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on Health Economics |
| By: | Chorniy, Anna |
| Abstract: | In the U.S., 8% of children are diagnosed with ADHD and 70% are taking medications, yet little evidence exists on the effects of ADHD treatment on children's outcomes. We use a panel of South Carolina Medicaid claims data to investigate the effects of ADHD drugs on the probability of risky sexual behavior outcomes (STDs and pregnancy), substance abuse disorders, and injuries. To overcome potential endogeneity, we instrument for treatment using physicians' preferences to prescribe medication. Our findings suggest that pharmacological treatment has substantial benefits. It reduces the probability of contracting an STD by 3.6 percentage points (7.7 percentage points if we include STD screening), reduces the probability of having a substance abuse disorder by 12.5 percentage points, reduces the probability of injuries by 3.1 percentage points per year, and associated with them Medicaid costs decrease by $122, or 0.07 standard deviation. |
| JEL: | I12 J18 I10 |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:vfsc16:145766&r=hea |
| By: | Hirsch, Boris; Lechmann, Daniel; Schnabel, Claus |
| Abstract: | Presenteeism, i.e. attending work while sick, is widespread and associated with significant costs. Still, economic analyses of this phenomenon are rare. In a theoretical model, we show that presenteeism arises due to differences between workers in the disutility from workplace attendance. As these differences are unobservable by employers, they set wages that incentivise sick workers to attend work. Using a large representative German data set, we test several hypotheses derived from our model. In line with our predictions, we find that stressful working conditions and bad health status are positively related to presenteeism. Better dismissal protection, captured by higher tenure, is associated with slightly fewer presenteeism days, whereas the role of productivity and skills is inconclusive. |
| JEL: | I19 J22 J29 |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:vfsc16:145478&r=hea |
| By: | Scheil-Adlung, Xenia. |
| Abstract: | This document presents data on: (i) current number of workers in the entire global health protection supply chains involving the health economies of 185 countries; (ii) employment potential created by addressing health workforce shortages and producing universal health coverage (UHC); (iii) ratio of jobs in health and non-health occupations needed to achieve health objectives; (iv) number of decent jobs required to allow family care workers filling in for workforce shortages to remain in the labour market. The paper calls for significantly increasing investments in decent jobs for the production of UHC, sustainable development and inclusive growth. |
| Keywords: | social protection, medical care, care worker, medical personnel, access to care, labour force, employment creation |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:ilo:ilowps:994940893002676&r=hea |
| By: | Marcos Agurto Adrianzén (Universidad de Piura) |
| Abstract: | This paper examines the effects of long term improved cooking stoves (ICS) usage on selfreported eye irritation symptoms and respiratory health in the Northern Peruvian Andes. To identify the effect of ICS, we exploit field data related to the quasi-random distribution of ICS with faulty iron frames. Our results indicate that ICS long term usage, with an operative chimney, reduces respiratory illnesses and eye discomfort symptoms among housewives. It is also shown that in the case of respiratory health, other household members may benefit from reduced household air pollution (HAP) exposure. |
| Date: | 2016–07 |
| URL: | http://d.repec.org/n?u=RePEc:ima:wpaper:2016-002&r=hea |
| By: | Angelini, Viola; Mierau, Joachim (Groningen University) |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:gro:rugsom:17002-eef&r=hea |
| By: | Lazuka, Volha (Department of Economic History, Lund University) |
| Abstract: | There is a growing body of literature showing that health in infancy has a strong influence on health and productivity later in life. This paper uses exogenous improvements in infant health generated by the introduction of a medical innovation in the late 1930s as treatment against several infectious diseases, in particular pneumonia reduced by the advent of the sulfa medicaments. Based on rich administrative population data for Sweden 1968–2012 and archival data on the availability of sulfa antibiotics, it explores the effect of reduction in exposure to pneumonia in infancy on labour market outcomes discerned in adulthood of the affected cohorts. Our findings suggest that mitigation of pneumonia disease burden in infancy substantially reduced probability of working disability and increased labour income in late adulthood. Regarding the mechanisms, the beneficial effects are strong for health, measured with reduced number of hospital admissions, and somewhat weaker for years of schooling. These effects are fairly equal among males and females, and larger among individuals from disadvantaged backgrounds. All effects are robust to various specifications including regional and family factors. |
| Keywords: | medical innovation; sulfa antibiotics; early-life effects; infancy; labour productivity; Health; human capital; Sweden |
| JEL: | H41 I15 I18 N34 |
| Date: | 2017–02–28 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:luekhi:0154&r=hea |
| By: | Bastian Ravesteijn (Erasmus School of Economics, Erasmus University Rotterdam, the Netherlands; Department of Health Care Policy, Harvard Medical School, USA; LIRAES (EA4470), Université Paris Descartes -Sorbonne Paris Cité, France); Hans van Kippersluis (Erasmus School of Economics, Erasmus University Rotterdam and Tinbergen Institute, The Netherlands); Mauricio Avendano (Department of Social Science, Health and Medicine at King’s College London, United Kingdom;); Pekka Martikainen (Department of Sociology, University of Helsinki, Finland); Hannu Vessari (Novo Nordisk, Aalto, Finland); Eddy van Doorslaer (Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the) |
| Abstract: | We investigate whether later educational tracking reduced the intergenerational persistence of socioeconomic disparities in mortality in Finland,where the tracking age was raised from 11 to 16 in the 1970s. We use a difference-in-differences approach that exploits the gradual rollout of the reform. We find that late tracking did reduce disparities in mortality around the age of 50 by parental income for men. However, the longevity gains of men from low-income families seem to have come at the cost of increased mortality among men who grew up in high-income families. This raises questions about the welfare implications of the reform. |
| Keywords: | Education; mortality; tracking; Difference-in-Difference; Finland |
| JEL: | C21 I14 I24 |
| Date: | 2017–02–27 |
| URL: | http://d.repec.org/n?u=RePEc:tin:wpaper:20170030&r=hea |
| By: | Sarah Brown (Department of Economics, University of Sheffield); Pulak Ghosh (Indian Institute of Management (IIMB), Bangalore, India); Daniel Gray (Department of Economics, University of Sheffield); Bhuvanesh Pareek (Indian Institute of Management (IIM), Indore, India); Jennifer Roberts (Department of Economics, University of Sheffield) |
| Abstract: | Using British panel data, we explore the relationship between saving behaviour and health,as measured by an extensive range of biomarkers, which are rarely available in large nationallyrepresentative surveys. The effects of these objective measures of health are compared withcommonly used self-assessed health measures. We develop a semi-continuous high-dimensionalBayesian modelling approach, which allows different data-generating processes for the decision tosave and the amount saved. We find that composite biomarker measures of health, as well asindividual biomarkers, are significant determinants of saving. Our results suggest that objectivebiomarker measures of health have differential impacts on saving behaviour compared to selfreported health measures, suggesting that objective health measures can further our understanding ofthe effect of health on financial behaviours. |
| Keywords: | bayesian modelling; biomarkers; household finances; saving; two-part model. |
| JEL: | D12 D14 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:shf:wpaper:2017005&r=hea |
| By: | Lorenzo Casaburi; Jack Willis |
| Abstract: | The gains from insurance arise from the transfer of income across states. Yet, by requiring that the premium be paid upfront, standard insurance products also transfer income across time. We show that this intertemporal transfer can help explain low insurance demand, especially among the poor, and in a randomized control trial in Kenya we test a crop insurance product which removes it. The product is interlinked with a contract farming scheme: as with other inputs, the buyer of the crop offers the insurance and deducts the premium from farmer revenues at harvest time. The take-up rate is 72%, compared to 5% for the standard upfront contract, and take-up is highest among poorer farmers. Additional experiments and outcomes indicate that liquidity constraints, present bias, and counterparty risk are all important constraints on the demand for standard insurance. Finally, evidence from a natural experiment in the United States, exploiting a change in the timing of the premium payment for Federal Crop Insurance, shows that the transfer across time also affects insurance adoption in developed countries. |
| Keywords: | Insurance, income transfer, development economics, contract farming |
| JEL: | D81 O13 O55 |
| Date: | 2016–12 |
| URL: | http://d.repec.org/n?u=RePEc:zur:uceswp:018&r=hea |
| By: | Rashad, Ahmed Shoukry; Sharaf, Mesbah Fathy; Mansour, Elhussien I. |
| Abstract: | We assess the impact of health insurance on the utilization of maternal health care services in Egypt. A propensity score matching is used to control for baseline differences in the characteristics of the insured and uninsured women, to determine the difference in health care utilization between the two groups that is attributed solely to the health insurance coverage. The results yield that the national health insurance has a strong positive impact on most of the maternal healthcare indicators. Public health insurance coverage increases the likelihood of receiving antenatal care by about 7%, delivering in a public health facility by 8%, and the likelihood that a newborn receive vitamin A dose after delivery by 8.2%. However, women who are less educated, from a poor household, and rural regions, are less likely to be covered by a health insurance. The findings of this study would guide intervention measures that aim at improving health care utilization especially among the poor and other vulnerable groups. |
| Keywords: | maternal care utilization,health insurance,propensity score matching,Egypt |
| JEL: | I14 I15 |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:fsfmwp:223&r=hea |
| By: | Nora Lustig (Stone Center for Latin American Studies, Department of Economics, Tulane University.) |
| Abstract: | Here, I examine the level, redistributive impact and pro-poorness of government spending on education and health for thirteen developing countries from the Commitment to Equity project. Social spending as a share of total income is high by historical standards, and it rises with income per capita and income inequality. Spending on education and health lowers inequality and its marginal contribution to the overall decline in inequality is, on average, 69 percent. There appears to be no “Robin Hood Paradox:” redistribution increases with income inequality, even if one controls for per capita income. Concentration coefficients indicate that spending on pre-school, primary and secondary education is pro-poor in twelve countries. Spending on tertiary education is regressive and unequalizing in three countries, and progressive and equalizing (but not pro-poor) in ten. Health spending is pro-poor in five countries. Of the remaining eight, health spending per capita is roughly equal across the income distribution in three, and progressive and equalizing (but not pro-poor) in five. |
| Keywords: | fiscal incidence, social spending, inequality, developing countries |
| JEL: | H22 D31 I3 |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:tul:ceqwps:30&r=hea |
| By: | James C. Cox; Vjollca Sadiraj; Kurt E. Schnier; John F. Sweeney |
| Abstract: | This paper reports research on improving decisions about hospital discharge ? a critical healthcare quality and cost determinant identified by the Centers for Medicare and Medicaid Services. We report an experiment on effects of subjective information about patients’ health status on discharge decisions as well as uptake of recommendations from a clinical decision support system (CDSS). Subjective information about readiness for discharge was obtained during examinations of standardized patients, who are regularly employed in medical education, but in our experiment had been given scripts developed for the experimental treatments. The CDSS presents evidence-based discharge recommendations obtained from econometric analysis of data from de identified electronic health records (EHR) of hospital patients. Subjects in the experiment were third and fourth year medical students. We find that the CDSS decreases hospital stay by one day while decreasing readmissions of high-risk patients. Subjects are responding appropriately to information conveyed by standardized patients when such information is consistent with the EHR. Compared to patient discharge from the hospital absent patient reports, Eager patients when also EHR-Fit are at least seven times more likely to be discharged whereas Reluctant patients when also EHR-Sick are about four times less likely to be discharged. |
| Keywords: | Experiment, Decision Support, Patient Reports, Default Option |
| JEL: | C91 D81 I10 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:exc:wpaper:2017-03&r=hea |
| By: | MATSUYAMA Yusuke; TSUBOYA Toru; TANIGAMI Kazuya; OMINAMI Takahiro; TASO Tadateru; MURAMATSU Gaku; BESSHO Shun-ichiro |
| Abstract: | After the Great East Japan Earthquake on March 11, 2011, survivors who suffered severe damages were exempted from paying their co-payments. They were located mainly in three prefectures: Miyagi, Fukushima, and Iwate. In Miyagi, which experienced the largest number of deaths, the exemption was suspended between April 1, 2013 and March 31, 2014 (FY2013) due to a political decision, while Fukushima and Iwate still hold this exemption. This study aimed to describe the trajectory of healthcare utilization via: 1) healthcare expenditure/capita/month, 2) number of medical visits/capita/month, and 3) healthcare expenditure/visit before and after the exemption period. We also examined associations between changes in healthcare utility and the exemption. First, we employed differences in differences (DID) analyses to compare healthcare utilization in Miyagi with that in the other prefectures. Healthcare utilization in Miyagi decreased just after the disaster and soon spiked higher than the previous level. This phenomenon was also observed in Fukushima and Iwate. Another sharp spike in healthcare utilization was observed just before the exemption suspension, while similar spikes were not observed in Fukushima or Iwate during the same period. The rapid increase in Miyagi was more significant in medical/dental service for outpatients than for inpatients. Second, we stratified DID analyses within Miyagi by co-payment level (30% or less). In Japan, the co-payment paid is typically 30% of the total medical/dental costs, however, elderly and preschool children are subject to co-pay of 10% or 20% respectively. Among thwho pay 30% rate, healthcare utilization decreased through the exemption suspension, while it remained stable among those who pay 10%-20%. During the same period, we did not observe a significant increase in mortality, a proxy of "adverse effect" of the exemption suspension, at least on the ecological level. These results suggested that the co-payment exemption helped the survivors, especially those with a relatively high co-payment rate of 30%, to obtain healthcare service one year after the disaster. Further research with individual-level data is needed to find out how long the exemption period should last and who should be eligible for the exemption for a longer period. |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:eti:rdpsjp:17004&r=hea |
| By: | Jana Brandt (Justus Liebig University Giessen) |
| Abstract: | This paper investigates the impacts of large scale land investments on the health of children. I use household data of the 2005 and 2011 Demographic Health Surveys (DHS) for Ethiopia and combine them with information of large scale land investment projects provided by the Land Matrix Observatory. This data provides information about the location of the land investments and about the location of children. With this information I develop an index that indicates the level of investment intensity for each child’s residential area. Taking advantage of the repeated cross sectional structure of the DHS data, I estimate the e ect of an increase in the investment intensity of a child’s residential area and how this e ect changes over time. The results indicate that the e ect is negative for children born between 2000-2005, but it rises over time by getting less negative or even positive for children born between 2006-2011. The di erence-in-di erences estimation with Gaussian kernel propensity score matching shows a benefit in the development status of children that are exposed to large scale land investments. This paper investigates the impacts of the recent wave of large scale land investments on the health of Ethiopian children that are exposed to such investments. I use household data of the 2005 and 2011 Demographic Health Surveys (DHS) for Ethiopia and combine them with information of large scale land investment projects provided by the Land Matrix Observatory. This data allows to identify the location of the land investments as well as the location of children born between 2000-2011. I use these information to construct an index that indicates the level of investment intensity for each child’s residential area. Taking advantage of the repeated cross sectional structure of the DHS data, I estimate the e ect of an increase in the investment intensity of a child’s residential area and how this e ect changes over time. The results indicate that the e ect is negative for children born between 2000-2005, but it rises over time by getting less negative or even positive for children born between 2006-2011. The di erence-in-di erences estimation with Gaussian kernel propensity score matching shows a benefit in the development status of children that are exposed to large scale land investments. |
| Keywords: | Large scale land investment, Child health, Development |
| JEL: | I15 O12 Q15 |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:mar:magkse:201713&r=hea |
| By: | Anna Alberini (University of Maryland) |
| Abstract: | This paper reviews and discusses the existing methods for placing a value on the effects of chemicals on human health and the environment. It surveys both methods and non-market methods, discussing their advantage and limitations. For example, when valuing non-fatal illnesses, the cost-of-illness approaches captures labour income lost to illness and medical expenditures undertaken to mitigate the illness, but fails to account for the value of the disutility of the illnesses. The paper also discusses mortality risk valuation, and the widely used metric termed the Value of a Statistical Life, the difficulties associated with estimating it, and the appropriateness of any adjustments for futurity, age, and the nature of the risk itself. Finally, the paper takes up the issue whether the source of the health risks (e.g., chemicals versus other forms of pollution versus others) affects how much the public values reducing those risks. |
| Keywords: | economic valuation, monetised benefits, non-market valuation, regulation of chemicals, toxics |
| JEL: | D61 J17 K32 Q51 Q53 Q57 Q58 |
| Date: | 2017–03–02 |
| URL: | http://d.repec.org/n?u=RePEc:oec:envaaa:116-en&r=hea |
| By: | Aurélie Pierre (IRDES Institut de recherche et documentation en économie de la santé, Université Paris Descartes); Florence Jusot (Université Paris-Dauphine Leda-Legos) |
| Keywords: | Complementary Health Insurance, Inequality, Risk aversion, Time preference, National Interprofessional Agreement, Simulation. |
| JEL: | I13 D63 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:irh:wpaper:dt67bis&r=hea |
| By: | Alexander Ahammer; Ivan Zilic |
| Abstract: | Do physicians respond to financial incentives? We address this question by analyzing the prescription behavior of physicians who are allowed to dispense drugs themselves through onsite pharmacies. Using administrative data comprising over 16 million drug prescriptions between 2008 and 2012 in Upper Austria, a naïve comparison of raw figures reveals that self-dispensing GPs induce 33.2% higher drug expenses than others. Our identification strategy rests on multiple pillars: First, we use an extensive array of covariates along with multi-dimensional fixed effects which account for patient and GP-level heterogeneity as well as sorting of GPs into onsite pharmacies. Second, we use a novel approach that allows us to restrict our sample to randomly allocated patient-GP matches which rules out endogenous sorting as well as principal-agent bargaining over prescriptions between patients and GPs. Contrary to our descriptive analysis, we find evidence that onsite pharmacies have a small negative effect on prescriptions. Although self-dispensing GPs seem to prescribe sligthly more expensive medication, this effect is absorbed by a much smaller likelihood to |
| Keywords: | Physician dispensing, drug expenses, physician agency, moral hazard |
| JEL: | I11 I12 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:jku:econwp:2017_02&r=hea |
| By: | Kieron Barclay (Max Planck Institute for Demographic Research, Rostock, Germany); Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany) |
| Abstract: | Annually, 6 million children under age five die and over 80% of these deaths happen in the developing world. However, under-five mortality did decrease by 53% between 1990 and 2015. For an individual mother, having a child at an older age means placing the child into a later birth cohort in which survival should be higher due to secular declines in mortality. Using data covering 7 million births, 77 developing countries, and 228 Demographic and Health Surveys collected from 1985-2014, we implement Cox proportional hazard models and stratified Cox models to study how secular declines in child mortality offset the risks associated with reproductive ageing. We also calculate the population attributable fraction to examine how a change in the distribution of maternal age at birth would affect under-five mortality. Our results show that if fertility in the DHS countries was on average postponed by as little as 1-year, 1.4%, or more than 68,000 of all child deaths per year, could be avoided. An increase in birth spacing by 1-year would reduce child mortality by 0.9% per year. In countries with the fastest rates of decline in under-five mortality, postponing all childbearing by 1-year would reduce child mortality by 3.0%, and a 1-year increase in birth spacing would reduce child mortality by 4.3%. This study shows that secular declines in under-five mortality can counterbalance or outweigh the risks associated with reproductive ageing in developing countries. Postponing fertility is not only the expressed preference of women, but would also help save childrens lives. |
| JEL: | J1 Z0 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:dem:wpaper:wp-2017-005&r=hea |
| By: | Jacqueline Damant; Martin Knapp; Paul P. Freddolino; Daniel Lombard |
| Abstract: | It is often asserted that older people's quality of life (QOL) is improved when they adopt information and communication technology (ICT) such as the Internet, mobile phones and computers. Similar assumptions are made about older people's use of ICT-based care such as telecare and telehealth. To examine the evidence around these claims, we conducted a scoping review of the academic and grey literature, coving the period between January 2007 and August 2014. A framework analysis approach, based on six domains of QOL derived from the ASCOT and WHOQOL models, was adopted to deductively code and analyse relevant literature. The review revealed mixed results. Older people's use of ICT in both mainstream and care contexts has been shown to have both positive and negative impacts on several aspects of QOL. Studies which have rigorously assessed the impact of older people's use of ICT on their QOL mostly demonstrate little effect. A number of qualitative studies have reported on the positive effects for older people who use ICT such as email or Skype to keep in touch with family and friends. Overall, the review unearthed several inconsistencies around the effects of older people's ICT use on their QOL, suggesting that implicit agreement is needed on the best research methods and instrumentation to adequately describe older people's experiences in today's digital age. Moreover, the available evidence does not consider the large number of older people who do not use ICT and how non-use affects QOL. |
| Keywords: | nternet; older people; quality of life; technology; telecare; telehealth |
| JEL: | L91 L96 |
| Date: | 2016–02–16 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:65650&r=hea |
| By: | Gina A. Livermore; Maura Bardos; Karen Katz |
| Abstract: | People with intellectual disability (ID) make up about 14 percent of all working-age Supplemental Security Income and Social Security Disability Insurance (DI) beneficiaries. |
| Keywords: | intellectual disability, SSI, Supplemental security income, SSDI, Social Security Disability Insurance, beneficiaries |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:2f51d63075084451a2f48ace57737bca&r=hea |
| By: | Jochen Hartwig (KOF Swiss Economic Institute, ETH Zurich, Switzerland); Jan-Egbert Sturm (KOF Swiss Economic Institute, ETH Zurich, Switzerland) |
| Abstract: | Michael Grossman’s human capital model of the demand for health has been argued to be one of the major achievements in theoretical health economics. Attempts to test this model empirically have been sparse, however, and with mixed results. These attempts so far relied on using – mostly cross-sectional – micro data from household surveys. For the first time in the literature we bring in macroeconomic panel data for 29 OECD countries over the period 1970-2010 to test the model. In order to check the robustness of the results for the determinants of medical spending identified by the model, we include additional covariates that have been suggested as determinants for medical spending in an Extreme Bounds Analysis (EBA) framework. The preferred model specifications (including the robust covariates) lend some support to the empirical relevance of the determinants of medical spending identified by the Grossman model, except for the relative medical price. |
| Keywords: | Medical spending, Grossman model, Extreme Bounds Analysis, OECD panel |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:kof:wpskof:17-426&r=hea |
| By: | Lindsey Leininger; Thomas DeLeire |
| Abstract: | Predictive modeling is frequently used in population health management programs to stratify populations by their risk of a poor health care outcome. This brief outlines scenarios for which a predictive modeling application is likely to be appropriate and describes key practical considerations for implementation. |
| Keywords: | predictive analytics, population health management, methods translation |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:590cfede34974c78849d4d0a9e42ddd5&r=hea |
| By: | Yaa Akosa Antwi; Johanna Catherine Maclean |
| Abstract: | In this study we re-visit the relationship between private health insurance mandates, access to employer-sponsored health insurance, and labor market outcomes. Specifically, we model employer-sponsored health insurance access and labor market outcomes across the lifecycle as a function of the number of high cost mandates in place at labor market entrance. Our analysis draws on a long panel of workers from the National Longitudinal Survey of Youth 1979 and exploits variation in five high cost state mandates between 1972 and 1989. Four principal findings emerge from our analysis. First, we find no strong evidence that high cost state health insurance mandates discourage employers from offering insurance to employees. Second, employers adjust both wages and labor demand to offset mandate costs, suggesting that employees place some value on the mandated benefits. Third, the effects are persistent, but not permanent. Fourth, the effects are heterogeneous across worker types. These findings have implications for thinking through the full labor market effects of health insurance expansions. |
| JEL: | H2 I13 J3 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23203&r=hea |
| By: | Alex Hollingsworth; Christopher J. Ruhm; Kosali Simon |
| Abstract: | Past research indicates that physical health measures (such as all-cause mortality) improve when economic conditions temporarily deteriorate, but the relationship between economic conditions and behavioral health remain unclear. The pro-cyclicality of mortality has declined in recent years while drug poisoning deaths have trended sharply upwards, suggesting a connection to the rising use of many types of drugs. We contribute new evidence to the literature by examining how severe, adverse outcomes related to use of opioid analgesics (hereafter abbreviated as opioids) and other drugs vary with short-term fluctuations in macroeconomic conditions. We use data on deaths and emergency department (ED) visits related to opioid and other drug poisonings together with information on state and county unemployment rates. We focus on opioids because they are a major driver of the recent, fatal drug epidemic. We use county-level mortality data for the entire U.S. from 1999-2014, and state and county level ED data covering 2002-2014 from a subset of states. We find that as the county unemployment rate increases by 1 percentage point, the opioid death rate (per 100,000) rises by 0.19 (3.6%) and the ED visit rate for opioid overdoses (per 100,000) increases by 0.95 (7.0%). We also uncover statistically significant increases in the overall drug death rate that are driven in most specifications by increases in opioid deaths. These results hold when performing a state, rather than county, level analysis. The results are primarily driven by adverse events among whites, although there is some sensitivity to choice of models in the results for nonwhites. Additionally, the findings are relatively stable across time periods; they do not pertain only to recession years, but instead represent a more generalizable and previously unexplored connection between economic development and the severe adverse consequences of substance abuse. |
| JEL: | I1 I12 I15 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23192&r=hea |
| By: | Mariana Carrera; Heather Royer; Mark F. Stehr; Justin R. Sydnor |
| Abstract: | The use of incentives to encourage healthy behaviors is increasingly widespread, but we have little evidence about how best to structure these programs. We explore how different incentive designs affect behavior on the extensive and intensive margins through an experiment offering incentives to employees of a Fortune 500 company to use their workplace gym. Overall the likelihood of joining the gym was not strongly affected by the incentive design. Notably, front-loading incentives to encourage initial participation was not more effective than an incentive kept constant over time. For those who were already at least occasional users of the gym, however, we find more evidence that the design of incentives matters. For this group, front-loading incentives appears to be detrimental relative to a constant incentive, but a novel design that spreads out the incentive budget by turning incentives on and off over a longer period of time is effective. |
| JEL: | D03 I10 J30 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23188&r=hea |