nep-hea New Economics Papers
on Health Economics
Issue of 2020‒03‒02
sixteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Economic Consequences of Increasing Sleep Among the Urban Poor By Pedro Bessone; Gautam Rao; Frank Schilbach; Heather Schofield; Mattie Toma
  2. Speed Limit Enforcement and Road Safety By Bauernschuster, Stefan; Rekers, Ramona
  3. Drug Firms' Payments and Physicians' Prescribing Behavior in Medicare Part D By Colleen Carey; Ethan M.J. Lieber; Sarah Miller
  4. The impact of a personalised blood pressure warning on health outcomes and behaviours By Bhalotra, Sonia; Delavande, Adeline; Fisher, Paul; James, Jonathan
  5. Effect of Prescription Opioids and Prescription Opioid Control Policies on Infant Health By Engy Ziedan; Robert Kaestner
  6. Cigarette Taxes and Smoking Among Sexual Minority Adults By Christopher Carpenter; Dario Sansone
  7. Early life shocks and mental health: The long-term effect of war in Vietnam By Saurabh Singhal
  8. A New Quantile Treatment Effect Model for Studying Smoking Effect on Birth Weight During Mother's Pregnancy By Shengfang Tang; Zongwu Cai; Ying Fang; Ming Lin
  9. Simplifying and Improving the Performance of Risk Adjustment Systems By Thomas G. McGuire; Anna L. Zink; Sherri Rose
  10. An Empirical Investigation of Obesity & Income and Education By Ozyapi, Sena
  11. Obesity, income and gender: the changing global relationship By Hannah Ameye; Jo Swinnen
  12. Working and disability expectancies at old ages: the role of childhood circumstances and education By Lorenti, Angelo; Dudel, Christian; Hale, Jo Mhairi; Myrskylä, Mikko
  13. Beyond the direct impact of retirement: coordination by couples in preventive and risky behaviors By Steve Briand
  14. The Social Value of Health Insurance Results from Ghana By Garcia Mandico,Silvia; Reichert,Arndt Rudiger; Strupat,Christoph
  15. Do Improved Biomass Cookstoves Reduce PM2.5 Concentrations ? If So, for Whom ? Empirical Evidence from Rural Ethiopia By Bluffstone,Randall; LaFave,Daniel; Mekonnen,Alemu; Dissanayake,Sahan; Beyene,Abebe Damte; Gebreegziabher,Zenebe; Toman,Michael A.
  16. Stability and Evolution of Preferences for Improved Cookstoves -- A Difference-in-Difference Analysis of a Choice Experiment from Ethiopia By Dissanayake,Sahan T. M.; Voigt,George; Cooper, Abbie; Beyene, Abebe Damte; Bluffstone,Randall; Gebreegziabher,Zenebe; LaFave, Daniel; Martinsson,Peter; Mekonnen,Alemu; Toman,Michael A.

  1. By: Pedro Bessone; Gautam Rao; Frank Schilbach; Heather Schofield; Mattie Toma
    Abstract: This paper measures sleep among the urban poor in India and estimates the economic returns to increased sleep. Adults in Chennai have strikingly low quantity and quality of sleep relative to typical guidelines: despite spending 8 hours in bed, they achieve only 5.6 hours per night of sleep, with 32 awakenings per night. A three-week treatment providing information, encouragement, and sleep-related items increased sleep quantity by 27 minutes per night without improving sleep quality. Increased night sleep had no detectable effects on cognition, productivity, decision-making, or psychological and physical well-being, and led to small decreases in labor supply and thus earnings. In contrast, offering high-quality naps at the workplace increased productivity, cognition, psychological well-being, and patience. Taken together, the returns to increased night sleep are low, at least at the low-quality levels typically available in home environments in Chennai. We find suggestive evidence that higher-quality sleep improves important economic and psychological outcomes.
    JEL: C93 D9 I1 I12 I15 O1 O12 O18
    Date: 2020–02
  2. By: Bauernschuster, Stefan (University of Passau); Rekers, Ramona (University of Passau)
    Abstract: We study the impact on road safety of one-day massive speed limit monitoring operations (SLMO) accompanied by media campaigns that announce the SLMO and provide information on the dangers of speeding. Using register data on the universe of police reported accidents in a generalized difference-in-differences approach, we find that SLMO reduce traffic accidents and casualties by eight percent. Yet, immediately after the SLMO day, all effects vanish. Further evidence suggests that people drive more slowly and responsibly on SLMO days to avoid fines; providing information on the dangers of speeding does not alter driving behavior in a more sustainable way.
    Keywords: traffic, law enforcement, safety, accidents
    JEL: H76 K42 R41
    Date: 2019–12
  3. By: Colleen Carey; Ethan M.J. Lieber; Sarah Miller
    Abstract: In a pervasive but controversial practice, drug firms frequently make monetary or in-kind payments to physicians in the course of promoting prescription drugs. We use a federal database on the universe of such interactions between 2013 and 2015 linked to prescribing behavior in Medicare Part D. We account for the targeting of payments with fixed effects for each physician-drug combination. In an event study, we show that physicians increase prescribing of drugs for which they receive payments in the months just after payment receipt, with no evidence of differential trends between paid and unpaid physicians prior to the payment. Using hand-collected efficacy data on three major therapeutic classes, we show that those receiving payments prescribe lower-quality drugs following payment receipt, although the magnitude is small and unlikely to be clinically significant. In addition, we examine five case studies of major drugs going off patent. Physicians receiving payments from the firms experiencing the patent expiry transition their patients just as quickly to generics as physicians who do not receive such payments.
    JEL: D83 I11 L15
    Date: 2020–02
  4. By: Bhalotra, Sonia; Delavande, Adeline; Fisher, Paul; James, Jonathan
    Abstract: In this paper we examine the impact of a tailored health warning on health outcomes. We exploit the design of a household panel survey that provided feedback to participants on their blood-pressure levels as a quasi-experiment. We find that many participants who were told their blood-pressure was high went on to get a formal diagnosis of hypertension from a medical practitioner. The effect of getting a formal hypertension diagnosis was to reduce the incidence of smoking and improve the quality of diets. However, we do not find changes in monthly alcohol spending. The behavioural changes (plus any prescribed medications) were large enough to reduce the incidence of cardiovascular disease.
    Date: 2020–02–25
  5. By: Engy Ziedan; Robert Kaestner
    Abstract: Prescription opioid use among women of reproductive age and pregnant women is relatively common and growing prescription opioid use is associated with a commensurate increase in opioid use disorder (OUD) among pregnant women and neonatal abstinence syndrome (NAS) among infants. In this article, we examine whether state opioid control policies affected prescription opioid use and, in turn, infant health and maternal behaviors. We conduct several types of analyses including reduced form analyses of the effect of policies on infant health and maternal behaviors, and instrumental variables analyses of the effects of prescription opioid use on infant health and maternal behaviors. Results from our analysis suggest that reductions in prescription opioid use because of state prescription opioid control policies have improved infant health modestly at the population level with larger implied effects at the individual level.
    JEL: I12 I18 J1
    Date: 2020–02
  6. By: Christopher Carpenter; Dario Sansone
    Abstract: We provide the first quasi-experimental evidence on the relationship between cigarette taxes and sexual minority adult smoking by studying individuals in same-sex households (a large share of whom are in same-sex romantic relationships) from the 1996-2018 Behavioral Risk Factor Surveillance System. We find that cigarette taxes significantly reduced smoking among men and women in same-sex households, and the effects we find for men in same-sex households are significantly larger than the associated effects for men in different-sex households (the vast majority of whom are heterosexual married/partnered men). This result suggests that the sizable disparities in adult smoking rates between heterosexual and sexual minority men would have been even larger in the absence of stricter tobacco control policy. In line with previous research indicating that cigarette taxes have ‘lost their bite’, we find no significant relationship between cigarette taxes and sexual minority smoking in more recent years.
    JEL: I1
    Date: 2020–01
  7. By: Saurabh Singhal (UNU-WIDER; Food and Agricultural Organization of the United Nations)
    Abstract: This paper provides causal evidence on early-life exposure to war on mental health status in adulthood. Using an instrumental variable strategy, the evidence indicates that early-life exposure to bombing during the American war in Vietnam has long-term effects. A one percent increase in bombing intensity during 1965-75 increases the likeli- hood of severe mental distress in adulthood by 16 percentage points (or approximately 50 percent of the mean) and this result is robust to a variety of sensitivity checks. The negative effects of war are similar for both men and women. These findings add to the evidence on the enduring consequences of conflict and identify a critical area for policy intervention.
    Keywords: Early-life, mental health, conflict, Vietnam JEL Classification: I1, I15, H56, I31, N35, O12
    Date: 2018–06
  8. By: Shengfang Tang (Department of Statistics, School of Economics, Xiamen University, Xiamen, Fujian 361005, China); Zongwu Cai (Department of Economics, The University of Kansas, Lawrence, KS 66045, USA); Ying Fang (The Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen, Fujian 361005, China); Ming Lin (The Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen, Fujian 361005, China)
    Abstract: This paper proposes a new quantile regression model to characterize the heterogeneity for distributional effects of maternal smoking during pregnancy on infant birth weight across different sub-populations denfied by the mother's age. By imposing a parametric restriction on the quantile functions of the potential outcome distributions conditional on the mother's age, we estimate the quantile treatment effects of maternal smoking during pregnancy on her baby's birth weight across different age groups of mothers. The results show strongly that the quantile effects of maternal smoking on infant birth weight are negative and substantially heterogenous across different ages.
    Keywords: Birth weight; Heterogeneity; Quantile regression; Smoking; Treatment effect
    JEL: C12 C13 C14 C23
    Date: 2020–02
  9. By: Thomas G. McGuire; Anna L. Zink; Sherri Rose
    Abstract: Risk-adjustment systems used to pay health plans in individual health insurance markets have evolved towards better “fit” of payments to plan spending, at the individual and group levels, generally achieved by adding variables used for risk adjustment. Adding variables demands further plan and provider-supplied data. Some data called for in the more complex systems may be easily manipulated by providers, leading to unintended “upcoding” or to unnecessary service utilization. While these drawbacks are recognized, they are hard to quantify and are difficult to balance against the concrete, measurable improvements in fit that may be attained by adding variables to the formula. This paper takes a different approach to improving the performance of health plan payment systems. Using the HHS-HHC V0519 model of plan payment in the Marketplaces as a starting point, we constrain fit at the individual and group level to be as good or better than the current payment model while reducing the number of variables called for in the model. Opportunities for simplification are created by the introduction of three elements in design of plan payment: reinsurance (based on high spending or plan losses), constrained regressions, and powerful machine learning methods for variable selection. We first drop all variables relying on drug claims. Further major reductions in the number of diagnostic-based risk adjustors are possible using machine learning integrated with our constrained regressions. The fit performance of our simpler alternatives is as good or better than the current HHS-HHC V0519 formula.
    JEL: I11 I13 I18
    Date: 2020–02
  10. By: Ozyapi, Sena
    Abstract: Rising trends in obesity epidemic have become a serious issue for states and policymakers. Earlier studies in the medical literature have discussed the impacts of income and education levels on obesity prevalence to detect the importance of socioeconomic patterns. Recently, in the economic literature, there are studies that investigate poverty-obesity paradox. In this study, using a cross-sectional data set covering 31 countries from Eurostat for 2014, we estimate the effects of income and education levels on obesity prevalence among different age groups and countries of origin. Our results show that increasing education and income have a significant and negative influence on obesity prevalence. In addition, we found that obesity is less likely to occur in countries with higher social welfare spending.
    Keywords: Obesity; Body Mass Index; Income; Education
    JEL: I0 I10 I14 I15 I18 I29 I38
    Date: 2019–03–15
  11. By: Hannah Ameye; Jo Swinnen
    Abstract: Obesity is considered one of the major health concerns of the 21st century and is frequently associated with economic development. This paper reviews evidence on internal (within countries) and external (across countries) relationships between obesity, income and gender. Obesity changes with income, but in a non-linear way. On average, obesity increases with income in poor countries, has no relationship with income in middle-income countries and decreases with income for rich countries. Within countries, obesity is concentrated among richer groups in low-income countries and evenly distributed in middle-income countries. In high-income countries, the poor are the most obese. The relationship differs for men and women. Women are more obese in low-income countries and much more obese in middle-income countries. The gender obesity gap disappears in high-income economies. The geographic concentration of obesity also changes with income growth: from urban areas in poor countries to rural areas in rich countries. Despite these patterns, total obesity rates continue to increase in all countries, and for the world as a whole.
    Date: 2019
  12. By: Lorenti, Angelo; Dudel, Christian (Max Planck Institute for Demographic Research); Hale, Jo Mhairi; Myrskylä, Mikko
    Abstract: The ability to work at older ages depends on health and education. Both accumulate starting very early in life. We assess how childhood disadvantages combine with education to affect working and health trajectories. Applying multistate period life tables to data from the Health and Retirement Study (HRS) for the period 2008-2014, we estimate how the residual life expectancy at age 50 is distributed in number of years of work and disability, by number of childhood disadvantages, gender, and race/ethnicity. Our findings indicate that number of childhood disadvantages is negatively associated with work and positively with disability, irrespective of gender and race/ethnicity. Childhood disadvantages intersect with low education resulting in shorter lives, and redistributing life years from work to disability. Among the highly educated, health and work differences between groups of childhood disadvantage are small. Combining multistate models and inverse probability weighting, we show that the return of high education is greater among the most disadvantaged.
    Date: 2020–02–18
  13. By: Steve Briand (SAF - Laboratoire de Sciences Actuarielle et Financière - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon)
    Abstract: This paper investigates changes in health behaviors upon retirement among couples using European SHARE survey data. Contrary to previous analyses studying retirement effect in a purely individual framework, or only measuring spillover effects, the econometric strategy controls for coordination by couples in health behaviors, also dealing with the endogeneity of both spouses' retirements. Using variations in official retirement ages for identification, estimations of simultaneous equations models confirm an always positive and statistically significant correlation between spouses' behaviors. Results show no global impact of retirement on smoking and obesity and limited impact on physical activities. However, retirement strongly reduce binge drinking behaviors. Exploring sources of heterogeneity, additional results show that individuals with low job physical burden have healthier lifestyles while results for other individuals are more mixed. Furthermore, with regard to spillover effects, women are particularly sensitive to men's retirement when they are retired themselves, while the inverse occurs for men. JEL codes: J26, I12, D19, C35.
    Keywords: Retirement,health behaviors,couple's coordination
    Date: 2020–02–05
  14. By: Garcia Mandico,Silvia; Reichert,Arndt Rudiger; Strupat,Christoph
    Abstract: This paper uses the roll-out of the national health insurance in Ghana to assess the cushioning effect of coverage on the financial consequences of health shocks and resulting changes in coping behaviors. The analysis finds a strong reduction in medical expenditures, preventing households from cutting non-food consumption and causing a decrease in the volume of received remittances as well as the labor supply of healthy adult household members. Moreover, the paper presents evidence that the insurance scheme reduced the likelihood that households experiencing a health shock pulled their children out of school to put them to work. Avoidance of such costly coping mechanisms is potentially an important part of the social value of formal health insurance.
    Keywords: Health Care Services Industry,Health Insurance,Health Economics&Finance,Child Labor Law,Labor Standards,Child Labor,Labor Markets,Rural Labor Markets,Pharmaceuticals&Pharmacoeconomics,Pharmaceuticals Industry
    Date: 2019–09–11
  15. By: Bluffstone,Randall; LaFave,Daniel; Mekonnen,Alemu; Dissanayake,Sahan; Beyene,Abebe Damte; Gebreegziabher,Zenebe; Toman,Michael A.
    Abstract: Improved biomass cookstoves have been promoted as important intermediate technologies to reduce fuelwood consumption and possibly cut household air pollution in low-income countries. This study uses a randomized controlled trial to examine household air pollution reductions from an improved biomass cookstove promoted in rural Ethiopia, the Mirt improved cookstove. This stove is used to bake injera, which is very energy intensive and has a very particular cooking profile. In the overall sample, the Mirt improved cookstove leads to only minor reductions in mean household air pollution (10 percent on average). However, for those who bake injera in their main living areas, the Mirt improved cookstove reduces average mean household air pollution by 64 percent and median household air pollution by 78 percent -- although the resulting household air pollution levels are still many times greater than the World Health Organization's guideline. These large percentage reductions may reflect decreased emissions due to less use of fuelwood, given Mirt's energy-efficient design, and the likelihood that higher-emissions three-stone cooking is moved outside the main living area once a Mirt improved cookstove is installed. Households in the subsample who experience a greater decline in household air pollution tend to be less wealthy and more remotely located and burn less-preferred biomass fuels, like agricultural waste and animal dung, than households that cook in a separate area.
    Keywords: Health Care Services Industry,Energy Demand,Energy and Mining,Energy and Environment,Pollution Management&Control,Air Quality&Clean Air,Brown Issues and Health,Global Environment,Disease Control&Prevention
    Date: 2019–06–28
  16. By: Dissanayake,Sahan T. M.; Voigt,George; Cooper, Abbie; Beyene, Abebe Damte; Bluffstone,Randall; Gebreegziabher,Zenebe; LaFave, Daniel; Martinsson,Peter; Mekonnen,Alemu; Toman,Michael A.
    Abstract: There is a growing effort in the non-market valuation literature toward better understanding of the stability and evolution of preferences over time. The study uses a novel approach combining a repeated choice experiment with a randomized controlled trial on stove adoption in Ethiopia to analyze the stability and evolution of preferences. The treatment group in the randomized controlled trial received an improved fuelwood stove with less fuelwood use, whereas the control group continued to use traditional cooking methods. Respondents were given the exact same choice questions in 2013 and 2016. The study began with 504 households in 36 communities in 2013, and 486 of the same households participated in 2016 (a 96 percent retention rate). The results show that preferences of the respondents from the control group are stable over the study period, while preferences of the respondents from the treatment group evolve. Moreover, households in the treatment group still using the stoves have significantly higher willingness to pay for all the stove's attributes in 2016 compared with 2013, indicating how longer experience can increase the willingness to pay for technology with environmentally preferable attributes.
    Keywords: Global Environment,Flood Control,Hydrology,Energy Demand,Energy and Environment,Energy and Mining,Health Care Services Industry
    Date: 2019–06–28

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