARE (The Survey of Health, Ageing and Retirement in Europe). The novelty of our approach consists in exploiting the recently published data on adverse childhood experiences for 19 SHARE countries, which enables us to account for country-specific heterogeneity and investigate the long-run effects of exposure to early-life adverse circumstances on different adult outcomes. Our results highlight a negative long-term effect of exposure to adverse childhood experiences -ACEs on risky behaviour such as smoking, as well as on socio-economic outcomes like unemployment and family dissolution.
    Keywords: Adverse Childhood Experiences, Smoking Behaviour, Unemployment, Family Dissolution
    JEL: H4 I12
    Date: 2019
  4. By: Cobb-Clark, Deborah A.; Dahmann, Sarah Christina; Kamhöfer, Daniel A.; Schildberg-Hörisch, Hannah
    Abstract: This paper studies self-control in a nationally representative sample. Using the wellestablished Tangney scale to measure trait self-control, we find that people's age as well as the political and economic institutions they are exposed to have an economically meaningful impact on their level of self-control. A higher degree of self-control is, in turn, associated with better health, educational and labor market outcomes as well as greater financial and overall well-being. Parents' self-control is linked to reduced behavioral problems among their children. Importantly, we demonstrate that self-control is a key behavioral economic construct which adds significant explanatory power beyond other more commonly studied personality traits and economic preference parameters. Our results suggest that self-control is potentially a good target for intervention policies.
    Keywords: self-control,Tangney scale,personality traits,intergenerational transmission
    JEL: D91 J24
    Date: 2019
  5. By: Richard J. Zeckhauser
    Abstract: Ordeals are burdens placed on individuals that yield no direct benefits to others. They represent a dead-weight loss. Ordeals – the most common being waiting time – play a prominent role in health care. Their goal is to direct scarce resources to recipients receiving greater value from them, hence presumed to be more willing to bear an ordeal’s burden. Ordeals are intended to prevent wasteful expenditures given that health care is heavily subsidized, yet avoid other forms of rationing, such as quotas or pricing. This analysis diagnoses the economic underpinnings of ordeals. Subsidies to nursing home versus home care illustrate.
    JEL: H21 H24 I13
    Date: 2019–07
  6. By: Annamaria Menichini (CSEF, Università di Salerno); Giovanni Immordino (Università di Napoli Federico II and CSEF); Maria Grazia Romano (University of Salerno and CSEF)
    Abstract: In a setting in which an agent has a behavioral bias that causes an underestimation or an overestimation of the health consequences of sin goods consumption, the paper studies how a social planner can affect the demand of such goods through education initiatives and/or taxation. When only optimistic consumers are present, depending on the elasticity of demand of the sin good with respect to taxation and the relative efficiency of educational measures, the two instruments can be used as substitutes or complements. When both optimistic and pessimistic consumers coexist, the correcting effect that taxation has on optimistic consumers has unintended distorting effects on pessimistic ones. In this framework, educational measures, by aligning both consumers' perceptions closer to the true probability of health damages, are more effective than taxation.
    Keywords: Overoptimism, Taxation, Educational initiatives, Sin goods.
    JEL: D03 H21 L51
    Date: 2019–07–20
  7. By: Zainab Alalawi; The Anh Han; Yifeng Zeng; Aiman Elragig
    Abstract: Spending by the UK's National Health Service (NHS) on independent healthcare treatment has been increased in recent years and is predicted to sustain its upward trend with the forecast of population growth. Some have viewed this increase as an attempt not to expand the patients' choices but to privatize public healthcare. This debate poses a social dilemma whether the NHS should stop cooperating with Private providers. This paper contributes to healthcare economic modelling by investigating the evolution of cooperation among three proposed populations: Public Healthcare Providers, Private Healthcare Providers and Patients. The Patient population is included as a main player in the decision-making process by expanding patient's choices of treatment. We develop a generic basic model that measures the cost of healthcare provision based on given parameters, such as NHS and private healthcare providers' cost of investments in both sectors, cost of treatments and gained benefits. A patient's costly punishment is introduced as a mechanism to enhance cooperation among the three populations. Our findings show that cooperation can be improved with the introduction of punishment (patient's punishment) against defecting providers. Although punishment increases cooperation, it is very costly considering the small improvement in cooperation in comparison to the basic model.
    Date: 2019–07
  8. By: Plümper, Thomas; Laroze, Denise; Neumayer, Eric
    Abstract: Premature mortality exhibits strong spatial patterns in Great Britain. Local authorities that are located further North and West, that are more distant from its political centre London and that are more urban tend to have a higher premature mortality rate. Premature mortality also tends to cluster among geographically contiguous and proximate local authorities. We develop a novel analytical research design that relies on spatial pattern recognition to demonstrate that an empirical model that contains only socio-economic variables can eliminate these spatial patterns almost entirely. We demonstrate that socioeconomic factors across local authority districts explain 81 percent of variation in female and 86 percent of variation in male premature mortality in 2012–14. As our findings suggest, policy-makers cannot hope that health policies alone suffice to significantly reduce inequalities in health. Rather, it requires strong efforts to reduce the inequalities in socio-economic factors, or living conditions for short, in order to overcome the spatial disparities in health, of which premature mortality is a clear indication.
    Keywords: regional inequality; spatial pattern recognition; premature mortality; health inequality
    JEL: N0
    Date: 2018–02–28
  9. By: Oliver, Adam
    Abstract: Prospect theory is the most influential descriptive alternative to the orthodox model of rational choice under risk and uncertainty, in terms of empirical analyses of some of its principal parameters and as a consideration in behavioural public policy. Yet the most distinctive implication of the theory – a fourfold predicted pattern of risk attitudes called the reflection effect – has been infrequently studied and with mixed results over money outcomes, and has never been completely tested over health outcomes. This article reports tests of reflection over money and health outcomes defined by life years gained from treatment. With open valuation exercises, the results suggest qualified support for the reflection effect over money outcomes and strong support over health outcomes. However, in pairwise choice questions, reflection was substantially ameliorated over life years, remaining significant only for treatments that offered short additional durations of life.
    Keywords: Expected utility theory; Markowitz; Prospect theory; Reflection effect; Risk
    JEL: B21 C12 C91
    Date: 2019–08
  10. By: Alberto Batinti; Joan Costa-i-Font; Timothy J. Hatton
    Abstract: We study the health effects of the spread of democratic institutions and the extension of voting rights in 15 European countries since the middle of the nineteenth century. We employ both cross country and cohort variation in heights and employ a new instrument for democracy and the extension of the franchise, the effect of decolonisation on democracy in the colonising country’s democratisation to identify the causal effect of democracy on heights. We find robust evidence of a link between democratic quality and human stature. The results indicate that the transition to democracy increased average male heights by 0.7 to 1 cm, equivalent to a one-decade average increase in stature across cohorts. Including the extension of the franchise to women increases the effect on average stature to about 1.7cm. The effect is driven by both to political participation and contestation in reducing inequality and expanding health insurance coverage.
    Keywords: height, democracy, transition, voting rights expansions, franchise
    JEL: H10 I10 J10
    Date: 2019
  11. By: Feliu-Soler, Albert; Cebolla, Ausias; McCracken, Lance M.; D'Amico, Francesco; Knapp, Martin; López-Montoyo, Alba; García-Campayo, Javier; Soler, Joaquim; Baños, Rosa M.; Pérez-Aranda, Adrián; Andrés-Rodriguez, Laura; Rubio-Valera, Maria; Luciano, Juan V.
    Abstract: The term third-wave cognitive behavioral therapy (CBT) encompasses new forms of CBT that both extend and innovate within CBT. Most third-wave therapies have been subject to randomized controlled trials (RCTs) focused on clinical effectiveness; however, the number and quality of economic evaluations in these RCTs has been unknown and may be few. Evidence about efficiency of these therapies may help support decisions on efficient allocation of resources in health policies. The main aim of this study was to systematically review the economic impact of third-wave therapies in the treatment of patients with physical or mental conditions. We conducted a systematic literature search in PubMed, PsycINFO, EMBASE, and CINALH to identify economic evaluations of third-wave therapies. Quality and Risk of Bias (RoB) assessment of economic evaluations was also made using the Drummond 35-item checklist and the Cochrane Collaboration’s tool for assessing risk of bias, respectively. Eleven RCTs were included in this systematic review. Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and extended Behaviour Activation (eBA) showed acceptable cost-effectiveness and cost-utility ratios. No study employed a time horizon of more than 3 years. Quality and RoB assessments highlight some limitations that temper the findings. There is some evidence that MBCT, MBSR, ACT, DBT, and eBA are efficient from a societal or a third-party payer perspective. No economic analysis was found for many third-wave therapies. Therefore, more economic evaluations with high methodological quality are needed.
    Keywords: third-wave cognitive behavioral therapies; mindfulness; acceptance; economic evaluation; systematic review
    JEL: J1
    Date: 2018–01–01

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