nep-hea New Economics Papers
on Health Economics
Issue of 2019‒10‒28
eleven papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. What to Expect When It Gets Hotter: The Impacts of Prenatal Exposure to Extreme Heat on Maternal and Infant Health By Kim, Jiyoon; Lee, Ajin; Rossin-Slater, Maya
  2. Supplemental Security Income and Child Outcomes: Evidence from Birth Weight Eligibility Cutoffs By Melanie E. Guldi; Amelia Hawkins; Jeffrey Hemmeter; Lucie Schmidt
  3. Disability and Multi-Dimensional Quality of Life: A Capability Approach to Health Status Assessment By Anand, Paul; Roope, Laurence; Culyer, Anthony J.; Smith, Ron P.
  4. The Long-Run Effects of Cesarean Sections By Costa-Ramón, Ana; Kortelainen, Mika; Rodríguez-González, Ana; Sääksvuori, Lauri
  5. The Impact of the ACA Medicaid Expansion on Disability Program Applications By Lucie Schmidt; Lara Shore-Sheppard; Tara Watson
  6. Health and Pollution in a Vertically Differentiated Duopoly By Stefano Quarta; Skerdilajda Zanaj
  7. Recent Increases in Air Pollution: Evidence and Implications for Mortality By Karen Clay; Nicholas Z. Muller
  8. Education and Health: Long-run Effects of Peers, Tracking and Years By Fischer, Martin; Gerdtham, Ulf-G; Heckley, Gawain; Karlsson, Martin; Kjellsson, Gustav; Nilsson, Therese
  9. Testing the Validity of the Single Interrupted Time Series Design By Katherine Baicker; Theodore Svoronos
  10. Health shocks and risk aversion: Panel and experimental evidence from Vietnam By Jan Priebe; Ute Rink; Henry Stemmler
  11. Ecosystems and Human Health: The Local Benefits of Forest Cover in Indonesia By Garg, Teevrat

  1. By: Kim, Jiyoon (Elon University); Lee, Ajin (Michigan State University); Rossin-Slater, Maya (Stanford University)
    Abstract: We use temperature variation within narrowly-defined geographic and demographic cells to show that prenatal exposure to extreme heat increases the risk of maternal hospitalization during pregnancy, and that this effect is larger for black than for white mothers. At childbirth, heat-exposed mothers are more likely to have hypertension and have longer hospital stays. For infants, fetal exposure to extreme heat leads to a higher likelihood of dehydration at birth and hospital readmission in the first year of life. Our results provide new estimates of the health costs of climate change and identify environmental drivers of the black-white maternal health gap.
    Keywords: extreme heat, maternal health, infant health
    JEL: I14 I18 Q54
    Date: 2019–10
  2. By: Melanie E. Guldi (University of Central Florida); Amelia Hawkins (University of Michigan); Jeffrey Hemmeter (Office of Research, Demonstration, and Employment, Social Security Administration); Lucie Schmidt (Williams College)
    Abstract: Low birth weight infants born to mothers with low educational attainment have a double hurdle to overcome in the production of human capital. We examine whether income transfers in the form of Supplemental Security Income (SSI) payments for children with disabilities can help close the gap in outcomes due to this initial health and environmental disadvantage. We exploit a discontinuity in SSI eligibility at 1200 grams and use a regression discontinuity approach to produce causal estimates of the effects of SSI eligibility. We find that eligibility increases disability benefit participation, improves child outcomes and parenting behaviors, and shifts maternal labor supply from full to part time.
    JEL: H51 H53 I38 J21
    Date: 2018–12
  3. By: Anand, Paul (The Open University); Roope, Laurence (University of Oxford); Culyer, Anthony J. (University of York); Smith, Ron P. (Birkbeck College, University of London)
    Abstract: This paper offers an approach to assessing quality-of-life, based on Sen's (1985) theory, which it uses to understand loss in quality-of-life due to mobility-impairment. Specifically, it provides a theoretical analysis which is able to account for the possibility that some functionings may increase when a person's capabilities decrease, if substitution effects are large enough. We then develop novel data consistent with our theoretical Senian framework that permits comparison of quality-of-life between those with a disability (mobility-impairment) and those without. Empirical results show that mobility impairment has widespread rather than concentrated impacts on capabilities and is associated with higher psychological costs.. We also find evidence that a small number of functionings are higher for those with a disability, as our theory allows. The paper concludes by discussing possible implications for policy and health assessment methods.
    Keywords: mobility impairment, disability, capabilities, health, Sen, extra-welfarism
    JEL: D60 I31
    Date: 2019–10
  4. By: Costa-Ramón, Ana; Kortelainen, Mika; Rodríguez-González, Ana; Sääksvuori, Lauri
    Abstract: This paper analyzes the long-term effects of potentially avoidable C-sections on children's health. Using Finnish administrative data, we document that physicians perform more unplanned C-sections during their regular working hours on days that precede a weekend or public holiday and use this exogenous variation as an instrument for C-sections. We supplement our instrumental variables results with a differences-in-differences estimation that exploits variation in birth mode within sibling pairs and across families. Our results suggest that avoidable unplanned C-sections increase the risk of asthma, but do not affect other immune-mediated disorders previously associated with C-sections.
    Keywords: c-section, child health, natural experiment, instrumental variables, family fixed effects, Local public finance and provision of public services, I10, I12, I18, J13,
    Date: 2019
  5. By: Lucie Schmidt (Williams College); Lara Shore-Sheppard (Williams College); Tara Watson (Williams College)
    Abstract: The Affordable Care Act (ACA) expanded the availability of public health insurance, decreasing the relative benefit of participating in disability programs but also lowering the cost of exiting the labor market to apply for disability program benefits. In this paper, we explore the impact of expanded access to Medicaid through the ACA on applications to the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs. Using the fact that the Supreme Court decision of June 2012 made the Medicaid expansion optional for the states, we compare changes in county-level SSI and SSDI caseloads in contiguous county pairs across a state border. We find no significant effects of the Medicaid expansion on applications or awards to either SSI or SSDI, and can reject economically meaningful impacts of Medicaid expansions on applications to disability programs.
    JEL: I10 I13
    Date: 2019–10
  6. By: Stefano Quarta; Skerdilajda Zanaj
    Abstract: In this paper, we analyze a vertically differentiated mixed duopoly in medical care services. Pollution is the source of illness. The government has a dual role. It decides how much to invest to reduce the pollution level and it may participate in the health market running a public hospital. We find that the presence of the public provider increases the average quality of the service in the market and it reduces the rate of mortality. Furthermore, when the public hospital offers services with the highest quality, then this has positive spillovers on the quality offered by the private provider. Despite these positive welfare improving features, the mixed duopoly in medical care goes along with the highest level of pollution. In the presence of an increasing concern about the relationship between pollution and health, understanding the role of public intervention appears crucial.
    Keywords: Pollution, health, public provider, mixed duopoly.
    JEL: L13 H42 H44 I11
    Date: 2019–11–14
  7. By: Karen Clay; Nicholas Z. Muller
    Abstract: After declining by 24.2% from 2009 to 2016, annual average fine particulate matter (PM2.5) in the United States in counties with monitors increased by 5.5% between 2016 and 2018. Increases occurred in multiple census regions and in counties that were in and out of attainment with National Ambient Air Quality Standards (NAAQS). We explore channels through which the increase may have occurred including increases in economic activity, increases in wildfires, and decreases in Clean Air Act enforcement actions. The health implications of this increase in PM2.5 between 2016 and 2018 are significant. The increase was associated with 9,700 additional premature deaths in 2018. At conventional valuations, these deaths represent damages of $89 billion.
    JEL: I10 Q51 Q52 Q53 Q54
    Date: 2019–10
  8. By: Fischer, Martin; Gerdtham, Ulf-G (Department of Economics); Heckley, Gawain (Department of Health Economics); Karlsson, Martin (Healf Economics); Kjellsson, Gustav (University of Gothenburg); Nilsson, Therese (Research Institute of Industrial Economics (IFN))
    Abstract: We investigate two parallel school reforms in Sweden to assess the long-run health effects of education. One reform only increased years of schooling, while the other increased years of schooling but also removed tracking leading to a more mixed socioeconomic peer group. By differencing the effects of the parallel reforms we can separate the effect of de-tracking and peers from that of more schooling. We find that the pure years of schooling reform reduced mortality and improved current health. Differencing the effects of the reforms shows significant differences in the estimated impacts, suggesting that de-tracking and subsequent peer effects resulted in worse health.
    Keywords: Health returns to education; School tracking; Peer effects
    JEL: I12 I18 I26
    Date: 2019–10–21
  9. By: Katherine Baicker (Center for International Development at Harvard University); Theodore Svoronos (Center for International Development at Harvard University)
    Abstract: Given the complex relationships between patients’ demographics, underlying health needs, and outcomes, establishing the causal effects of health policy and delivery interventions on health outcomes is often empirically challenging. The single interrupted time series (SITS) design has become a popular evaluation method in contexts where a randomized controlled trial is not feasible. In this paper, we formalize the structure and assumptions underlying the single ITS design and show that it is significantly more vulnerable to confounding than is often acknowledged and, as a result, can produce misleading results. We illustrate this empirically using the Oregon Health Insurance Experiment, showing that an evaluation using a single interrupted time series design instead of the randomized controlled trial would have produced large and statistically significant results of the wrong sign. We discuss the pitfalls of the SITS design, and suggest circumstances in which it is and is not likely to be reliable.
    Keywords: Single Interrupted Time Series
    JEL: C1 I1 I13
    Date: 2019–07
  10. By: Jan Priebe (German Institute of Global and Area Studies (GIGA), Hamburg, Germany); Ute Rink (University of Goettingen); Henry Stemmler (University of Goettingen)
    Abstract: This paper looks at individual risk behavior and disability in Vietnam, where many households live with a disabled family member. Due to the Vietnam war, disability is a common phenomenon and shapes individuals’ daily life and decision making. Using longitudinal data of 2200 households in Vietnam and an instrumental variable strategy, we show that individuals who live with a disabled family member are more risk averse than others. In addition we employ field experiments and psychological primes to elicit risk and loss behavior of individuals living in the Vietnam province Ha-Thinh. The experimental results, underpin our panel results. We show in addition that a negative recollection of health issues, leads to a lower risk attitude of individuals who do not live with a disabled family member and that individuals who live with a disabled family member are less loss averse. Our findings are causal and contribute to existing studies showing that households who are characterized by higher backward risks are more risk averse than others.
    Keywords: risk, disability, Vietnam
    JEL: I14 D1 Z1
  11. By: Garg, Teevrat (University of California, San Diego)
    Abstract: This paper documents the effect of primary forest cover loss on increased incidence of malaria. The evidence is consistent with an ecological response. I show that land use change, anti-malarial programs or migration cannot explain the effect of primary forest cover loss on increased malarial incidence. Falsification tests reveal that the effect is specific to malaria, with forest cover having no discernible effect on other diseases with a disease ecology different from that of malaria. Back-of-the-envelope calculations indicate that the morbidity-related malaria-reducing local benefits of primary forests are at least $1-$2 per hectare.
    Keywords: deforestation, malaria
    JEL: Q53 O13 Q56 Q57 Q20
    Date: 2019–10

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