nep-hea New Economics Papers
on Health Economics
Issue of 2019‒11‒25
thirteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Mental Health Effects of Retirement By Jan van Ours; Matteo Picchio
  2. Latent Work Capacity and Retirement Expectations By Italo Lopez Garcia; Nicole Maestas; Kathleen J. Mullen
  3. Regional Decentralisation and the Demand for Public Health Care By Joan Costa-Font; Ada Ferrer-i-Carbonell
  4. Intergenerational Health Mobility: Magnitudes and Importance of Schools and Place By Jason Fletcher; Katie M. Jajtner
  5. School Tracking and Mental Health By Petri Böckerman; Mika Haapanen; Christopher Jepsen; Alexandra Roulet
  6. How Do Economic Shocks Affect Family Health Care Spending Burdens? By Irina B. Grafova; Alan C. Monheit; Rizie Kumar
  7. How Do Couples Choose Individual Insurance Plans? Evidence from Medicare Part D By Tomas Pedro Sanguinetti
  8. Whistleblowers, The False Claims Act, and the Behavior of Healthcare Providers By Jetson Leder-Luis
  9. Investments in Worker Health and Labor Productivity: Evidence from Vietnam By Massimo Filippini; Suchita Srinivasan
  10. The Effect of Antimalarial Campaigns on Child Mortality and Fertility in Sub-Saharan Africa By Joshua Wilde; Bénédicte H. Apouey; Joseph Coleman; Gabriel Picone
  11. Persistent Effects of Temporary Incentives: Evidence from a Nationwide Health Insurance Experiment By Aurélien Baillon; Joseph Capuno; Owen O'Donnell; Carlos Tan; Kim van Wilgenburg
  12. Causes of haze and its health effects in Singapore; a replication study By Kiviet, Jan
  13. Social tariffs and democratic choice – do population-based health state values reflect the will of the people? By Schneider, Paul

  1. By: Jan van Ours (Erasmus University Rotterdam); Matteo Picchio (March Polytechnic University)
    Abstract: We study the retirement effects on mental health using a fuzzy regression discontinuity design based on the eligibility age to the state pension in the Netherlands. We find that the mental effects are heterogeneous by gender and marital status. Retirement of partnered men positively affects mental health of both themselves and their partners. Single men retiring experience a drop in mental health. Female retirement has hardly any effect on their own mental health or the mental health of their partners. Part of the effects seem to be driven by loneliness after retirement.
    Keywords: Retirement, health, regression discontinuity design
    JEL: J26 H55 J14
    Date: 2019–11–19
  2. By: Italo Lopez Garcia (RAND); Nicole Maestas (Harvard Medical School and NBER); Kathleen J. Mullen (RAND)
    Abstract: Understanding how health decline influences retirement decisions is fundamental for the design of targeted policies that encourage working longer. While there is wide agreement on the relevance of age-related health decline for determining labor supply and retirement decisions, the process of how health deterioration affects labor supply remains a black box. This paper explores the match between individuals’ functional abilities and job demands in the national economy using a new methodology to measure work capacity. Specifically, we construct a one-dimensional measure of individuals’ work capacities by comparing an individual’s own ability levels to the levels needed to perform different occupations, using new data containing individuals’ ratings of the same 52 abilities included in the Occupational Information Network (O*NET) database. We find that a one-unit increase in the fraction of jobs for a given education level that an individual can do — our measure of work capacity — is associated with a 15 to 21 percentage point increase in labor force participation, a 10 to 17 percentage point decrease in the percentage of respondents receiving SSDI benefits, a 7 to 10 percentage point increase in the subjective percent chance individuals will work longer, a 9 to 12 percentage point increase in the chance that retired individuals will return to the labor force, and a 17 to 25 percentage point increase in the chance that individuals with disabilities will return to the labor force. The magnitudes of these associations are all economically relevant and exist even when controlling for health status.
    Date: 2019–09
  3. By: Joan Costa-Font; Ada Ferrer-i-Carbonell
    Abstract: This paper examines the effect of the decentralisation of the Spanish national health system on the demand for publicly funded health care. We find thatdecentralisation increased the demand for public health care, improved the perceptions of the well-functioning of the system and reduced the uptake of private health insurance amongrelatively high income individuals.
    Date: 2019–11
  4. By: Jason Fletcher; Katie M. Jajtner
    Abstract: Nascent research suggests intergenerational health mobility may be relatively high and non-genetic factors may make room for policy intervention. This project broadens this direction by considering heterogeneous intergenerational health mobility in spatial and contextual patterns. With 14,797 parent-child pairs from a school-based representative panel survey of adolescents (Add Health), this study finds large spatial variation in intergenerational health mobility in the United States. On average relative mobility in this sample is approximately 0.17 and expected health rank for children of parents at the 25th percentile of parent health is 47. These metrics however mask substantial spatial heterogeneity. In cases of low health mobility, rank-rank slopes can approach 0.5 or expected child health rank may only be the 34th percentile. Descriptive school- and contextual-level correlates of this spatial variation indicate localities with higher proportions of non-Hispanic blacks, school PTAs, or a school health education requirement may experience greater health mobility.
    JEL: I1 I12 I14 J62
    Date: 2019–11
  5. By: Petri Böckerman; Mika Haapanen; Christopher Jepsen; Alexandra Roulet
    Abstract: We examine the effects of a comprehensive school reform on mental health. The reform postponed the tracking of students into vocational and academic schools from age 11 to age 16. The reform was implemented gradually across Finnish municipalities between 1972 and 1977. We use difference-in-differences variation and administrative data. Our results show that there is no discernible effect on mental health related hospitalizations on average even though the effect is precisely estimated. Heterogeneity analysis shows that, after the reform, females from highly-educated families were more likely to be hospitalized for depression.
    Keywords: tracking age, comprehensive school, mental health, depression, hospitalization
    JEL: I12 I26 I28
    Date: 2019
  6. By: Irina B. Grafova; Alan C. Monheit; Rizie Kumar
    Abstract: We use data from the Medical Expenditure Panel Survey (MEPS) for the years 2004 - 2012 to examine the impact of economic shocks on the family’s out-of-pocket health care spending burden. We define this burden as the share of family income devoted to out-of-pocket health care spending. In contrast to static, cross-sectional analyses, our study examines how the within-family change in spending burden over the two-year MEPS observation period responds to losses in family income, insurance, and employment. We also consider the impact of such losses on single-mother and two-parent families. To do so, we apply fractional response and health expenditure models using the correlated random effects (CRE) method to control for time-invariant, unobserved heterogeneity across family units. We find evidence that the change in the out-of-pocket spending burden is sensitive to income shocks, and that income changes rather than changes in health spending per se appears to drive changes in the out-of-pocket burden.
    JEL: I1 I13
    Date: 2019–11
  7. By: Tomas Pedro Sanguinetti
    Abstract: This research is the first economic study to investigate how couples make enrollment choices in individual insurance markets. I leverage administrative records for Medicare Part D enrollees to distinguish widows and divorcees from married couples. I estimate a stochastic choice model of household demand that takes into account risk aversion, expenditure risk, risk sharing and inertia. I use the model estimates to study how coordination within couples and interaction between couples and singles affects the way that markets adjust to policies designed to nudge individuals toward choosing higher value plans, particularly with respect to adverse selection. The data reveals striking facts about insurance choice. Strikingly, I find that 78% of couples decide to âpoolâ by buying the same plan. This figure remains constant even for couples with extremely different health risk. My estimates imply that monetary value of plan pooling to the average couple is approximately half their monetary value of inertia, $1,584 vs $3,152. I use the model estimates to conduct several counterfactual policy experiments and find that nudging consumers to choose the plans that maximize their expected utility in a hypothetical deregulated environment without risk adjustment and premium subsidies would increase couplesâ welfare by 11% and decrease singlesâ welfare by 2% on average. Adding the federal governmentâs current risk adjustment formula increases the disparity between welfare gains for couples and welfare losses for singles. Additionally adding the federal governmentâs current formula for subsidizing plan premiums causes the policy to generate average welfare gains among both couples and singles of 36% and 5% respectively.
    JEL: I13 D81
    Date: 2019–11–11
  8. By: Jetson Leder-Luis
    Abstract: This paper studies the effects of litigation by whistleblowers against healthcare providers for misreporting claims for payment to the Medicare program. Under the U.S. False Claims Act, whistleblowers bring lawsuits on behalf of the government in exchange for a share of recovered payments. I combine a new dataset on whistleblower cases from the Department of Justice with the universe of Medicare Fee- for-Service claims from 1999-2016. First, I measure the deterrence effects of successful whistleblowing lawsuits using a synthetic control design. I find that whistleblower settlements totaling to $1.9 billion in recovery generated future cost savings of more than $18 billion over 5 years. Next, I examine how whistleblowing impacts care decisions by providers. Using a case study of spine procedures for osteoporotic patients, I find that after a whistleblower settlement, care shifted from inpatient to less-expensive outpatient treatment and towards patients with the greatest expected benefit.
    JEL: H51 D73 M48
    Date: 2019–11–08
  9. By: Massimo Filippini (Center of Economic Research (CER-ETH), ETH Zurich, Switzerland and Universita della Svizzera Italiana (USI), Switzerland); Suchita Srinivasan (Center of Economic Research (CER-ETH), ETH Zurich, Switzerland)
    Abstract: The health and safety of workers are important determinants of their productivity. In manufacturing industries, occupational health and safety (OHS) measures are critical workplace practices for employers to ensure better working conditions for employees, particularly in industries with rampant indoor pollution. This paper studies the impact of investments undertaken by small and medium enterprises in Vietnam in worker health and safety (including in air quality improvements, heat and noise protection as well as in lighting measures) on labor productivity using a production function approach and panel data from 2011-2015. We find that the amount invested by the firm per worker has a significant positive effect on labor productivity. Moreover, our results hold true for both small and large firms, and for firms belonging to different subgroups of industries. Given historically poor working conditions in Vietnam, policy implications relate to the importance of OHS measures and pollution abatement in influencing economic outcomes such as productivity.
    Keywords: Investments in health, Indoor pollution, Labor productivity, Small and medium enterprises, Vietnam
    JEL: D83 Q18 Q54 C23 C26
    Date: 2019–11
  10. By: Joshua Wilde (MPIDR - Max Planck Institute for Demographic Research - Max-Planck-Gesellschaft); Bénédicte H. Apouey (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique); Joseph Coleman (USF - University of South Florida); Gabriel Picone (USF - University of South Florida)
    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: Malaria,Bed nets,Child mortality,Fertility,Sub-Saharan Africa
    Date: 2019–09
  11. By: Aurélien Baillon (Erasmus University Rotterdam); Joseph Capuno (University of the Philippines Diliman); Owen O'Donnell (Erasmus University Rotterdam); Carlos Tan (University of the Philippines Diliman); Kim van Wilgenburg (Erasmus University Rotterdam)
    Abstract: Temporary incentives are offered in anticipation of persistent effects, but these are seldom estimated. We use a nationwide randomized experiment in the Philippines to estimate effects three years after the withdrawal of two incentives for health insurance. A premium subsidy had a persistent effect on enrollment that is more than four fifths of the immediate effect. Application assistance had a much larger immediate impact, but less than a fifth of this effect persisted. The subsidy persuaded those with higher initial willingness to pay to enroll and keep enrolling, while application assistance achieved a larger immediate effect by drawing in those who valued insurance less and were less likely to re-enroll.
    Keywords: incentives, persistence, health insurance, subsidy, randomized experiment
    JEL: I13 C93
    Date: 2019–11–17
  12. By: Kiviet, Jan
    Abstract: Intermittently Singapore suffers from severe air pollution in periods of intense forest and peatland fires on neighboring South-Asian islands. A recent American Economic Review article modeled the causal relationships between fire intensity in Indonesia and air pollution (PSI) in Singapore, and between PSI and health clinic visits in Singapore. We find serious flaws in the quantitative assessment of these relationships. Attempts are made to repair these using the same classic methodology and data, but also by alternative methods requiring less speculative assumptions. Although actually more detailed data are required, also some results are produced which seem more credible.
    Keywords: endogeneity robust inference, environmental economics, health economics, instrument invalidity, sensitivity analysis.
    JEL: C12 C13 C26 I1 Q53
    Date: 2019–11–11
  13. By: Schneider, Paul
    Abstract: In economic evaluations of health technologies, health outcomes are commonly measured in terms of QALYs. QALYs are the product of time and health-related quality of life. Health-related quality of life, in turn, is determined by a social tariff, which is supposed to reflect the public’s preference over health states. This paper argues that, because of the tariff’s role in the societal decision making process, it should not be understood as merely a statistical model, but as a major instrument of democratic participation. I outline what implications this might have for both the method used to aggregate individual preferences, and the set of individuals whose preferences should count. Alternative tariff specifications are explored, and future research directions are proposed.
    Date: 2019–09–05

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