nep-hea New Economics Papers
on Health Economics
Issue of 2020‒01‒20
nine papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Financial Consequences of Health Insurance: Evidence from the ACA’s Dependent Coverage Mandate By Nathan Blascak; Vyacheslav Mikhed
  2. A model of a randomized experiment with an application to the PROWESS clinical trial By Amanda Kowalski
  3. Does the Marginal Hospitalization Save Lives? The Case of Respiratory Admissions for the Elderly By Janet Currie; David Slusky
  4. Long-run effects of health shocks in a highly regulated labour market By Belloni, Michele; Simonetti, Irene; Zantomio, Francesca
  5. Comparability of Mortality Estimates from Social Surveys and Vital Statistics Data in the United States By Brown, Dustin C; Lariscy, Joseph T.; Kalousova, Lucie
  6. The Negative Consequences of Loss-Framed Performance Incentives By Lamar Pierce; Alex Rees-Jones; Charlotte Blank
  7. Anchoring Latent Scale Values for the EQ-5D-Y at 0 = Dead By Shah, K.K; Ramos-Goñi, J.M; Kreimeier, S.; Devlin, N.J
  8. Straw Burning, PM2.5 and Death: Evidence from China By Guojun He; Tony Liu; Maigeng Zhou
  9. Mosquito-Borne Disease and Newborn Health By Afrouz Azadikhah Jahromi

  1. By: Nathan Blascak; Vyacheslav Mikhed (Federal Reserve Bank of Philadelphia)
    Abstract: We study the financial effects of health insurance for young adults using the Affordable Care Act’s dependent coverage mandate as a source of exogenous variation. Using nationally repre-sentative, anonymized credit report and publicly available survey data on medical expenditures, we exploit the mandate’s implementation in 2010 and its automatic disenrollment mechanism at age 26. Our estimates show that increasing access to health insurance lowered young adults’ out-of-pocket medical expenditures, debt in third-party collections, and the probability of per-sonal bankruptcy. However, most improvements in financial outcomes are transitory, as they diminish after an individual ages out of the mandate at age 26.
    Keywords: health insurance; consumer credit; financial outcomes; Affordable Care Act
    JEL: D14 I13 I18
    Date: 2019–12–17
  2. By: Amanda Kowalski (Institute for Fiscal Studies and Yale)
    Abstract: I develop a model of a randomized experiment with a binary intervention and a binary outcome. Potential outcomes in the intervention and control groups give rise to four types of participants. Fixing ideas such that the outcome is mortality, some participants would live regardless, others would be saved, others would be killed, and others would die regardless. These potential outcome types are not observable. However, I use the model to develop estimators of the number of participants of each type. The model relies on the randomization within the experiment and on deductive reasoning. I apply the model to an important clinical trial, the PROWESS trial, and I perform a Monte Carlo simulation calibrated to estimates from the trial. The reduced form from the trial shows a reduction in mortality, which provided a rationale for FDA approval. However, I fi nd that the intervention killed two participants for every three it saved.
    Date: 2019–03–20
  3. By: Janet Currie; David Slusky
    Abstract: Some commentators estimate that up to a third of U.S. medical spending may be wasted. This study focuses on the decision to hospitalize elderly Medicare patients who present at the emergency room (ER) with respiratory conditions. Failing to hospitalize sick patients could have dire consequences. However, in addition to generating higher costs, unnecessary hospitalization puts patients at risk of hospital acquired conditions and disrupts their lives. We use variation in the patient’s nearest hospital’s propensity to admit patients with similar observable characteristics as an instrument for the admission decision. While OLS estimates suggest that admitted patients are more likely to die, when we instrument for patient admission we find that the marginal hospital admission increases the number of hospital days by seven days and increases charges by $42,000 but has no effect on the risk of death in the course of the next year. The marginal hospitalization also reduces the risk of another emergency department visit in the next 30 days but increases outpatient visits over the same time horizon with no overall impact on charges. Longer term effects also include increased outpatient visits but effects on patient costs and health outcomes over the next year are minimal. Overall, these results lend support to the argument that in many cases the marginal hospitalization is unnecessary.
    JEL: I1
    Date: 2020–01
  4. By: Belloni, Michele; Simonetti, Irene; Zantomio, Francesca (University of Turin)
    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.
    Date: 2019–11
  5. By: Brown, Dustin C; Lariscy, Joseph T. (University of Memphis); Kalousova, Lucie
    Abstract: Social surveys prospectively linked with death records provide invaluable opportunities for the study of the relationship between social and economic circumstances and mortality. Although survey-linked mortality files play a prominent role in U.S. health disparities research, it is unclear how well mortality estimates from these datasets align with one another and whether they are comparable with U.S. vital statistics data. We conduct the first study that systematically compares mortality estimates from several widely-used survey-linked mortality files and U.S. vital statistics data. Our results show that mortality rates and life expectancies from the National Health Interview Survey Linked Mortality Files, Health and Retirement Study, Americans’ Changing Lives study, and U.S. vital statistics data are similar. Mortality rates are slightly lower and life expectancies are slightly higher in these linked datasets relative to vital statistics data. Compared with vital statistics and other survey-linked datasets, General Social Survey-National Death Index life expectancy estimates are much lower at younger adult ages and much higher at older adult ages. Cox proportional hazard models regressing all-cause mortality risk on age, gender, race, educational attainment, and marital status conceal the issues with the General Social Survey-National Death Index that are observed in our comparison of absolute measures of mortality risk. We provide recommendations for researchers who use survey-linked mortality files.
    Date: 2019–04–03
  6. By: Lamar Pierce; Alex Rees-Jones; Charlotte Blank
    Abstract: Behavioral economists have proposed that loss-averse employees increase productivity when bonuses are "loss framed"—prepaid then clawed back if targets are unmet. We theoretically document that loss framing raises incentives for costly risk mitigation and for inefficient multitasking, potentially leading to large negative performance effects. We empirically document evidence of these concerns in a nationwide field experiment among 294 car dealers. Dealers randomized into loss-framed (but financially identical) contracts sold 5% fewer vehicles than control dealers, generating a revenue loss of $45 million over 4 months. We discuss implications regarding the use of behavioral economics to motivate both employees and firms.
    JEL: D03 D81 J22 J31
    Date: 2020–01
  7. By: Shah, K.K; Ramos-Goñi, J.M; Kreimeier, S.; Devlin, N.J
    Abstract: To date there have been no value sets to support the use of the EQ-5D-Y in cost-utility analysis. Discrete choice experiments (DCEs) can be used to obtain values on a latent scale, but these values require anchoring at 0 = dead to meet the conventions of quality-adjusted life year (QALY) estimation. This Research Paper describes a study in which four stated preference methods for anchoring EQ-5D-Y values were compared - visual analogue scale, DCE (with a duration attribute), lag-time TTO and the recently developed 'location-of-dead' (LOD) element of the personal utility function approach. A sample of adult members of the UK general public valued both EQ-5D-3L health states from an adult perspective (considering their own health) and EQ-5D-Y health states from a child perspective (considering the health of a 10-year-old child). Overall, respondents gave lower values under the adult perspective compared to child perspective, with some variation across methods. Values for health state 33333 (the worst health state defined by the EQ-5D-3L and EQ-5D-Y descriptive systems) tended to be negative for the adult perspective and closer to 0 for the child perspective. The paper presents potential criteria for selecting a preferred anchoring method, and discusses the decision-making circumstances under which utilities and QALY estimates for children and adults need to be commensurate in order to achieve allocative efficiency.
    Keywords: Measuring and valuing outcomes
    JEL: I1
    Date: 2020–01–01
  8. By: Guojun He (Division of Social Science, Division of Environment and Sustainability, Department of Economics, The Hong Kong University of Science and Technology.); Tony Liu (Division of Social Science, The Hong Kong University of Science and Technology.); Maigeng Zhou (National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention.)
    Abstract: This study uses satellite data to detect agricultural straw burnings and estimates its impact on air pollution and health in China. We find that straw burning increases particulate matter pollution and causes people to die from cardio-respiratory diseases. Middle-aged and old people in rural areas are particularly sensitive to straw burning pollution. We estimate that a 10μg/m3 increase in PM2.5 will increase mortality by 3.25%. Subsidizing the recycling of straw brings significant health benefits and is estimated to avert 21,400 pre-mature deaths annually.
    Date: 2019–05
  9. By: Afrouz Azadikhah Jahromi (Department of Economics, Temple University)
    Abstract: While mosquito-borne diseases are currently most prevalent in mid-latitude countries, rising global temperatures are expanding their range. This paper investigates whether one such disease, dengue, harms newborns. Health at birth has been shown to impact economic outcomes throughout life. The empirical design exploits variation in lagged dengue rates in a town's closest neighbors and largest trading partner. The underlying source of exogeneity in this variation comes from two components: the uneven allocation, across municipalities, of funding to combat the mosquito vector and random weather patterns. Past disease rates in adjacent areas are used as instruments for the dengue rate in a newborn's municipality of residence. Using administrative individual data from birth records in Brazil, I find that a one standard deviation increase in the incidence of dengue in the third trimester of gestation reduces birth weight by 0.75 grams on average. The effect is more pronounced for baby girls and for children of more educated mothers. Moreover, there seems to exist a positive effect of dengue exposure during the early stages of gestation among children of mothers that do not receive scheduled prenatal care. The likely channel is that these women access pregnancy resources as a consequence of seeking medical treatment for dengue.
    Keywords: Birth, Dengue, Municipality, Weather, Weight
    JEL: J13 I14 I18 Q54
    Date: 2020–01

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