nep-hea New Economics Papers
on Health Economics
Issue of 2021‒11‒15
seventeen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Medical Innovations and Ageing: A Health Economics Perspective By Volker Grossmann
  2. Willingness to pay or willingness to accept? An experimental study on secondhand smoke By Eleanya Nduka
  3. Modelling life trajectories of body-mass index By Sabine Vuik; Michele Cecchini
  4. How Communications that Portray Unhealthy Food Consumption Reduce Food Intake Among Dieters By Mia M. Birau; Diogo Hildebrand; Carolina O. C. Werle
  5. Health and Aging before and after Retirement By Ana Lucia Abeliansky; Holger Strulik
  6. Does Expanding Access to Cannabis Affect Traffic Crashes? County-Level Evidence from Recreational Marijuana Dispensary Sales in Colorado By Gunadi, Christian
  7. Flood Disasters and Health Among the Urban Poor By Michelle Escobar Carias; David Johnston; Rachel Knott; Rohan Sweeney
  8. Subjective risk belief function in the field: Evidence from cooking fuel choices and health in India By Yokoo, Hide-Fumi; 横尾, 英史; Arimura, Toshi H.; 有村, 俊秀; Chattopadhyay, Mriduchhanda; Katayama, Hajime; 片山, 東
  9. Multiple Pricing for Health Care Services By Andersson, Tommy; Enache, Andreea; Erlanson, Albin; Thami, Prakriti
  10. The many faces of health justice By Anand, Sudhir
  11. Modelling the size, cost and health impacts of universal basic income: what can be done in advance of a trial? By Johnson, Matthew Thomas; Johnson, Elliott Aidan; Webber, Laura; Friebel, Rocco; Reed, Howard Robert; Lansley, Stewart; Wildman, John
  12. Mental Health Consequences of Working from Home during the Pandemic By Kim, Jun Hyung; Koh, Yu Kyung; Park, Jinseong
  13. Mass Covid-19 Vaccination and Excess Mortality: Direct and Indirect Pathways By John Gibson
  14. Optimally Targeting Interventions in Networks during a Pandemic: Theory and Evidence from the Networks of Nursing Homes in the United States By Pongou, Roland; Tchuente, Guy; Tondji, Jean-Baptiste
  15. Race against time to save human lives during the COVID-19 with vaccines: Global evidence By Nguyen, Phuc V.; Huynh, Toan L. D.; Ngo, Vu M.; Nguyen, Huan H.
  16. The COVID-19 Curtain: Can Past Communist Regimes Explain the Vaccination Divide in Europe By Inés Berniell; Yarine Fawaz; Anne Laferrère; Pedro Mira; Elizaveta Pronkina
  17. Federal Food Policy Response to the COVID-19 Pandemic By Katherine Harris-Lagoudakis

  1. By: Volker Grossmann
    Abstract: This paper discusses the relationship between medical innovations and ageing from a health economics perspective and surveys empirical evidence on medical R&D incentives, R&D costs of pharmaceuticals, and the cost-effectiveness of health innovations. Particular focus is on the endogeneity of medical technological progress to expected market size and on the conceptualization of ageing as an accumulation of health deficits. The paper also discusses the role of medical progress for longevity and health inequality and presents a framework to assess the effect of increased longevity on the value of life.
    Keywords: healthcare, health deficits, health innovations, medical technological progress, longevity
    JEL: I10 O30
    Date: 2021
  2. By: Eleanya Nduka (Department of Economics, University of Exeter)
    Abstract: The anomaly between willingness to pay (WTP) and willingness to accept (WTA) invokes a well-established discussion in the stated preference literature. The debate involves which of the two is a better welfare measure. Although a few studies have tried to provide some insights, many researchers settle for eliciting WTP rather than WTA. However, WTA is a better welfare measure in some circumstances, especially in situations involving spillover effects and property rights. We investigate one of such situations and provide insights into how individuals in heterogeneous healthcare systems (private (U.S.) and public (U.K.)) value the effects of a spillover. First, we use choice experiments and contingent valuation techniques to quantify the attributes of secondhand smoke (SHS) health risks, focusing on generating crosscountry comparisons. We then compare the WTP and WTA welfare estimates. We find that agents differ significantly in valuing "external" health risks. Hence, this study uncovers an aspect of health risks valuation lacking in the literature. We also find that the two welfare measures differ significantly; thus, we contribute to the ongoing debate between WTP and WTA.
    Date: 2021–11–06
  3. By: Sabine Vuik (OECD); Michele Cecchini (OECD)
    Abstract: Body-mass index (BMI) tends to follow a typical trajectory over the life-course of an individual, increasing in early life while decreasing after middle age. To be able to reflect these trends in the OECD Strategic Public Health Planning for Non-Communicable Diseases (SPHeP-NCDs) model, this paper analyses longitudinal BMI data from 22 countries to build a mixed, autoregressive model predicting an individual’s BMI based on their sex, age and previous BMI. The resulting model shows how young people are likely to see an increase in BMI year-on-year, even if they already have overweight or obesity. It also shows that that a healthy weight in childhood does not protect against future overweight, as BMI continues to increase well into adulthood even for children who start off with a healthy weight. The results of this analysis will be incorporated in the OECD SPHeP NCDs model, to better simulate the longer-term impact of interventions, in particular interventions targeting childhood obesity.
    Keywords: BMI, Public Health
    Date: 2021–11–11
  4. By: Mia M. Birau (emlyon business school); Diogo Hildebrand (Baruch College [CUNY] - CUNY - City University of New York [New York]); Carolina O. C. Werle (GEM - Grenoble Ecole de Management)
    Abstract: Both regulatory agencies and nonprofit organizations seek to understand how different tactics and appeals contained in food and public health advertisements might influence the food intake of an increasingly dieting-concerned population. This article addresses this important issue by examining how consumers who are concerned with their diets react to rich images of unhealthy food consumption. Results of two experiments show that exposure to food advertisements containing unhealthy food consumption imagery reduces food intake among consumers chronically concerned with dieting, whereas a third experiment shows a similar decrease in intended consumption when a public health advertisement portrays the consumption of unhealthy food. These findings in turn offer guidelines for maximizing the effectiveness of messages that attempt to promote healthy eating habits. Additionally, this research provides theoretical contributions to the self-control and mental imagery research domains which have public policy implications for regulatory agencies and nonprofit organizations.
    Keywords: counteractive control theory,health goal,consumption imagery,dieting concern
    Date: 2021
  5. By: Ana Lucia Abeliansky; Holger Strulik
    Abstract: We investigate health and aging before and after retirement for specific occupational groups. We use five waves of the Survey of Health, Aging, and Retirement in Europe (SHARE) and construct a frailty index for elderly men and women from 10 European countries. Occupational groups are classified according to low vs. high education, blue vs. white collar color, and high vs. low physical or psychosocial job burden. Controlling for individual fixed effects, we find that, regardless of the used classification, workers from the first (low status) group display more health deficits at any age and accumulate health deficits faster than workers from the second (high status) group. We instrument retirement by statutory retirement ages (“normal” and “early”) and find that the health of workers in low status occupations benefits greatly from retirement, whereas retirement effects for workers in high status occupations are small and frequently insignificant. We also find that workers from low status occupations always have higher health deficits, i.e. we find evidence for an occupational health gradient that widens with increasing age, before and after retirement.
    Keywords: health deficits, occupation, retirement, frailty index, Europe
    JEL: I10 I19 J13
    Date: 2021
  6. By: Gunadi, Christian
    Abstract: This article examines the effect of recreational cannabis dispensary sales on traffic crashes by employing difference-in-differences model that exploits the variation in the timing of recreational marijuana dispensary entry across counties within Colorado. Using marijuana-related hospital discharge as a proxy for marijuana use, the results indicate a sizable rise in marijuana-related hospital discharges after the entry of retail cannabis stores. However, there is a lack of evidence that traffic crash incidents are affected by the entry. The preferred estimate suggests that, at 90% confidence level, a large increase in traffic crashes by more than 5% can be ruled out.
    Keywords: Recreational Marijuana Laws,Cannabis Access,Traffic Crashes
    JEL: K00 I1 R41 H23
    Date: 2021
  7. By: Michelle Escobar Carias; David Johnston; Rachel Knott; Rohan Sweeney
    Abstract: Billions of people live in urban poverty, with many forced to reside in disaster-prone areas. Research suggests that such disasters harm child nutrition and increase adult morbidity. However, little is known about impacts on mental health, particularly of people living in slums. In this paper we estimate the effects of flood disasters on the mental and physical health of poor adults and children in urban Indonesia. Our data come from the Indonesia Family Life Survey and new surveys of informal settlement residents. We find that urban poor populations experience increases in acute morbidities and depressive symptoms following floods, that the negative mental health effects last longer, and that the urban wealthy show no health effects from flood exposure. Further analysis suggests that worse economic outcomes may be partly responsible. Overall, the results provide a more nuanced understanding of the morbidities experienced by populations most vulnerable to increased disaster occurrence.
    Date: 2021–11
  8. By: Yokoo, Hide-Fumi; 横尾, 英史; Arimura, Toshi H.; 有村, 俊秀; Chattopadhyay, Mriduchhanda; Katayama, Hajime; 片山, 東
    Abstract: We investigate the accuracy of the perceptions of health risks in India. The context of our study is the risk of developing physical symptoms related to household air pollution caused by cooking. Using field data collected from 588 respondents in 17 villages in West Bengal, we regress the probability of symptoms on fuel choices to predict respondent-specific health risk changes. The estimated risks, which we treat as objective risks, are then compared with the corresponding subjective probabilistic beliefs, which are elicited by an interactive method with visual aids. Our results show that, on average, the respondents slightly underestimate the change in risk when switching from cooking with firewood to cooking with liquefied petroleum gas, even though their beliefs are qualitatively correct. The results further show that risk misperception is associated only with religion among individuals’ observed characteristics, suggesting that their unobserved characteristics play a substantial role in risk misperception.
    Keywords: Belief, Cooking fuel choice, Health risk, India, Risk misperception, Subjective probabilistic expectation
    JEL: D83 D84 I12 O13 Q53
    Date: 2021–11
  9. By: Andersson, Tommy (Department of Economics, Lund University); Enache, Andreea (Stockholm School of Economics); Erlanson, Albin (University of Essex); Thami, Prakriti (Department of Economics, Lund University)
    Abstract: This paper provides a theoretical model that captures the essential features of a Swedish health care reform where private and public health care providers serve patients with certain functional impairments, but where only private providers can reject service requests from patients. Since the hourly price compensation is fixed, this type of systems is expected to result in a monetary deficit for public providers (since they can not reject proposals from “unprofitable” patients). This paper proposes a more advanced pricing system and characterizes its optimal solution. A numerical analysis demonstrates that the deficit for the public provider can be substantially reduced without affecting the total budget.
    Keywords: health care services; public and private providers; multiple pricing; welfare
    JEL: C61 D47 D78 I11
    Date: 2021–11–05
  10. By: Anand, Sudhir
    Abstract: This paper develops the idea of health justice as a plural conception. It draws on the literature on justice from philosophy and economics, and investigates its application and reach in the space of health. Several distinctions are invoked in identifying and contrasting different facets of health justice and injustice. These include active versus passive injustice; process fairness versus substantive justice; comparative versus noncomparative justice; compensatory and distributive justice. Within distributive justice, the health implications of alternate principles – viz. equality, priority, sufficiency, and efficiency – are examined and evaluated. Many faces of health justice are thus exposed which help to address the varieties of injustice observed in the health sphere.
    JEL: N0
    Date: 2021–10
  11. By: Johnson, Matthew Thomas; Johnson, Elliott Aidan; Webber, Laura; Friebel, Rocco; Reed, Howard Robert; Lansley, Stewart; Wildman, John
    Abstract: Opposition to Universal Basic Income (UBI) is encapsulated by Martinelli’s claim that ‘an affordable basic income would be inadequate, and an adequate basic income would be unaffordable’. In this article, we present a model of health impact that transforms that assumption. We argue that UBI can affect higher level social determinants of health down to individual determinants of health and on to improvements in public health that lead to a number of economic returns on investment. Given that no trial has been designed and deployed with that impact in mind, we present a methodological framework for assessing prospective costs and returns on investment through modelling to make the case for that trial. We begin by outlining the pathways to health in our model of change in order to present criteria for establishing the size of transfer capable of promoting health. We then consider approaches to calculating cost in a UK context to estimate budgetary burdens that need to be met by the state. Next, we suggest means of modelling the prospective impact of UBI on health before asserting means of costing that impact, using a microsimulation approach. We then outline a set of fiscal options for funding any shortfall in returns. Finally, we suggest that fiscal strategy can be designed specifically with health impact in mind by modelling the impact of reform on health and feeding that data cyclically back into tax transfer module of the microsimulation.
    Keywords: health impact; modelling; social determinants; tax; Universal Basic Income
    JEL: N0 E6
    Date: 2021–12–01
  12. By: Kim, Jun Hyung; Koh, Yu Kyung; Park, Jinseong
    Abstract: This paper examines the effects of working from home on mental health, using unique real time survey data from South Korea collected during the COVID-19 pandemic. We find that working from home negatively affects the mental health of workers in the first half of 2020. Furthermore, we find substantial heterogeneity across gender and home environment. The negative impact of working from home is concentrated on women, and on those who are primarily responsible for housework while also maintaining market work. Surprisingly, workers who live with children in the household do not suffer from the negative effects of working from home. Our findings suggest that family-work interaction may be an important factor in the optimal design of working from home.
    Keywords: Working from home,home working,remote work,COVID-19,mental health,subjective well-being
    JEL: D13 L23 L84 M11 M54
    Date: 2021
  13. By: John Gibson (University of Waikato)
    Abstract: The rollout of Covid-19 vaccinations is unprecedented in pace and scope. Over seven billion doses have been administered to date so aggregate effects should have become apparent. This cross-country panel data study relates weekly estimates of excess mortality to the incidence of Covid-19 vaccinations, for the 32 OECD countries with high frequency excess mortality data available. The correlation between excess mortality and vaccination incidence is decomposed into two pathways: one from vaccination via Covid-attributed deaths to excess mortality and a non-Covid pathway that goes directly from vaccination to excess mortality, with Covid-19 deaths held constant. The non-Covid pathway from vaccination to excess mortality appears at least as large as the Covid pathway, and is the larger of the two pathways if lagged effects are captured. In results broken down by age, the effects are not apparent for the youngest age group who, until recently, were not exposed to Covid-19 vaccination.
    Keywords: Covid-19; excess mortality; vaccination
    JEL: I18 J11
    Date: 2021–11–26
  14. By: Pongou, Roland; Tchuente, Guy; Tondji, Jean-Baptiste
    Abstract: This study develops an economic model for a social planner who prioritizes health over short- term wealth accumulation during a pandemic. Agents are connected through a weighted undirected network of contacts, and the planner's objective is to determine the policy that contains the spread of infection below a tolerable incidence level, and that maximizes the present discounted value of real income, in that order of priority. The optimal unique policy depends both on the configuration of the contact network and the tolerable infection incidence. Comparative statics analyses are conducted: (i) they reveal the tradeoff between the economic cost of the pandemic and the infection incidence allowed; and (ii) they suggest a correlation between different measures of network centrality and individual lockdown probability with the correlation increasing with the tolerable infection incidence level. Using unique data on the networks of nursing and long-term homes in the U.S., we calibrate our model at the state level and estimate the tolerable COVID-19 infection incidence level. We find that laissez-faire (more tolerance to the virus spread) pandemic policy is associated with an increased number of deaths in nursing homes and higher state GDP growth. In terms of the death count, laissez-faire is more harmful to nursing homes than more peripheral in the networks, those located in deprived counties, and those who work for a profit. We also find that U.S. states with a Republican governor have a higher level of tolerable incidence, but policies tend to converge with high death count.
    Keywords: COVID-19,health-vs-wealth prioritization,economic cost,weighted networks,network centrality,nursing homes,optimally targeted lockdown policy
    JEL: D85 E61 H12 I18 J15
    Date: 2021
  15. By: Nguyen, Phuc V.; Huynh, Toan L. D.; Ngo, Vu M.; Nguyen, Huan H.
    Abstract: Voluminous vaccine campaigns are used globally since the COVID-19 pandemic owes devastating mortality and destructively unprecedented consequences on different aspects of economies. Notwithstanding different approaches to measure the effectiveness of COVID-19 vaccines in clinical medicines, this paper sheds new light on the efficacy of COVID-19 vaccines by using the difference-in-differences (DiD) design of 127 countries in the daily frequency from February 2020 till the end of August 2021. We show that the number of new deaths per million significantly decreases after half of the population is vaccinated, but the number of new cases witnesses an insignificant change. We found that the effects are more pronounced in Europe and North America by offering insights about different continents. Our results remain robust after using other proxies and testing the sensitivity of the vaccinated proportion, providing causality and evidence that expanding and expediting COVID-19 vaccination can save human lives.
    Keywords: COVID-19,global scope,effectiveness,vaccines
    JEL: I10 I18
    Date: 2021
  16. By: Inés Berniell (CEDLAS-IIE-FCE-UNLP); Yarine Fawaz (CEMFI); Anne Laferrère (Universit´e Paris-Dauphine); Pedro Mira (CEMFI); Elizaveta Pronkina (Universit´e Paris-Dauphine)
    Abstract: As of November 2021, all former Communist countries from Central and Eastern Europe exhibit lower vaccination rates than Western European countries. Can institutional inheritance explain, at least in part, this heterogeneity in vaccination decisions across Europe? To study this question we exploit novel data from the second wave of the SHARE (Survey of Health, Ageing, and Retirement in Europe) Covid-19 Survey fielded in Summer 2021 that covers 27 European countries and Israel. First, we document lower Covid-19 vaccine take-up amongst individuals above 55 years old who were born under Communism in Europe. Next, we turn to reunified Germany to get closer to a causal effect of exposure to Iron curtain regimes. We find that exposure to the Communist regime in East Germany decreases one’s probability to get vaccinated against Covid-19 by 8 percentage points, increases that of not wanting the vaccine by 4 percentage points. Both effects are quite large and statistically significant, and they hold when controlling for individual socio-economic and demographic characteristics. We identify low social capital -measured as voluntary work, political engagement, trust in people- as a plausible channel through which past Communist regimes would still affect individuals’ preferences for Covid-19 vaccination.
    JEL: I15 I12 P36 Z18
    Date: 2020–11
  17. By: Katherine Harris-Lagoudakis (Center for Agricultural and Rural Development (CARD) at Iowa State University)
    Abstract: In the 2019 fiscal year, one in four US residents participated in one of USDA's 15 food assistance programs. The COVID-19 pandemic, which has led to unprecedented spikes in unemployment as well as widespread school closures, has exacerbated already limited access to resources and sources of food for food insecure households. Harris-Lagoudakis examines how the federal governmental has addressed the effects of the pandemic by altering food policy and making changes to the National School Lunch Program, School Breakfast Program, SNAP, and other USDA food assistance programs. She finds that the economic downturn and the emergency federal policy provisions have increased the number of SNAP participating households and the amount of benefits allotted to SNAP beneficiaries. However, the NSLP and SBP have faced significant challenges in providing free and reduced price meals to children at risk for food insecurity.
    Date: 2020–10

This nep-hea issue is ©2021 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.