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on Health Economics |
| By: | Maryaline Catillon; David Cutler; Thomas Getzen |
| Abstract: | Using two hundred years of national and Massachusetts data on medical care and health, we examine how central medical care is to life expectancy gains. While common theories about medical care cost growth stress growing demand, our analysis highlights the importance of supply side factors, including the major public investments in research, workforce training and hospital construction that fueled a surge in spending over the 1955-1975 span. There is a stronger case that personal medicine affected health in the second half of the twentieth century than in the preceding 150 years. Finally, we consider whether medical care productivity decreases over time, and find that spending increased faster than life expectancy, although the ratio stabilized in the past two decades. |
| JEL: | H51 I15 I18 J1 N3 O1 |
| Date: | 2018–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25330&r=hea |
| By: | Frank R. Lichtenberg |
| Abstract: | I investigate whether the types of cancer (breast, colon, lung, etc.) subject to greater penetration of new ideas had larger subsequent survival gains and mortality reductions, controlling for changing incidence. I use the MEDLINE/PubMED database, which contains more than 23 million references to journal articles published in 5400 leading biomedical journals, to construct longitudinal measures of the penetration of new medical ideas. The 5-year survival rate is strongly positively related to the novelty of ideas in articles published 12-24 years earlier. This finding is consistent with evidence from case studies that it takes a long time for research evidence to reach clinical practice. The estimates suggest that about 70% of the 1994-2008 increase in the 5-year observed survival rate for all cancer sites combined may have been due to the increase in the novelty of medical ideas 12-24 years earlier. The number of years of potential life lost from cancer before ages 80 and 70 are inversely related to the novelty of ideas in articles published 12-24 years earlier, conditional on incidence. The increase in medical idea novelty was estimated to have caused a 38% decline in the premature (before age 80) cancer mortality rate 12-24 years later. |
| JEL: | I1 J11 O3 |
| Date: | 2018–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25328&r=hea |
| By: | Guy Lacroix; Francois LalibertŽe-Auger; Pierre-Carl Michaud; Daniel Parent |
| Abstract: | We investigate the returns to college attendance in Canada in terms of health and mortality reduction. To do so, we first use a dynamic health microsimulation model to document how inter-ventions which incentivize college attendance among high school graduates may impact their health trajectory, health care consumption and life expectancy. We find large returns both in terms of longevity (4.1 years additional years at age 51), reduction in the prevalence of various health conditions (10-15 percentage points reduction in diabetes and 5 percentage points for stroke) and health care consumption (27.3% reduction in lifetime hospital stays, 19.7 for specialists). We find that education impacts mortality mostly by delaying the incidence of health conditions as well as providing a survival advantage conditional on having diseases. Second, we provide qua-si-experimental evidence on the impact of college attendance on long- term health outcomes by exploiting the Canadian Veteran's Rehabilitation Act, a program targeted towards returning WW-II veterans and which incentivized college attendance. The impact on mortality are found to be larger than those estimated from the health microsimulation model (hazard ratio of 0.216 com-pared to 0.6 in the simulation model) which suggest substantial returns to college education in terms of healthy life extension which we estimate around one million canadian dollars. |
| Keywords: | mortality, education, microsimulation, quasi-experimental, instrumental variables, veterans |
| JEL: | I14 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:lvl:crrecr:1820&r=hea |
| By: | Marianne Tenand (Erasmus University Rotterdam); Pieter Bakx (Erasmus University Rotterdam); Eddy (E.K.A.) van Doorslaer (Erasmus University Rotterdam) |
| Abstract: | The Netherlands is one of the few countries that offer generous universal coverage of long-term care (LTC). Does this ensure that the Dutch elderly with similar care needs receive similar LTC, irrespective of their income? In contrast with previous studies of inequity in care use that relied on a statistically derived variable of needs, our paper exploits a readily available, administrative measure of LTC needs, stemming from the eligibility assessment organized by the Dutch LTC assessment agency. Using exhaustive administrative register data on 616,934 individuals aged 60 and older eligible for public LTC, we find a substantial pro-poor concentration of LTC use that is only partially explained by poorer individuals’ greater needs. Among those eligible for institutional care, higher-income individuals are more likely to use – less costly – home care. This pattern may be explained by differences in preferences, but also by their higher copayments for nursing homes and by greater feasibility of home-based LTC arrangements for richer elderly. At face value, our findings suggest that the Dutch LTC insurance ‘overshoots’ its target to ensure that LTC is accessible to poorer elderly. Yet, the implications depend on the origins of the difference and one’s normative stance. |
| Keywords: | Long-term care; Equity in care use; Horizontal equity; Socio-economic inequality |
| JEL: | J14 I14 D63 |
| Date: | 2018–12–13 |
| URL: | http://d.repec.org/n?u=RePEc:tin:wpaper:20180098&r=hea |
| By: | Daniel Avdic (CINCH - Health Economics Research Center and University of Duisburg-Essen); Tugba Büyükdurmus (CINCH - Health Economics Research Center); Giuseppe Moscelli (School of Economics, University of Surrey, Guildford, UK); Adam Pilny (RWI – Leibniz-Institut für Wirtschaftsforschung); Ieva Sriubaite (CINCH - Health Economics Research Center and RWI – Leibniz-Institut für Wirtschaftsforschung) |
| Abstract: | We study patient choice of healthcare provider based on both objective and subjective quality measures in the context of maternal care hospital services in Germany. Objective measures are obtained from publicly reported clinical indicators, while subjective measures are based on satisfaction scores from a large and nationwide patient survey. We merge both quality metrics to detailed hospital discharge records and quantify the additional distance expectant mothers are willing to travel to give birth in maternity clinics with higher reported quality. Our results reveal that patients are on average willing to travel between 0.7-4.2 additional kilometers for a one standard deviation increase in reported quality. Furthermore, patients respond independently to both objective and subjective quality measures, suggesting that satisfaction scores may constitute important complements to clinical indicators when choosing healthcare provider. |
| Keywords: | hospital competition, hospital choice, maternal care, quality reporting |
| JEL: | C25 D82 H51 I11 I18 |
| URL: | http://d.repec.org/n?u=RePEc:duh:wpaper:1803&r=hea |
| By: | Berta, P.;; De Fraja, G.;; Verzillos, S.; |
| Abstract: | In this paper we investigate the nature of the contracts between a large health-care purchaser and health service providers in a prospective payment system. We model theoretically the interaction between patients choice and cream-skimming by hospitals. We test the model using a very large and detailed administrative dataset for the largest region in Italy. In line with our theoretical results, we show that the state funded purchaser offers providers a system of incentives such that the most efficient providers both treat more patients and also treat more difficult patients, thus receiving a higher average payment per treatment. |
| Keywords: | patients choice; cream skimming; optimal healthcare contracts; hospitals; Lombardy; |
| JEL: | I11 I18 D82 H42 |
| Date: | 2018–12 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:18/33&r=hea |
| By: | Christopher Cronin (Department of Economics, University of Notre Dame); Matthew Forsstrom (Wheaton College); Nicholas Papageorge (Department of Economics, Johns Hopkins University) |
| Abstract: | There are two primary treatment alternatives available to those with mild to moderate depression or anxiety: psychotherapy and medication. The medical literature and our analysis suggests that in many cases psychotherapy, or a combination of therapy and medication, is more curative than medication alone. However, few individuals choose to use psychotherapy. We develop and estimate a dynamic model in which individuals make sequential medical treatment and labor supply decisions while jointly managing mental health and human capital. The results shed light on the relative importance of several drawbacks to psychotherapy that explain patients' reluctance to use it: (1) therapy has high time costs, which vary with an individual's opportunity cost of time and flexibility of the work schedule; (2) therapy is less standardized than medication, which results in uncertainty about its productivity for a given individual; and (3) therapy is expensive. The estimated model is used to simulate the impacts of counterfactual policies that alter the costs associated with psychotherapy. |
| Keywords: | Mental Health, Demand for Medical Care, Labor Supply, Structural Models |
| JEL: | I10 I12 J22 J24 |
| URL: | http://d.repec.org/n?u=RePEc:duh:wpaper:1704&r=hea |
| By: | Nicolai Brachowicz Quintanilla (Center for Research in Health and Economics (CRES-UPF) & Universitat Pompeu Fabra); Judit Vall Castelló (Universitat de Barcelona & Institut d’Economia de Barcelona (IEB)) |
| Abstract: | In year 1991 regional governments in Spain started a period of implementation of a law that rose the Minimum Legal Drinking Age from 16 to 18 years old. This process was fully completed in year 2015. To evaluate the effects of this change on consumption of legal drugs and its related morbidity outcomes, we construct a regional panel dataset on alcohol consumption and hospital entry registers and compare variation in several measures of prevalence between the treatment group (16-18 years old individuals) and the control group (20-22 years old individuals). Our findings show important differences by gender. Firstly, our main result regarding overall drinking prevalence show reductions ranging from -11.57% for the subsample including both genders to -14.31% for the subsample of males. Secondly, effects on males are driven mainly by reductions in beer with alcohol consumption (-8.98%). Thirdly, effects on wine and/or cava drinking prevalence range from -12.62% for the subsample including both genders to -9.65% for the subsample of females. No effects regarding overall smoking prevalence are found. Fourthly, we do not find evidence that these reductions in alcohol consumption are translated into hospitalizations related to alcohol overdose. To our knowledge, this is the first paper providing evidence on gender-based differences to policies aimed at reducing alcohol consumption. Our results have important policy implications for countries currently considering changes in the Minimum Legal Drinking Age. |
| Keywords: | Evaluation of Public Policies, Health Economics, Minimum Legal Drinking Age, Differences in Differences, Drug Consumption |
| JEL: | H22 H75 I18 J19 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:ieb:wpaper:doc2018-19&r=hea |
| By: | Toshiaki Iizuka; Hitoshi Shigeoka |
| Abstract: | This study exploits over 5,000 variations in subsidy generosity across ages and municipalities in Japan to examine how children respond to healthcare prices. We find that free care significantly increases outpatient spending, with price elasticities considerably smaller than for adults. Price responses are substantially larger when small copayments are introduced, indicating more elastic demand around a zero price. We also find that increased utilization primarily reflects low-value and costly care: increased outpatient spending neither reduces subsequent hospitalization by “avoidable” conditions nor improves short- or medium-term health outcomes. By contrast, inappropriate use of antibiotics and costly after-hours visits increase. |
| JEL: | I11 I13 I18 J13 |
| Date: | 2018–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25306&r=hea |
| By: | Beatty, Timothy K.M.; Ritter, Joseph A. |
| Abstract: | How much does a year of unemployment affect a person’s health? Previous studies estimate the health effects of job loss after a follow-up period, but the length of unemployment spells within the follow-up is an implicitly variable treatment. Thus estimates based on a fixed follow up average over unemployment spells of different lengths, which implicitly depend on macroeconomic conditions. We estimate the effects of time unemployed and find robust negative effects of duration on men’s self-assessed health. For women the estimated effects are smaller and less precise. We use an instrumental variables approach to account for dynamic selection driven by feedback from health to duration via search intensity or reservation wages. Combining these effects with prior estimates of the relationship between self-assessed health and specific-cause mortality suggests the effects correspond to large social costs. |
| Keywords: | Health Economics and Policy, Labor and Human Capital |
| Date: | 2018–07 |
| URL: | http://d.repec.org/n?u=RePEc:ags:umaesp:280435&r=hea |
| By: | Caoimhe Rice (University of Bristol & University of York); Judit Vall Castelló (Universitat de Barcelona & Institut d’Economia de Barcelona (IEB)) |
| Abstract: | We exploit a change in the public healthcare entitlement of undocumented migrants in Spain to investigate the causal link between withdrawal of healthcare and changes in help-seeking behaviour of women experiencing intimate partner violence (IPV). We contribute to the new literature modelling domestic violence by taking a novel look at the role of human capital in decisions to seek help when in violent relationships. We use a difference-in-differences (DiD) methodology to compare the number of foreign applicants for protection orders before and after the reform using Spanish applicants as the counterfactual. The impact of the reform was immediate; foreign applicants decreased by 16% after the health policy reform was introduced and this drop amounts to 19% in areas with stronger enforcement of the reform. We perform several robustness checks including addressing potential bias from migration changes after the reform. Our findings are important for current policy discussions on granting/limiting access to public programs for the undocumented population. We provide evidence that restricted access to the healthcare system can have unintended negative consequences for the most vulnerable groups of the population with potentially important spill-over effects to the next generation. |
| Keywords: | Domestic Violence, Healthcare Access, Undocumented Migrants |
| JEL: | I12 I18 H51 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:ieb:wpaper:doc2018-22&r=hea |
| By: | Dhanushka Thamarapani (Department of Economics, California State University); Marc Rockmore (Department of Economics, Clark University); Willa Friedman (Department of Economics, University of Houston) |
| Abstract: | An emerging literature finds that childhood exposure to adverse events determines adult outcomes and behavior. We extend this research to understand the influence of witnessing a sibling death as a child on subsequent educational and fertility outcomes in Indonesia. Using panel data and a sibling fixed effects model, we identify this relationship based on variation in the age of surviving children within the same family. Our findings strongly support the importance and persistence of adverse childhood experiences. In particular, for surviving sisters, witnessing a sibling death reduces the years of completed education and the likelihood of completing secondary schooling. The effect on surviving brothers is more muted. A potential channel for this result is that women respond by changing their fertility behavior. While surviving the death of a sibling has little effect on desired fertility levels, we find evidence that surviving sisters start a family about 3-4 years earlier. This suggests that interventions targeted at early-life outcomes may have important ripple effects and that the full impact of health interventions may not be visible until decades afterwards |
| Keywords: | Child mortality, Siblings, Education, Fertility |
| JEL: | I10 J13 J16 O53 |
| URL: | http://d.repec.org/n?u=RePEc:duh:wpaper:1801&r=hea |
| By: | Pamela Giustinelli (Bocconi University, IGIER, and LEAP); Matthew D. Shapiro (University of Michigan and NBER) |
| Abstract: | This paper develops an innovative approach to measuring the effect of health on retirement. The approach elicits subjective probabilities of working at specified time horizons fixing health level. Using a treatment-effect framework, within-individual differences in elicited probabilities of working given health yield individual-level estimates of the causal effect of health (the treatment) on working (the outcome). We call this effect the Subjective ex ante Treatment Effect (SeaTE). The paper then develops a dynamic programming framework for the SeaTE. This framework allows measurement of individual-level value functions that map directly into the dynamic programming model commonly used in structural microeconometric analysis of retirement. The paper analyzes conditional probabilities elicited in the Vanguard Research Initiative (VRI)—a survey of older Americans with positive assets. Among workers 58 and older, a shift from high to low health would on average reduce the odds of working by 28.5 percentage points at a two-year horizon and 25.7 percentage points at a four-year horizon. There is substantial variability across individuals around these average SeaTEs, so there is substantial heterogeneity in taste for work or returns to work. This heterogeneity would be normally unobservable and hard to disentangle from other determinants of retirement in data on realized labor supply decisions and health states. The paper’s approach can overcome the problem that estimates of the effect of health on labor supply based on behavioral (realizations) data can easily overstate the effect of health on retirement whenever less healthy workers tend to retire earlier for reasons other than health. |
| Date: | 2018–02 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp382&r=hea |
| By: | Saha, Sanjib (Health Economics Unit, Department of Clinical Science, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University); Toresson, Håkan (Clinical Memory Research Unit, Department of Clinical Science, Lund University); Minthon, Lennart (Clinical Memory Research Unit, Department of Clinical Science, Lund University, Sweden); Jarl, Johan (Health Economics Unit, Department of Clinical Science, Lund University) |
| Abstract: | Objective: The objective is to systematically review the literature on economic evaluations of the interventions for the management of dementia and Alzheimer patients in home, hospital or institutional care. Methods: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: Twelve studies were identified and there was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of interventions. Interventions for the management of dementia patients are in general, not cost-effective. Interventions at the community and home setting for managing both the dementia patients and caregivers on a large scale may have the potential to save societal resources. Conclusion: More effectiveness studies as well as good quality economic evaluations are required before implementation decisions on management strategies can be made based on cost-effectiveness. |
| Keywords: | Dementia; nursing home care; community care; residential care; economic evaluation |
| JEL: | H43 I10 I18 |
| Date: | 2018–12–13 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2018_041&r=hea |
| By: | Nathalie Mathieu-Bolh (University of Vermont, USA); Ronald Wendner (University of Graz, Austria) |
| Abstract: | The empirical evidence of a non-monotone relation between income and obesity is not well explained. We build a theoretical model combining income inequality and social comparisons to explain the link between income and obesity and study tax policy implications for fighting obesity. We assume that differences in food consumption patterns between poor and wealthy households partly reflect positionality, which is the concern for social status. Our key assumption is that positionality for low-calorie food consumption is positively related to a country’s wealth. In this framework, body weight outcomes reflect competing income and positionality effects, yielding the following results. We explain the link between average obesity rates, and standards of living and suggest the existence of a Kuznets curve for obesity. For cross sections of the population, we explain the observed correlation between income and obesity, which is positive in poor countries, and negative rich countries. We find that increasing the relative cost of high-calorie food is less effective at decreasing the relative weight of poor individuals in rich countries than in poor countries. |
| Keywords: | Obesity; Status; Consumption Reference Points; Kuznets Curve; Tax Policy |
| JEL: | D11 D30 H31 I15 O41 |
| Date: | 2018–12 |
| URL: | http://d.repec.org/n?u=RePEc:grz:wpaper:2018-21&r=hea |
| By: | James J. Feigenbaum; Christopher Muller; Elizabeth Wrigley-Field |
| Abstract: | In the first half of the twentieth century, the rate of death from infectious disease in the United States fell precipitously. Although this decline is well-known and well-documented, there is surprisingly little evidence about whether it took place uniformly across the regions of the U.S. We use data on infectious disease deaths from all reporting U.S. cities to describe regional patterns in the decline of urban infectious mortality from 1900 to 1948. We report three main results: First, urban infectious mortality was higher in the South in every year from 1900 to 1948. Second, infectious mortality declined later in southern cities than in cities in the other regions. Third, comparatively high infectious mortality in southern cities was driven primarily by extremely high infectious mortality among African Americans. From 1906 to 1920, African Americans in cities experienced a rate of death from infectious disease greater than what urban whites experienced during the 1918 flu pandemic. |
| JEL: | I14 J1 N3 |
| Date: | 2018–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25345&r=hea |
| By: | Sebastian Vollmer (University of Göttingen); Juditha Wójcik (University of Mainz) |
| Abstract: | Several country-level studies, including a prominent one for the United States, have identified long-term effects of in-utero exposure to the 1918 influenza pandemic (also known as the Spanish Flu) on economic outcomes in adulthood. In-utero conditions are theoretically linked to adult health and socioeconomic status through the fetal origins or Barker hypothesis. Historical exposure to the Spanish Flu provides a natural experiment to test this hypothesis. Although the Spanish Flu was a global phenomenon, with around 500 million people infected worldwide, there exists no comprehensive global study on its long-term economic effects. We attempt to close this gap by systematically analyzing 117 Census data sets provided by IPUMS International. We do not find consistent global long-term effects of influenza exposure on education, employment and disability outcomes. A series of robustness checks does not alter this conclusion. Our findings indicate that the existing evidence on long-term economic effects of the Spanish Flu is likely a consequence of publication bias. |
| Keywords: | Spanish Flu, 1918 Influenza Pandemic, Fetal Origins Hypothesis |
| JEL: | I15 N30 O57 |
| URL: | http://d.repec.org/n?u=RePEc:duh:wpaper:1708&r=hea |
| By: | Bloom, David E. (Harvard University); Kuhn, Michael (Vienna Institute of Demography) |
| Abstract: | The positive cross-country correlation between health and economic growth is well-established, but the underlying mechanisms are complex and difficult to discern. Three issues are of central concern. First, assessing and disentangling causality between health and economic growth is empirically challenging. Second, the relation between health and economic growth changes over the process of economic development. Third, different dimensions of health (mortality vs. morbidity, children's and women's health, and health at older ages) may have different economic effects. |
| Keywords: | longevity, health, productivity, poverty traps, economic development, economic well-being, living standards, neoclassical and R&D-based growth |
| JEL: | I10 J13 J24 |
| Date: | 2018–11 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11939&r=hea |
| By: | Isabel Casas; Jiti Gao; Shangyu Xie |
| Abstract: | Income elasticity dynamics of health expenditure is considered for the OECD and the Eurozone over the period 1995-2014. This paper studies a novel non-linear cointegration model with fixed effects, controlling for cross-section dependence and unobserved heterogeneity. Most importantly, its coefficients can vary over time and its variables can be non-stationary. The resulting asymptotic theory is fundamentally different with a faster rate of convergence to similar kernel smoothing methodologies. A fully modified kernel regression method is also proposed to reduce the asymptotic bias. Results show a steep increase in the income elasticity for the OECD and a small increase for the Eurozone. |
| Keywords: | cross-sectional dependence, health expenditure, income elasticity, nonparametric kernel smoothing, non-stationarity, super-consistency. |
| JEL: | C14 C23 G13 H51 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:msh:ebswps:2018-22&r=hea |
| By: | Bloom, David E. (Harvard University); Canning, David (Harvard School of Public Health); Kotschy, Rainer (LMU Munich); Prettner, Klaus (University of Hohenheim); Schünemann, Johannes (University of Göttingen) |
| Abstract: | Micro-based and macro-based approaches have been used to assess the effects of health on economic growth. Micro-based approaches aggregate the return on individual health from Mincerian wage regressions to derive the macroeconomic effects of population health. Macro-based approaches estimate a generalized aggregate production function that decomposes output into its components. The microbased approach tends to find smaller effects than the macro-based approach, thus presenting a micromacro puzzle regarding the economic return on health. We reconcile these two strands of literature by showing that the point estimate of the macroeconomic effect of health is quantitatively close to that found by aggregating the microeconomic effects, controlling for potential spillovers of population health at the aggregate level. Our results justify using the micro-based approach to estimate the direct economic benefits of health interventions. |
| Keywords: | productivity, population health, human capital, economic development, return on health |
| JEL: | I15 I25 J11 O11 O15 |
| Date: | 2018–11 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11940&r=hea |
| By: | Dara Lee Luca; David E. Bloom |
| Abstract: | This paper investigates the economic returns to parental health. To account for potential endogeneity between parental health and child outcomes, we leverage longitudinal microdata from Indonesia to estimate individual fixed effects models. Our results show that the economic returns to parental health are high. We show that maternal health not only significantly affects her children’s health, but is also intrinsically linked to her spouse’s labor market status and earnings. Paternal health appears to be more linked to child schooling outcomes, especially for girls. When both parents are in poor health, the negative effects on their children are compounded. Additionally, the consequences of poor parental health are enduring. Longer-run effects of poor parental health manifest in a lower likelihood of high school completion, fewer years of schooling, and poorer adult health. |
| JEL: | I10 J13 J24 |
| Date: | 2018–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25304&r=hea |
| By: | Bo, Shiyu; Chen, Y. Joy; Song, Yan; Zhou, Sen |
| Abstract: | We study the relationship between media attention and major choices by evaluating how newspaper reports on violence against doctors in China deter students from choosing medicine as their college majors. We collect relevant articles from over 1,200 newspapers and combine them with an administrative dataset including the universe of students admitted to Chinese colleges from 2005 to 2011. An additional article on violence against doctors leads to a 0.5 percent decrease in the number of students choosing medicine majors, especially those training physicians and nurses. This effect doubles when we focus on sub-disciplines training physicians and nurses. Students attending elite colleges and with above-median test scores are more responsive to media attention. Moreover, our analysis reveals that exposure to relevant articles significantly reduce the quality of students choosing medicine majors. Consequently, it significantly reduces the quality of admitted medical students, measured by their entrance exam performance. |
| Keywords: | Media attention,College majors,Occupational choice,Health care |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:284&r=hea |
| By: | Chen, Xi; Wang, Tianyu; Busch, Susan H. |
| Abstract: | We estimate the impact of pension enrollment on mental well-being using China’s New Rural Pension Scheme (NRPS), the largest existing pension program in the world. Since its launch in 2009, more than 400 million Chinese have enrolled in the NRPS. We first describe plausible pathways through which pension may affect mental health. We then use the national sample of China Family Panel Studies (CFPS) to examine the effect of pension enrollment on mental health, as measured by CES-D and self-reported depressive symptoms. To overcome the endogeneity of pension enrollment or of income change on mental health, we exploit geographic variation in pension program implementation. Results indicate modest to large reductions in depressive symptoms due to pension enrollment; this effect is more pronounced among individuals eligible to claim pension income, among populations with more financial constraints, and among those with worse baseline mental health. Our findings hold for a rich set of robustness checks and falsification tests. |
| Keywords: | pension enrollment,pension income,depression,mental health,older populations |
| JEL: | H55 I18 I38 J14 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:285&r=hea |
| By: | Borooah, Vani |
| Abstract: | This chapter uses data from India’s National Sample Survey (NSS), relating to respondents’ health outcomes between January and June 2014, to quantify a particular form of gender inequality: inequality in self-rated health (SRH) outcomes between men and women aged 60 years or over. In so doing, it makes five contributions to the existing literature. The first is in terms of analytical technique: this study contains a more detailed and nuanced exposition of the regression results than in previous studies. Second, it controls for environmental factors — such as poor drainage, absence of toilets, or lack of ventilation in the kitchen — which might adversely impact on health and, in particular, affect the health of women more than that of men. Third, it takes account of interaction effects by which the effect of a variable on an elderly person’s SRH differed according to whether the person was male or female. Lastly, it examines whether SRH is correlated with objective health outcomes. In particular, this study answers two central questions. Did men and women, considered collectively, have significantly different likelihoods of ‘poor’ SRH between the different regions/income classes/social groups/education levels? Did men and women, considered separately, have significantly different likelihoods of a ‘poor’ SRH within a region/income class/social group/education level? |
| Keywords: | Gender, Elderly, India, Disparity, Health Outcomes |
| JEL: | I1 I12 I14 |
| Date: | 2018–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:90551&r=hea |
| By: | Goldberg, Jessica (University of Maryland); Macis, Mario (Johns Hopkins University); Chintagunta, Pradeep (University of Chicago) |
| Abstract: | Peer referrals are a common strategy for addressing asymmetric information in contexts such as the labor market. They could be especially valuable for increasing testing and treatment of infectious diseases, where peers may have advantages over health workers in both identifying new patients and providing them credible information, but they are rare in that context. In an experiment with 3,182 patients at 128 tuberculosis (TB) treatment centers in India, we find peers are indeed more effective than health workers in bringing in new suspects for testing, and low-cost incentives of about $US 3 per referral considerably increase the probability that current patients make referrals that result in the testing of new symptomatics and the identification of new TB cases. Peer outreach identifies new TB cases at 25%-35% of the cost of outreach by health workers and can be a valuable tool in combating infectious disease. |
| Keywords: | tuberculosis, referrals, social networks, case finding, incentives, India, health |
| JEL: | O1 I1 |
| Date: | 2018–11 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11942&r=hea |