nep-hea New Economics Papers
on Health Economics
Issue of 2020‒01‒13
eleven papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Trends in Health and Mortality Inequalities in the United States By Péter Hudomiet; Michael D. Hurd; Susann Rohwedder
  2. The social cost of leaded gasoline: Evidence from regulatory exemptions By Hollingsworth, Alex; Rudik, Ivan
  3. How threatening are transformations of reported happiness to subjective wellbeing research? By Kaiser, Caspar; Vendrik, Maarten C. M.
  4. New evidence on disability benefit claims in the UK: The role of health and local labour market By Jennifer Roberts; Karl Taylor
  5. Does Commuting Mode Choice Impact Health? By Nikita Jacob; Luke Munford; Nigel Rice; Jennifer Roberts
  6. Long Term Care Insurance with State-Dependent Preferences By De Donder, Philippe; Leroux, Marie-Louise
  7. Does stress shorten your life? Evidence from parental bereavement By Schmidpeter, Bernhard
  8. How to Attract Physicians to Underserved Areas? Policy Recommendations from a Structural Model By Costa, Francisco J M; Nunes, Letícia; Sanches, Fábio Miessi
  9. International health worker mobility and trade in services By Carzaniga, Antonia Giulia; Dhillon, Ibadat S.; Magdeleine, Joscelyn; Xu, Lihui
  10. Inferring health conditions from fMRI-graph data By Porta Mana, PierGianLuca; Bachmann, Claudia; Morrison, Abigail
  11. Determinants of child mortality risk in Kazakhstan By Pena-Boquete, Yolanda; Samambayeva, Aizhan; Zhumakanova, Aigerim; Makhmejanov, Galym

  1. By: Péter Hudomiet (RAND); Michael D. Hurd (RAND); Susann Rohwedder (RAND)
    Abstract: Recent literature has documented a widening gap in mortality in the United States between individuals with high socioeconomic status (SES) and low SES. An important question is whether this trend will continue. In this paper we document trends and inequalities in the health status at ages 54 to 60 of individuals born between 1934 and 1959. We do so by using detailed subjective and objective measures of health in the Health and Retirement Study to examine contributors to mortality inequality and to forecast life expectancy. We found that the health of individuals 54 to 60 years old has generally declined in recent years. In particular, we found large increases in obesity rates, notable increases in diabetes and reported levels of pain, and lower self-reported health and subjective survival probabilities. We also found strong evidence for increasing health inequalities, as the health of individuals in these cohorts with high SES remained largely stable while that for individuals with low SES declined. When we forecast life expectancies using these predictor variables, as well as gender- and SES-specific time trends, we predict overall life expectancy to increase further. However, the increase is concentrated among high SES individuals, suggesting growing mortality inequality. Results are similar among men and women.
    Date: 2019–09
  2. By: Hollingsworth, Alex; Rudik, Ivan (Cornell University)
    Abstract: Leaded gasoline is still widely used in the United States for aviation and automotive racing. Exploiting regulatory exemptions and a novel quasi-experiment, we find that leaded gasoline increases ambient lead concentrations, elevated blood lead rates, and elderly mortality. The estimated effects indicate the social cost of a gram of lead added to gasoline is over $1,100. Our results are the first causal estimates linking adult mortality to leaded gasoline, highlight the historic value of banning on-road leaded gasoline, demonstrate the costs of continued regulatory exemptions, and provide policy-relevant cost estimates of lead emissions at the lowest ambient levels to date.
    Date: 2019–09–23
  3. By: Kaiser, Caspar (University of Oxford); Vendrik, Maarten C. M.
    Abstract: A recent paper by Bond & Lang (2018) forcefully argues that the results of most happiness research are reversible. If they are right, empirical happiness research is in crisis. In this paper, we make four related contributions. First, we show that B&L’s reversal conditions imply that respondents answer happiness questions in a manner that is implausible and which is contradicted by previous empirical research. Second, we show that reversals are driven by effect heterogeneities across the distribution of reported happiness. Third, we give a simple procedure by which such heterogeneities can be detected and provide conditions under which OLS coefficients can be reversed by appropriately relabeling response categories. These conditions turn out to be similar to those given by Schröder & Yitzhaki (2017). Fourth, using GSOEP data, we empirically assess the plausibility of Bond & Lang’s reversal conditions and check whether coefficients from OLS and fixed-effects models can be reversed. Our analysis focuses on household income, unemployment, childbirth, sickness, and marriage. Bond & Lang’s reversal conditions turn out to be implausible for all these variables. Moreover, when using a full set of controls, no reversals of coefficients of the OLS and FE models are possible.
    Date: 2019–07–19
  4. By: Jennifer Roberts (Department of Economics, University of Sheffield); Karl Taylor (Department of Economics, University of Sheffield)
    Abstract: During the 1980s and 1990s there was a steep rise in disability benefit claims in the UK, especially among older male workers, and the debate centred on the relative generosity of these benefits as well as the effects of deindustrialisation and job destruction. Since that time the disability benefit system has been subject to a series of reforms all largely aimed at reducing the number of claims and targeting benefits more closely to those with the greatest health need. At the same time the UK labour market has also evolved and in particular now has an historically low level of unemployment, accompanied by falling real earnings. In this paper we use individual longitudinal data from 2009 to 2018 in a dynamic panel framework to explore the relative importance of health status, benefit generosity and local labour market conditions for disability benefit claims in the modern UK labour market. We focus particularly on spatial variation in claims, and find that, in line with older evidence, while health status is clearly important, geographic variation in labour market conditions and benefit generosity still influence the propensity to claim those disability benefits that are conditional on not working. In addition, local benefit work capability re-assessment rates, which reflect the stringency that new procedures are being implemented locally, are an important factor. The average effects also mask important heterogeneity by sex, age, education level, income and across regions.
    Keywords: Adaptation; health; disability; employment support allowance; local labour markets
    JEL: I12 I38 J23
    Date: 2019–12
  5. By: Nikita Jacob (Centre for Health Economics, University of York, UK); Luke Munford (School of Health Sciences, University of Manchester, UK); Nigel Rice (Centre for Health Economics, University of York, UK); Jennifer Roberts (Department of Economics, University of Sheffield)
    Abstract: Governments around the world are encouraging people to switch away from sedentary modes of travel towards more active modes, including walking and cycling. The aim of these schemes is to improve population health and to reduce emissions. There is considerable evidence on the latter, yet relatively little on the former. This paper investigates the impact of mode choice on measures of physical and mental health as well as satisfaction with health. Using data from the UK Household Longitudinal Study from 2009-2016, our empirical strategy exploits changes in the mode of commute to identify health outcome responses. Individuals who change modes are matched with those whose mode remains constant. Overall we find that mode switches affect both physical and mental health. Specifically we find an increase in physical health for women and an increase in mental health for both genders, when switching from car to active travel. In contrast, both men and women who switch from active travel to car are shown to experience a significant reduction in their physical health and health satisfaction, and a decline in their mental health when they change from active to public transport.
    Keywords: Commuting mode; health; panel data econometrics
    JEL: C1 I1
    Date: 2019–12
  6. By: De Donder, Philippe; Leroux, Marie-Louise
    Abstract: We study the demand for actuarially fair Long Term Care (LTC hereafter) insurance in a setting where autonomous agents only care for daily life consumption while dependent agents also care for LTC expenditures. We assume that dependency decreases the marginal utility of daily life consumption. We rst obtain that some agents optimally choose not to insure themselves, while no agent wishes to buy complete insurance. We then show that the comparison of marginal utility of income (as opposed to consumption) across health states depends on (i) whether agents do buy LTC insurance at equilibrium or not, (ii) the comparison of the degree of risk aversion for consumption and for LTC expenditures, and (iii) the income level of agents. Our results then oer testable implications that can explain (i) why few people buy Long Term Care insurance and (ii) the discrepancies between various empirical works when measuring the extent of state-dependent preferences for LTC.
    Keywords: Long Term Care Insurance Puzzle; Actuarially Fair Insurance; Risk Aversion
    JEL: D11 I13
    Date: 2019–12
  7. By: Schmidpeter, Bernhard
    Abstract: This paper studies how stress affects the mortality risk. Using a flexible approach and allowing for timevarying treatment effects, I find no impact of stress on the short-run mortality risk but a substantially increase in the long-run. The effects are especially pronounced for men. I provide evidence that this is likely caused by changes towards adverse health behaviours as a reaction to stress. Investigating the possible protective effects of mental health support, I find that it can substantially lower the mortality risk for women. The results for men point towards lower effectiveness likely due to stigma effects associated with mental health care. Finally, I show that my results are robust to specific departure of my identifying assumptions.
    Keywords: stress,mortality,mental health,bereavement,propensity score weighting,adjusted Kaplan-Meier Estimator,direct effects,indirect effects
    JEL: I12 I11 C31 C41
    Date: 2019
  8. By: Costa, Francisco J M (FGV EPGE Brazilian School of Economics and Finance); Nunes, Letícia; Sanches, Fábio Miessi
    Abstract: The lack of physicians in poorer areas is a matter of concern in developed and developing countries. This paper exploits location choices and individual characteristics of all generalist physicians who graduated in Brazil between 2001 and 2013 to study policies that aim at increasing the supply of physicians in underserved areas. We estimate physicians' locational preferences using a random coefficients discrete choice model. We find that physicians have substantial utility gains if they work close to the region they were born or from where they graduated. We show that wages and health infrastructure, though relevant, are not the main drivers of physicians' location choices. Simulations from the model indicate that quotas in medical schools for students born in underserved areas and the opening of vacancies in medical schools in deprived areas improve the spatial distribution of physicians at lower costs than financial incentives or investments in health infrastructure.
    Date: 2019–07–04
  9. By: Carzaniga, Antonia Giulia; Dhillon, Ibadat S.; Magdeleine, Joscelyn; Xu, Lihui
    Abstract: Despite its substantial and increasing importance to health systems and inclusive economic growth, the relationship between international trade in services and health worker mobility has been largely unexplored. However, international health worker mobility and trade in services have both been increasing rapidly, and at a growing pace in recent years. Trade in services frameworks (global, regional, bilateral) are an important vehicle for health worker mobility. In this paper we analyse the commitments made in the context of the General Agreement on Trade in Services (GATS) and regional and bilateral trade agreements that cover services. Although there is room for more and deeper commitments, undertakings related to health worker mobility are already made in many trade agreements, with commitments more numerous and deeper in the regional and bilateral agreements than in the context of GATS. In addition, trade in services frameworks contain flexibility to strengthen and advance ethical health worker mobility, in accordance with the principles and recommendations of the WHO Global Code of Practice on the International Recruitment of Health Personnel. A strengthened collaboration between health and trade stakeholders could therefore serve to significantly expand sustainable development worldwide. There is potential for health stakeholders to strategically leverage trade dialogue and agreements to meet health system needs. Building on available tools, trade in services could help address the concerns of the health sector by ensuring that health worker mobility can respond to worldwide demand, while explicitly addressing health systems concerns across countries.
    Keywords: health services,trade in services,health worker,worker mobility
    JEL: F13 F16 F22 F66 I11 J61
    Date: 2019
  10. By: Porta Mana, PierGianLuca (Norwegian University of Science and Technology); Bachmann, Claudia; Morrison, Abigail
    Abstract: Automated classification methods for disease diagnosis are currently in the limelight, especially for imaging data. Classification does not fully meet a clinician's needs, however: in order to combine the results of multiple tests and decide on a course of treatment, a clinician needs the likelihood of a given health condition rather than binary classification yielded by such methods. We illustrate how likelihoods can be derived step by step from first principles and approximations, and how they can be assessed and selected, using fMRI data from a publicly available data set containing schizophrenic and healthy control subjects, as a working example. We start from the basic assumption of partial exchangeability, and then the notion of sufficient statistics and the "method of translation" (Edgeworth, 1898) combined with conjugate priors. This method can be used to construct a likelihood that can be used to compare different data-reduction algorithms. Despite the simplifications and possibly unrealistic assumptions used to illustrate the method, we obtain classification results comparable to previous, more realistic studies about schizophrenia, whilst yielding likelihoods that can naturally be combined with the results of other diagnostic tests.
    Date: 2018–01–30
  11. By: Pena-Boquete, Yolanda; Samambayeva, Aizhan; Zhumakanova, Aigerim; Makhmejanov, Galym
    Abstract: Child mortality rate is one of the key indicators of the Sustainable Development Goals from the United Nations. In the last two decades, this indicator became 6 times smaller during 1990 to 2017 (from 54.1 deaths/1,000 live births to 8.9) in Kazakhstan. This decrease in child mortality rate have been much faster in Kazakhstan than in other countries of Central Asia, so it would be useful to understand the reasons why. Thus, the aim of the paper is to analyze the socio-economic determinants of child mortality in Kazakhstan in order to shed light on the factors behind its huge reduction. In order to estimate the determinants of child mortality we run a logit model based on Multiple Indicator Cluster Surveys (MICS) database provided by UNICEF for Kazakhstan in 2006, 2010-2011, 2015. Results show that household composition may be a relevant variable for explaining child mortality: head of household is a relevant variable; however maternal education doesn’t come out significant. Additionally, the access to health resources also reduce infant mortality. On the one hand, the probability that women had experienced the death of a children increases for the 2th and 3th quintile of wealth, i.e. for those who have a worse access to the health resources. On the other hand, the probability that the child dies are higher for families living the rural areas compared with urban areas (explained for the difficulties of reaching the health facilities in rural areas). Results of this paper can be used to keep the positive path in the infant mortality decrease for Kazakhstan and taken as an example for other countries in Central Asia where infant mortality is still high.
    Keywords: child mortality risk, inequality, socio-economic status
    JEL: I15 I18
    Date: 2019

This nep-hea issue is ©2020 by Nicolas R. Ziebarth. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.