nep-hea New Economics Papers
on Health Economics
Issue of 2019‒11‒18
eleven papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Lock-in in Dynamic Health Insurance Contracts: Evidence from Chile By Juan Pablo Atal
  2. Birth Order, Parental Health Investment, and Health in Childhood By Gerald J. Pruckner; Nicole Schneeweis; Thomas Schober; Martina Zweimüller
  3. Maternal Stress and Birth Outcomes: Evidence from an Unexpected Earthquake Swarm By Andrea K. Menclova; Steven Stillman
  4. Mining pollution and infant health in modern Japan:from village/ town statistics of infant mortality By Keisuke Moriya; Kenichi Tomobe
  5. Long-run effects of health shocks in a highly regulated labour market By Michele Belloni; Irene Simonetti; Francesca Zantomio
  6. Hospital ownership type and service provision, a structural approach By Bayindir, Esra Eren
  7. Publication Bias and Editorial Statement on Negative Findings By Brodeur, Abel; Blanco-Perez, Cristina
  8. A Bayesian Approach to Account for Misclassification in Prevalence and Trend Estimation* By van Hasselt, Martijn; Bollinger, Christopher; Bray, Jeremy
  9. Adaptation To Disability - Evidence From the UK Household Longitudinal Study By An Thu Ta
  10. Applying the three core concepts of economic evaluation in health to education in the UK By Sebastian Hinde; Simon Walker; Hugues Lortie-Forgues
  11. Bread and Social Justice: Measurement of Social Welfare and Inequalities Using Anthropometrics By Mohammad Abu-Zaineh; Ramses H. Abul Naga

  1. By: Juan Pablo Atal (University of Pennsylvania)
    Abstract: Long-term health insurance contracts have the potential to efficiently insure against reclassification risk, but at the expense of other limitations like provider lock-in. This paper empirically investigates the workings of long-term contracts which are subject to this trade-off. Individuals are shielded against premium increases and coverage denial as long as they stay with their initial contract, but those that become higher risk are subject to premium increases or coverage denials upon switching, potentially leaving them locked-in with their original network of providers. I provide the first empirical evidence on the importance of this phenomenon using administrative panel data from the universe of the private health insurance market in Chile, where competing insurers o?er long term contracts. I fit a structural model to yearly plan choices, and am able to jointly estimate evolving preferences for different insurance companies and supply-side underwriting in the form of premium risk-rating and coverage denial. To quantify the welfare effects of lock-in, I compare simulated choices under the current rules to those in a counterfactual scenario with no underwriting. The results show that consumers would be willing to pay around 13 percent more in yearly premiums to avoid lock-in. Finally, I study a counterfactual scenario where long-term contracts are replaced with community-rated spot contracts, and I find only minor general-equilibrium effects on premiums and on the allocation of individuals across insurers. I argue that these small effects are the result of large levels of preference heterogeneity uncorrelated to risk.
    Keywords: Health Insurance, Guaranteed-Renewability, Lock-in
    JEL: D82 G22 I11
    Date: 2019–11–08
  2. By: Gerald J. Pruckner; Nicole Schneeweis; Thomas Schober; Martina Zweimüller
    Abstract: Research has shown that cognitive and non-cognitive skills, education and earnings decrease with birth order. Less is known about birth order effects on health. This paper provides a comprehensive analysis of the relationship between birth order, health at birth and in childhood, and parental health investment. High-quality administrative data on children born in Austria between 1984 and 2015 allow us to exploit within-family variation in birth order to account for confounding familylevel factors. In a sample of families with two to four children, we find statistically significant and quantitatively important birth order effects on health at birth and in primary school. These birth order effects are positive, in that later-born siblings are healthier than the first-born child, and increase with birth order. Consequently, first-born children are more likely to consume medical drugs and to utilize inpatient and outpatient medical services. We also find significant birth order differences in parental health investment. Compared to their later-born siblings, first-born children are more likely to receive preventive medical care and immunization against measles, mumps, and rubella.
    Keywords: Birth order, parental health investment, parental health behavior, health at birth, health in childhood, health care utilization
    JEL: I10 I12 I14 J12 J13
    Date: 2019–08
  3. By: Andrea K. Menclova (University of Canterbury); Steven Stillman
    Abstract: We examine the impact of a major earthquake that unexpectedly affected the Canterbury region of New Zealand on a wide-range of birth outcomes, including birth weight, gestational age and an indicator of general newborn health. We control for observed and unobserved differences between pregnant women in the area affected by the earthquake and other pregnant women by including mother fixed effects in all of our regression models. We extend the previous literature by comparing the impact of the initial unexpected earthquake to the impacts of thousands of aftershocks that occurred in the same region over the 18 months following the initial earthquake. We find that exposure to these earthquakes reduced gestational age, increased the likelihood of having a late birth and negatively affected newborn health - with the largest effects for earthquakes that occurred in the first and third trimesters of pregnancy. Our estimates are similar when we focus on just the impact of the initial earthquake or, in contrast, on all earthquakes controlling for endogenous location decisions using an instrumental variables approach. This suggests that the previous estimates in the literature that use this approach are likely unbiased and that treatment effects are homogenous in the population. We present supporting evidence that the likely channel for these adverse effects is maternal stress.
    Keywords: Maternal stress, pregnancy, earthquakes, birth weight, Apgar score
    JEL: I12 J13 I31
    Date: 2019–11–01
  4. By: Keisuke Moriya (Graduate School of Economics, Hitotsubashi University,); Kenichi Tomobe (Graduate School of Economics, Hitotsubashi University,)
    Abstract: The purpose of the paper is to explain the relationship between infant mortality rate (IMR) and mining pollution. In Japan, the pollution became a problem in various places in the 1960 fs, but it had occurred since then. For example, around Ashio Copper Mine in Tochigi Prefecture, the mining pollution had been occurring since 1880 fs, and it had become a social problem in Japan. In our previous analysis, the IMR in Japan have declined irreversibly since 1920 fs because people got over the beriberi and syphilis, but in the specific area, such as mining area, the IMR remained still high rate in 1930 fs. So we will consider the relationship between the IMR and mining pollution.
    Keywords: infant mortality, mining pollution, environmental pollution
    JEL: N35 N55 Q53 J13
    Date: 2019–11
  5. By: Michele Belloni (University of Turin; NETSPAR; CeRP-Collegio Carlo Alberto); Irene Simonetti (Department of Economics, University Of Venice Cà Foscari); Francesca Zantomio (Department of Economics, University Of Venice Cà Foscari; CRIEP; Health Econometrics and Data Group (York))
    Abstract: Based on administrative data covering employment, social security and hospital record histories, we investigate the effect of acute cardiovascular health shocks resulting in unplanned hospitalisation, on blue collars’ long-term labour outcomes in Italy. The Italian institutional setting, characterised by a highly regulated labour market and high job protection, is different from that of countries – mainly Nordic and Anglo-Saxon – covered in previous studies. We apply matching and parametric regression techniques to remove possible bias arising from observable and time-invariant unobservable confounders. Results point at sizeable and persistent reductions in employment and labour income, while hours and wage adjustments appear limited. Whereas a relatively generous social insurance system might compensate the earnings loss, our findings question the appropriateness of existing labour inclusion policies.
    Keywords: Health shocks, employment, labour market institutions, administrative data
    JEL: I10 J22 J24 J31 C14
    Date: 2019
  6. By: Bayindir, Esra Eren
    Abstract: Not-for-profit hospitals are argued to differ little from their for-profit counterparts in the provision of care yet they enjoy tax-exempt status and face almost no requirements. In this work, I estimate the valuations hospitals assign to service provision relative to the value they assign to profits by hospital ownership, (for-profit, not-for-profit or government owned) in a structural way and present evidence that valuations differ significantly by ownership type. Despite the absence of requirements, not-for-profit hospitals value services relative to profits much more than their for-profit counterparts. The estimates are obtained by comparing the profits hospitals would have made had they provided the service and the costs had they not provided the service to what was actually done, which is calculated using demand models.
    Keywords: hospital ownership type,service provision
    JEL: I11 L20 L33
    Date: 2019
  7. By: Brodeur, Abel; Blanco-Perez, Cristina
    Abstract: In February 2015, the editors of eight health economics journals sent out an editorial statement which aims to reduce the incentives to engage in specification searching and reminds referees to accept studies that: "have potential scientific and publication merit regardless of whether such studies' empirical findings do or do not reject null hypotheses that may be specified." In this study, we collect z-statistics from two health economics journals and compare the distribution of tests before and after the editorial statement. Our results suggest that the editorial statement decreased the proportion of test statistics rejecting the null hypothesis and that incentives may be aligned to promote more transparent research.
    Date: 2017–11–28
  8. By: van Hasselt, Martijn (University of North Carolina at Greensboro, Department of Economics); Bollinger, Christopher (University of Kentucky); Bray, Jeremy (University of North Carolina at Greensboro, Department of Economics)
    Abstract: In this paper we present a Bayesian approach to estimate the mean of a binary variable and changes in the mean over time, when the variable is subject to misclassification error. These parameters are partially identified and we derive identified sets under various assumptions about the misclassification rates. We apply our method to estimating the prevalence and trend of prescription opioid misuse, using data from the 2002-2014 National Survey on Drug Use and Health. Using a range of priors, the posterior distribution provides evidence that the prevalence of opioid misuse increases multiple times between 2002 and 2012.
    Keywords: Misclassification; partial identification; Bayesian estimation;
    JEL: C11 C13 C15 I12
    Date: 2019–10–24
  9. By: An Thu Ta (Department of Economics, University of Sheffield)
    Abstract: Do people adapt to disability? Little work has examined hedonic adaptation to disability, especially by looking at physical and mental disability separately. This study is the first to investigate the effect of physical, mental, and general disability on subjective well-being (SWB) and focus on the phenomenon of hedonic adaptation, conditional on an observed reduction in SWB at onset of disability, and its heterogeneity across age at onset and gender. Using a fixed effects (FE) lag model, this study analyses data from the UK Household Longitudinal Study (UKHLS) 2009-2018. The main sample in this study is restricted to only those individuals who reported a drop in SWB at onset. Furthermore, the analysis looks at heterogeneity across genders and age at onset. The results show that mental disability has larger negative impacts on SWB than physical disability. There is evidence of partial adaptation (20% to 80%) to both physical and mental disability at three years or more after onset conditional on an observed reduction in SWB at onset. Regarding adaptation after onset, across most age groups, there is no evidence for adaptation to disability. The exception is the youngest onset group, which partially adapt to general disability after three or more years after onset. There appears to be no difference in hedonic adaptation to physical and mental disability by gender.
    Keywords: Adaptation; Well-being; Subjective Well-being; Disability; General Disability; Physical Disability; Mental Disability; Life Satisfaction
    JEL: D63 I3 I31
    Date: 2019–10
  10. By: Sebastian Hinde (Centre for Health Economics, University of York, York, UK); Simon Walker (Centre for Health Economics, University of York, York, UK); Hugues Lortie-Forgues (Department of Education,University of York, York, UK)
    Abstract: In a UK policy context, education and healthcare sectors share many characteristics; however, the role of economic evaluation in informing policy making is very different. While in health it has become a key part of the deliberative processes of the National Institute for Health and Care Excellence (NICE) in their recommendations to the NHS, it has not played the same role in education. In this article we explore three key components that are required to underpin robust evaluations: a clear perspective, the identification of a single maximand, and recognition of the opportunity costs. We demonstrate the importance of each, how it has been applied in the NICE framework, and how it may be implemented in a UK education setting. We conclude that the failure in education to address the three components has reduced the ability to consider the cost-effectiveness of funding decisions, potentially resulting in inefficient use of educational funding.
    Keywords: Evaluation, economic evaluation, health economics, education, cost-effectiveness analysis
    Date: 2019–11
  11. By: Mohammad Abu-Zaineh (Aix-Marseille Univ, CNRS, EHESS, Ecole Centrale, AMSE & IDEP, Marseille, France); Ramses H. Abul Naga (Business School and Health Economics Research Unit, University of Aberdeen, Scotland.)
    Abstract: We address the question of the measurement of pure health inequalities and achievement in the context of welfare decreasing variables. We adopt a general framework whereby the health variable is reported on an interval, from an optimum level to a critical survival threshold. There are two problems that require some departures from the usual framework used to measure inequality and social welfare. Firstly, we show that for welfare decreasing variables, the equally distributed equivalent value is decreasing in progressive transfers (instead of being increasing). Accordingly, appropriate achievement and inequality indices for welfare decreasing variables are introduced. Secondly, because the Lorenz curve and the associated inequality indices are not robust to alternative values of the survival threshold, we argue that the family of translation invariant social welfare functions and related absolute Lorenz curve allow us to undertake inequality comparisons between distributions that are robust to the chosen level of the survival threshold. An illustrative application of the methodology is provided.
    Keywords: health achievement and inequality; welfare decreasing variables; survival thresholds; relative and absolute Lorenz curves.
    JEL: D63 I14
    Date: 2019–11

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