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on Health Economics |
| By: | Govert Bijwaard (NIDI, The Hague, IZA, Bonn); Hans van Kippersluis (Erasmus University Rotterdam); Justus Veenman (Erasmus University Rotterdam) |
| Abstract: | We aim to disentangle the relative contributions of (i) cognitive ability, and (ii) education on health and mortality using a structural equation model suggested by Conti et al. (2010). We extend their model by allowing for a duration dependent variable, and an ordinal educational variable. Data come from a Dutch cohort born around 1940, including detailed measures of cognitive ability and family background at age 12. The data are subsequently linked to the mortality register 1995-2011, such that we observe mortality between ages 55 and 75. The results suggest that the treatment effect of education (i.e. the effect of entering secondary school as opposed to leaving school after primary education) is positive and amounts to a 4 years gain in life expectancy, on average. Decomposition results suggest that the raw survival differences between educational groups are about equally split between a 'treatment effect' of education, and a 'selection effect' on basis of cognitive ability and family background. |
| Keywords: | Education; Cognitive Ability; Mortality; Structural Equation Model; Duration Model |
| JEL: | C41 I14 I24 |
| Date: | 2013–03–15 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:uvatin:20130044&r=hea |
| By: | ADRIENNE M. LUCAS (Department of Economics,University of Delaware); NICHOLAS L.WILSON (Department of Economics, Williams College) |
| Abstract: | One in five Zambian children lives with an HIV/AIDS-infected adult. We estimate the effect that the availability of adult antiretroviral therapy (ART) has on the health of such children. Using a triple difference specification, we find that adult access to ART resulted in increased weight-for-age and decreased incidence of stunting among children younger than 60 months who resided with an infected father or other infected adult in an intact household. Because the increased availability of adult ART in sub-Saharan Africa has multigenerational effects, cost-effectiveness estimates restricted to direct recipients understate the economic benefit of the treatment. |
| Keywords: | antiretroviral therapy, HIV, health, anthropometrics, children, Zambia |
| JEL: | I12 I15 J13 O12 O15 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:dlw:wpaper:13-02.&r=hea |
| By: | Sanders Korenman; Dahlia Remler |
| Abstract: | Census’s Supplemental Poverty Measure (SPM) nearly doubles the elderly poverty rate compared to the “Official” Poverty Measure (OPM), a result of the SPM subtraction of medical out-of-pocket (MOOP) expenditures from income. Neither the SPM nor OPM counts health benefits or assets as resources. Validation studies suggest that subtracting MOOP from resources worsens a poverty measure’s predictive validity and excluding assets exacerbates this bias, since assets fund MOOP. The SPM is based on a 1995 NAS report that recommended a health-exclusive poverty measure, despite considering it, conceptually, a “second best” to a Health-Inclusive Poverty Measure (HIPM). We analyze the reasons for the NAS recommendation and argue that constructing a HIPM is now feasible if we conceptualize health needs as a need for health insurance, and if plans with non-risk-rated premiums and caps on MOOP are universally available, a condition largely met by the Affordable Care Act and Medicare Advantage Plans. We describe four HIPM variants and present analyses that suggest the SPM treatment of MOOP results in a less valid measure of elderly poverty and an overstatement of the elderly poverty rate (by up to 5.5 percentage points or 50 percent). Many elderly classified as poor by the SPM’s unlimited MOOP deduction are not poorly insured persons with incomes near the poverty line, but well-insured persons with incomes well above the poverty line. |
| JEL: | I32 |
| Date: | 2013–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18900&r=hea |
| By: | Keith Marzilli Ericson; Judd B. Kessler |
| Abstract: | We examine how the articulation of government policy affects behavior. Our experiment compares a government mandate to purchase health insurance to a financially equivalent tax on the uninsured. Participants report their probability of purchasing health insurance under one of the two articulations of the policy. The experiment was conducted in four waves, from December 2011 to November 2012. We document the controversy over the Affordable Care Act’s insurance mandate provision that changed the political discourse during the year. Pre-controversy, articulating the policy as a mandate, rather than a financially equivalent tax, increased probability of insurance purchase by 10.6 percentage points — an effect comparable to a $1000 decrease in annual premiums. After the controversy, the mandate is no more effective than the tax. Our results show that how a policy is articulated affects behavior and that persuasion and public opinion management can help achieve policy objectives at lower cost. |
| JEL: | D02 D03 D04 H2 H3 K42 |
| Date: | 2013–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18913&r=hea |
| By: | Ernst R. Berndt; Iain M. Cockburn |
| Abstract: | We estimate hedonic price indexes for clinical trial research, an important component of biomedical R&D, using a large sample of agreements between trial sponsors and clinical investigators obtained from MediData Solutions Worldwide Inc. Nominal prices measured as total grant cost per patient rose by a factor of 4.5 between 1989 and 2011, while the NIH Biomedical R&D Price Index (BRDPI) focused on input costs rose only 2.2-fold. Most of the disparity appears to be attributable to changes in the nature and organization of clinical trials: during this period the average number of patients per site fell substantially while “site work effort” more than doubled. After controlling for these changes in the characteristics of investigator agreements using a variety of methods based on hedonic regressions, we find that the estimated rate of inflation in clinical trials costs tracks the BDRPI very closely. Results from this study suggest that it should be feasible for statistical agencies to develop a producer price index for this type of R&D activity, contributing to broader efforts to develop a deflator for contracted R&D services. |
| JEL: | E31 L65 O49 |
| Date: | 2013–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18918&r=hea |
| By: | Lawless, Lydia J.R.; Nayga, Rodolfo; Drichoutis, Andreas |
| Abstract: | Time preferences indicate preferences over streams of future consumption which significantly shape individual decision making including the health domain. In this paper, we review published studies to assess the influence of time preferences on human health behaviour. We first discuss the theoretical background of time preferences; ascertain the differences between private and social discount rates; identify the impact of time preferences on governments of developing nations; and then assess how time preferences influence risky behaviour such as being overweight, smoking, and engaging in risky sexual behaviour. The issue of whether to use proxies or experimental time preference elicitation methods in time preference studies is also addressed. |
| Keywords: | time preference; health domain; risk aversion; discount rate; behaviour |
| JEL: | D90 I0 |
| Date: | 2013–03–21 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:45382&r=hea |
| By: | Vincenzo Atella (University of Rome "Tor Vergata"); Valentina Conti (University of Rome "Tor Vergata") |
| Abstract: | There exists a large body of literature, mainly based on hospital costs, showing that time to death is by far a better predictor of health spending than age. In this paper, we investigate if this finding holds true also in presence of outpatient costs (drugs, diagnostic tests and specialist visits). To accomplish this task we use data from the Health Search-SiSSI dataset, a large unbalanced panel of Italian patients that collects detailed information on patient clinical records and costs. Our results show that age is a strong driver of outpatient costs in Italy. In particular, we find that age produces a 500% increase in health costs from age 40 to 80, while proximity to death rises costs only by about 30%. Our advice for policy makers is then to use disaggregated models to better disentangle the role that age and time to death may have on different components of health expenditure. |
| Keywords: | ageing, time to death, outpatient health care expenditure, cost of dying |
| JEL: | J14 I12 |
| Date: | 2013–03–08 |
| URL: | http://d.repec.org/n?u=RePEc:rtv:ceisrp:267&r=hea |
| By: | Kai Zhao (University of Western Ontario) |
| Abstract: | This paper studies the effects of health shocks on the demand for health insurance and annuities, precautionary saving, and the welfare implications of public policies in a simple life-cycle model. I show that when the health shock simultaneously increases health expenses and reduces longevity, the following results can be obtained via closed-form solutions. First, utility-maximizing agents would neither fully insure their uncertain health expenses nor fully annuitize their wealth, even in the absence of market frictions and bequest motives. Second, the effect of uncertain health expenses on precautionary saving may be smaller than what has been found in previous studies. Under certain conditions, uncertain health expenses may even reduce precautionary saving. Third, mandatory health insurance (e.g. public health insurance) tends to benefit the poor more, while mandatory annuitization (e.g. public pension) is more likely to favor the rich. A simple numerical application of the model to the US long term care (LTC) insurance market suggests that the simultaneous effect of health shock on health expenses and longevity is a quantitatively important reason why agents (especially the rich) do not purchase more private LTC insurance. |
| Keywords: | Saving; Annuities; Health Insurance; Social Security; Medicare |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:uwo:uwowop:20131&r=hea |
| By: | Kuehnle, Daniel |
| Abstract: | Despite a recent growth in studies examining the association between family income and child health, very few studies investigate whether this is a causal relationship. This paper addresses this major methodological gap and examines the causal effect of family income on child health in the UK. Using rich observational data from a British cohort study, we exploit exogenous variation in local labour market characteristics to instrument for family income. We estimate the effect of family income on subjective child health and control for potential transmission channels through which income could affect child health. The results from our models provide novel evidence that income has a small but significant causal effect on subjective child health. Moreover, the analysis shows that parental health does not drive a spurious relationship between family income and child health as argued in recent contributions. We do not find significant effects of family income on chronic indicators of child health. The results are robust to different sets of instrumental variables, and to alternative measures of income. -- |
| Keywords: | child health,income gradient,instrumental variables,transmission channels,UK |
| JEL: | I1 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:esprep:70821&r=hea |