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on Health Economics |
| By: | Delaney, Liam (University College Dublin); Fernihough, Alan (University College Dublin); Smith, James P. (RAND) |
| Abstract: | The Irish-born population in England is in worse health than both the native population and the Irish population in Ireland, a reversal of the commonly observed healthy migrant effect. Recent birth-cohorts living in England and born in Ireland, however, are healthier than the English population. The substantial Irish health penalty arises principally for cohorts born between 1920 and 1960. This paper attempts to understand the processes that generated this migrant health pattern. Our results suggest a strong role for early childhood conditions and economic selection in driving the dynamics of health differences between the Irish-born migrants and White English populations. |
| Keywords: | healthy migrants, mental health, migrant selectivity |
| JEL: | J60 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp5852&r=hea |
| By: | Haan, Peter (DIW Berlin); Prowse, Victoria L. (Cornell University) |
| Abstract: | How can public pension systems be reformed to ensure fiscal stability in the face of increasing life expectancy? To address this pressing open question in public finance, we estimate a life-cycle model in which the optimal employment, retirement and consumption decisions of forward-looking individuals depend, inter alia, on life expectancy and the design of the public pension system. We calculate that, in the case of Germany, the fiscal consequences of the 6.4 year increase in age 65 life expectancy anticipated to occur over the 40 years that separate the 1942 and 1982 birth cohorts can be offset by either an increase of 4.34 years in the full pensionable age or a cut of 37.7% in the per-year value of public pension benefits. Of these two distinct policy approaches to coping with the fiscal consequences of improving longevity, increasing the full pensionable age generates the largest responses in labor supply and retirement behavior. |
| Keywords: | life expectancy, public pension reform, retirement, employment, life-cycle models, consumption, tax and transfer system |
| JEL: | D91 J11 J22 J26 J64 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp5858&r=hea |
| By: | Datta Gupta, Nabanita (Aarhus School of Business); Simonsen, Marianne (University of Aarhus) |
| Abstract: | This paper investigates pre-teenage effects of the choice of type of non-parental child care at age three (preschool relative to more informal family day care). We exploit a Danish panel data child survey merged with administrative records along with a pseudo-experiment that generates variation in the take-up of preschool across municipalities. As outcomes, we consider measures of overall and risky behavior in addition to objective and self-evaluated abilities. We find no strong evidence that one type of non-parental care outperforms the other, though children who have been placed in preschool tend to like school better. |
| Keywords: | child care, skills, risky behaviors, evaluation |
| JEL: | J13 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp5848&r=hea |
| By: | Drydakis, Nick (University of Patras) |
| Abstract: | By utilizing the 2008 Athens Area Study (AAS) data set, this study investigates four aspects of job satisfaction – total pay, promotion prospects, respect received from one’s supervisor, and total job satisfaction – between healthy and heath-impaired employees. Health impaired employees are found to be less satisfied according to all job satisfaction measures even when a large number of productivity features, and job characteristics are controlled for. The outcomes suggest also that women are more satisfied with their jobs than men are, regardless of health status. Moreover, the estimations show that health impaired employees' job satisfaction is affected more than healthy employees' job satisfaction by adverse mental health symptoms (life dissatisfaction). Finally, health impaired employees are found to become more satisfied with their jobs with time after disability onset. The study concludes that health impaired employees may have higher expectations about what they will obtain from their work, and that they may have job satisfaction adjustments. |
| Keywords: | two-step quasi-likelihood exogeneity test, health impairments, job satisfaction, ordered probit model, switching regression model |
| JEL: | J10 J28 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp5849&r=hea |
| By: | Liu, Hong (Central University of Finance and Economics); Zhao, Zhong (Renmin University of China) |
| Abstract: | Beginning in the mid 1990s, China sped up its urban labor market reform and drastically restructured its state-owned enterprises (SOEs), which resulted in massive layoff of the SOEs' workers and a high unemployment rate. In this paper, we investigate the impact of the parents’ job loss on the health of their children, using six waves of the China Health and Nutrition Survey covering the period from 1991 to 2006. We find that paternal job loss has a significant negative effect on children's health, whilst maternal job loss has no significant effect. The rationale behind the findings is that the income loss resulting from maternal job loss is much smaller; at the same time, the unemployed mothers are likely to increase the time they devote to care of their children, and this may alleviate the negative effect resulting from maternal job loss. Our findings are robust to various specifications. |
| Keywords: | children’s health, job loss, Grossman’s model, China |
| JEL: | I12 J63 N35 J13 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp5846&r=hea |
| By: | Ours, J.C. van; Williams, J. (Tilburg University, Center for Economic Research) |
| Abstract: | This paper investigates whether cannabis use aects physical and mental health. To do so, information on prime aged individuals living in Amsterdam in 1994 is used. Dutch data offer a clear advantage in estimating the health impacts of cannabis use because the legal status of cannabis in the Netherlands ensures that estimates are free from confounding with the physical and psychological effects of engaging in a criminal activity. Accounting for selection into cannabis use and shared frailties in mental and physical health, the results suggest that cannabis use reduces the mental wellbeing of men and women and the physical wellbeing of men. Although statistically significant, the magnitude of the effect of using cannabis on mental and physical health is found to be small. |
| Keywords: | cannabis use;physical health;mental health;duration models. |
| JEL: | C41 D12 I19 |
| Date: | 2011 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:kubcen:2011079&r=hea |
| By: | J.S. Cramer (University of Amsterdam) |
| Abstract: | The Brabant Data Set, now freely accessible, contains information on a sample cohort of 3,000 individuals born around 1940 from surveys in 1952, 1983 and 1993, as well as on deaths between 1994 and 2009. In line with numerous epidemiological studies we find that among the early variables recorded at age 12 the only significant determinant of adult mortality is intelligence. Preliminary attempts to trace this effect in the later surveys are not successful. |
| Keywords: | IQ; mortality |
| JEL: | I12 |
| Date: | 2011–07–19 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:uvatin:20110097&r=hea |
| By: | J.S. Cramer (University of Amsterdam) |
| Abstract: | This technical note consists of three parts. The first describes the origins of the Brabant data set, the later surveys and the mortality data. The second section discusses the variation of mortality rates with age in the population and in the sample. The third section sets out the proportional hazard model that has been used in the analysis and its estimation. |
| Keywords: | IQ; mortality |
| JEL: | I12 |
| Date: | 2011–07–19 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:uvatin:20110098&r=hea |
| By: | Taylor, Mark P.; Jenkins, Stephen P.; Sacker, Amanda |
| Abstract: | We examine whether financial capability has impacts on psychological health independent of income and financial resources more generally using a nationally representative survey. British Household Panel Survey data are used to construct a measure of financial capability, which we relate to respondents psychological health using the 12-item General Health Questionnaire. We find that financial capability has significant and substantial effects on psychological health over and above those associated with income and material wellbeing more generally. The sizes of these impacts are considerably larger than those associated with changes in household income. Furthermore having low financial capability exacerbates the psychological costs associated with unemployment and divorce. |
| Date: | 2011–07–22 |
| URL: | http://d.repec.org/n?u=RePEc:ese:iserwp:2011-18&r=hea |
| By: | Carlo Favero; Marco Giacoletti |
| Abstract: | In this paper we propose a model to forecast future mortality that includes information on the limits to life and on progress in medicine. We apply the model to forecasting future mortality and survival rates for the males population in England andWales. Our proposal extends the benchmark stochastic mortality model along two dimensions. First, we try and deal explicitly with tail risk in the cross-sectional estimation. by including information about the "limit to life" in the sample used to construct factors for the cross-sectional dimension of mortality rates. Second, we propose to substitute the usual stochastic trend model adopted for the time series of risk factors with a predictive framework based on available evidence on medical progress and causes of death. The model projects very little variability for limits to life over the next ten years and predicts that in 2020 the probability that an individual age 65 will survive until 85 is 20% with an upper bound of 23% and a lower bound of 17%. |
| Date: | 2011 |
| URL: | http://d.repec.org/n?u=RePEc:igi:igierp:406&r=hea |
| By: | David Johnston; Carol Propper; Stephen Pudney (Institute for Fiscal Studies and Institute for Social and Economic Research); Michael Shields |
| Abstract: | <p>We examine the effect of survey measurement error on the empirical relationship between child mental health and personal and family characteristics, and between child mental health and educational progress. Our contribution is to use unique UK survey data that contains (potentially biased) assessments of each child's mental state from three observers (parent, teacher and child), together with expert (quasi-) diagnoses, using an assumption of optimal diagnostic behaviour to adjust for reporting bias. We use three alternative restrictions to identify the effect of mental disorders on educational progress. Maternal education and mental health, family income, and major adverse life events, are all significant in explaining child mental health, and child mental health is found to have a large influence on educational progress. Our preferred estimate is that a 1-standard deviation reduction in 'true' latent child mental health leads to a 2-5 months loss in educational progress. We also find a strong tendency for observers to understate the problems of older children and adolescents compared to expert diagnosis.</p> |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:ifs:cemmap:27/11&r=hea |
| By: | Mario Schnalzenberger (Department of Economics, Johannes Kepler University Linz, Austria) |
| Abstract: | I investigate the effect of income on mortality of the pensioners, com- paring three subsequent policy periods in Austria. The pensioners who retired in the second period received 25% lower pension than those in the first period. This reduction in income was removed in the third policy period. These two reforms allow a causal identification of the effect of in- come on health. I estimate that lower pension did not change the mortality rate. The results are confirmed using both experiments and different meth- ods of estimation. Furthermore, with regard to the expenditure on health services, I get that only prescribed drug consumption increased, with the remaining analyzed factors being unaffected. |
| Keywords: | Income, Mortality, Health, Expenditure |
| JEL: | I12 J14 H55 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:jku:econwp:2011_09&r=hea |
| By: | Gijs Roelofs; Daniel van Vuuren |
| Abstract: | <p>In this paper, we assess spillover effects of Social Assistance (SA) decentralization in the Netherlands, in particular towards (a centrally administered) Disability Insurance scheme (DI). DI enrolment has increased strongly since the decentralization of SA. </p><p>Many economists and policymakers believe that fiscal decentralization, the decentralization of government expenditures to local governments, enhances public sector efficiency. Vertical externalities – i.e. spillovers between local and central government – may however undo part of this advantage. In this paper, we assess spillover effects of Social Assistance (SA) decentralization in the Netherlands, in particular towards (a centrally administered) Disability Insurance scheme (DI). DI enrolment strongly increased since the decentralization of SA. We find that the sensitivity of local DI enrolment with respect to the stock of local SA recipients has increased over time, given that we control for both observed and unobserved disability risk factors. IV estimates show that, since the decentralization of SA, at least one third of DI inflow was diverted from SA.</p> |
| JEL: | H40 H53 H70 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpb:discus:185&r=hea |
| By: | Abe Dunn (Bureau of Economic Analysis) |
| Abstract: | The pharmaceutical industry is characterized as having substantial investment in R&D and a large number of new product introductions, which poses special problems for price measurement caused by the quality of drug products changing over time. This paper applies recent demand estimation techniques to construct a constant- quality price index for anti-cholesterol drugs. Demand is estimated using a nationally representative sample of individuals over the period 1996 to 2007 that includes detailed information on individual health conditions, demographics, insurance, and prescription drug choices. Although the average price for anti-cholesterol drugs does not change over the sample period, I .nd that the constant-quality price index drops by 22 percent, a pace more in line with our expectations in such a dynamic segment of the industry. This result is robust to a number of alternative assumptions, highlighting the importance of controlling for quality in markets with signi.cant innovation. The demand estimates also reveal that the bene.ts from new innovations depend on the health conditions of individuals which may impact quality-adjusted prices for di¤erent populations. |
| JEL: | E60 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:bea:wpaper:0057&r=hea |
| By: | Micah Hartman; Robert Kornfeld; Aaron Catlin (Bureau of Economic Analysis) |
| Abstract: | This paper provides a most detailed reconciliation to date of the National Health Expenditure Accounts (NHEA), the official estimates of health care spending in the United States from the Centers for Medicare and Medicaid Services (CMS), and the estimates of health expenditures that are part of gross domestic product (GDP) produced by the Bureau of Economic Analysis (BEA) as part of the national income and product accounts (NIPAs). For the period from 1997-2008, the estimates of total national health spending in the NHEA and in the GDP data are relatively similar, differing by less than 2 percent annually. Well over 90 percent of the total estimated expenditures in the two accounts appear to consist of the same expenditures. The differences in the estimates of expenditures for specific categories of health care – physician services, hospitals, drugs, health insurance, investment in equipment, and government programs – are, however, proportionately larger. The differences in the estimates of spending for specific categories of health care partly reflect differences in the way CMS and BEA classify certain healthrelated expenditures that are included in both accounts. The differences in the two estimates of health care spending also reflect some differences in the composition of health care spending in the two accounts, the use of some different estimation methods, and the use of some different data sources. |
| JEL: | E60 |
| Date: | 2010–09 |
| URL: | http://d.repec.org/n?u=RePEc:bea:wpaper:0060&r=hea |
| By: | Ana Aizcorbe; Ralph Bradley; Ryan Greenaway-McGrevy; Brad Herauf; Richard Kane; Eli Liebman; Sarah Pack; Lyubov Rozental (Bureau of Economic Analysis) |
| Abstract: | Spending on medical care is a large and growing component of GDP. There are wellknown measurement problems that are estimated to overstate inflation and understate real growth for this sector by as much as 1-1/2 percentage points per year. Because of its size, this would translate into an overstatement of inflation for the overall economy of about ¼ percentage point with an equal understatement in real GDP growth. In this paper, we use data from the Medical Expenditure Panel Survey to obtain new, more comprehensive estimates for this bias and to explore a possible adjustment to existing official price indexes. The MEPS data show an upward bias to price growth in this sector of 1 percentage point, which translates into an overstatement of overall inflation of .2 percentage point and an understatement of GDP growth of the same amount. We also find that an adjustment recently used in Bradley et al provides a useful approximation to the indexes advocated by health economists. |
| JEL: | E60 |
| Date: | 2011–02 |
| URL: | http://d.repec.org/n?u=RePEc:bea:wpaper:0069&r=hea |
| By: | Abe Dunn (Bureau of Economic Analysis) |
| Abstract: | This paper examines the impact of coverage on demand for health insurance in the Medicare Advantage (MA) insurance market. Estimating the e¤ects of coverage on demand poses a challenge for researchers who must must consider both the hundreds of bene.ts that a¤ect out-of-pocket costs (OOPC) to consumers, but also the endogeneity of coverage. These problems are addressed in a discrete choice demand model by employing a unique measure of OOPC that considers a consumer.s expected payments for a .xed bundle of health services and applying instrumental variable techniques to address potential endogneity bias. The results of the demand model show that OOPC have a signi.cant e¤ect on consumer surplus and that not instrumenting for OOPC results in a signi.cant underestimate of the value of coverage. |
| JEL: | E60 |
| Date: | 2010–09 |
| URL: | http://d.repec.org/n?u=RePEc:bea:wpaper:0061&r=hea |
| By: | Abe Dunn; Eli Liebman; Sarah Pack; Adam Shapiro (Bureau of Economic Analysis) |
| Abstract: | In recent years, healthcare service utilization has undergone several shifts, having potentially important implications for the cost of medical care. |
| JEL: | E60 |
| Date: | 2010–09 |
| URL: | http://d.repec.org/n?u=RePEc:bea:wpaper:0055&r=hea |
| By: | Fiorillo, Damiano; Sabatini, Fabio |
| Abstract: | This paper presents the first empirical assessment of the causal relationship between social capital and health in Italy. The analysis draws on the 2000 wave of the Multipurpose Survey on Household conducted by the Italian Institute of Statistics on a representative sample of the population (n = 50,618). Our measure of social capital is the frequency of meetings with friends. Based on probit and instrumental variables estimates, we find that higher levels of social capital increase perceived good health. |
| Keywords: | health; instrumental variables; income; social interactions; social capital; Italy |
| JEL: | I12 H51 I19 Z13 I10 |
| Date: | 2011–07–22 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:32367&r=hea |
| By: | Anneke Exterkate; Robin L. Lumsdaine |
| Abstract: | This paper considers the role of survey design and question phrasing in evaluating the subjective health assessment responses using the Survey of Health, Ageing and Retirement in Europe (SHARE) dataset. A unique feature of this dataset is that respondents were twice asked during the survey to evaluate their health on a five-point scale, using two different sets of descriptors to define the five points, with the ordering of which set was first given determined randomly. We find no evidence to refute the assertion that the order was determined by random assignment. Yet we document differences in the response distributions between the two questions, as well as differences in inference in comparing the two populations (those that were asked one question first versus those that were asked the other). We then consider determinants of the degree of concordance between the two questions, as well as the determinants of individuals that provide conflicting responses. There appears to be evidence to suggest that individuals’ assessments of their health in response to the second question may be influenced by the battery of health questions that were asked following the first assessment. We find that information in self-assessed health responses is useful in examining health outcomes. Our results suggest that adjusting such responses to take into account framing and sequencing of questions may improve inference. In addition, we show that accounting for survey design may be important in models for predicting outcomes of interest, such as the probability of a major health event. |
| JEL: | D84 I1 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17244&r=hea |
| By: | Jean M. Abraham; Anne Beeson Royalty; Thomas DeLeire |
| Abstract: | We develop an empirical method to assess the generosity of employer-sponsored insurance across groups within the U.S. population. A key feature of this method is its simplicity – it only requires data on out-of-pocket (OOP) health care spending and total health care spending and does not require detailed knowledge of health insurance benefit design. We apply our method to assess whether households with a chronically ill member have more or less generous insurance relative to households with no chronically ill members. We find that the chronically ill have less generous insurance coverage than the non-chronically ill. Additional analyses suggest that the reason for this less generous coverage is not that households with a chronically ill member are in different, less generous plans, on average. Rather, households with a chronically ill member have higher spending on certain types of medical services (e.g., pharmaceutical drugs) that are covered less generously by insurance. Given recent work on value-based insurance design and coinsurance as an obstacle to medication adherence, our findings suggest that the current design of health plans may put the health and financial well-being of the chronically ill at risk. |
| JEL: | I1 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17232&r=hea |
| By: | Martin Gaynor; Robert J. Town |
| Abstract: | This paper reviews the literature devoted to studying markets for health care services and health insurance. There has been tremendous growth and progress in this field. A tremendous amount of new research has been done in this area over the last 10 years. In addition, there has been increasing development and use of frontier industrial organization methods. We begin by examining research on the determinants of market structure, considering both static and dynamic models. We then model the strategic determination of prices between health insurers and providers where insurers market their products to consumers based, in part, on the quality and breadth of their provider network. We then review the large empirical literature on the strategic determination of hospital prices through the lens of this model. Variation in the quality of health care clearly can have large welfare consequences. We therefore also describe the theoretical and empirical literature on the impact of market structure on quality of health care. The paper then moves on to consider competition in health insurance markets and physician services markets. We conclude by considering vertical restraints and monopsony power. |
| JEL: | I11 I18 L10 L13 L30 L40 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17208&r=hea |
| By: | Mark Duggan; Tamara Hayford |
| Abstract: | From 1991 to 2003, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 58 percent. This increase was largely driven by state and local mandates that required most Medicaid recipients to enroll in an MMC plan. Theoretically, it is ambiguous whether the shift from fee-for-service into managed care would lead to an increase or a reduction in Medicaid spending. This paper investigates this effect using a data set on state and local level MMC mandates and detailed data from CMS on state Medicaid expenditures. The findings suggest that shifting Medicaid recipients from fee-for-service into MMC did not reduce Medicaid spending in the typical state. However, the effects of the shift varied significantly across states as a function of the generosity of the state’s baseline Medicaid provider reimbursement rates. These results are consistent with recent research on managed care among the privately insured, which finds that HMOs and other forms of managed care achieve their savings largely through reduced prices rather than lower quantities. |
| JEL: | H51 H72 I11 I18 L33 |
| Date: | 2011–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17236&r=hea |