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on Health Economics |
| By: | Friedrich Breyer; Normann Lorenz; Thomas Niebel |
| Abstract: | It is still an open question whether increasing life expectancy as such is causing higher health care expenditures (HCE) in a population. According to the "red herring" hypothesis, the positive correlation between age and HCE is exclusively due to the fact that mortality rises with age and a large share of HCE is caused by proximity to death. As a consequence, rising longevity - through falling mortality rates - may even reduce HCE. However, a weakness of previous empirical studies is that they use cross-sectional evidence to make inferences on a development over time. In this paper we analyse the impact of rising longevity on the trend of HCE over time by using data for a pseudo-panel of German sickness fund members over the period 1997-2009. Using (dynamic) panel data models, we find that age, mortality and five-year survival rates have a positive impact on per-capita HCE. Our explanation for the last finding is that physicians treat patients more aggressively if they think the result will pay off for a longer time span, which we call "Eubie Blake effect". A simulation on the basis of an official population forecast for Germany is used to isolate the effect of demographic ageing on real per-capita HCE over the next decades. |
| Keywords: | Health care expenditures, ageing, longevity, 5-year survival rate |
| JEL: | H51 J11 I19 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwwpp:dp1226&r=hea |
| By: | Hippolyte D'Albis (EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris, CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon Sorbonne); Emmanuel Thibault (Toulouse School of Economics - TSE, CDED - Université de Perpignan, IDEI - Université Toulouse I Capitole) |
| Abstract: | In this paper, ambiguity aversion to uncertain survival probabilities is introduced in a life-cycle model with a bequest motive to study the optimal demand for annuities. Provided that annuities return is sufficiently large, and notably when it is fair, positive annuitization is known to be optimal strategy of ambiguity neutral individuals. Conversely, we show that the demand for annuities decreases with ambiguity aversion and that there exists a finite degree of aversion above which the demand is non positive : the optimal strategy is then to either sell annuities short or to hold zero annuities if the former option is not available. To conclude, ambiguity aversion appears as a relevant candidate for explaining the annuity puzzle. |
| Keywords: | Demand for annuities; uncertain survival probabilities; ambiguity aversion |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:hal:cesptp:halshs-00721281&r=hea |
| By: | Michael Kuhn; Klaus Prettner |
| Abstract: | We consider an endogenous growth model with Blanchard-Yaari-type overlapping generations that is built around four sectors: final and intermediate goods production, an R&D sector and a health care sector. Health care serves to lower mortality and morbidity, the latter being related to participation/productivity in the labor market. We show that, regardless of its finance, the impact of health care on economic growth crucially depends on whether or not it increases employment in the R&D sector. Even if an increasing health care sector reduces the (effective) labor available for production and R&D, it may still fuel R&D employment and economic growth if the increase in aggregate wealth that comes with expanding longevity raises the capital intensity in the final goods sector to an extent that labor shifts to alternative employment in R&D. While numerical assessment indicates that the health sectors of the Euro area economies are too large from a growth perspective, we can establish mild conditions under which an expansion of health care beyond the growth-maximizing level constitutes a Pareto-improvement. |
| Keywords: | Endogenous growth, mortality, (Blanchard) overlapping generations, health care, research and development, sectoral composition |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:vid:wpaper:1206&r=hea |
| By: | Timothy W. Guinnane (Economics Department, Yale University); Jochen Streb (University of Mannheim) |
| Abstract: | The German government introduced compulsory accident insurance for industrial firms in 1884. This insurance scheme was one of the main pillars of Bismarck’s famous social insurance system. The accident-insurance system achieved only one of its intended goals: it successfully compensated workers and their survivors for losses due to accidents. The accident-insurance system was less successful in limiting the growth of work-related accidents, although that goal had been a reason for the system’s creation. We trace the failure to stem the growth of accidents to faulty incentives built into the 1884 legislation. The law created mutual insurance groups that used an experience-rating system that stressed group rather than firm experience, leaving firms with little hope of saving on insurance contributions by improving the safety of their own plants. The government regulator increasingly stressed the imposition of safety rules that would force all firms to adopt certain safety practices. Econometric analysis shows that even the flawed tools available to the insurance groups were powerful, and that more consistent use would have reduced industrial accidents earlier and more extensively. |
| Keywords: | Social insurance, accident insurance, workman’s compensation, regulation |
| JEL: | N33 G22 H55 |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:egc:wpaper:1013&r=hea |
| By: | Steven F. Koch |
| Abstract: | The impact of the abolition of user fees in South Africa, a policy implemented in 1994 for children under the age of six and the elderly, as well as pregnant and nursing mothers, is examined via regression discontinuity. The analysis focuses on provider choice decisions for curative care treatment, but also examines potential externalities that could arise from the policy. As a result of the policy, curative care demand in the public sector is found to increase by approximately 7%; however, the demand for curative care in the private sector is found to decrease by nearly the same amount, suggesting that the policy led to provider choice substitution. The analysis further supports the hypothesis that the health of young children improved marginally. |
| Keywords: | Free Health Care, Regression Discontinuity |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:rza:wpaper:301&r=hea |
| By: | Boes, Stefan (University of Bern); Nüesch, Stephan (University of Zurich); Stillman, Steven (University of Otago) |
| Abstract: | We explore two unexpected changes in flight regulations to identify the causal effect of aircraft noise on health. Detailed yearly noise metrics are linked with panel data on health outcomes using exact address information. Controlling for individual and spatial heterogeneity, we find that aircraft noise significantly increases sleeping problems, weariness and headaches. Our pooled models substantially underestimate the detrimental health effects, which suggests that individuals self-select into residence based on their unobserved noise sensitivity and idiosyncratic vulnerability. Generally, we show that the combination of fixed effects and quasi-experiments is very powerful to identify causal effects in epidemiological field studies. |
| Keywords: | health, noise pollution, selection bias, fixed effects, quasi-experimental data |
| JEL: | I10 Q53 C23 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp6744&r=hea |
| By: | Rustichini, Aldo (University of Minnesota); DeYoung, Colin G. (University of Minnesota); Anderson, Jon (University of Minnesota, Morris); Burks, Stephen V. (University of Minnesota, Morris) |
| Abstract: | Trait-based personality psychology and economics have taken different approaches to understanding individual differences, with the former emphasizing variables derived from the factor analysis of trait assessments, and the latter emphasizing variables derived from formal decision theory. In a data set on trainee truckers in a large US company, we provide a systematic initial assessment of the empirical pattern of relationships between the elements from these two approaches by comparing the predictive power of measurements derived from personality theory and decision theory for several individual characteristics and outcomes, and relating the two sets of measurements to each other. We show that personality traits have a comparable or stronger predictive power than do economic preferences for several dependent variables, including credit score, job persistence, and heavy truck accidents. They also have strong predictive power for Body Mass Index (BMI) and smoking status. Further, decision theory and personality variables are meaningfully related. For example, we confirm that cognitive ability explains a substantial part of time preferences, and find that Neuroticism and cognitive ability together explain attitudes toward risk. In addition, Agreeableness and cognitive ability explain aspects of other-regarding behavior in a strategic setting. |
| Keywords: | personality theory, decision theory, strategic behavior, credit score, smoking, obesity, prisoners' dilemma, job performance, heavy truck accident, truckload, turnover, trucker |
| JEL: | D83 C72 C93 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp6750&r=hea |
| By: | James M. Verdier |
| Keywords: | Dual Eligibles, Medicare, Special Needs Plans, Medicaid Managed Care |
| JEL: | I |
| Date: | 2012–02–29 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7376&r=hea |
| By: | Matthew Hodges; Cheryl A. Camillo; Paul M. Montebello; Ashley Zlatinov |
| Abstract: | There is a growing need for separate Children's Health Insurance Program (S-CHIP) program data to examine program transitions, access to services, and quality of care, among other priorities. However, standardized person-level data for S-CHIP programs has never been available at the national level. Mathematica, under contract with the Centers for Medicare & Medicaid Services, has provided technical assistance to states to report person-level demographic, enrollment, utilization, and payment data to the Medicaid and CHIP Statistical Information System (MSIS). Seven states are now reporting complete or partial CHIP data to MSIS and additional states are expected to do so in the coming months. This guide describes for state stakeholders the steps for successfully planning and implementing CHIP data reporting. It will be supplemented by a technical specifications guide for programmers. |
| Keywords: | Separate CHIP, MSIS, Technical Assistance to States, MAX PDQ, MAX |
| JEL: | I |
| Date: | 2012–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7511&r=hea |
| By: | David Baugh; Shinu Verghese |
| Keywords: | Medicaid; enrollment , enrollees; movers, double-counting, migration |
| JEL: | I |
| Date: | 2012–06–15 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7517&r=hea |
| By: | John L. Czajka |
| Abstract: | This brief uses Medicaid administrative records to examine the movement of children between Medicaid and the Children's Health Insurance Program (CHIP) from 2005 through 2007. |
| Keywords: | CHIP, Medicaid, MAX, Health |
| JEL: | I |
| Date: | 2012–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7465&r=hea |
| By: | David Baugh; Shinu Verghese |
| Keywords: | Medicaid; enrollment , enrollees; movers, double-counting, migration |
| JEL: | I |
| Date: | 2012–08–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7518&r=hea |
| By: | Cheryl A. Camillo |
| Abstract: | Whether or not states expand Medicaid under the Affordable Care Act, they still must implement provisions to streamline Medicaid eligibility determinations. These provisions recommend the use of information technology to provide coverage that fits an individual's circumstances and needs. States can draw on the lessons from the Children's Health Insurance Program (CHIP), which introduced a more consumer-friendly approach to eligibility determinations for constituents at all income levels. |
| Keywords: | Health Reform, State Medicaid, CHIP, ACA, Affordable Care Act |
| JEL: | I |
| Date: | 2012–07–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7492&r=hea |
| By: | Debra J. Lipson |
| Keywords: | State Capacity, Medicaid Managed Long Term Supports and Services, Health |
| JEL: | I |
| Date: | 2012–08–03 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7512&r=hea |
| By: | Leslie Foster |
| Abstract: | Health-e-App Public Access (HeA PA) is a self-service, online application for California's Healthy Families Program. This research brief describes the potential benefits of HeA PA for applicants and the state enrollment system, as well as use of the tool during its first year. The study found that in 2011 about 50,000 applicants used HeA PA (about 19 percent of all applications). |
| Keywords: | Health-e-App, HeA PA, Low-Income Children, Children's Health Care Coverage, Califonia |
| JEL: | I |
| Date: | 2012–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7387&r=hea |
| By: | John L. Czajka |
| Abstract: | This report uses Medicaid administrative records to investigate discontinuities in Medicaid enrollment by eligibility group and state from January 2005 through December 2007. Nearly half of those enrolled in Medicaid in January 2005 and eligible for full benefits in all their months of enrollment remained enrolled through the end of 2007, but more than one-fifth disenrolled and then reenrolled at least once. Brief interruptions—one or two months in length—accounted for more than one-third of all gaps in enrollment that started in 2005 or 2006 among established enrollees with full benefits. Brief gaps were more common among new enrollees than among established enrollees, accounting for nearly 45 percent of all breaks in service. |
| Keywords: | administrative records, MAX, continuity of coverage, churning |
| JEL: | I |
| Date: | 2012–04–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7491&r=hea |
| By: | Winnie Wang |
| Keywords: | Medicare Tracker, Health, Prescription Drug Plans, Tracking Medicare |
| JEL: | I |
| Date: | 2012–07–18 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7501&r=hea |
| By: | Shimizutani, Satoshi; Fujii, Mayu; Oshio, Takashi |
| Abstract: | This study examines retirement decisions in Japan, using the option value (OV) model proposed by Stock and Wise (1990) and examined by subsequent studies. This model assumes that an individual maximizes a weighted average of utility from labor income until retirement as well as that from pension income afterwards and determines when to retire based on the OV of postponing retirement. Using micro-level data collected from the Japanese Study on Aging and Retirement (JSTAR), we computed the OV for each individual working in 2007 and examined its association with retirement decisions made in 2009. We found that the probability of retirement correlates negatively with the OV and that healthier individuals are somewhat more sensitive to the OV. Furthermore, our simulations based on the OV models show that more generous parameters vis-a-vis eligibility for disability pension benefits slightly increases the probability of retirement, while a reduced pension benefit has no significant impact. |
| Keywords: | retirement, option value model, social security wealth, JSTAR |
| JEL: | H55 J26 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:hit:cisdps:566&r=hea |
| By: | Mierau; Angelini (Groningen University) |
| Abstract: | We study how social and economic conditions relate to the health status of children using a retrospective survey for Western-Europe. We use the state of the business cycle and the level of Gross Domestic Product as indicators of the macroeconomic conditions. In order to differentiate between fetal and childhood effects, we control for macroeconomic conditions after birth separately. To measure household conditions we construct a measure of the social economic status of the household based on the number of rooms per capita in the household, the number of facilities in the house, the occupation of the main bread winner and the number of books in the household. In addition, we study the impact of episodes of hunger and the presence of both parents. Our main findings are that being born during a boom and growing up during a boom are detrimental for childhood health. In addition, the social economic status of the parents is positively associated to the health status of the child, while experiencing hunger, living without the father and growing up with a parent that drinks heavily are all negatively associated with childhood health. |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:rugsom:12002-eef&r=hea |
| By: | Timothy J. Halliday (University of Hawai’a at Manoa and IZA) |
| Abstract: | In this paper, we use the death file from the Panel Study of Income Dynamics to investigate the relationship between county-level unemployment rates and mortality risk. After partialling out important confounding factors including baseline health status as well as state, industry and occupation fixed effects, we show that poor local labor market conditions are associated with higher mortality risk for working-aged men. There is little to no such relationship for people with weaker labor force attachments such as women or the elderly. Our results contribute to a growing body of work that suggests that poor economic conditions pose health risks and illustrate an important contrast with studies based on aggregate data. The latter underscores the need to arrive at a better understanding of the aggregation mechanism linking the micro and macro studies. |
| Keywords: | Recessions, Mortality, Health, Aggregation |
| JEL: | I0 I12 J1 |
| Date: | 2012–08–02 |
| URL: | http://d.repec.org/n?u=RePEc:hai:wpaper:201214&r=hea |
| By: | Galeotti, Andrea; Rogers, Brian W. |
| Abstract: | We consider the spread of a harmful state through a population divided into two groups. Interaction patterns capture the full spectrum of assortativity possibilities. We show that a central planner who aims for eradication optimally either divides equally the resources across groups, or concentrates entirely on one group, depending on whether there is positive or negative assortativity, respectively. We study a game in which agents can, at a cost, immunize. Negative assortative interactions generate highly asymmetric equilibrium outcomes between ex-ante identical groups. When groups have an underlying difference, even a small amount of inter-group contacts generates large asymmetries.We study the diffusion of a harmful state through a population. Immunity is available, but is costly. The state is meant to capture various kinds of choices or risky behaviors such as, for example, tobacco use, in which case immunity is interpreted as a commitment to avoid the temptation of smoking. The state can also capture the presence of an electronic virus on a computer network; in this case immunity represents the purchase of anti-virus software, or other costly measures taken to avoid the virus. But perhaps the most conventional interpretation is that the state represents human infection of various communicable diseases that spread through social contacts; in this case immunity captures a decision to vaccinate oneself. |
| Date: | 2012–08–08 |
| URL: | http://d.repec.org/n?u=RePEc:ese:iserwp:2012-16&r=hea |
| By: | Geoffrey L. Wallace; Robert Haveman; Karen Holden; Barbara Wolfe |
| Abstract: | Retirement years are a precarious time for many older Americans. Even if successful in accumulating resources expected to be sufficient to maintain their pre-retirement standard of living, many retirees face unexpected adverse health shocks after retirement. Because of the uncertainty of shocks to physical and cognitive health, there exists the potential for significant deterioration in resource adequacy both at the time of retirement and into the retirement years due to their occurrence. In this study, we select a sample of new retirees constructed from the Health and Retirement Study (HRS) data and follow them during the first decade of their retirement. Using these data, we identify the nature of shocks to physical and cognitive health for which individuals are at risk during their retirement years, and estimate both the absolute and relative risk of these shocks. We then estimate the impact of the occurrence of these shocks on wealth-based measures of retirement adequacy. |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:auu:dpaper:669&r=hea |
| By: | Mark E. McGovern (Harvard Center for Population and Development Studies) |
| Abstract: | The prevalence of low birth weight is an important aspect of public health which has been linked to increased risk of infant death, increased cost of care, and a range of later life outcomes. Using data from a new Irish cohort study, I document the relationship between birth weight and socioeconomic status. The association of maternal education with birth weight does not appear to be due to the timing of birth or complications during pregnancy, even controlling for a wide range of background characteristics. However, results do suggest intergenerational persistence in the transmission of poor early life conditions. Birth weight predicts a number of outcomes at age 9, including test scores, hospital stays and health. An advantage of the data is that I am able to control for a number of typically unmeasured variables. I determine whether parental investments (as measured by the quality of interaction with the child, parenting style, or school quality) mediate the association between birth weight and later indicators. For test scores, there is evidence of non-linearity, and boys are more adversely aected than girls. I also consider whether there are heterogeneous eects by ability using quantile regression. These results are consistent with a literature which nds that there is a causal relationship between early life conditions and later outcomes. |
| Keywords: | Early Life Conditions, Birth Weight, Health Inequalities, Test Scores |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:gdm:wpaper:9512&r=hea |
| By: | d'Albis, Hippolyte; Lau, Paul S.; Sanchez-Romero, Miguel |
| Abstract: | Many studies specify human mortality patterns parametrically, with a parameter change affecting mortality rates at different ages simultaneously. Motivated by the stylized fact that a mortality decline affects primarily younger people in the early phase of mortalitytransition but mainly older people in the later phase, we study how a mortality change at an arbitrary age affects optimal retirement age. Using the Volterra derivative for a functional, we show that mortality reductions at older ages delay retirement unambiguously, but that mortality reductions at younger ages may lead to earlierretirement due to a substantial increase in the individualʼs expected lifetime human wealth. |
| Keywords: | incentive for early retirement; lifetime human wealth effect; years-to-consume effect; mortality decline; |
| JEL: | D91 J11 J26 |
| Date: | 2012 |
| URL: | http://d.repec.org/n?u=RePEc:ner:dauphi:urn:hdl:123456789/6825&r=hea |
| By: | Daisuke Ishikawa (Policy Research Institute, Ministry of Finance Japan); Junji Ueda (Policy Research Institute, Ministry of Finance Japan); Real Arai (Graduate School of Social Sciences, Hiroshima University) |
| Abstract: | In order to quantify the effects of declining birthrate and changing demographic structure on the Japanese economy, we show the results of simulations by using a multi-sector dynamic general equilibrium model with overlapping generations (OLG) in an open economy. The model is constructed to incorporate substitutability between domestic products and imports and show the evolution of the industrial structure, reflecting the impacts of aging population from both supply and demand sides of the economy. Based on the scenario of increasing public demands for healthcare services, the share of healthcare sector expands to almost 2.5 times in 2050 relative to the base year 1985. The result of a simulation based on an alternative scenario where the government increases net transfer to the elderly shows smaller labor participation and GDP per capita, due to the income effects and crowding out of private capital by the increase of government debt outstanding in the long run. |
| Keywords: | multi-sector OLG model, demographic change, soaring public healthcare spending |
| JEL: | J11 H51 H68 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:mof:wpaper:ron243&r=hea |
| By: | Marcello Basili; Filippo Belloc |
| Abstract: | Vector-borne diseases (VBDs) are widespread in less developed countries and re-emerging in developed ones. Available economic studies agree that VBDs induce significant effects on countries' economic outcomes, and affirm that a systematic evaluation of such effects is crucial to the efficient allocation of resources to health priorities. This paper provides a comparative assessment of available methodologies for measuring the economic impact of VBDs at a national level. We review both macroeconometric and micro-based approaches, and examine advantages and disadvantages of currently used methods. We conclude by suggesting possible methodological advancements and new challenges for future research. |
| Keywords: | Vector-borne diseases, economic growth, health indicators. |
| JEL: | C50 I15 O44 Q57 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:usi:wpaper:648&r=hea |
| By: | Fu-Min Tseng; Dennis Petrie |
| Abstract: | This paper uses an exogenous increase in income for a specific sub-group in Taiwan to explore the extent to which higher income leads to higher levels of health and wellbeing. In 1995, the Taiwanese government implemented the Senior Farmer Welfare Benefit Interim Regulation (SFWBIR) which was a pure cash injection, approximately US$110 (£70) per month in 1996, to senior farmers. A Difference-in-differences (DiD) approach is used on survey data from the Taiwanese Health and Living Status of Elderly in 1989 and 1996 to evaluate the short term effect of the SFWBIR on self-assessed health, depression, and life satisfaction. Senior manufacturing workers are employed as a comparison group for the senior farmers in the natural experiment because their demographic backgrounds are similar. This paper provides evidence that the increase in income from the SFWBIR significantly improved the mental health of senior farmers by reducing the scale of depression (CES-D) by 1.718, however, it had no significant short term impact on self-assessed health or life satisfaction. |
| Keywords: | social welfare benefit, life satisfaction, mental health, natural experiment, difference-in-differences |
| JEL: | I10 I38 |
| Date: | 2012–02 |
| URL: | http://d.repec.org/n?u=RePEc:dun:dpaper:263&r=hea |
| By: | Vincenzo Atella (Faculty of Economics, University of Rome "Tor Vergata"); Joanna Kopinska (Faculty of Economics, University of Rome "Tor Vergata") |
| Abstract: | In this work we investigate the causal impact of cost sharing schemes on drug compliance using a Difference-in-Differences approach within a quantile regression framework. We exploit a series of natural experiments occurred in Italy between 2000 and 2010, referring to the introduction of regional co-payment schemes. We find that co-payments have a negative impact on compliance, causing a reallocation of individuals from the upper to the lower tail of the compliance distribution, thus hurting the already narrow group of good compliers. The empirical evidence suggests also that gender, clinical history and geographic residence are important drivers of compliance, particularly within the group of poor compliers. |
| Keywords: | Compliance, Cost sharing, Quantile regression, Difference-in-Differences,Statins, Cholesterol |
| JEL: | I10 I18 I19 |
| Date: | 2012–07–27 |
| URL: | http://d.repec.org/n?u=RePEc:rtv:ceisrp:247&r=hea |
| By: | Michael Hummer; Thomas Lehner (Department of Economics, Johannes Kepler University Linz, Austria); Gerald J. Pruckner |
| Abstract: | Using administrative panel data of health insurants, we estimate the effects of low birth weight on health service utilization among children and young adults between birth and 21 years old. To account for time-invariant heterogeneity of mothers, we use sibling fixed- effects estimation. We find that low birth weight strongly increases subsequent health expenditures and that the effect is particularly pronounced in the first year of life. Starting in compulsory schooling, we observe a shift in expenditures to mental-health problems. Whereas the effects on physical health disappear over time, we provide evidence that mental-health problems prevail until early adulthood. We therefore suggest a screening program tailored to the conditions more likely to be contracted by low-birth-weight children in order to mitigate the negative health consequences. |
| Keywords: | Low birth weight, health expenditures, sibling fixed-effects |
| JEL: | I10 I12 I18 |
| Date: | 2012–05 |
| URL: | http://d.repec.org/n?u=RePEc:jku:nrnwps:2012_05&r=hea |
| By: | Kannan, Srinivasan; Sarma, P.Sankara |
| Abstract: | Introduction. The study gathered information on work load among women public health workers and factors associated with this in Thiruvananthapuram, Alappuzha, Ernakulam, Malappuram and Wayanad districts of Kerala. An increasing number of nurses were reported to have occupational hazards and are suffering from back injuries due to lifting and moving patients. A study in Australia found work and age related factors increase difficulties that lead to perceived workload (Fragar and Depczynski 2011). Philibin et.al. study in Ireland on public health nurses’ role in changing society emphasized the need for defining and redesigning their role for better community service. Methodology: Primary data collection was done from 1238 respondents that included, Junior Public Health Nurses, Junior Health Inspector, Staff nurses, Lady Health Inspectors and Lady Health Supervisors. In addition, time and work study in selected work places and Qualitative enquiries also been done. Findings: The prevalence of three components of workload namely role overload, role stagnation and self role distance were 75.26% (95% CI: 72.78, 77.59), 55.62% (95% CI: 52.84, 58.37) and 12.04% (95% CI: 10.34, 13.97) respectively. The role stagnation decreases with age (p=0.004). The Role overload is higher among women and the role stagnation and self role distance are higher among men. Workload is higher to those who disagree that their training helped in upgrading skills and knowledge. Conclusion: Workload of public health nurses is related to their salary, additional duties such as managing funds, attending meetings, maintaining records and so on. They affect their assigned routine health delivery activities. |
| Keywords: | Nurses; Public Health; Workload; stress; labor; Kerala |
| JEL: | A3 M5 M54 J2 |
| Date: | 2012–07–23 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:40409&r=hea |
| By: | Francesco Decarolis (Department of Economics, University of Wisconsin-Madison) |
| Abstract: | In Medicare Part D, low income individuals receive subsidies to enroll into insurance plans. This paper studies how premiums are distorted by the combined effects of this subsidy and the default assignment of low income enrollees into plans. Removing this distortion could reduce the cost of the program without worsening consumers' welfare. Using data from the the first five years of the program, an econometric model is used to estimate consumers demand for plans and to compute what premiums would be without the subsidy distortion. Preliminary estimates suggest that the reduction in premiums of affected plans would be substantial. |
| Keywords: | Medicare; prescription drugs; health insurance demand; auctions |
| JEL: | I11 I18 L22 D44 H57 |
| Date: | 2012–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:pen:papers:12-026&r=hea |
| By: | Joel C. Cantor; Alan C. Monheit; Derek DeLia; Kristen Lloyd |
| Abstract: | This paper evaluates one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA) which permits young adults up to age 26 to enroll as dependents on a parent’s private health plan. The paper also considers how the interaction between prior state laws expanding dependent coverage to young adults and the ACA affected young adult coverage. Using data from the Current Population Survey for calendar years 2004-2010, we apply a difference-in-differences framework to estimate how these provisions affected coverage of eligible young adults compared to slightly older adults. Our findings indicate that controlling for state laws, early implementation of the ACA increased young adult dependent coverage by 5.3 percentage points and resulted in a 3.5 percentage point decline in their uninsured rate. The interaction between state laws and the ACA suggests that the increase in dependent coverage and decline in the uninsured rate may have been greater among young adults who were targeted by both the ACA and state laws. |
| JEL: | I18 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18254&r=hea |
| By: | Péter Hudomiet; Robert J. Willis |
| Abstract: | Based on subjective survival probability questions in the Health and Retirement Study, we use an econometric model to estimate the determinants of individual-level uncertainty about personal longevity. This model is built around the Modal Response Hypothesis (MRH), a mathematical expression of the idea that survey responses of 0, 50 or 100 percent to probability questions indicate a high level of uncertainty about the relevant probability. We show that subjective survival expectations in 2002 line up very well with realized mortality of the HRS respondents between 2002 and 2010. We show that the MRH model performs better than typically used models in the literature of subjective probabilities. Our model gives more accurate estimates of low probability events and it is able to predict the unusually high fraction of focal 0, 50 and 100 answers observed in many datasets on subjective probabilities. |
| JEL: | C11 J1 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18258&r=hea |
| By: | Nathaniel Hendren |
| Abstract: | Across a wide set of non-group insurance markets, applicants are rejected based on observable, often high-risk, characteristics. This paper argues private information, held by the potential applicant pool, explains rejections. I formulate this argument by developing and testing a model in which agents may have private information about their risk. I first derive a new no-trade result that theoretically explains how private information could cause rejections. I then develop a new empirical methodology to test whether this no-trade condition can explain rejections. The methodology uses subjective probability elicitations as noisy measures of agents beliefs. I apply this approach to three non-group markets: long-term care, disability, and life insurance. Consistent with the predictions of the theory, in all three settings I find significant amounts of private information held by those who would be rejected; I find generally more private information for those who would be rejected relative to those who can purchase insurance; and I show it is enough private information to explain a complete absence of trade for those who would be rejected. The results suggest private information prevents the existence of large segments of these three major insurance markets. |
| JEL: | H0 I11 |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18282&r=hea |
| By: | Bruce D. Meyer; Laura R. Wherry |
| Abstract: | This paper uses a policy discontinuity to identify the immediate and long-term effects of public health insurance coverage during childhood. Our identification strategy exploits a unique feature of several early Medicaid expansions that extended eligibility only to children born after September 30, 1983. This feature resulted in a large discontinuity in the lifetime years of Medicaid eligibility of children at this birthdate cutoff. Those with family incomes at or just below the poverty line had close to five more years of eligibility if they were born just after the cutoff than if they were born just before. We use this discontinuity in eligibility to measure the impact of public health insurance on mortality by following cohorts of children born on either side of this cutoff from childhood through early adulthood. We examine changes in rates of mortality by the underlying causes of death, distinguishing between deaths due to internal and external causes. We also examine outcomes separately for black and white children. Our analysis shows that black children were more likely to be affected by the Medicaid expansions and gained twice the amount of eligibility as white children. We find a substantial effect of public eligibility during childhood on the later life mortality of black children at ages 15-18. The estimates indicate a 13-18 percent decrease in the internal mortality rate of black teens born after September 30, 1983. We find no evidence of an improvement in the mortality of white children under the expansions. |
| JEL: | I14 |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18309&r=hea |
| By: | David Dranove; Christopher Forman; Avi Goldfarb; Shane Greenstein |
| Abstract: | We examine the heterogeneous relationship between the adoption of electronic medical records (EMR) and hospital operating costs at thousands of US hospitals between 1996 and 2009. Combining data from multiple sources, we first identify a puzzle that has been seen in prior studies: Adoption of EMR is generally associated with a slight increase in costs. We draw on the literature on information technology as a business process innovation to analyze why this average effect arises, and explain why it masks important differences over time, across locations, and across hospitals. We find evidence consistent with this approach, namely, that: (1) EMR adoption is initially associated with a rise in costs; (2) EMR adoption at hospitals in favorable conditions – such as urban locations – leads to a decrease in costs after three years; and (3) Hospitals in unfavorable conditions experience a sharp increase in costs even after six years. |
| JEL: | I10 L30 |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18281&r=hea |
| By: | Kevin Callison; Robert Kaestner |
| Abstract: | There is a general consensus among policymakers that raising tobacco taxes reduces cigarette consumption. However, evidence that tobacco taxes reduce adult smoking is relatively sparse. In this paper, we extend the literature in two ways: using data from the Current Population Survey Tobacco Use Supplements we focus on recent, large tax changes, which provide the best opportunity to empirically observe a response in cigarette consumption, and employ a novel paired difference-in-differences technique to estimate the association between tax increases and cigarette consumption. Estimates indicate that, for adults, the association between cigarette taxes and either smoking participation or smoking intensity is negative, small and not usually statistically significant. Our evidence suggests that increases in cigarette taxes are associated with small decreases in cigarette consumption and that it will take sizable tax increases, on the order of 100%, to decrease adult smoking by as much as 5%. |
| JEL: | I12 I18 |
| Date: | 2012–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18326&r=hea |
| By: | Jason M. Fletcher; Stephen L. Ross |
| Abstract: | This paper estimates the effects of friends’ health behaviors, smoking and drinking, on own health behaviors for adolescents while controlling for the effects of correlated unobservables between those friends. Specifically, the effect of friends’ health behaviors is identified by comparing similar individuals who have the same friendship opportunities because they attend the same school and make similar friendship choices, under the assumption that the friendship choice reveals information about an individual’s unobservables. We combine this identification strategy with a cross-cohort, within school design so that the model is identified based on across grade differences in the clustering of health behaviors within specific friendship patterns. Finally, we use the estimated information on correlated unobservables to examine longitudinal data on the on-set of health behaviors, where the opportunity for reverse causality should be minimal. Our estimates for both behavior and on-set are very robust to bias from correlated unobservables. |
| JEL: | I12 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18253&r=hea |
| By: | Robert Kaestner; Anthony T. Lo Sasso |
| Abstract: | By exploiting a unique health insurance benefit design, we provide novel evidence on the causal association between outpatient and inpatient care. Our results indicate that greater outpatient spending was associated with more hospital admissions: a $100 increase in outpatient spending was associated with a 2.7% increase in the probability of having an inpatient event and a 4.6% increase in inpatient spending among enrollees in our sample. Moreover, we present evidence that the increase in hospital admissions associated with greater outpatient spending was for conditions in which it is plausible to argue that the physician and patient could exercise discretion. |
| JEL: | I12 |
| Date: | 2012–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18255&r=hea |