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on Health Economics |
| By: | Bahiotra,Sonia; Soest,Arthur van (Tilburg University, Center for Economic Research) |
| Abstract: | A dynamic panel data model of neonatal mortality and birth spacing is analyzed, accounting for causal effects of birth spacing on subsequent mortality and of mortality on the next birth interval, while controlling for unobserved heterogeneity in mortality (frailty) and birth spacing (fecundity). The model is estimated using micro data on about 29000 children of 6700 Indian mothers, for whom a complete retrospective record of fertility and child mortality is available. Information on sterilization is used to identify an equation for completion of family formation that is needed to account for right-censoring in the data. We find clear evidence of frailty, fecundity, and causal effects of birth spacing on mortality and vice versa, but find that birth interval effects can explain only a limited share of the correlation between neonatal mortality of successive children in a family. |
| JEL: | J12 J13 C33 |
| Date: | 2005 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:kubcen:200506&r=hea |
| By: | Ours,Jan C. van (Tilburg University, Center for Economic Research) |
| Abstract: | This paper uses information about prime age individuals living in Amsterdam, to study whether the use of alcohol, or tobacco stimulates the use cannabis, i.e. whether alcohol or cannabis are stepping stones for cannabis. The special element of the study is that it concerns the use in an environment where not only alcohol and tobacco but also cannabis is a legal drug. It turns out that alcohol and cannabis are intertemporal substitutes while tobacco and cannabis are intertemporal complements. Only tobacco is a stepping stone for cannabis use. |
| JEL: | C41 D12 I19 |
| Date: | 2005 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:kubcen:200512&r=hea |
| By: | Ours,Jan C. van (Tilburg University, Center for Economic Research) |
| Abstract: | This paper uses a dataset collected among inhabitants of Amsterdam, to study the employment effects of the use of cannabis and cocaine. For females no negative effects of drug use on the employment rate are found. For males there is a negative correlation between past cannabis and cocaine use and employment. However, after correcting for the effect of unobserved personal characteristics there is no negative effect of cannabis use or cocaine use on the employment status of males. |
| JEL: | C41 D12 I19 |
| Date: | 2005 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:kubcen:200515&r=hea |
| By: | Ours,Jan C. van (Tilburg University, Center for Economic Research) |
| Abstract: | This paper uses information about prime age individuals living in Amsterdam to study the patterns of use of ecstasy and cocaine. The information was collected in surveys in 1994, 1997 and 2001. The analysis shows that the use of ecstasy and cocaine is mainly influenced by calendar year, family situation, and parental cannabis use. Individuals that are more likely to use cocaine are also more likely to use ecstacy. Whether or not an individual starts using ecstasy or cocaine is highly age dependent, i.e. it usually happens between age 20 and 35. If an individual has not used at age 35 he or she is very unlikely to do so at a later age. The entrance of ecstasy in the Amsterdam drugs market in the course of the 1990s did not reduce the use of cocaine. |
| JEL: | D12 I19 |
| Date: | 2005 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:kubcen:200516&r=hea |
| By: | Ours,Jan C. van (Tilburg University, Center for Economic Research) |
| Abstract: | This paper uses information about prime age individuals living in Amsterdam to study the dynamics in the use of drugs, in particular alcohol, tobacco, cannabis, cocaine, and ecstasy. The analysis concerns starting rates, transitions from non-use to use, as well as quit rates, transitions from use to non-use. Particular attention is given to the effect of the age of onset on quit behavior. The empirical analysis shows that for most of the drugs investigated the age of onset has a positive effect on the quit rate. The earlier individuals start using a particular drug the less likely they are to stop using that drug. |
| JEL: | C41 D12 I19 |
| Date: | 2005 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:kubcen:200521&r=hea |
| By: | Dahlberg, Matz (Department of Economics); Lundin, Douglas (Läkemedelsförmånsnämnden) |
| Abstract: | Recent research claims that the major part of the observed reduction in suicide rates during the 1990’s can be explained by the increase in the prescription of antidepressants. This conclusion is however based on research that only looks at raw correlations; confounding effects from other variables are not controlled for. Using a rich data set, we reinvestigate the issue. After controlling for other covariates, observed as well as unobserved, that might affect the suicide rate, we find, overall, no statistically significant effects from antidepressants on the suicide rate; when we do get significant effects, they are positive for young persons. Regarding the latter result, more research is needed before any firm policy conclusion can be made. |
| Keywords: | Suicide; antidepressants; Poisson fixed effects |
| JEL: | C23 I12 |
| Date: | 2005–01–15 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:uunewp:2005_004&r=hea |
| By: | Haruko Noguchi; Satoshi Shimizutani |
| Abstract: | This study examines how the price mechanism affects the length of residents' nursing home stay and their destination after exit. The purpose of this analysis is to evaluate policy options to reduce the number of socially institutionalized elderly nursing home residents in Japan. To address these issues, we take advantage of micro-level data from The Survey on Care Service Providers compiled by the Japanese government. Our duration estimates show that the price elasticity of the hazard of exit from welfare care facilities was 1.7 (95% CI: 0.4-3.0) and 1.8 (95% CI: 0.0-3.8) from health care facilities. The probit estimates show that a 1 percentage point increase in copayments leads to an increase in the probability of returning home by 0.04% for patients of welfare care facilities and 3.7% for those of health care facilities. In contrast, the price elasticity of the probability of being re-hospitalized is -3.3% for patients of health care facilities and -1.9% for those of medical care facilities. An appropriate price policy may work well to shorten patients' length of stay and to reduce the number of the socially institutionalized. Since the effects of the introduction of a price mechanism may differ for different types of facilities, public policies aimed at broadening residents' range of choices need to be designed with care and incorporate an appropriate risk adjustment system to provide a safety net for those elderly highly at risk of being socially institutionalized. |
| Date: | 2005–01 |
| URL: | http://d.repec.org/n?u=RePEc:hst:hstdps:d04-67&r=hea |
| By: | Haruko Noguchi; Satoshi Shimizutani |
| Abstract: | In 2000, government deregulation along with the introduction of the long-term insurance scheme for the first time allowed for-profit providers of at-home care for the elderly to compete directly with nonprofit operators. According to the contract failure hypothesis, we would expect consumers to prefer nonprofit providers over their for-profit counterparts as a result of information asymmetry and non-distributional constraints. This study takes advantage of household level data to examine whether households' choice of care provider is biased toward nonprofits. We find that nonprofit providers to command a larger market share, but this is at least partly explained by having operated in the market longer and by continuing restrictions in medical and institutional care that confer various advantages on nonprofit providers. However, we do find that user with better knowledge of providers tend to favor for-profit providers, suggesting that measures to reduce information asymmetries may help to provide a more level playing field. |
| Date: | 2005–02 |
| URL: | http://d.repec.org/n?u=RePEc:hst:hstdps:d04-73&r=hea |
| By: | Frijters, Paul (RSSS, Australian National University); Haisken-DeNew, John (RWI Essen and IZA Bonn); Shields, Michael A. (University of Melbourne and IZA Bonn) |
| Abstract: | The socio-economic gradient in health remains a controversial topic in economics and other social sciences. In this paper we develop a new duration model that allows for unobserved persistent individual-specific health shocks and provides new evidence on the roles of socioeconomic characteristics in determining length of life using 19-years of high-quality panel data from the German Socio-Economic Panel. We also contribute to the rapidly growing literature on life satisfaction by testing if more satisfied people live longer. Our results clearly confirm the importance of income, education and marriage as important factors in determining longevity. For example, a one-log point increase in real household monthly income leads to a 12% decline in the probability of death. We find a large role for unobserved health shocks, with 5-years of shocks explaining the same amount of the variation in length of life as all the other observed individual and socio-economic characteristics (with the exception of age) combined. Individuals with a high level of life satisfaction when initially interviewed live significantly longer, but this effect is completely due to the fact that less satisfied individuals are typically less healthy. We are also able to confirm the findings of previous studies that self-assessed health status has significant explanatory power in predicting future mortality and is therefore a useful measure of morbidity. Finally, we suggest that the duration model developed in this paper is a useful tool when analyzing a wide-range of single-spell durations where individual-specific shocks are likely to be important. |
| Keywords: | income, education, marriage, life satisfaction, shocks, mortality, duration analysis |
| JEL: | I1 C23 |
| Date: | 2005–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp1488&r=hea |
| By: | Todd E. Elder (Institute of Labor and Industrial Relations); Elizabeth T. Powers (Institute of Government and Public Affairs) |
| Abstract: | The Supplemental Security Income (SSI) program provides an income and health care safety net for the elderly poor. The phenomenon of apparently eligible households that do not enroll in, or 'take up' SSI has been noted as a severe problem since the program's inception in 1974. This paper examines SSI eligibility, applications, and participation in the aged population from 1984 (the most recent year analyzed in the literature to date) through 1997. We are fortunate to have administrative data on SSI use that is linked to various panels of the SIPP. We use this information to estimate the SSI-aged application choice. The key findings from the earlier literature are sensitive with respect to exact sample specification, alternative approaches to imputing the expected SSI benefit, and more detailed information on application and receipt culled from administrative files. Our findings suggest that cash benefits may be less influential, and Medicaid access through SSI more influential, than previously estimated. |
| Date: | 2004–01 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp076&r=hea |
| By: | Lynn A. Karoly (RAND); Paul S. Davies (Social Security Administration) |
| Abstract: | The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 changed the definition of disability used to determine eligibility for disabled children under the Supplemental Security Income (SSI) program and made other changes in the program. The law required the redetermination of eligibility status for children potentially affected by the new definition of disability. As a result, an estimated 100,000 children were expected to lose SSI benefits. The goal of this paper is to understand the impact of benefit loss on affected children and their families. The analysis draws on data from the 1992, 1993 and 1996 panels of the Survey of Income and Program Participation matched with Social Security Administration records on SSI program participation. The data are used to analyze the impact of the loss of SSI income as a result of the 1996 legislation on family labor supply, welfare program participation, and income and poverty. Compared with families that lost SSI benefits due to normal attrition from the program, the excess benefit loss due to the 1996 childhood disability reforms is associated with lower levels of family labor supply, higher levels of participation in AFDC/TANF and food stamps, and lower levels of family income relative to poverty. For some outcomes, these effects—measured one month after benefit loss—persist for up to 12 months. |
| Date: | 2004–06 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp079&r=hea |
| By: | David McCarthy (Tanaka Business School, Imperial College) |
| Abstract: | This paper develops an equilibrium model of the annuities market where agents have private information about their mortality, and where the predictive value of this information decays over time. The paper shows that in this case, insurance companies will observe a duration-related trend in the mortality of annuitants under certain conditions. This effect is tested for using a Cox proportional hazards methodology and data from the South African annuities market, which since the early 1990’s has permitted phased withdrawals of retirement savings instead of mandating pure annuitisation. Evidence is equivocal: substantial differences are found between the duration-related mortality trends of different insurance companies, data problems seem to have some effect, and factors outside the model which might change the results cannot be excluded. However, the presence of a strong duration-related trend cannot be decisively rejected. The observed trend indicates that mortality at earlier policy durations is better than at later durations by the equivalent of about 6 years of age, although data factors cannot be precluded as a cause of this trend. |
| Date: | 2004–06 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp080&r=hea |
| By: | Cassio M. Turra (University of Pennsylvania); Olivia S. Mitchell (University of Pennsylvania) |
| Abstract: | This paper describes how differences in health status at retirement can influence the decision to purchase a life annuity. We extend previous research on annuitization decisions by incorporating the effect of health differentials via differences in survival throughout the latter portion of life. Next, we consider how precautionary savings motivated by uncertain out-of-pocket medical expenses influence annuitization decisions. Our results show that annuities become less attractive to people facing uncertain medical expenses. While full annuitization would still be optimal if annuity markets were truly complete and both life- and health-contingent, lacking this, annuity equivalent wealth values are much lower for those in poor health, as compared to persons in good health. |
| Date: | 2004–07 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp086&r=hea |
| By: | Richard V. Burkhauser (Cornell University); John Cawley (Cornell University) |
| Abstract: | Between the early 1980s and 2002, both the prevalence of obesity and the number of beneficiaries of the Social Security Disability Insurance program doubled. We test whether these trends are related; specifically, we test whether obesity causes disability and movement onto the disability rolls. We estimate models of instrumental variables using two nationally representative data sets, the Panel Survey of Income Dynamics and the National Longitudinal Survey of Youth, 1979 Cohort. The results are mixed but we find evidence that weight increases the probability of health-related work limitations and the probability of receiving disability related income. Our results suggest that the failure to treat obesity as endogenous leads to dramatic underestimates of the link between obesity and disability outcomes. Authors’ Acknowledgements We thank seminar participants at Ohio State University and the 2004 Conference of the Social Security Retirement Research Consortium for their helpful comments. We gratefully acknowledge financial support from the University of Michigan Retirement Research Consortium and the Bronfenbrenner Life Course Center at Cornell University. We thank Shuaizhang Feng for expert research assistance. |
| Date: | 2004–10 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp089&r=hea |
| By: | John Bound (University of Michigan and NBER); Todd Stinebrickner (University of Western Ontario); Timothy Waidman (Urban Institute) |
| Abstract: | In this paper, we specify a dynamic programming model that addresses the interplay among health, financial resources, and the labor market behavior of men in the later part of their working lives. The model is estimated using data from the Health and Retirement Study. We use the model to simulate the impact on behavior of raising the normal retirement age, eliminating early retirement altogether and introducing universal health insurance. |
| Date: | 2004–10 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp091&r=hea |
| By: | Michael Baker; Kevin Milligan |
| Abstract: | Maternity leaves can affect mothers%u2019 and infants%u2019 welfare if they first affect the amount of time working women stay at home post birth. We provide new evidence of the labor supply effects of these leaves from an analysis of the introduction and expansion of job-protected maternity leave in Canada. The substantial variation in leave entitlements across mothers by time and space is likely exogenous to their unobserved characteristics. This is important because unobserved heterogeneity correlated with leave entitlement potentially biases many previous studies of this topic. We find that modest mandates of 17-18 weeks do not increase the time mothers spend at home. The physical demands of birth and private arrangements appear to render short mandates redundant. These mandates do, however, decrease the proportion of women quitting their jobs, increase leave taking, and increase the proportion returning to their pre-birth employers. In contrast, we find that expansions of job-protected leaves to lengths up to 70 weeks do increase the time spent at home (as well as leave-taking and job continuity). We also examine whether this increase in time at home affects infant health, finding no evidence of an effect on the incidence of low birth weight or infant mortality. |
| JEL: | J13 J32 |
| Date: | 2005–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11135&r=hea |
| By: | Philip J. Cook; Jan Ostermann; Frank A. Sloan |
| Abstract: | Regression results from a 30-year panel of the state-level data indicate that changes in alcohol-excise taxes cause a reduction in drinking and lower all-cause mortality in the short run. But those results do not fully capture the long-term mortality effects of a permanent change in drinking levels. In particular, since moderate drinking has a protective effect against heart disease in middle age, it is possible that a reduction in per capita drinking will result in some people drinking "too little" and dying sooner than they otherwise would. To explore that possibility, we simulate the effect of a one percent reduction in drinking on all-cause mortality for the age group 35-69, using several alternative assumptions about how the reduction is distributed across this population. We find that the long-term mortality effect of a one percent reduction in drinking is essentially nil. |
| JEL: | I12 |
| Date: | 2005–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11138&r=hea |
| By: | Rexford Santerre; John A. Vernon |
| Abstract: | This paper uses national data for the period 1960 to 2000 to estimate an aggregate private consumer demand for pharmaceuticals in the U.S. The estimated demand curve is then used to simulate the value of consumer surplus gains from a drug price control regime that holds drug price increases to the same rate of growth as the general consumer price level over the time period from 1981 to 2000. Based upon a 7 percent real interest rate, we find that the future value of consumer surplus gains from this hypothetical policy would have been $319 billion at the end of 2000. According to a recent study, that same drug price control regime would have led to 198 fewer new drugs being brought to the U.S. market over this period. Therefore, we approximate that the average social opportunity cost per drug developed during this period to be approximately $1.6 billion. Recent research on the value of pharmaceuticals suggests that the social benefits of a new drug may be far greater than this estimated social opportunity cost. |
| JEL: | I1 L5 K2 |
| Date: | 2005–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11139&r=hea |