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on Health Economics |
| By: | Marcus Keogh-Brown; Simon Wren-Lewis; W. John Edmunds; Philippe Beutels; Richard D. Smith |
| Abstract: | Little is known about the possible impact of an influenza pandemic on a nation’s economy. We applied the UK macroeconomic model ‘COMPACT’ to epidemiological data on previous UK influenza pandemics, and extrapolated a sensitivity analysis to cover more extreme disease scenarios. Analysis suggests that the economic impact of a repeat of the 1957 or 1968 pandemics, allowing for school closures, would be short lived, constituting a loss of 3.35% and 0.58% of GDP in the first pandemic quarter and year respectively. A more severe scenario (with more than 1% of the population dying) could yield impacts of 21% and 4.5% respectively. The economic shockwave would be gravest when absenteeism (through school closures) increases beyond a few weeks, creating policy repercussions for influenza pandemic planning as the most severe economic impact is due to policies to contain the pandemic rather than the pandemic itself. Accounting for changes in consumption patterns made in an attempt to avoid infection worsens the potential impact. Our mild disease scenario then shows first quarter/first year reductions in GDP of 9.5%/2.5%, compared to our severe scenario reductions of 29.5%. These results clearly indicate the significance of behavioural change over disease parameters. |
| Keywords: | Pandemic, Influenza, Simulation, COMPACT |
| JEL: | E17 I18 Q54 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:oxf:wpaper:431&r=hea |
| By: | Nicolas R. Ziebarth |
| Abstract: | Sick leave payments represent a significant portion of public health expenditures and labor costs. Reductions in replacement levels are a commonly used instrument to tackle moral hazard and to increase the efficiency of the health insurance market. In Germany's Statutory Health Insurance (SHI) system, the replacement level for periods of sickness of up to six weeks was reduced from 100 percent to 80 percent of an employee's gross wage at the end of 1996. At the same time, the replacement level for individuals absent for a long-term period, i.e., from the seventh week onwards, was reduced from 80 to 70 percent. We show theoretically that the net reform effects on long-term absenteeism can be disentangled into a direct and an indirect effect. Using SOEP data, a natural control group, and two different treatment groups, we estimate the net and the direct effect on the incidence and duration of long-term absenteeism by difference-in-differences. Our findings suggest that, on population average, the reforms have not affected long-term absenteeism significantly, which is in accordance with our theoretical predictions, assuming that employees on long-term sick leave are seriously sick. However, we find some heterogeneity in the effects and a small but significant decrease in the duration of long-term absenteeism for the poor and middle-aged full-time employed persons. All in all, moral hazard and presenteeism seem to be less of an issue in the right tail of the sickness spell distribution. Finally, our calculations suggest that from 1997 to 2006, around five billion euros were redistributed from persons on long-term sick leave to the SHI insurance pool. |
| Keywords: | Long-term absenteeism, sick pay, moral hazard, natural experiment, SOEP |
| JEL: | I18 J22 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwwpp:dp888&r=hea |
| By: | Cervellati, Matteo (University of Bologna); Sunde, Uwe (University of St. Gallen) |
| Abstract: | In this paper we investigate the causal effect of life expectancy on economic growth by explicitly accounting for the role of the demographic transition. In addition to focusing on issues of empirical identification, this paper emphasizes the role of the econometric specification. We present a simple theory of the economic and demographic transition where individuals' education and fertility decisions depend on their life expectancy. The theory predicts that before the demographic transition improvements in life expectancy primarily increase population. Improvements in life expectancy do, however, reduce population growth and foster human capital accumulation after the onset of the demographic transition. This implies that the effect of life expectancy on population, human capital and income per capita is not the same before and after the demographic transition. Moreover, a sufficiently high life expectancy is ultimately the trigger of the transition to sustained income growth. We provide evidence supporting these predictions using data on exogenous mortality reductions in the context of the epidemiological revolution. |
| Keywords: | life expectancy, demographic transition, epidemiological revolution, heterogeneous treatment effects |
| JEL: | E10 J10 J13 N30 O10 O40 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp4160&r=hea |
| By: | Buchmueller, Thomas C. (University of Michigan); DiNardo, John (University of Michigan); Valletta, Rob (Federal Reserve Bank of San Francisco) |
| Abstract: | Over the past few decades, policy makers have considered employer mandates as a strategy for stemming the tide of declining health insurance coverage. In this paper we examine the long term effects of the only employer health insurance mandate that has ever been enforced in the United States, Hawaii's Prepaid Health Care Act, using a standard supply-demand framework and Current Population Survey data covering the years 1979 to 2005. During this period, the coverage gap between Hawaii and other states increased, as did real health insurance costs, implying a rising burden of the mandate on Hawaii's employers. We use a variant of the traditional permutation (placebo) test across all states to examine the magnitude and statistical properties of these growing coverage differences and their impacts on labor market outcomes, conditional on an extensive set of covariates. As expected, the coverage gap is larger for workers who tend to have low rates of coverage in the voluntary market (primarily those with lower skills). We also find that relative wages fell in Hawaii over time, but the estimates are statistically insignificant. By contrast, a parallel analysis of workers employed fewer than 20 hours per week indicates that the law significantly increased employers' reliance on such workers in order to reduce the burden of the mandate. We find no evidence suggesting that the law reduced employment probabilities. |
| Keywords: | health insurance, employment, hours, wages |
| JEL: | J32 I18 J23 |
| Date: | 2009–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp4152&r=hea |
| By: | Frijters, Paul (Queensland University of Technology); Barón, Juan D. (Banco de la República de Colombia) |
| Abstract: | A recent debate in the medical literature has arisen around the mortality effects of obesity. Whereas it has been argued that the obese die younger, the data that have become available do not immediately support this. This potentially undermines the hypothesis that modern life with its physical ease and cheap food would eventually make us die younger, and undermines the notion that economic growth comes with health warnings. We revisit this debate going over the mortality effects of obesity, using the US Health and Retirement Study. Whilst we find that obesity leads to chronic diseases that reduce length of life, we also find that the obese survive strokes and lung disease more often than the non-obese. A possible explanation is that the obese are under greater medical scrutiny, meaning that lung disease is more quickly diagnosed. This result holds when controlling for smoking and the long-term effects of obesity. |
| Keywords: | obesity, longitudinal data, mortality, smoking, reverse-causality |
| JEL: | I10 I18 C23 |
| Date: | 2009–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp4149&r=hea |
| By: | Salm, Martin (Tilburg University) |
| Abstract: | This study estimates the effect of job loss on health for near elderly employees based on longitudinal data from the Health and Retirement Study. Previous studies find a strong negative correlation between unemployment and health. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason – the closure of their previous employers' business. I find that the unemployed are in worse health than employees, and that health reasons are a common cause of job termination. In contrast, I find no causal effect of exogenous job loss on various measures of physical and mental health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality. |
| Keywords: | job displacement, health, unemployment |
| JEL: | I12 J63 |
| Date: | 2009–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp4147&r=hea |
| By: | Haan, Peter (DIW Berlin); Myck, Michal (DIW Berlin) |
| Abstract: | While there is little doubt that the probability of poor health increases with age, and that less healthy people face a more difficult situation on the labour market, the precise relationship between facing the risks of health deterioration and labour market instability is not well understood. Using twelve years of data from the German Socio-Economic Panel we study the nature of the relationship between poor health and non-employment on a sample of German men aged 30-59. We propose to model poor health and non-employment as interrelated risks determined within a dynamic structure conditional on a set of individual characteristics. Applying dynamic panel estimation we identify the mechanism through which poor health contributes to the probability of being jobless and vice versa. We find an important role of unobserved heterogeneity and evidence for correlation in the unobservable characteristics determining the two processes. The results also show strong persistence in the dynamics of poor health and non-employment. |
| Keywords: | health, non-employment, risk, ageing, dynamic panel data |
| JEL: | C33 J21 J14 |
| Date: | 2009–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp4154&r=hea |
| By: | Farasat A.S. Bokhari (Department of Economics, Florida State University); Gary M. Fournier (Department of Economics, Florida State University) |
| Abstract: | In this paper, we exploit a novel approach for instrumenting a differentiated products demand system for therapeutically equivalent drugs. Using unusually detailed sales data on psychostimulant drugs, used to treat Attention Deficit Hyperactivity Disorder (ADHD), we are able to identify and measure substitution patterns across a range of drugs. We find that the demand for ADHD drugs is quite elastic and there are significant substitution possibilities among these drugs, both within the molecule and form, as well as across the segments. In addition, the first-time introduction of a generic drug shows large welfare gains due to expansion of the market to price sensitive consumers. Further, the welfare gains due to the introduction of me-too drugs vary by the novelty of the drug, and for significantly new varieties can be as large as those of the introduction of a generic. Our results bear policy implications for both, the speed with which new drugs are approved for marketing, as well as for actions among pharmaceutical firms that may delay the entry of a generic drug. |
| Keywords: | Differentiated products demand, multistage budgeting, AIDS model, psychostimulant drugs, new introductions, welfare analysis |
| JEL: | I10 I18 L65 L40 L50 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:fsu:wpaper:wp2009_05_01&r=hea |
| By: | Svensson, Mikael (Department of Business, Economics, Statistics and Informatics); Hagquist, Curt (Karlstad University) |
| Abstract: | In this paper adolescent alcohol- and illicit drug-use among 1st and 2nd generation immigrants from Nordic, non-Nordic European and non-European countries were compared with the Swedish majority population. Multilevel logistic regression analysis was performed based on survey data from three different Swedish regions including 24 municipalities sampled in 2005 including 13,070 adolescents. Immigrants from Nordic countries were more likely to use alcohol (OR: 1.10-1.37) while immigrants from non- European countries were less likely to use alcohol (OR: 0.52-0.81), mainly explained by the relatively low use by girls from non-European countries. All immigrant groups were more likely to use illicit-drugs compared to the majority population. Highest drug-use were found among first generation Nordic Immigrants (OR: 3.15-4.17) and non-European immigrants (OR: 2.92-3.13). Consumption patterns among second generation immigrants were more similar to the Swedish majority population, implying more alcohol-use and less illicit drug-use. |
| Keywords: | alcohol; drug use; ethnicity; immigrants; adolescents |
| JEL: | I12 I18 J15 |
| Date: | 2009–05–13 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oruesi:2009_008&r=hea |
| By: | Svensson, Mikael (Department of Business, Economics, Statistics and Informatics) |
| Abstract: | Are adolescents who attend schools with a high level of alcohol use more likely to use alcohol themselves? This paper analyzes peer-effects in adolescent alcohol use based on a survey of 13,337 adolescents in Sweden in 2005. The empirical analysis uses multi-level logistic model to handle non-observable heterogeneity between the schools and the results show that attending a school with a high level of alcohol use is a strong predictor of alcohol use for the individual. However, a positive association is only seen within Swedes and within non-Swedes (1st and 2nd generation immigrants). Between Swedes and non-Swedes there is actually a negative association, i.e. if many Swedes drink in a certain school, alcohol use among non-Swedes is lower (and vice-versa). An exception to these results are schools with a very low share of non-Swedish adolescents, where non-Swedes alcohol use also is positively associated with Swedish peers’ alcohol use. |
| Keywords: | Alcohol use; Adolescents; Peer-effects; Immigrants; Sweden |
| JEL: | D10 I12 |
| Date: | 2009–05–13 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oruesi:2009_007&r=hea |
| By: | Svensson, Mikael (Department of Business, Economics, Statistics and Informatics); Hagquist, Curt (Karlstad University) |
| Abstract: | This paper examines how the unemployment rate is related to adolescent alcohol use during a time period characterized by big societal changes using repeated cross-sectional adolescent survey data from a Swedish region, collected in 1988, 1991, 1995, 1998, 2002 and 2005. Individual level alcohol use is connected to local level unemployment rate to estimate the relationship using multilevel modeling. The results show that the unemployment rate is negatively associated with adolescents alcohol use. When the unemployment rate increases, more adolescents, mainly girls, do not drink at all. Regular drinking (2/month or more) is, on the other hand, unrelated to the unemployment rate. This implies that we may se decreases in adolescent alcohol use in the now expected real economic crisis with increasing unemployment. |
| Keywords: | alcohol use; unemployment rate; multilevel methods; Sweden. |
| JEL: | E32 I12 |
| Date: | 2009–05–13 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oruesi:2009_006&r=hea |
| By: | Norin, Anna (Department of Economics, Umeå University) |
| Abstract: | The aim of the present paper is to empirically estimate the monetary value workers place on safer working conditions. The marginal willingness to pay for workplace safety is estimated using data on job durations together with data on accident risks and wages. The results indicate that individuals value safety to 0.65-4.1 percent of annual wages. Male workers in service occupations are found to have the highest marginal willingness to pay. Female blue-collar workers are found to value workplace safety higher than male blue-collar workers. |
| Keywords: | Search; Accelerated duration; Wage differentials; Sweden |
| JEL: | J17 J28 J31 J81 |
| Date: | 2009–05–11 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:umnees:0771&r=hea |
| By: | Thalberg, Sara (Institute for Futures Studies) |
| Abstract: | <p>This paper examines childbearing behaviour among Swedish students, and mothers’ enrolment in education in the period 1984 to 1999. By means of longitu¬dinal data on individual childbearing and study activity we detect whether the relative propensity of female students to have a child was affected by macro level changes, such as the student financial aid reform in 1989 and the economic recession in the early 1990s. It also investigates whether the dramatic increase in number of students have changed students’ childbearing patterns. Finally, couples’ higher order birth risks are explored, as well as the influence of the parents’ student status and income on their propensity to have another child. <p><p> The results show that the reform in 1989 had no noticeable impact on students’ childbearing behaviour or on mothers’ propensity to enrol in education. The recession seems to have had the same negative effect on students’ childbearing risks as it did on the population in general. Despite the dramatic rise in enrolment the negative effect of being a student on childbearing behaviour is stable over time. Another conclusion is that birth risks among female students differ by age and income; the negative effect of being a student on birth risks is much stronger among younger age groups. Among younger students, the propensity to have a child also seems to be slightly more dependent on level of income. Couple data showed that couples where the mother is a student show a lower propensity to have another child, while – more surprising– couples, where the father is a student, have a much higher propensity to have a second or a third child than other couples. <p> |
| Keywords: | childbearing behaviour; Swedish students; female students; birth risks; parents' student status; financial aid reform |
| JEL: | I12 I22 J12 J13 |
| Date: | 2009–05–13 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:ifswps:2009_006&r=hea |
| By: | Jan Swasthya Abhiyan JSS |
| Abstract: | In this article hard realities of people’s health in India today, and some of the maladies of recent health policies are examined. This is followed by core recommendations to strengthen and reorient the health system so as to ensure quality health care for all. The political parties can include these in their election manifestos for the upcoming general election as a demonstration of their commitment to public health. Jan Swasthya Abhiyan, looks forward to such a commitment from all political forces in the country. |
| Keywords: | political parties, medical education, child, India, china, infant mortality, NFHS, vaccination coverage, health, policies, system, election manifestos, care, |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:ess:wpaper:id:1933&r=hea |
| By: | Petra Brhlikova |
| Abstract: | This paper reassesses the nature of the epidemiological evidence underpinning one of the Global Burden of Disease topics: the estimate for the global burden of depression. Specifically, we look at the quality and representativeness of data on prevalence and incidence of depression used for the 2000 GBD estimates, which stated that neuropsychiatric disorders contribute around 14 per cent to the total disease burden and ranked depression as the fourth major cause of disease burden worldwide. These numbers are often cited to support further research and various initiatives in mental health - the 2001 World Health Report was devoted to mental health and in 2007 the Lancet published a series on Global Mental Health – and potentially divert resources from other health care priorities of developing countries. |
| Keywords: | Global Burden of Disease, GBD, Global Mental Health, world health, epidemiological evidence, resourcees for health care, global burden of depression, Health Studies, pharmaceuticals, drugs |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:ess:wpaper:id:1939&r=hea |
| By: | Del bono E (Institute for Social and Economic Research); Ermisch J (Institute for Social and Economic Research) |
| Abstract: | In this paper we explore the impact of birth weight on childrenÂ’s cognitive and behavioural outcomes using data from the UK Millennium Cohort Study. In order to deal with the endogeneity of birth weight we propose an eliminant estimator, which exploits the availability of multiple outcomes for the same individual at the same point in time. The results show that birth weight has significant but very small effects on male cognitive development at age 3 and on female cognitive and behavioural outcomes at age 3. We also find that birth weight affects age 5 outcomes only through previous achievements, and that the overall impact fades out over time. These findings call into question the effectiveness of birth weight as a policy target. |
| Date: | 2009–05–14 |
| URL: | http://d.repec.org/n?u=RePEc:ese:iserwp:2009-16&r=hea |
| By: | Zeynep Or (IRDES institut for research and information in health economics); Thomas Renaud (IRDES institut for research and information in health economics); Laure Com-Ruelle (IRDES institut for research and information in health economics) |
| Abstract: | Within the framework of its activity-based payment system, introduced in 2005, the French government is now seeking to achieve price convergence between public and private hospitals. This paper questions the economic justification of this convergence by examining the literature on hospital costs variation and analyzing French hospital activity data. The literature on hospital economics identifies many factors which can generate cost differences between hospitals a part from efficiency. These include hospital size and its range of activity, differences in patient characteristics and quality of the care. The results from the literature suggest that DRG prices should be adjusted to take into account these factors, which are not always under the control of public hospitals but which have a direct impact on their costs. In addition, the analysis of French hospital activity indicates a strong partitioning of the type of care provided between the public and private sectors, corresponding to different hospital profiles. Not taking these different profiles into account when setting DRG prices could endanger the capacity of the hospital system to provide necessary care as well as equity of access. |
| Keywords: | DRG, Activity based payment, hospital cost variation, regulation, France. |
| JEL: | H3 H4 L8 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:irh:wpaper:dt25&r=hea |
| By: | Anna Alberini (University of Maryland and Fondazione Eni Enrico Mattei); Stefania Tonin (University IUAV of Venice); Margherita Turvani (University IUAV of Venice) |
| Abstract: | What is the rate at which people discount future lives saved? The answer to this question has important implications when comparing policies on the grounds of cost per life saved, especially in the context of hazardous waste site remediation, where risk reductions may occur at different times, depending on the permanence of the remedy. We estimate this rate by asking a sample of Italian residents to choose between saving 100 lives now and X lives in T years, where both X and T are varied to the respondents. Assuming constant exponential discounting, the responses to these questions imply a rate of time preference for saving lives of 12%. There is little evidence that this rate is systematically associated with observable individual characteristics of the respondent. There is, however, strong evidence that it declines with the time horizon when the lives would be saved, ranging from 16% for T=10 to less than 4% for T³40. We fit a hyperbolic discount model, finding that it yields a similar value of the discount function for T=10 (the shortest horizon we used in the survey), and that it discounts the future less heavily than the regular exponential discounting model for longer time horizon. We apply our estimated discount functions to two alternate remedial plans for a heavily contaminated area in Italy, and find that—due to the high estimated discount rates—the less permanent solution is found to be more cost-effective. |
| Keywords: | Value of a Statistical Life, Latent Risk Reductions, Individual Discount Rates, Rate of Time Preference for Saving Lives, Contaminated Sites, Remediation |
| JEL: | J17 I18 K32 Q51 Q53 |
| Date: | 2009–01 |
| URL: | http://d.repec.org/n?u=RePEc:fem:femwpa:2009.3&r=hea |
| By: | Raghav Gaiha; Vani S. Kulkarni; Manoj K. Pandey; Katsushi S. Imai |
| Abstract: | Despite accelerated growth there is pervasive hunger, child undernutrition and mortality. Our analysis focuses on their determinants. Raising living standards alone will not reduce hunger and undernutrition. Reduction of rural/urban disparities, income inequality, consumer price stabilisation, mothers’ literacy have all roles of varying importance in different nutrition indicators. Somewhat surprisingly, PDS does not have a significant effect on any of them. Generally, child undernutrition and mortality rise with poverty. Our analysis confirms that media exposure triggers public action, and helps avert child undernutrition and mortality. Drastic reduction of economic inequality is in fact key to averting child mortality. |
| Keywords: | Hunger, underweight, child mortality, prices, inequality, literacy, India |
| JEL: | I10 I31 I32 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:pas:asarcc:2009-04&r=hea |
| By: | Natacha Raffin (Centre d'Economie de la Sorbonne - Paris School of Economics) |
| Abstract: | This article aims at investigating the interplay between environmental quality, health and development. We consider an OLG model, where human capital dynamics depend on the current environment, through its impact on children's school attendance. In turn, environmental quality dynamics depend on human capital, through maintenance and pollution. This two-way causality generates a co-evolution of human capital and environmental quality and may induce the emergence of an environmental poverty trap characterized by a low level of human capital and deteriorated environmental quality. Our results are consistent with empirical observation about the existence of Environmental Kuznets Curve. Finally, the model allows for the assessment of an environmental policy that would allow to escape the trap. |
| Keywords: | Education, environmental quality, growth, health. |
| JEL: | D90 H51 I20 Q01 |
| Date: | 2009–04 |
| URL: | http://d.repec.org/n?u=RePEc:mse:cesdoc:09026&r=hea |
| By: | Sule Akkoyunlu (KOF Swiss Economic Institute, ETH Zurich, Switzerland); Frank R. Lichtenberg (Columbia University, Graduate School of Business, New York,); Boriss Siliverstovs (KOF Swiss Economic Institute, ETH Zurich, Switzerland); Peter Zweifel (University of Zürich, Socioeconomic Institute, Zürich,) |
| Abstract: | In this paper, we address the issue of spurious correlation in the production of health in a systematic way. Spurious correlation entails the risk of linking health status to medical (and nonmedical) inputs when no links exist. This note first presents the bounds testing procedure as a method to detect and avoid spurious correlation. It then applies it to a recent contribution by Lichtenberg (2004), which relates longevity in the United States to pharmaceutical innovation and public health care expenditure. The results of the bounds testing procedure show longevity to be linearly related to these two factors. Therefore, the estimates reported by Lichtenberg (2004) cannot be said to be result of spurious correlation, to the contrary, they very likely reflect an effective relationship, at least for the United States. |
| Keywords: | Health, Life expectancy, Innovation, Pharmaceuticals, Health care expenditure, Cointegration |
| JEL: | H51 I12 J18 C22 O33 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:kof:wpskof:09-227&r=hea |
| By: | Johannes Gräb (Georg-August-Universität Göttingen / Germany); Jan Priebe (Georg-August-Universität Göttingen / Germany) |
| Abstract: | Exploiting DHS data from 235 regions in 29 Sub-Saharan Africa countries, we find that the combination of low levels of malnutrition together with dramatically high rates of mortality, encountered in Kenya\'s Lake Victoria territory, is unique for Sub-Saharan Africa. This paper explores the causes of this paradox for the Kenyan context. Our identification strategy consists of two parts. First of all, we apply multilevel regression models to control simultaneously for family and community clustering of the observed malnutrition and mortality outcomes. Secondly, to address unobserved but correlated factors, we exploit information from GIS and malaria databases to construct variables that capture additional components of children\'s geographic, political and cultural environment. Our analysis reveals that beneficial agricultural conditions and feeding practices lead to the observed sound anthropometric outcomes around Lake Victoria. In contrast, high mortality rates rest upon an adverse disease environment (malaria prevalence, water pollution, HIV rates) and a policy neglect (underprovision of health care services). Nonetheless, a significant effect of the local ethnic group, the Luo, on mortality remains. |
| Keywords: | Child mortality, undernutrition, poverty, multilevel modeling, Sub-Saharan Africa |
| JEL: | I10 I30 O12 R12 |
| Date: | 2009–03–26 |
| URL: | http://d.repec.org/n?u=RePEc:got:iaidps:185&r=hea |
| By: | Manolis Galenianos; Rosalie Liccardo Pacula; Nicola Persico |
| Abstract: | A search-theoretic model of the retail market for illegal drugs is developed. Trade occurs in bilateral, potentially long-lived matches between sellers and buyers. Buyers incur search costs when experimenting with a new seller. Moral hazard is present because buyers learn purity only after a trade is made. The model produces testable implications regarding the distribution of purity offered in equilibrium, and the duration of the relationships between buyers and sellers. These predictions are consistent with available data. The effectiveness of different enforcement strategies is evaluated, including some novel ones which leverage the moral hazard present in the market. |
| JEL: | J64 K14 K42 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:14980&r=hea |
| By: | Bisakha Sen; Stephen Mennemeyer; Lisa C. Gary |
| Abstract: | It has long been posited by scientists that we need to have a better understanding in the role that larger contextual factors – like neighborhood quality and the built environment – may have on the nation’s obesity crisis. This paper explores whether maternal perceptions of neighborhood quality affect children’s bodyweight outcomes, and whether racial and ethnic differences in such perceptions may explain any of the hitherto unexplained gap in bodyweight and obesity prevalence among Whites and minorities. The project uses data from the NLSY79 and the CoNLSY datasets. Results indicate that overall neighborhood quality is not significantly related to children’s bodyweight. However, one particular characteristic, namely whether or not the mother believes there is enough police protection in the neighborhood, is related. Lack of police protection has robust and significant effects on the BMI-percentile of the children, though it has less robust effects on the risk of becoming obese per se. Finally, there are differences in perceptions about adequate police protection in their neighborhood between Whites and minorities which remain after controlling for other socio-economic characteristics like maternal education, family income and family structure. However, these differences play a minor role in explaining part of the gap in bodyweight between White and minority children. |
| JEL: | I1 J13 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:14985&r=hea |
| By: | Anne Case; Christina Paxson |
| Abstract: | We document the impact of the AIDS crisis on non-AIDS related health services in fourteen sub-Saharan African countries. Using multiple waves of Demographic and Health Surveys (DHS) for each country, we examine antenatal care, birth deliveries, and rates of immunization for children born between 1988 and 2005. We find deterioration in nearly all of these dimensions of health care over this period. The most recent DHS survey for each country collected data on HIV prevalence, which allows us to examine the association between HIV burden and health care. We find that erosion of health services is highly correlated with increases in AIDS prevalence. Regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions currently shouldering the heaviest burdens have seen the largest erosion in treatment for pregnant women and children. Using semi-parametric techniques, we can date the beginning of the divergence in health services between high and low HIV regions to the mid-1990s. |
| JEL: | I18 O12 O55 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15000&r=hea |
| By: | Robert Sandy; Gilbert Liu; John Ottensmann; Rusty Tchernis; Jeffrey Wilson; O.T. Ford |
| Abstract: | We utilize clinical records of successive visits by children to pediatric clinics in Indianapolis to estimate the effects on their body mass of environmental changes near their homes. We compare results for fixed-residence children with those for cross-sectional data. Our environmental factors are fast food restaurants, supermarkets, parks, trails, and violent crimes, and 13 types of recreational amenities derived from the interpretation of annual aerial photographs. We looked for responses to these factors changing within buffers of 0.1, 0.25, 0.5, and 1 mile. We found that cross-sectional estimates are quite different from the Fixed Effects estimates of the impacts of amenities locating near a child. In cross section nearby fast food restaurants were associated with higher BMI and supermarkets with lower BMI. These results were reversed in the FE estimates. The recreational amenities that appear to lower children’s BMI were fitness areas, kickball diamonds, and volleyball courts. We estimated that locating these amenities near their homes could reduce the weight of an overweight eight-year old boy by 3 to 6 pounds. |
| JEL: | I1 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:14989&r=hea |
| By: | John Cawley; Joshua A. Price |
| Abstract: | Obesity rates in the U.S. have doubled since 1980. Given the medical, social, and financial costs of obesity, a large percentage of Americans are attempting to lose weight at any given time but the vast majority of weight loss attempts fail. Researchers continue to search for safe and effective methods of weight loss, and this paper examines one promising method - offering financial rewards for weight loss. This paper studies data on 2,407 employees in 17 worksites who participated in a year-long worksite health promotion program that offered financial rewards for weight loss. The intervention varied by employer, in some cases offering steady quarterly rewards for weight loss and in other cases requiring participants to post a bond that would be refunded at year’s end conditional on achieving certain weight loss goals. Still others received no financial incentives at all and serve as a control group. We examine the basic patterns of enrollment, attrition, and weight loss in these three groups. Weight loss is modest. After one year, it averages 1.4 pounds for those paid steady quarterly rewards and 3.6 pounds for those who posted a refundable bond, under the assumption that dropouts experienced no weight loss. Year-end attrition is as high as 76.4%, far higher than that for interventions designed and implemented by researchers. |
| JEL: | D01 I1 J01 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:14987&r=hea |
| By: | Nikhil Agarwal; Chanont Banternghansa; Linda Bui |
| Abstract: | We examine the effect of exposure to toxic releases that are tracked by the Toxic Release Inventory (TRI) on county-level infant and fetal mortality rates in the United States between 1989-2002. We find significant adverse effects of TRI concentrations on infant mortality rates, but not on fetal mortality rates. In particular, we estimate that the average county-level decrease in aggregate TRI concentrations saved in excess of 25,000 infant lives from 1989-2002. Using a value of life of $1.8M - $8.7M, the savings in lives would be valued at $45B - $217.5B. We also find that the effect of toxic exposure on health outcomes varies across pollution media: air pollution has a larger impact on health outcomes than either water or land. And, within air pollution, releases of carcinogens are particularly problematic for infant health outcomes. We do not, however, find any significant effect on health outcomes from exposure to two criteria air pollutants – PM10 and ozone. |
| JEL: | I12 Q51 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:14977&r=hea |
| By: | Kerry Anne McGeary |
| Abstract: | We provide the first comprehensive assessment of the effects of state-level nutrition-education program funding on individual-level BMI, the probability of obesity and the probability of above normal weight. We estimate models using pooled cross-sectional data from the Centers for Disease Control’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) and data from the United States Department of Agriculture’s (USDA) funding of state-specific nutrition-education programs from 1992 – 2006. During this period federal funding for state-specific nutrition-education programs rose from $0 to nearly $248 million. We isolate the effect of nutrition-education funding while controlling for demographics, state and year fixed effects. Our results suggest that nutrition-education program funding is associated with reductions in BMI and the probability of an individual having an above normal BMI. Furthermore, we find evidence that the nutrition-education program funding is a complement to education, individuals with a higher level of education will have a larger response to funding than those with lower levels of education. |
| JEL: | I0 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15001&r=hea |
| By: | Robert Kaestner; Michael Grossman; Benjamin Yarnoff |
| Abstract: | In this paper, we investigate the association between weight and adolescent’s educational attainment, as measured by highest grade attended, highest grade completed, and drop out status. Data for the study came from the 1997 cohort of the National Longitudinal Survey of Youth (NLSY), which contains a large, national sample of teens between the ages of 14 and 18. We obtained estimates of the association between weight and educational attainment using several regression model specifications that controlled for a variety of observed characteristics. Our results suggest that, in general, teens that are overweight or obese have levels of attainment that are about the same as teens with average weight. |
| JEL: | I1 I21 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:14994&r=hea |