nep-hea New Economics Papers
on Health Economics
Issue of 2019‒09‒30
fifteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Did the War on Terror Ignite an Opioid Epidemic? By Resul Cesur; Joseph J. Sabia; W. David Bradford
  2. Primary Care Physician Practice Styles and Patient Care: Evidence from Physician Exits in Medicare By Itzik Fadlon; Jessica N. Van Parys
  3. Quality Regulation and Competition: Evidence from Pharmaceutical Markets By Jesus Juan Pablo Atal; Jose´ Ignacio Cuesta; Morten Sæthre
  4. Temperature and Mental Health: Evidence from the Spectrum of Mental Health Outcomes By Mullins, Jamie; White, Corey
  5. Residential Noise Exposure and Health: Evidence from Aviation Noise and Birth Outcomes By Argys, Laura M.; Averett, Susan L.; Yang, Muzhe
  6. Estimating and Decomposing Conditional Average Treatment Effects: The Smoking Ban in England By Robson, M.;; Doran, T.;; Cookson, R.;
  7. Global alcohol markets: evolving consumption patterns, regulations and industrial organizations By Kym Anderson; Giulia Meloni; Jo Swinnen
  8. Social Health Insurance: A Quantitative Exploration By Juergen Jung; Chung Tran
  9. The Effects of the Affordable Care Act on Workplace Absenteeism of Overweight and Obese Workers By Grumstrup, Ethan; Mobarak Hossain, Md.; Mukhopadhyay, Sankar; Shapoval, Olga
  10. Minimum Wages and the Health and Access to Care of Immigrants' Children By Averett, Susan L.; Smith, Julie K.; Wang, Yang
  11. State-level gun policy changes and rate of workplace homicide in the United States By Christopher F Baum; Erika Sabbath; Summer Sherburne Hawkins
  12. Does co-living improve the physical and mental health of residents? By Jeongseob Kim; Gi-Hyoug Cho
  13. HTA and Payment Mechanisms for New Drugs to Tackle AMR By Neri, M.; Hampson, G.; Henshall, C.; Towse, A.
  14. The effect of antimalarial campaigns on child mortality and fertility in sub-Saharan Africa By Joshua Wilde; Bénédicte Apouey; Joseph Coleman; Gabriel Picone
  15. Malaria Control and Infant Mortality in Africa By Denis Cogneau; Pauline Rossi

  1. By: Resul Cesur; Joseph J. Sabia; W. David Bradford
    Abstract: Grim national statistics about the U.S. opioid crisis are increasingly well known to the American public. Far less well known is that U.S. war veterans are at ground zero of the epidemic, facing an overdose rate twice that of civilians. Post-9/11 deployments to Afghanistan and Iraq have exposed servicemembers to injury-related chronic pain, psychological trauma, and cheap opium supplies, each of which may fuel opioid addiction. This study is the first to estimate the causal impact of combat deployments in the Global War on Terrorism on opioid abuse. We exploit a natural experiment in overseas deployment assignments and find that combat service substantially increased the risk of prescription painkiller abuse and illicit heroin use among active duty servicemen. War-related physical injuries, death-related battlefield trauma, and Post-Traumatic Stress Disorder emerge as primary mechanisms. The magnitudes of our estimates imply lower-bound combat exposure-induced health care costs of $1.04 billion per year for prescription painkiller abuse and $470 million per year for heroin use.
    JEL: H56 I1 I12
    Date: 2019–09
  2. By: Itzik Fadlon; Jessica N. Van Parys
    Abstract: Primary care physicians (PCPs) provide frontline health care to patients in the U.S.; however, it is unclear how their practice styles affect patient care. In this paper, we estimate the long-lasting effects of PCP practice styles on patient health care utilization by focusing on Medicare patients affected by PCP relocations or retirements, which we refer to as "exits." Observing where patients receive care after these exits, we estimate event studies to compare patients who switch to PCPs with different practice style intensities. We find that PCPs have large effects on a range of aggregate utilization measures, including physician and outpatient spending and the number of diagnosed conditions. Moreover, we find that PCPs have large effects on the quality of care that patients receive, and that all of these effects persist for several years. Our results suggest that switching to higher-quality PCPs could significantly affect patients' longer-run health outcomes.
    JEL: I11 I13 I18
    Date: 2019–09
  3. By: Jesus Juan Pablo Atal (University of Pennsylvania); Jose´ Ignacio Cuesta (University of Chicago); Morten Sæthre (Norwegian School of Economics)
    Abstract: Quality regulation attempts to ensure quality and to foster price competition by reducing vertical di?erentiation, but may also have unintended consequences through its e?ects on market structure. We study these e?ects in the context of pharmaceutical bioequivalence, which is the primary quality standard for generic drugs. Exploiting the staggered phase-in of bioequivalence requirements in Chile, we show that stronger quality regulation decreased the number of drugs in the market by 25%, increased average paid prices by 10%, decreased total sales by 20%, and did not have a significant e?ect on observed outcomes related to drug quality. These adverse e?ects were concentrated among small markets. Our results suggest that the intended e?ects of quality regulation on price competition through increased (perceived) quality of generics were overturned by adverse competitive e?ects arising from the costs of complying with the regulation.
    Keywords: Aggregate quality regulation, competition, bioequivalence, generic pharmaceuticals
    JEL: I11 L11 L15
    Date: 2019–07–15
  4. By: Mullins, Jamie (University of Massachusetts Amherst); White, Corey (California Polytechnic State University)
    Abstract: This paper characterizes the link between ambient temperatures and a broad set of mental health outcomes. We find that higher temperatures increase emergency department visits for mental illness, suicides, and self-reported days of poor mental health. Specifically, cold temperatures reduce negative mental health outcomes while hot temperatures increase them. Our estimates reveal no evidence of adaptation, instead the temperature relationship is stable across time, baseline climate, air conditioning penetration rates, accessibility of mental health services, and other factors. The character of the results suggests that temperature affects mental health very differently than physical health, and more similarly to other psychological and behavioral outcomes. We provide suggestive evidence for sleep disruption as an active mechanism behind our results and discuss the implications of our findings for the allocation of mental health services and in light of climate change.
    Keywords: mental health, weather, climate, suicide, health
    JEL: I10 I12 I18 Q50 Q51 Q54
    Date: 2019–09
  5. By: Argys, Laura M. (University of Colorado Denver); Averett, Susan L. (Lafayette College); Yang, Muzhe (Lehigh University)
    Abstract: Exploiting recent concentration of flight patterns under a new Federal Aviation Administration policy (called NextGen), we examine the impact of exposure to excessive noise levels on birth outcomes. Using birth records that include mothers’ home addresses to measure airport proximity, we find the risk of low birth weight babies increases by 17 percent among mothers living near the airport in the direction of the runway. We utilize exogenous variation in noise exposure triggered by NextGen, which unintentionally increased noise in communities affected by the new flight patterns. Our finding informs policy-makers regarding the trade-off between flight optimization and human health.
    Keywords: noise, airport runway, low birth weight, NextGen
    JEL: I10 I18 Q53 Q58 R11
    Date: 2019–09
  6. By: Robson, M.;; Doran, T.;; Cookson, R.;
    Abstract: We develop a practical method for estimating and decomposing conditional average treatment effects using locally-weighted regressions. We illustrate with an application to the smoking ban in England using a regression discontinuity design, based on Health Survey for England data. We estimate average treatment effects conditional on socioeconomic status and decompose these effects by smoking location. Results show, the ban had no effect on the level of active smoking, but significantly reduced average exposure to second-hand smoke among non-smokers by 1.38 hours per week. Our method reveals a complex relationship between socioeconomic status and the effect on passive smoking. Decomposition analysis shows that these effects stem primarily from exposure reductions in pubs, but also from workplace exposure reductions for high socioeconomic status individuals.
    Keywords: health inequality; equity; conditional average treatment effects; regression discontinuity; heterogeneity; smoking ban; lwcate;
    JEL: C14 C21 C87 D63 I14 I38
    Date: 2019–09
  7. By: Kym Anderson; Giulia Meloni; Jo Swinnen
    Abstract: For millennia alcoholic drinks have played an important role in food security and health (both positive and negative), but consumption patterns of beer, wine and spirits have altered substantially over the past two centuries. So too have their production technologies and industrial organization. Globalization and economic growth have contributed to considerable convergence in national alcohol consumption patterns. The industrial revolution contributed to excess consumption by stimulating demand and lowering the cost of alcohol. It also led to concentration in some alcohol industries, expecially brewing. In recent years the emergence of craft producers has countered firm concentration and the homogenization of alcoholic beverages. Meanwhile, governments have intervened extensively in alcohol markets to reduce excessive consumption, raise taxes, protect domestic industries and/or ensure competition. These regulations have contributed to, and been affected by, evolving patterns of consumption and changing structures of alcohol industries.
    Keywords: Globalization of preferences, Convergence of national beverage consumption mix, Alcohol and health, Restrictions on alcohol consumption and production, Beverage firm concentration
    Date: 2018–02
  8. By: Juergen Jung (Towson University); Chung Tran (Australian National University)
    Abstract: We quantitatively explore the welfare benefits of health insurance over the lifecycle in a dynamic general equilibrium model with health risk and a health care sector. We consider three distinct approaches to designing a health insurance system: (i) a mixed private and public health insurance system similar to the US system, (ii) private health insurance (PHI), and (iii) universal public health insurance (UPHI). Our results indicate that the introduction of the US system into an economy without any health insurance results in large welfare gains, but does not produce the best welfare outcome. The PHI system with some government regulation on premiums is viable and produces welfare gains comparable to the welfare gains generated by the US system. The UPHI system with a high enough coinsurance rate produces better overall welfare outcomes than the other two systems. There exists an optional coinsurance rate that maximizes the welfare benefits of the UPHI system. A structural reform that replaces the US system with the UPHI system—i.e., Medicare for all—is welfare improving, but would face political headwinds due to opposing welfare effects across income groups.
    Date: 2019
  9. By: Grumstrup, Ethan (University of Nevada, Reno); Mobarak Hossain, Md. (University of Nevada, Reno); Mukhopadhyay, Sankar (University of Nevada, Reno); Shapoval, Olga (University of Nevada, Reno)
    Abstract: In this paper, we examine whether the expansion of health insurance coverage brought on by the Patient Protection and Affordable Care Act of 2010 (ACA), led to a decline in absenteeism among overweight and obese individuals. We use data from the National Health Insurance Survey (NHIS) to compare absenteeism among overweight and obese workers to absenteeism among normal-weight workers before and after the ACA. Our results suggest that in the post-ACA period, the probability of being absent declined by about 1.3 (1.5) percentage points among obese (overweight) individuals. Disaggregated regressions suggest that the effect is significant among women, but not among men. Furthermore, our estimates (using a Tobit model) indicate that the obese (overweight) workers missed 0.33 (0.46) fewer days after the ACA. Again, the effect is concentrated among women. Our results show that improved health outcomes led to reduced absenteeism. Our results also show that there are no decline in absenteeism among elderly (age>=65) adults (who did not experience any increase in health insurance coverage as a result of the ACA), suggesting that the decline in absenteeism is indeed due to the expansion of health insurance coverage due to the ACA. Our estimates imply that the ACA reduced the cost associated with absenteeism by about $350 million per year.
    Keywords: Affordable Care Act, obesity, overweight, absenteeism
    JEL: I13 I18 J08
    Date: 2019–09
  10. By: Averett, Susan L. (Lafayette College); Smith, Julie K. (Lafayette College); Wang, Yang (University of Wisconsin-Madison)
    Abstract: States are increasingly resorting to raising the minimum wage to boost the earnings of those at the bottom of the income distribution. In this paper, we examine the effects of minimum wage increases on the health of the children of immigrants. Their parents are disproportionately represented in minimum wage jobs, typically have less access to health care and are a growing part of the U.S. labor force. Using a difference-in-differences identification strategy and data drawn from the National Health Interview Survey from the years 2000 - 2015, we examine whether children of low-educated immigrants experience any changes in health or access to care when the minimum wage increases.
    Keywords: minimum wage, immigrant children, access to care, health insurance, health
    JEL: J15 I12 I13 I14
    Date: 2019–09
  11. By: Christopher F Baum (Boston College; DIW Berlin); Erika Sabbath (Boston College); Summer Sherburne Hawkins (Boston College)
    Abstract: Nearly 40,000 people in the U.S. die from firearm-related causes annually. Of these, about 1% are intentionally shot and killed while at work; work-related homicides account for about 10% of all workplace fatalities. While firearm policies have remained essentially unchanged at the national level, there is greater variation in state-level gun control legislation. Moreover, the gun control landscape between and within states has changed considerably over the past 10 years. Little recent work has focused on determinants or epidemiology of workplace homicide. The purpose of this study is to test whether changes in state-level gun control policies are associated with changes in state-level workplace homicide rates. Our analysis shows that stronger gun-control policies, particularly around concealed carry permitting, background checks, and domestic violence, may be effective means of reducing work-related homicide.
    Date: 2019–09–15
  12. By: Jeongseob Kim; Gi-Hyoug Cho
    Abstract: Co-living or shared housing has become popular as an emerging housing option for young adults in many countries. Co-living allows residents to save rent by sharing common spaces such as a kitchen and living room in their home. In addition, co-living could provide a new opportunity for social relationship with housemates. Personal privacy is not fully ensured in shared housing so that social conflicts can occur among residents. However, co-living could improve the health of residents through social interactions with housemates. In this regard, this study examines whether co-living can improve physical and mental health of residents. This study explores the relationship between co-living and the health of residents based on the survey with a sample of 830 young adults in Seoul, South Korea. We compared the mental and physical health of house-shares with those of residents in general housing. There is no difference in the physical health between house-sharers and general people, but the mental health of house-sharers, specifically for the depression, is better than that of general people. The results imply that co-living could have the potential to improve the mental health of residents by providing the social relationship with housemates. The findings of this study could be a basis for developing an effective housing policy and planning for young adults.
    Keywords: co-living; mental health; physical health; shared housing; Young Adults
    JEL: R3
    Date: 2019–01–01
  13. By: Neri, M.; Hampson, G.; Henshall, C.; Towse, A.
    Abstract: Antimicrobial resistance (AMR) is a growing public health threat, limiting the ability of health care systems to prevent and treat infections and save lives. In parallel, global antibiotic development pipelines are weak. Various R&D incentives have been proposed to address the challenges associated to low economic returns from investment in antibiotics. Value assessment methods recognising the value of new antibiotics to the whole health system are needed to help match the size of the required monetary incentives to the value that they offer. At present, HTA methods for new antibiotics include benefits and costs associated with treating the immediate patient, while 'public health effects', such as preventing infection transmission and slowing down AMR development, are not captured. Furthermore, traditional pricing arrangements where revenues depend on volumes sold are unlikely to be profitable, as AMR stewardship will limit the use of the new antibiotic. Use may increase in the long-term when the build-up of resistance means that the antibiotic is used as a first line treatment. However, at that point in time the product may be off-patent and priced as a generic. This paper provides an overview of the current state of HTA and contracting for antibiotics in five European countries, and of the recent proposals in the literature for revising them. It also includes the recommendations developed following a stakeholder Forum on 'Value Assessment and Contracting for Antibiotics' held in February 2019.
    Keywords: Judging value for money and improving decision making
    JEL: I1
    Date: 2019–09–01
  14. By: Joshua Wilde (Max Planck Institute for Demographic Research, Rostock, Germany); Bénédicte Apouey; Joseph Coleman; Gabriel Picone
    Abstract: We examine the extent to which recent declines in child mortality and fertility in Sub-Saharan Africa can be attributed to insecticide-treated bed nets (ITNs). Exploiting the rapid increase in ITNs since the mid-2000s, we employ a difference-in-differences estimation strategy to identify the causal effect of ITNs on mortality and fertility. We show that the ITN distribution campaigns reduced all-cause child mortality, but surprisingly increased total fertility rates in the short run in spite of reduced desire for children and increased contraceptive use. We explain this paradox in two ways. First, we show evidence for an unexpected increase in fecundity and sexual activity due to the better health environment after the ITN distribution. Second, we show evidence that the effect on fertility is positive only temporarily – lasting only 1-3 years after the beginning of the ITN distribution programs – and then becomes negative. Taken together, these results suggest the ITN distribution campaigns may have caused fertility to increase unexpectedly and temporarily, or that these increases may just be a tempo effect -- changes in fertility timing which do not lead to increased completed fertility.
    Keywords: Africa, child mortality, fertility, malaria
    JEL: J1 Z0
    Date: 2019–09
  15. By: Denis Cogneau (Paris School of Economics); Pauline Rossi (University of Amsterdam)
    Abstract: Has massive distribution of insecticide-treated-nets contributed to the reduction in infant mortality in Sub-Saharan Africa over the past 15 years? Using large household surveys collected in 16 countries and exploiting the spatial correlation in distribution campaigns, we estimate the relationship between the diffusion of bednets and the progress in child survival. We find no evidence of a causal link in cities, and no impact either in rural areas with low malaria prevalence. By contrast, in highly malarious rural areas where bednet coverage reached high levels, above 75% of households, infant mortality has been reduced by at least 3 percentage points, which amounts to 25% of the initial mortality. The identified impact is even higher for the children of mothers with no education. It lies at the upper bound found with RCTs, most likely because those were implemented in contexts with lower mortality and/or malaria prevalence.
    Keywords: Child mortality, Malaria, Africa, Foreign aid
    JEL: I1 J1 O1 F35
    Date: 2019–09–20

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