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on Health Economics |
| By: | G. Zanella; R. Banerjee |
| Abstract: | We study unique data from a dynamic natural experiment involving more than 7,000 American women to understand how a woman’s propensity to perform an annual mammography changes over time after a co-worker is diagnosed with breast cancer. We find that in the year this event occurs the probability that a woman performs a mammography drops by about 8 percentage points, off a base level of about 70%. This impact effect is persistent during at least the following 2 years, is driven by cases of breast cancer diagnosed at non-early stages, and by the behavior of individuals who are less knowledgeable about health issues. This negative effect is confirmed when we allow for serial correlation in screening behavior and when we estimate the effect of the treatment on the hazard of not screening, at the daily frequency. However, the effect vanishes in placebo experiments. |
| JEL: | I10 C31 D03 Z10 |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:bol:bodewp:wp938&r=hea |
| By: | C. J. Krizan; Adela Luque; Alice Zawacki |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:cen:wpaper:14-22&r=hea |
| By: | Abigail McKnight |
| Abstract: | It is well established that on average disabled people and the households in which they live face greater financial disadvantage in terms of income than their counterparts. What is less well understood is how they fare in terms of their wealth status. In this paper we use data from two large scale social surveys to examine the relationship between disability status and household wealth holdings. We find that overall disabled people have substantially lower household wealth and all components of wealth (property, financial, pension, physical) than non-disabled people but even these average differences mask important lifecycle patterns. The incidence of disability increases with age and the effect of this is that disabled people are on average older than non-disabled people. As wealth accumulation also increases with age up to retirement the effect is that average differences understate the true disability wealth-penalty. People who experience disability later in life have been in a stronger position to accumulate assets over their working lives than people who experience disability over the crucial wealth-accumulation stage (35-64 years) of the lifecycle. The full extent of the disability wealth-penalty can only be observed by looking at age or lifecycle profiles. We find evidence of cumulative disadvantage related to disability longevity and cumulative advantage to remaining disability free. Part of the disability wealth-penalty can be accounted for by lower average levels of education among disabled people and by their lower position in the socio-economic classification (NS-SEC) reflecting lower profiles of lifetime earnings and household income. The evidence points to a situation where disabled people have been unable to save and accumulate assets to anything like the extent of their non-disabled peers most likely through lower long term income and extra costs associated with disability. This puts them at a disadvantage in terms of being able to draw on an asset in times of need when expenditure needs exceed current levels of income, lower pension wealth on entering retirement and less likely to be in a position to benefit from the 'asset-effect' and more generally is a matter of concern in terms of equality and social mobility. |
| Keywords: | wealth, disability, inequality, lifecycle |
| JEL: | D31 D63 |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:cep:sticas:/181&r=hea |
| By: | Antoine Bommier (ETH Zurich, Switzerland) |
| Abstract: | The paper discusses the impact of longevity extension on aggregate wealth accumulation, accounting for changes in individual behaviors as well as changes in population age structure. It departs from the stan- dard literature by adopting risk-sensitive preferences. Human impatience is then closely related to mortality rates and aggregate wealth accumula- tion appears to be much more sensitive to demographic factors than usually found. Illustrations are provided using historical mortality data from dif- ferent countries. |
| Keywords: | longevity; life-cycle savings; wealth accumulation; risk-sensitive pref- erences; risk aversion. |
| JEL: | J1 E21 D91 |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:eth:wpswif:14-194&r=hea |
| By: | Helber, Stefan; Böhme, Daniel; Oucherif, Farid; Lagershausen, Svenja; Kasper, Steffen |
| Abstract: | The transportation processes for patients, personnel, and material in large and complex maximum-care hospitals with many departments can consume significant resources and thus induce substantial logistics costs. These costs are largely determined by the allocation of the different departments and wards in possibly multiple connected hospital buildings. We develop a hierarchical layout planning approach based on an analysis of organizational and operational data from the Hannover Medical School, a large and complex university hospital in Hannover, Germany. The purpose of this approach is to propose locations for departments and wards for a given system of buildings such that the consumption of resources due to those transportation processes is minimized. We apply the approach to this real-world organizational and operational dataset as well as to a fictitious hospital building and analyze the algorithmic behavior and resulting layout. |
| Keywords: | Hospital layout planning, quadratic assignment problem, fix-and-optimize heuristic |
| Date: | 2014–03 |
| URL: | http://d.repec.org/n?u=RePEc:han:dpaper:dp-527&r=hea |
| By: | Bejenariu, Simona (Department of Economics, School of Business, Economics and Law, Göteborg University); Mitrut, Andreea (Department of Economics, School of Business, Economics and Law, Göteborg University) |
| Abstract: | Roma, Europe’s largest minority, face poverty, social exclusion and life-long inequalities, despite the intensified efforts to alleviate their plight. Surprisingly, despite substantial funding aimed at improving Roma outcomes, there is a very little evidence on the effectiveness of these programs. This is the first paper to analyze the Roma Health Mediation Program (RHM), a large-scale public health program implemented first in Romania and developed further in other countries, whose main aim was to improve the health status of pregnant and postpartum Roma women and children, with the help of specially trained Roma health mediators. Using unique registered data from Romania, we exploit the spatial and temporal variation in implementation dates of the program to investigate the effects of the RHM on prenatal care take-up rates and child health. We find that the program had a very large impact on the take-up of prenatal care services, but this improvement was not reflected in the health outcomes at birth of Roma children. However, we do find evidence of decreased stillbirths and infant deaths after the program implementation. |
| Keywords: | Roma; exclusion; poverty; program take-up; health at birth |
| JEL: | I14 J13 J15 |
| Date: | 2014–04–15 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:gunwpe:0590&r=hea |
| By: | Mörk, Eva (Department of Economics, Uppsala University); Sjögren, Anna (IFAU - Institute for Evaluation of Labour Market and Education Policy); Svaleryd, Helena (Department of Economics, Uppsala University) |
| Abstract: | We analyze to what extent health outcomes of Swedish children are worse among children whose parents become unemployed. To this end we combine Swedish hospitalization data for 1992-2007 for children 3-18 years of age with register data on parental unemployment. We find that children with unemployed parents are 17 percent more likely to be hospitalized than other children, but that most of the difference is driven by selection. A child fixed-effects approach suggests a small effect of parental unemployment on child health. |
| Keywords: | Parental unemployment; child health; human capital |
| JEL: | I12 J13 |
| Date: | 2014–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:ifauwp:2014_008&r=hea |
| By: | James Heckman (University of Chicago); John Eric Humphries (University of Chicago); Gregory Veramendi (Arizona State University); Sergio Urzua (University of Maryland) |
| Abstract: | This paper develops and estimates a model with multiple schooling choices that identifies the causal effect of different levels of schooling on health, health-related behaviors, and labor market outcomes. We develop an approach that is a halfway house between a reduced form treatment effect model and a fully formulated dynamic discrete choice model. It is computationally tractable and identifies the causal effects of educational choices at different margins. We estimate distributions of responses to education and find evidence for substantial heterogeneity in unobserved variables on which agents make choices. The estimated treatment effects of education are decomposed into the direct benefits of attaining a given level of schooling and indirect benefits from the option to continue on to further schooling. Continuation values are an important component of our estimated treatment effects. While the estimated causal effects of education are substantial for most outcomes, we also estimate a quantitatively important effect of unobservables on outcomes. Both cognitive and socioemotional factors contribute to shaping educational choices and labor market and health outcomes. We improve on LATE by identifying the groups affected by variations in the instruments. We find benefits of cognition on most outcomes apart from its effect on schooling attainment. The benefits of socioemotional skills on outcomes beyond their effects on schooling attainment are less precisely estimated. |
| Keywords: | education, early endowments, factor models, health, treatment effects |
| JEL: | C32 C38 I12 I14 I21 |
| Date: | 2014–03 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2014-007&r=hea |
| By: | Andersson, Henrik; Tago, Damian; Treich, Nicolas |
| Date: | 2014–03 |
| URL: | http://d.repec.org/n?u=RePEc:ide:wpaper:27994&r=hea |
| By: | Avdic, Daniel (CINCH); Lundborg, Petter (Lund University); Vikström, Johan (IFAU) |
| Abstract: | Although learning-by-doing is believed to be an important source of productivity growth, there is limited evidence that production volume affects productivity in a causal sense. We document evidence of learning-by-doing in a highly skilled profession where stakes are high; advanced cancer surgery. For this purpose, we introduce a novel instrument that exploits the closure and opening of entire cancer clinics which have given rise to sharp and exogenous changes in the cancer surgical volumes at Swedish public sector hospitals. Using detailed register data on more than 100,000 episodes of advanced cancer surgery, our results suggest positive effects of surgery volumes on survival. In addition, we provide evidence on the mechanisms through which these improvements occur. We also show that the results are not driven by changes in patient composition or by other changes at the hospital level. |
| Keywords: | hospital volume, learning-by-doing, cancer surgery, survival, causal effect |
| JEL: | I11 I12 I18 L11 |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp8099&r=hea |
| By: | Martyn Andrews; Obbey Elamin; Alastair R. Hall; Kostas Kyriakoulis; Matthew Sutton |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:man:sespap:1401&r=hea |
| By: | Lassila, Jukka; Valkonen, Tarmo |
| Abstract: | Can longer working lives bring sufficient tax revenues to pay for the growing public health and care expenditure that longer lifetimes cause? We review studies concerning retirement decisions and pension policies, the role of mortality in health and long-term care costs, and errors in mortality projections. We combine key results into a numerical OLG model where changes in mortality have direct effects both on working careers and on per capita use of health and long-term care services. The model has been calibrated to the Finnish economy and demographics. Although there are huge uncertainties concerning future health and long-term care expenditure when people live longer, our simulations show that without policies directed to disability admission rules and old-age pension eligibility ages, working lives are unlikely to extend sufficiently. But, importantly, with such policies it seems quite possible that generations enjoying longer lifetimes can also pay for the full costs by working longer. |
| Keywords: | life expectancy, working careers, health and long-term care expenditure, fiscal sustainability |
| JEL: | H30 H63 H68 J11 |
| Date: | 2014–04–09 |
| URL: | http://d.repec.org/n?u=RePEc:rif:wpaper:24&r=hea |
| By: | Herzer, Dierk (Helmut Schmidt University, Hamburg); Nunnenkamo, Peter (Kieler Institut für Weltwirtschaft) |
| Abstract: | We assess the effect of income inequality on life expectancy by performing separate estimations for developed and developing countries. Our empirical analysis challenges the widely held view that inequality matters more for health in richer countries than for health in poorer countries. Employing panel cointegration and conventional panel regressions, we find that income inequality increases life expectancy in developed countries. By contrast, the effect on life expectancy is significantly negative in developing countries. While the quantitative effects are small, the striking contrast between the two country groups proves to be robust to modifications in measurement, specification and methodological choices. |
| Keywords: | health; inequality; panel cointegration |
| JEL: | C23 I14 |
| Date: | 2014–04–17 |
| URL: | http://d.repec.org/n?u=RePEc:ris:vhsuwp:2014_141&r=hea |
| By: | Andersson, Henrik; Hole, Arne Risa; Svensson, Mikael |
| Abstract: | This study elicits individual preferences for reducing morbidity and mortality risk in the context of an infectious disease (campylobacter) using choice experiments. Respondents are in the survey asked to choose between different policies that, in addition to the two health risks, also vary with respect to source of disease being targeted (food or water), when the policy takes place (in time), and the monetary cost. Our results in our baseline model are in line with expectations; respondents prefer the benefits of the program sooner than later, programs that reduce both the mortality and morbidity risk, and less costly programs. Moreover, our results suggest that respondents prefer water- compared with food-safety programs. However, a main objective of this study is to examine scope sensitivity of mortality risk reductions using a novel approach. Our results from a split-sample design suggest that the value of the mortality risk reduction, defined as the value of a statistical life, is SEK 3 177 (USD 483 million) and SEK 50 million (USD 8 million), respectively, in our two sub-samples. This result cast doubt on the standard scope sensitivity tests in choice experiments, and the results also cast doubt on the validity and reliability of VSL estimates based on stated preference (and revealed preference) studies in general. This is important due to the large empirical literature on non-market evaluation and the elicited values’ central role in policy making, such as benefit-cost analysis. |
| Keywords: | Choice experiments; Morbidity risk; Mortality risk; Scope sensitivity; Willingness to pay |
| JEL: | D61 H41 I18 Q51 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:27900&r=hea |