nep-hea New Economics Papers
on Health Economics
Issue of 2019‒09‒16
eight papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Free for Children? Patient Cost-sharing and Healthcare Utilization By Iizuka, Toshiaki; Shigeoka, Hitoshi
  2. Oakland’s Sugar-Sweetened Beverage Tax: Impacts on Prices, Purchases and Consumption by Adults and Children By John Cawley; David E. Frisvold; Anna Hill; David Jones
  3. Dynamic Social Interactions and Health Risk Behavior By Tiziano Arduini; Alberto Bisin; Onur Özgür; Eleonora Patacchini
  4. Developmental Origins of Health Inequality By Gabriella Conti; Giacomo Mason; Stavros Poupakis
  5. Consequences of Parental Job Loss on the Family Environment and on Human Capital Formation - Evidence from Plant Closures By Eva Maria Mörk; Anna Sjögren; Helena Svaleryd
  6. State Drug Policy Effectiveness: Comparative Policy Analysis of Drug Overdose Mortality By Jarrod Olson; Po-Hsu Allen Chen; Marissa White; Nicole Brennan; Ning Gong
  7. The Baby Year Parental Leave Reform in the GDR and Its Impact on Children's Long-Term Life Satisfaction By Katharina Heisig; Larissa Zierow
  8. Cost of maternal health services in low- and middle-income countries: protocol for a systematic review By Banke-Thomas, Aduragbemi; Abejirinde, Ibukun-Oluwa Omolade; Banke-Thomas, Oluwasola; Maikano, Adamu; Ameh, Charles

  1. By: Iizuka, Toshiaki; Shigeoka, Hitoshi
    Abstract: We examine how children's healthcare utilization responds to prices by exploiting over 10,000 variations in the levels and forms of patient cost-sharing across Japanese municipalities over time. Free care significantly increases outpatient spending, with price elasticities considerably smaller for children than adults. Small copayments alongside free care reduce utilization of healthier—rather than sicker—children, suggesting that moral hazard can be reduced without increasing financial and health risks. We find that cost-sharing is a "blunt tool," affecting utilization regardless of service type. Increased outpatient spending from free care neither improves short- and medium-term health outcomes nor reduces future healthcare spending
    Keywords: Children, Patient Cost-Sharing, Healthcare Utilization, Price Elasticity, Zero-price Effects, Moral Hazard
    JEL: I18 I13 I11 J13
    Date: 2019–08
  2. By: John Cawley; David E. Frisvold; Anna Hill; David Jones
    Abstract: Several cities in the U.S. have implemented taxes on sugar-sweetened beverages (SSBs) in an attempt to improve public health and raise revenue. On July 1, 2017, Oakland California introduced a tax of one cent per ounce on SSBs. In this paper, we estimate the impact of the tax on retail prices, product availability, purchases, and child and adult consumption of taxed beverages in Oakland, as well as of potential substitute beverages. We collected data from Oakland stores and their customers and a matched group of stores in surrounding counties and their customers. We collected information in the months prior to the implementation of the tax and again a year later on: (1) prices, (2) purchase information from customers exiting the stores, and (3) a follow-up household survey of adults and child beverage purchases and consumption. We use a difference-in-differences identification strategy to estimate the impact of the tax on prices, purchases, and consumption of taxed beverages. We find that roughly 60 percent of the tax was passed on to consumers in the form of higher prices. There was a slight decrease in the volume of SSBs purchased per shopping trip in Oakland and a small increase in purchases at stores outside of the city, and we find some evidence of increased shopping by Oakland residents at stores outside of the city. We do not find evidence of substantial changes in the overall consumption of SSBs or of added sugars consumed through beverages for either adults or children after the tax.
    JEL: H71 H75 I18
    Date: 2019–09
  3. By: Tiziano Arduini; Alberto Bisin; Onur Özgür; Eleonora Patacchini
    Abstract: We study risky behavior of adolescents. Concentrating on smoking and alcohol use, we structurally estimate a dynamic social interaction model in the context of students' school networks included in the National Longitudinal Study of Adolescent Health (Add Health). The model allows for forward-looking behavior of agents, addiction effects, and social interactions in the form of preferences for conformity in the social network. We find strong evidence for forward looking dynamics and addiction effects. We also find that social interactions in the estimated dynamic model are quantitatively large. A misspecified static model would fit data substantially worse, while producing a much smaller estimate of the social interaction effect. With the estimated dynamic model, a temporary shock to students' preferences in the 10th grade has effects on their behavior in grades 10, 11, 12, with estimated social multipliers 1:53, 1:03, and 0:76, respectively. The multiplier effect of a permanent shock is much larger, up to 3:7 in grade 12. Moreover (semi-) elasticities of a permanent change in the availability of alcohol or cigarettes at home on child risky behavior implied by the dynamic equilibrium are 25%, 63%, and 79%, in grades 10, 11, 12, respectively.
    JEL: C18 C33 C62 C63 C73 I12
    Date: 2019–09
  4. By: Gabriella Conti (University College London); Giacomo Mason (University College London); Stavros Poupakis (University College London)
    Abstract: Building on early animal studies, 20th-century researchers increasingly explored the fact that early events – ranging from conception to childhood – affect a child’s health trajectory in the long-term. By the 21st century, a wide body of research had emerged, incorporating the original ‘Fetal Origins Hypothesis’ into the ‘Developmental Origins of Health and Disease’. Evidence from OECD countries suggests that health inequalities are strongly correlated with many dimensions of socio-economic status, such as educational attainment; and that they tend to increase with age and carry stark intergenerational implications. Different economic theories have been developed to rationalize this evidence, with an overarching comprehensive framework still lacking. Existing models widely rely on human capital theory, which has given rise to separate dynamic models of adult and child health capital, within a production function framework. A large body of empirical evidence has also found support for the developmental origins of inequalities in health. On the one hand, studies exploiting quasi-random exposure to adverse events have shown long-term physical and mental health impacts of exposure to early shocks, including pandemics or maternal illness, famine, malnutrition, stress, vitamin deficiencies, maltreatment, pollution and economic recessions. On the other hand, studies from the 20th century have shown that early interventions of various content and delivery format improve life course health. Further, given that the most socioeconomically disadvantaged groups show the greatest gains, such measures can potentially reduce health inequalities. However, studies of long-term impacts, as well as the mechanisms via which shocks or policies affect health, and the dynamic interaction amongst them, are still lacking. Mapping the complexities of those early event dynamics is an important avenue for future research.
    Keywords: developmental origins, health inequality, early intervention, health production function, health economics
    JEL: I14 J13 H52
    Date: 2019–06
  5. By: Eva Maria Mörk; Anna Sjögren; Helena Svaleryd
    Abstract: We study the consequences of mothers’ and fathers’ job loss for parents, families, and children. Rich Swedish register data allow us to identify plant closures and account for non-random selection of workers to closing plants by using propensity score matching and controlling for pre-displacement outcomes. Our overall conclusion is positive: childhood health, educational and early adult outcomes are not adversely affected by parental job loss. Parents and families are however negatively affected in terms of parental health, labor market outcomes and separations. Limited effects on family disposable income suggest that generous unemployment insurance and a dual-earner norm shield families from financial distress, which together with universal health care and free education is likely to be protective for children.
    Keywords: parental unemployment, workplace closure, family environment, child health, human capital formation
    Date: 2019
  6. By: Jarrod Olson; Po-Hsu Allen Chen; Marissa White; Nicole Brennan; Ning Gong
    Abstract: Opioid overdose rates have reached an epidemic level and state-level policy innovations have followed suit in an effort to prevent overdose deaths. State-level drug law is a set of policies that may reinforce or undermine each other, and analysts have a limited set of tools for handling the policy collinearity using statistical methods. This paper uses a machine learning method called hierarchical clustering to empirically generate "policy bundles" by grouping states with similar sets of policies in force at a given time together for analysis in a 50-state, 10-year interrupted time series regression with drug overdose deaths as the dependent variable. Policy clusters were generated from 138 binomial variables observed by state and year from the Prescription Drug Abuse Policy System. Clustering reduced the policies to a set of 10 bundles. The approach allows for ranking of the relative effect of different bundles and is a tool to recommend those most likely to succeed. This study shows that a set of policies balancing Medication Assisted Treatment, Naloxone Access, Good Samaritan Laws, Medication Assisted Treatment, Prescription Drug Monitoring Programs and legalization of medical marijuana leads to a reduced number of overdose deaths, but not until its second year in force.
    Date: 2019–09
  7. By: Katharina Heisig; Larissa Zierow
    Abstract: This article investigates the effects of an increase in paid parental leave — twelve months instead of six months — on children’s long-term life satisfaction. The historical setting under study, namely the former German Democratic Republic (GDR), allows us to circumvent problems of selection of women into the labor market and an insufficient or heterogeneous non-parental child care supply, which are issues many other studies on parental leave reforms face. Using data from the German Socio-Economic Panel (SOEP) we analyze the birth cohorts from 1980 to 1989 at adult age, and apply a difference-in-difference design making use of the very specific timing of the GDR’s parental leave reforms in 1976 and 1986. We find significant and robust positive parental leave effects on life satisfaction. We also analyze whether the increase in life satisfaction is driven by a positive development of personality, health factors, schooling or labor market outcomes. Our results suggest that the increase in life satisfaction might be partially explained by personality development for individuals from low socioeconomic backgrounds and boys. For individuals from high socioeconomic backgrounds, it might be driven by a better health.
    Keywords: parental leave, child care, child development, well-being, happiness, socio-emotional development
    JEL: J13 J22 I31
    Date: 2019
  8. By: Banke-Thomas, Aduragbemi; Abejirinde, Ibukun-Oluwa Omolade; Banke-Thomas, Oluwasola; Maikano, Adamu; Ameh, Charles
    Abstract: There is substantial evidence that maternal health services across the continuum of care are effective in reducing morbidities and mortalities associated with pregnancy and childbirth. There is also consensus regarding the need to invest in the delivery of these services towards the global goal of achieving Universal Health Coverage in low- and middle-income countries (LMICs). However, there is limited evidence on the costs of providing these services. This protocol describes the methods and analytical framework to be used in conducting a systematic review of costs of providing maternal health services in LMICs.
    JEL: N0
    Date: 2019–08–20

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