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on Health Economics |
| By: | Frank J. Infurna; Denis Gerstorf; Nilam Ram; Jürgen Schupp; Gert G. Wagner |
| Abstract: | Perceived control plays an important role in shaping development throughout adulthood and old age. Using data from the adult lifespan sample of the national German Socio-Economic Panel (SOEP; N > 10,000, covering 25 years of measurement), we explored long-term antecedents, correlates, and outcomes of perceived control and examined if associations differ with age. Targeting correlates and antecedents of control, findings indicated that higher concurrent levels of social participation, life satisfaction, and self-rated health as well as more positive changes in social participation over the preceding 11 years were each predictive of between-person differences in perceived control. Targeting health outcomes of control, survival analyses revealed that perceived control predicted 14-year hazard rates for disability (n = 996 became disabled) and mortality (n = 1,382 died). The effect for mortality, but not for disability, was independent of socio-demographic and psychosocial factors. Overall, we found very limited support for age-differential associations. Our results provide further impetus to thoroughly examine processes involved in antecedent-consequent relations among perceived control, facets of social life, well-being, and health. |
| Keywords: | Control, lifespan development, disability, mortality, psychosocial |
| Date: | 2011 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwsop:diw_sp355&r=hea |
| By: | van den Berg, Gerard J. (University of Mannheim); Gupta, Sumedha (Indiana University-Purdue University Indianapolis) |
| Abstract: | This paper analyzes the interplay between early-life conditions and marital status, as determinants of adult mortality. We use individual data from Dutch registers (years 1815-2000), combined with business cycle conditions in childhood as indicators of early-life conditions. The empirical analysis estimates bivariate duration models of marriage and mortality, allowing for unobserved heterogeneity and causal effects. Results show that conditions around birth and school ages are important for marriage and mortality. Men typically enjoy a protective effect of marriage on mortality, whereas women suffer during childbearing ages. Having been born under favorable economic conditions reduces female mortality during childbearing ages. |
| Keywords: | death, longevity, recession, life expectancy, lifetimes, marital status, timing of events, selectivity, health |
| JEL: | I12 J14 E32 N33 N13 C41 |
| Date: | 2011–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp5454&r=hea |
| By: | Isaac Kalonda-Kanyama (Department of Economics, The University of Kansas) |
| Abstract: | This paper estimates the effect of conflict and conflict-related vulnerability factors, namely sexual violence and economic vulnerability, on HIV prevalence rates. We find that HIV prevalence rates are higher in conflict-affected regions of the Democratic Republic of the Congo (DRC) than in non-conflict regions, and that sexual violence and economic vulnerability significantly affect HIV prevalence rates. Specifically we find that (i) HIV prevalence is 1.64 % higher in war-affected zones than elsewhere in the DRC; (ii) the impact of sexual violence in conflict-affected regions is 55 times greater than on average (1.10 % versus 0.02 %); (iii) Civil war and sexual violence jointly increase HIV infection rates by 1.45 %; (iv) Finally, economic conflict-related vulnerability does not explain HIV infection rates. In contrast, a one percent point decrease in the poverty incidence, that is a reduction in economic vulnerability, increases HIV prevalence rates by 0.048 % regardless of the situation of conflict. |
| Keywords: | AIDS, HIV, Civil war, sexual violence, DRC, Sub-Saharan Africa. |
| Date: | 2011–01 |
| URL: | http://d.repec.org/n?u=RePEc:kan:wpaper:201101&r=hea |
| By: | Lyttkens, Carl Hampus (Department of Economics, Lund University) |
| Abstract: | A period of two and a half millennia separates us from the Classical period of ancient Greece. Nevertheless, looking at ancient Greek medicine from the perspective of modern health economics is an interesting endeavour in that it increases our understanding of the ancient world and provides insights into contemporary society. Ancient Greece is rightly famous for pioneering secular and scientific medicine, but equally noteworthy is the prominence of healing cults, such as that of Asklepios. In this paper, the market for secular physicians is illuminated with tools from modern economics, for example the concern for the physician’s reputation. The simultaneous emergence in ancient Greece of a scientific and rational approach to medicine and the proliferation of religious medicine provides an interesting vantage point for a study of the current market for alternative medicine. Similar circumstances arguably lie behind the dual nature of the health market that was present then and is still present now. The underlying mechanism in both periods is hypothesised to be increased uncertainty in everyday life. |
| Keywords: | health; economics; medicine; ancient Greece; alternative |
| JEL: | I11 N33 |
| Date: | 2011–01–28 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2011_007&r=hea |
| By: | Poterba, James M. (NBER); Venti, Steven F. (Dartmouth College); Wise, David A. (Harvard Kennedy School) |
| Abstract: | This paper examines the correlation between poor health and asset accumulation for households in the first nine waves of the Health and Retirement Survey. Rather than enumerating the specific costs of poor health, such as out of pocket medical expenses or lost earnings, we estimate how the evolution of household assets is related to poor health. We construct a simple measure of health status based on the first principal component of HRS survey responses on self-reported health status, diagnoses, ADLs, IADL, and other indicators of underlying health. Our estimates suggest large and substantively important correlations between poor health and asset accumulation. We compare persons in each 1992 asset quintile who were in the top third of the 1992 distribution of latent health with those in the same 1992 asset quintile who were in the bottom third of the latent health distribution. By 2008, those in the top third of the health distribution had accumulated, on average, more than 50 percent more assets than those in the bottom third of the health distribution. This "asset cost of poor health" appears to be larger for persons with substantial 1992 asset balances than for those with lower balances. |
| JEL: | E21 H10 J14 |
| Date: | 2011–01 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:harjfk:rwp11-005&r=hea |
| By: | Götze, Ralf |
| Abstract: | This paper deals with the changing role of the state in the Dutch healthcare system. At the eve of the first oil crisis the Netherlands had a relatively compound healthcare system combining several characteristics of the three Western healthcare system types: National Health Service, social health insurance system, and private health insurance system. Comparative case-studies on OECD countries indicate a hybridization trend from relatively pure to mixed healthcare systems during the era of 'permanent austerity'. The adequate question is therefore, how and why the role of the state has changed in the relatively mixed Dutch social health insurance system. In order to approach this research question in a systematic way, we distinguish between three dimensions of the healthcare system: regulation, financing, and service provision. In the regulation dimension we observe an increasing state influence on coverage by an incremental socialization of the private sector. This progress culminated in 2006 in the merger of sickness funds and private health insurances into a functional social health insurance under private law. Since the early 1980s the state also directly intervened in the corporatist bargaining of providers and insurers in order to contain costs and regain global competiveness. At the beginning of the new millennium tight budgets resulting in long waiting lists were no longer accepted against the background of a booming economy. Instead, the role of competition increased through new opportunities and incentives for selective contracting between insurers and providers. Therefore, we observe a shift from corporatist self-regulation towards state-regulated market competition within the institutional framework of a social health insurance system. This ongoing reform process towards a welfare market for medical goods was supported by the main political parties on the left and right in order to enhance efficiency and safeguard solidarity. -- Gegenstand dieses Papiers ist die veränderte Rolle des Staates im niederländischen Gesundheitssystem. Vor der ersten Ölkrise zeichneten sich die Niederlande durch ein vergleichsweise gemischtes Gesundheitssystem aus, das einzelne Elemente der drei westlichen Gesundheitssystemtypen beinhaltete: Nationaler Gesundheitsdienst, Sozialversicherungssystem und Privatversicherungssystem. Vergleichende politikwissenschaftliche Studien zeigen einen Hybridisierungstrend in der OECD-Welt von eher idealtypischen zu hybriden Gesundheitssystemen seit dem Ende des Goldenen Zeitalters der Wohlfahrtstaaten in den 1970er Jahren. Daraus ergibt sich die Frage, wie sich die Rolle des Staates im bereits zum Ausgangspunkt vergleichsweise gemischten niederländischen Sozialversicherungssystem entwickelt. Zur systematischen Beantwortung dieser Frage wird in diesem Papier zwischen drei Dimensionen eines Gesundheitssystems unterschieden: Regulierung, Finanzierung und Leistungserbringung. In der Regulierung zeigt sich ein deutlicher Anstieg des Staatseinflusses bei der Absicherung durch eine inkrementelle Sozialisierung der Privatversicherung. Dieser Prozess fand 2006 mit der Verschmelzung der gesetzlichen und privaten Krankenversicherung zu einer funktionalen Sozialversicherung auf privater Basis seinen vorläufigen Höhepunkt. Auch in der Interaktion zwischen Versicherern und Leistungserbringern baute der Staat seit Anfang der 1980er Jahre stetig seinen direkten Einfluss aus, um mit einer strikten Kostendämpfung die internationale Wettbewerbsfähigkeit der Niederlande zu verbessern. Zur Jahrtausendwende war die restriktive staatliche Budgetplanung allerdings angesichts steigender Wartezeiten nicht mehr vermittelbar, wodurch verstärkt Möglichkeiten und Anreize für mehr Vertragswettbewerb geschaffen wurden. Damit wurde die für Sozialversicherungssysteme typische korporatistische Selbstverwaltung schrittweise unterhöhlt und durch Elemente eines staatlich regulierten Wettbewerbs ersetzt. Diese sich weiterhin im Prozess befindliche Hinwendung zu einem Wohlfahrtsmarkt für Gesundheitsgüter wurde von den relevanten linken und bürgerlichen Parteien in unterschiedlichen Koalitionen in der Überzeugung mitgetragen, Effizienzpotenziale zu heben und die Solidarität nicht zu gefährden. |
| Date: | 2010 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:sfb597:141&r=hea |
| By: | Ana Balsa; Nestor Gandelman |
| Abstract: | This paper summarizes randomized experiment to study the effects of an Internetbased intervention on type 2 diabetes patients in Montevideo, Uruguay. The intervention consisted of a specially designed website and an electronic social network where participants were able to navigate freely, download materials, and interact with other diabetics and with specialists. No significant impact was found on participants` knowledge, behavior, or health outcomes. It was also found that only a minority of patients logged on to the website, and most were only reached by email and mobile text (SMS). Participation in the website is correlated with patients` characteristics, such as gender, marital status, and education. |
| Keywords: | Randomized trial, Diabetes, Public health, Uruguay |
| JEL: | C93 I1 O31 |
| Date: | 2010–12 |
| URL: | http://d.repec.org/n?u=RePEc:idb:wpaper:4703&r=hea |
| By: | Courtney Harold Van Houtven; Norma B. Coe; Meghan Skira |
| Abstract: | Cross-sectional evidence in the United States finds that informal caregivers have less attachment to the labor force, measured both by the number of hours worked and labor force participation. The causal mechanism is unclear: do children who work less become informal caregivers, or are children who become caregivers working less? Using longitudinal data from the Health and Retirement Study (HRS), this project identifies the relationship between informal care and labor force participation in the United States, both on the intensive and extensive margins, and whether there are wage penalties from informal care. We use our results to examine retirement wealth effects, in particular, changes in Social Security benefits. In our approach we carefully test for endogeneity; control for time invariant individual heterogeneity; and, lastly, explore the effects across key domains of behavior for men and women – stage and duration of care. We find that there are modest decreases – around 2 percentage points – in the likelihood of being in the labor force for caregivers. We find that female caregivers who have longer spells face significant but modest risks of not working, that the negative effect on work for male caregivers occurs right away, and that both male and female caregivers who have ended caregiving are not significantly more likely to work. In addition, wage penalties exist for female caregivers and wage premiums exist for male caregivers. There are minimal expected changes to caregivers’ future Social Security benefits. Finally, despite strong instruments, there is no evidence of endogeneity between informal care and work, suggesting that controlling for individual heterogeneity with fixed effects is a sufficient approach in longitudinal inquiries of informal care’s effect on work and wealth. |
| Date: | 2010–12 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2010-22&r=hea |
| By: | Douglas A. Wolf; Janet M. Wilmoth |
| Abstract: | Past research has shown that income from the Social Security program has contributed to trends towards smaller households, greater residential independence—the tendency to live alone rather than with others—and a greater prevalence of home ownership late in life. However, the mechanism through which these associations operate has remained relatively unstudied. This paper addresses the possibility that Social Security income mediates the consequences of adverse events, whether “health shocks” such as a stroke or hip fracture, or “marital shocks,” principally the death of a spouse. We measure housing consumption using the ratio of dwelling unit size (number of rooms) to number of household members—i.e., “rooms per person.” We use panel data from the Health and Retirement Survey to model current housing consumption in relation to Social Security income as well as the occurrence of health and marital shocks over the two-year period preceding each survey year (1995; 2000; 2002; 2004; and 2006). We also use an instrumental-variables approach to deal with omitted-variables bias in the housing consumption equation, and include an additional control for selective loss from the sample due to entry into a nursing home. We find no effects of Social Security income on housing consumption once we control for selection and endogeneity, a result that contrasts sharply with past research findings. We also fail to find any evidence that Social Security mediates either health or marital shocks. However, we do find that health shocks, and to a lesser extent marital shocks, are strongly associated with both nursing home entry and changes in housing consumption. |
| Date: | 2010–09 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2010-9&r=hea |
| By: | Perry Singleton |
| Abstract: | The onset of a work-limiting disability coincides with an immediate decline in earnings with little recovery. This study examines whether this relationship is attributable to the labor disincentives of disability insurance. The data come from the Survey of Income and Program Participation linked to administrative data from the Social Security Administration. The analysis suggests that disability insurance accounts for little of the initial drop in earnings at the time of disability onset, but its effect may increase as time since disability onset elapses. The results highlight the advantages of immediate, though temporary disability benefits. |
| Date: | 2010–11 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2010-18&r=hea |
| By: | Norma B. Coe; Kelly Haverstick |
| Abstract: | The increase in the full retirement age in the Social Security program provides exogenous variation in the generosity in the Social Security Disability Insurance (SSDI) program, based only on birth year. We exploit this variation to estimate how responsive SSDI applications are to the financial incentive to apply. We find that a 1-percentage-point decrease in the retirement-to-disability benefit ratio leads to a 0.25-percentage-point increase in the SSDI application rate for the sample, which represents an 8-percent increase in applications per two years. When weighted to account for sampling design, we estimate that this change in the financial incentive accounted for about 5 percent of the SSDI applications in 2009. However, we do not find a corresponding increase in SSDI receipt based on the financial incentives. In addition, we find little difference in the covariates for individuals who eventually receive SSDI, suggesting that the increase in applications may increase the administrative costs of the SSDI program, but should not have a dramatic impact on the long-term financial solvency of the program. |
| Date: | 2010–12 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2010-20&r=hea |
| By: | Mariacristina De Nardi (Federal Reserve Bank of Chicago and NBER); Eric French (Federal Reserve Bank of Chicago); John Bailey Jones (University at Albany, SUNY) |
| Abstract: | We study a model in which retired single people optimally choose consumption, medical spending and saving while facing uncertainty about their health, lifespan and medical needs. This uncertainty is partially offset by insurance provided by the government and private institutions. We first show how well the model matches important features of the data and we analyze the degree of insurance provided by current programs. We then analyze the effects of some reforms, meant to capture changes in Medicaid and Medicare, on savings and medical expenditures. |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp236&r=hea |
| By: | John Bound (University of Michigan and National Bureau of Economic Research); Stephan Lindner (University of Michigan); Timothy Waidmann (Urban Institute) |
| Abstract: | Over the last 25 years the Social Security Disability Insurance Program (DI) has grown dramatically. During the same period of time employment rates for men with work limitations showed substantial declines in both absolute and relative terms. While the timing of these trends suggests that the expansion of DI was a major contributor to employment decline and raises questions about the targeting of disability benefits, studies using denied applicants suggest a more modest role for DI expansion. In order to reconcile these findings, we decompose total employment changes into population and employment changes for three categories: DI beneficiaries, denied applicants and non-applicants. Our results show that during the early 1990s, the growth in DI can fully explain the employment decline for men only under an extreme assumption about the employment potential of beneficiaries. For the period after the mid-1990s, we find little role for the DI program in explaining the continuing employment decline for men with work limitations. |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp239&r=hea |
| By: | Suzanne Bianchi (University of California, Los Angeles); Kathleen McGarry (University of California, Los Angeles and NBER); Judith Seltzer (University of California, Los Angeles) |
| Abstract: | Perhaps the largest problem confronting our aging population is the rising cost of health care, particularly the costs borne by Medicare and Medicaid. A chief component of this expense is long-term care. Much of this care for an unmarried (mostly widowed) mother is currently provided by adult children. The provision of family care depends importantly on the geographic dispersion of family members. In this study we provide preliminary evidence on the geographic dispersion of adult children and their older unmarried mother. Coresidence is less likely for married adult children, those who are parents and the highly educated and more likely for those who are not working or only employed part time and for black and Hispanic adult children. Close proximity is more common for married children who are parents but less common for the highly educated. When we look at transitions between one wave of data collection and the next (a 2-year interval), about half of adult children live more than 10 miles away at both points, a little less than one quarter live within 10 miles at both points, and 8 percent are coresident at both points in time. Among the 17 percent who make a transition, about half of the changes result in greater distance between the adult child and mother and half bring them into closer proximity. The needs of both generations are likely reflected in these transitions. In fact, a mother’s health is not strongly related to most transitions and if anything, distance tends to be greater for older mothers relative to those mothers in their early 50s. |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp234&r=hea |
| By: | Jody Schimmel (Mathematica); David C. Stapleton (Mathematica) |
| Abstract: | Many proposals designed to reduce federal budget deficits include retirement policy reforms that would delay workers’ access to retirement benefits or reduce the value of benefits to those who retire early. Such reforms would have adverse consequences for the economic well-being of older workers with health-related work limitations. In this paper, we explore a set of policy options that take a "work-support" approach-an earned income tax credit (EITC), an employment services allowance, and a health insurance subsidydesigned to encourage and help workers continue to work if they can. To arrive at a population that might be eligible for such benefits, we first develop a straightforward model to predict the likelihood that a worker reporting a health-related work limitation would experience economic hardship as a result. The model bounds the target population by excluding those who are not expected to experience financial hardship from earnings loss due to a health-related work limitation. It also demonstrates an approach to eligibility determination that would discourage gaming and support rapid eligibility determination-critical for a program designed to extend employment and prevent financial hardship. Using conservative assumptions about program costs, our most expensive program would have a per capita cost of $14,600, or $11,300 if the health insurance subsidy is viewed as an ACA cost. This can be compared to estimated mean annual benefits of $14,855 in 2009 for Social Security Disability Insurance (SSDI) beneficiaries age 50 and older, plus $11,000 per year for Medicare after the 24-month waiting period. Because of its more favorable work incentives, a work-support program is likely to reduce hardship more than a program that preserves existing benefits for the same workers at comparable cost and is likely to be no more difficult to administer. |
| Date: | 2010–12 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp244&r=hea |
| By: | John Karl Scholz (University of Wisconsin-Madison); Ananth Seshadri (University of Wisconsin-Madison) |
| Abstract: | This paper presents a preliminary model of health investments over the life cycle. Health affects both longevity and provides flow utility. We analyze the interplay between consumption choices and investments in health by solving each household’s dynamic optimization problem to obtain predictions on health investments and consumption choices over the lifecycle. Our preliminary model does a good job of matching the distribution of medical expenses across households in the sample. We illustrate the scope of future model applications by examining the effects of a stylized Medicare program on patterns of wealth and mortality. |
| Date: | 2010–09 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp224&r=hea |
| By: | Michael D. Hurd (RAND and NBER); Susann Rohwedder (RAND) |
| Abstract: | After retirement, the primary sources of uncertainty with respect to an individual’s economic status are longevity, investment outcomes and out-of-pocket spending on health care. In previous work, we estimated economic preparation for retirement, taking into account the risk of living to an advanced old age and the concomitant risk of running out of resources. But while we accounted for the average level out-of-pocket spending for health care, we did not account for the risk of out-of-pocket spending. In this paper we augment our model for this omission. We find that the risk of out-of-pocket health care spending reduces economic preparation for retirement from about 72% of persons in the age range 65-69 to about 63%. However, this relatively modest reduction is quite unequally distributed: about 57% of single persons are adequately prepared when health care spending is not stochastic, but just 44% when it is. Among single women who are not high school graduates the percentage adequately prepared declines from 33% to 15%. |
| Date: | 2010–09 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp232&r=hea |
| By: | Nicole Maestas (RAND); Kathleen Mullen (RAND); Alexander Strand (Social Security Administration) |
| Abstract: | We present the first estimates of the causal effect of SSDI receipt on the labor supply generalizable to the entire population of program entrants in the present day system. We take advantage of a unique workload management database to match Social Security Disability Insurance (SSDI) applicants to disability examiners, and use natural variation in examiners’ allowance rates to estimate the labor supply effects of SSDI. Because applicants are randomly assigned to examiners (conditional on observable characteristics), examiner-specific allowance rates can be used to instrument for the allowance decision in a labor supply equation contrasting denied vs. allowed applicants. We find that the labor force participation rate of the marginal entrant would be on average 21 percentage points greater in the absence of SSDI benefit receipt. His or her likelihood of engaging in substantial gainful activity as defined by the SSDI program would be on average 13 percentage points higher, and he or she would earn $1,600 to $2,600 more per year on average in the absence of SSDI benefit receipt. The marginal entrant is likely to have a mental impairment, be young, and have low pre-onset earnings. Importantly, the disincentive effect varies across individuals with impairments of different degrees of unobservable severity, ranging from a low of 10 percentage points for those with more severe impairments to a high of 60 percentage points for entrants with relatively less severe impairments. |
| Date: | 2010–12 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp241&r=hea |
| By: | Hanming Fang (University of Pennsylvania); Lauren Nicholas (University of Michigan); Daniel Silverman (University of Michigan) |
| Abstract: | Prior research indicates that retirees with less cognitive ability are at greater financial risk because they have lower incomes yet higher medical expenditures. Linking HRS data to administrative records, we evaluate two hypotheses about why this group spends more on health: (1) they are in worse health; (2) they receive more expensive or less effective care for the same conditions. We find that the bulk, but not all, of the cross-sectional relationship can be attributed to the poorer health of those with lower cognitive functioning. Much of this relationship appears to be driven by coincident declines in cognitive ability and health. While, in this respect, the data have important limitations, we find no evidence of substantial differences in care, conditional on observable health. |
| Date: | 2010–09 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp230&r=hea |