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on Health Economics |
| By: | Lucie Schmidt; Lara Shore-Sheppard; Tara Watson |
| Abstract: | The Affordable Care Act (ACA) expanded the availability of public health insurance, decreasing the relative benefit of participating in disability programs but also lowering the cost of exiting the labor market to apply for disability program benefits. In this paper, we explore the impact of expanded access to Medicaid through the ACA on applications to the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs. Using the fact that the Supreme Court decision of June 2012 made the Medicaid expansion optional for the states, we compare changes in county-level SSI and SSDI caseloads in contiguous county pairs across a state border. We find no significant effects of the Medicaid expansion on applications or awards to either SSI or SSDI, and can reject economically meaningful impacts of Medicaid expansions on applications to disability programs. |
| JEL: | I10 I13 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26192&r=all |
| By: | Borgschulte, Mark (University of Illinois at Urbana-Champaign); Vogler, Jacob (University of Illinois at Urbana-Champaign) |
| Abstract: | We estimate the effect of the Affordable Care Act Medicaid expansion on county-level mortality in the first four years following expansion. We find a reduction in all-cause mortality in ages 20 to 64 equaling 11.36 deaths per 100,000 individuals, a 3.6 percent decrease. This estimate is largely driven by reductions in causes of death likely to be influenced by access to health care, and equates to one life saved per 310 newly covered individuals. A cost-benefit analysis shows that the improvement in welfare due to mortality responses may offset the entire net-of-transfers expenditure associated with the expansion. |
| Keywords: | health insurance, Medicaid, mortality, public health insurance, healthcare, Affordable Care Act |
| JEL: | H75 I13 I14 I18 I38 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12552&r=all |
| By: | French, Eric Baird; Jones, John Bailey; Kelly, Elaine; McCauley, Jeremy |
| Abstract: | In this review, we document end-of-life medical spending: its level, composition, funding and contribution to aggregate medical spending, both for the US and abroad. We discuss how end-of-life expenses affects household savings and other financial behaviour such as insurance choices. Lastly, we review economic evidence on the efficacy of medical spending at the end of life, assessing the value of palliative and other care for both longevity and patient satisfaction. |
| Keywords: | End of Life; Insurance; medical spending; Savings |
| JEL: | I12 I13 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:13913&r=all |
| By: | White, Corey (California Polytechnic State University) |
| Abstract: | Vaccination represents a canonical example of externalities in economics, yet there are few estimates of their magnitudes. I estimate social and externality benefits of influenza vaccination in two settings. First, using a natural experiment, I estimate the impacts of aggregate vaccination rates on mortality and work absences in the United States. Second, I examine a setting with large potential externality benefits: vaccination mandates for health care workers. I find that the social benefits of vaccination are substantial, most of benefits operate through an externality, and that the benefits of health care worker vaccination are particularly large. |
| Keywords: | vaccine, vaccination, influenza, flu, externality, health |
| JEL: | I12 I18 D62 H23 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12525&r=all |
| By: | Cristina Belles-Obrero; Sergi Jiménez-Martín; Judit Vall Castello |
| Abstract: | We examine the gender asymmetries in the health benefits of acquiring further education at a time of increasing gender equality and women’s greater access to economic opportunities. A labor market reform in Spain in 1980 raised the minimum legal working age from 14 to 16, while the school-leaving age remained at 14. We apply a difference-in-difference strategy to identify the reform’s within-cohort effects, where treated and control individuals differ only in their month of birth. Although the reform improved the educational attainment of both women and men, the long-term effects over mortality differ by gender. We find that the reform decreased mortality at young ages (14-29) by 6.3% among men and by 8.9% among women. This was driven by a decrease (12.2% for men, 14.7% for women) in the probability of dying from external causes of death (accidents). However, we also find that the child labor reform increased mortality for prime-age women (30-45) by 6.3%. This effect is driven by increases in HIV mortality (11.6%), as well as by diseases of the nervous and circulatory system (8.7%).This patter helps explain the narrowing age gap in life expectancy between women and men in Spain. |
| Date: | 2019–03 |
| URL: | http://d.repec.org/n?u=RePEc:fda:fdaddt:2019-05&r=all |
| By: | De Cao, Elisabetta (London School of Economics); McCormick, Barry (Nuffield College, Oxford); Nicodemo, Catia (University of Oxford) |
| Abstract: | We study the effect of unemployment on birth outcomes by exploiting geographical variation in the unemployment rate across local areas in England, and comparing siblings born to the same mother via family fixed effects. Using rich individual data from hospital administrative records between 2003 and 2012, babies' health is found to be strongly pro-cyclical. A one-percentage point increase in the unemployment rate leads to an increase in low birth weight and preterm babies of respectively 1.3 and 1.4%, and a 0.1% decrease in foetal growth. We find heterogenous responses: unemployment has an effect on babies' health which varies from strongly adverse in the most deprived areas, to mildly favourable in the most prosperous areas. We provide evidence of three channels that can explain the overall negative effect of unemployment on new-born health: maternal stress; unhealthy behaviours - namely excessive alcohol consumption and smoking; and delays in the take-up of prenatal services. While the heterogenous effects of unemployment by area of deprivation seem to be explained by maternal behaviour. Most importantly, we also show for the first time that selection into fertility is the main driver for the previously observed, opposite counter-cyclical results, e.g., Dehejia and Lleras-Muney (2004). Our results are robust to internal migration, different geographical aggregation of the unemployment rate, the use of gender-specific unemployment rates, and potential endogeneity of the unemployment rate which we control for by using a shift-share instrumental variable approach. |
| Keywords: | unemployment rate, birth outcomes, birth weight, fertility, England |
| JEL: | E24 I10 I12 J13 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12568&r=all |
| By: | von Hinke Kessler Scholder, Stephanie (University of Bristol); Rice, Nigel (University of York); Tominey, Emma (University of York) |
| Abstract: | We identify the causal effect of mothers' mental health during early - and soon after pregnancy on a range of child psychological, socio-emotional and cognitive outcomes measured between ages 4-16. Results suggest a negative effect on children's psychological and socio-emotional skills in early childhood, but these effects fade-out between the ages of 11-13. We find no significant effect on cognitive outcomes. The fade-out of effects may be partly explained by compensatory behaviour of parents, as we find that mental health during or soon after pregnancy raises breastfeeding and improves measures of interaction between mother and child. |
| Keywords: | prenatal psychological health, child psychological outcomes, child socio-emotional outcomes, child cognitive outcomes, ALSPAC |
| JEL: | I12 I14 I3 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12544&r=all |
| By: | Mörk, Eva (Uppsala University); Sjögren, Anna (IFAU); Svaleryd, Helena (Uppsala University) |
| Abstract: | We study the consequences of mothers' and fathers' job loss for parents, families, and children. Rich Swedish register data allow us to identify plant closures and account for non-random selection of workers to closing plants by using propensity score matching and controlling for pre-displacement outcomes. Our overall conclusion is positive: childhood health, educational and early adult outcomes are not adversely affected by parental job loss. Parents and families are however negatively affected in terms of parental health, labor market outcomes and separations. Limited effects on family disposable income suggest that generous unemployment insurance and a dual-earner norm shield families from financial distress, which together with universal health care and free education is likely to be protective for children. |
| Keywords: | parental unemployment, workplace closure, family environment, child health, human capital formation |
| JEL: | I12 J1 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12559&r=all |
| By: | Alfonso Flores-Lagunes (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Amin Vikesh (Central Michigan University); Carlos A. Flores (California Polytechnic State University at San Luis Obispo) |
| Abstract: | We examine the relationship between body mass index (BMI) and mental health for young adults and elderly individuals using data from the National Longitudinal Study of Adolescent Health and the Health & Retirement Study. While ordinary least squares (OLS) estimates show that BMI is significantly associated with worse mental health in both young adulthood and old age, they are likely to be confounded by (i) unobserved factors that affect both BMI and mental health and (ii) reverse causality. To tackle confounding, we take two complementary approaches. First, we use a polygenic score for BMI as an instrumental variable (IV) and adjust for polygenic scores for other factors that may invalidate this IV. The IV estimates indicate that there is no statistically significant relationship between BMI and mental health for young adults, whereas there is a positive and statistically significant relationship for the elderly. Moreover, we show that IV estimates likely have to be interpreted as identifying a weighted average of effects of BMI on mental health mostly for individuals on the upper quantiles of the BMI distribution. Given potential remaining concerns about the validity of the IV, our second approach is to consider it an “imperfect” IV and estimate an upper bound on the average treatment effect for the corresponding population following Nevo & Rosen (2012). The estimated upper bounds reinforce the conclusions from the IV estimates: they show little evidence of a detrimental effect of BMI on mental health for young adults while being consistent with an economically meaningful effect for elderly individuals. Lastly, we explore some of the potential channels through which BMI may affect mental health for the elderly. |
| Keywords: | Obesity, Mental Health, Depression, Polygenetic Scores |
| JEL: | I10 I12 |
| Date: | 2019–09 |
| URL: | http://d.repec.org/n?u=RePEc:max:cprwps:216&r=all |
| By: | Yuki Takeyama (Graduate School of Business Administration and Computer Science); Katsunori Fujii (Graduate School of Business Administration and Computer Science); Toshiro Sakai (Chube University); Nozomi Tanaka (Tokaigakuen University); Yuki Kani (Graduate School of Business Administration and Computer Science, Aichi Institute of Technology); Yusaku Ogura (Graduate School of Business Administration and Computer Science, Aichi Institute of Technology) |
| Abstract: | Obesity refers to a state in which excessive fat is accumulated in the body. According to the World Health Organization (WHO), people with a body mass index (BMI) of ?25 are taken to be obese. This is the standard indicating increased risk of diseases such as myocardial infarction and stroke attributable to obesity. That is, it is considered to be an indicator below which risk is inhibited and people can live in health. However, the critical point for risk affecting health is not clear. If the risks associated with health information could be analyzed by degree of obesity, it may be possible to identify a cut-off value for obesity. In this study we assessed the level of health risk based on BMI fluctuations, calculated the mean health information values for each unit of BMI from 14 to 34, and analyzed fluctuations in each health information item based on BMI fluctuation. The results showed that the risk from blood pressure and maximum oxygen uptake increased together with fluctuations in BMI. With this it is thought that a new cutoff point for obesity risk can be established. |
| Keywords: | Obesity, Health Information, BMI Fluctuation, Cutoff Value |
| JEL: | I00 I10 I12 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:9211463&r=all |
| By: | Yuzuru Naito (Aichi Institute of Technology); Katsunori Fujii (Aichi Institute of Technology); Yuki Kani (Aichi Institute of Technology); Yusaku Ogura (Aichi Institute of Technology); Toshiro Sakai (Chubu University); Yuki Takeyama (Aichi Institute of Technology) |
| Abstract: | Body composition in children can be measured until about the age of 6 years using the impedance method, but in children below that age the findings are often treated as reference values. However, information on body composition is needed to verify body fatness in early childhood. In this study, we investigated the validity of obesity and leanness Judgment using a simple impedance analysis in young children, by comparing body fat percentage derived with the impedance method and body fatness judged from standard height and weight curves, with the aim of constructing a standardized system for judging obesity and leanness in young children. we constructed a 5-step mean evaluation together with body fat percentage statistics and judged levels of obesity and leanness. For judgments of obesity with regression evaluation of weight against height, we constructed a 5-step regression evaluation chart after deriving valid order regression polynomials, and determined levels of obesity and leanness based on them. The results of comparisons of the distributions of obesity and leanness judgments obtained with the two evaluations using the ?2 test showed no significant differences in all subjects from 3 to 5 years old. |
| Keywords: | Young Children, Obesity and Leanness Judgment, Standardization System, Body Fat Percentage, Regression polynomial |
| JEL: | I00 I10 I19 |
| Date: | 2019–07 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:9211526&r=all |
| By: | Hu, Jiafei (University of Queensland); Megalokonomou, Rigissa (University of Queensland); Yuan, Haishan (University of Queensland) |
| Abstract: | To reduce sugar intake in children, California regulates the provision of sugar-sweetened beverages and juice by child care facilities. The regulation may reduce children's consumption of sugary beverages in the short run and weaken their preferences for sugary drinks in the long run. Whether these objectives are achieved depends on how parents respond to the regulation by providing sugary drinks at home. Using detailed scanner data of grocery purchases, we find that affected California households increased their juice purchases right after the regulation became effective. However, this increase disappears after one year. Moreover, we find no increase in the purchases of sugary substitutes. Our findings suggest that parents provide more juice for their children after child cares limit their juice provision, but such offsetting behavior disappears after one year. Regulating the consumption of sugary drinks in child cares may be an effective policy to lower children's preferences for sugary drinks. |
| Keywords: | obesity, health, sugary beverage, children, child care regulation |
| JEL: | O15 O18 P16 H54 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12539&r=all |
| By: | Boyer, Martin; De Donder, Philippe; Fluet, Claude; Leroux, Marie-Louise; Michaud, Pierre-Carl |
| Abstract: | We conduct a stated-choice experiment where respondents are asked to rate various insurance products aimed to protect against financial risks associated with long-term care needs. Using exogenous variation in prices from the survey design and individual cost estimates, these stated-choice probabilities are used to predict market equilibrium for long-term care insurance. We find that information frictions are pervasive. We measure the welfare losses associated with these three causes in a framework that also allows for selection. We show that information frictions reduce equilibrium take-up and lead to large welfare loss while selection plays little role. |
| Keywords: | Long-term care insurance; adverse selection; stated-preference; health; insurance |
| Date: | 2019–09–03 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:123346&r=all |
| By: | Schünemann, Johannes (Faculty of Economics and Social Sciences); Strulik, Holger; Trimborn, Timo |
| Abstract: | For the population over 65, nursery care expenditures constitute on average the largest share in total health expenditures. In this paper, we distinguish between medical care, intended to improve one›s state of health, and personal care required for daily routine. Personal care can be either carried out autonomously or by a third party. In the course of aging, autonomous personal care is eventually substituted by nursery care. We set up a life-cycle model in which individuals are subject to physiological aging, calibrate it with data from gerontology, and analyze the interplay between medical and nursery care. We replicate health behavior and life expectancy of individuals and in particular the empirically observed patterns of medical and nursery care expenditure. We then analyze the impact of better health and rising life expectancy, triggered by rising income and medical progress, on the expected cost of nursery care in the future. We predict an elasticity of nursery care expenditure with respect to life expectancy of 1/3. In terms of present value at age 20, life-time nursery care expenditure is predicted to decline with rising life expectancy. |
| JEL: | D11 D91 I12 J11 |
| Date: | 2019–09–03 |
| URL: | http://d.repec.org/n?u=RePEc:fri:fribow:fribow00505&r=all |
| By: | Bardey, David; De Donder, Philippe |
| Abstract: | Personalized medicine is still in its infancy, with costly genetic tests providing little actionable information in terms of efficient prevention decisions. As a consequence, few people undertake these tests currently, and health insurance contracts pool all agents irrespective of their genetic background. Cheaper and especially more informative tests will induce more people to undertake these tests and will impact not only the pricing but also the type of health insurance contracts. We develop a setting with endogenous prevention decisions and we study which contract type (pooling or separating) emerges at equilibrium as a function of the proportion of agents undertaking the genetic test as well as of the informativeness of this test. Starting from the current low take-up rate generating at equilibrium a pooling contract with no prevention effort, we obtain that an increase in the take-up rate has first an ambiguous impact on welfare, and then unambiguously decreases welfare as one moves from a pooling to a separating equilibrium. It is only once the take-up rate is large enough that the equilibrium is separating that any further increase in take-up rate increases aggregate welfare, by a composition effect. However, a better pooling contract in which policyholders undertake preventive actions (and lower their health risk) can also be attained if the informativeness of the genetic tests increases sufficiently. |
| Keywords: | discrimination risk; informational value of test; personalized medecine; pooling and separating equilibria. |
| JEL: | D82 I18 |
| Date: | 2019–09–03 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:123347&r=all |
| By: | Pestel, Nico (IZA); Wozny, Florian (IZA) |
| Abstract: | This paper studies health effects from restricting the access of high-emission vehicles to innercities by implementing Low Emission Zones. For identification, we exploit variation in the timing and the spatial distribution of the introduction of new Low Emission Zones across cities in Germany. We use detailed hospitalization data combined with geo-coded information on the coverage of Low Emission Zones. We find that Low Emission Zones significantly reduce levels of air pollution in urban areas and that these improvements in air quality translate into population health benefits. The number of diagnoses related to air pollution is significantly reduced for hospitals located within or in close proximity to a Low Emission Zone after it becomes effective. The results are mainly driven by reductions in chronic cardiovascular and respiratory diseases. |
| Keywords: | Low Emission Zone, air pollution, health, Germany |
| JEL: | I18 Q52 Q53 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12545&r=all |
| By: | Keefer, Quinn (California State University San Marcos); Kniesner, Thomas J. (Claremont Graduate University) |
| Abstract: | Similar to other workers in industrial settings NFL running backs can choose to provide additional work effort with possible negative health consequences. We find that the most informative measure for running backs is yards gained after contact, which not only increases total rushing yards but also increases injuries that can cause subsequent lost income due to future games missed. We econometrically examine the decisions running backs reveal in trading off injury risk against total yards gained and salary in the short run and how the tradeoff appears in the longer run where career length considerations come into play. Our estimates reveal subtle nonlinearities and interpersonal heterogeneity in risky effort and the associated short and long run injury risk and economic payoffs. |
| Keywords: | non-fatal injuries, NFL, running backs, risky effort, rate-of-return, career length, Poisson regression, Arellano-Bond model, panel data, fixed effects |
| JEL: | C23 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12556&r=all |
| By: | Domenico Depalo; Jay Bhattacharya; Vincenzo Atella; Federico Belotti |
| Abstract: | The support for scientific investigation in biomedicine depends in part on the adoption of new knowledge into medical practice. We investigate how a technological advance, in the form of a large and influential 2010 randomized controlled study, changed physician practice in statin (a medication used to manage high cholesterol levels) prescribing. We analyze data representative of the Italian population for the period 2003-2014. Our analysis accounts for possible non-random sorting of patients into treatment. We show that both doctors and patients responded promptly to this technological shock, changing the mix of patients who received therapy, drug dosing, and frequency of testing for side effects, as well as patient adherence to therapy. The results show that investments in scientific knowledge can rapidly diffuse into practice in professions where continuing education is the norm. |
| JEL: | I1 I12 O33 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26202&r=all |
| By: | Nikolov, Plamen (State University of New York); Adelman, Alan (State University of New York) |
| Abstract: | Higher life expectancy and rapidly aging populations have led to the introduction of pension programs in developing countries in the last two decades. Using the introduction of a new public policy in China, we estimate the effects of pension benefits on individual cognition, measured by episodic memory and intact mental status, among individuals ages 60 and above. We find large and significant negative effects of the provision of pension benefits on cognitive functioning among the elderly. We find the largest effect of the program on delayed recall, a measure implicated in neurobiological research as an important predictor of the onset of dementia. We show that the program leads to more negative impacts among the female sample. Our findings support the mental retirement hypothesis that decreased mental activity results in atrophy of cognitive skills. We show that retirement plays a significant role in explaining cognitive decline at older ages. |
| Keywords: | life-cycle, cognitive functioning, cognition, aging, health, mental retirement, middle-income countries, developing countries, China |
| JEL: | J14 H55 H75 J26 J24 D91 O12 N35 O10 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12524&r=all |
| By: | April Yanyuan Wu; Denise Hoffman; Paul O'Leary |
| Abstract: | The prevalence of opioid use nationwide, coupled with the large share of new Social Security Disability Insurance (SSDI) awardees who have conditions associated with opioid use, suggests that opioid use may be common and increasing among SSDI applicants. |
| Keywords: | Opioid use, SSDI applicants, disability |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:fc157553017a49f38a9c8058ae13007c&r=all |
| By: | Abhijit Banerjee; Amy Finkelstein; Rema Hanna; Benjamin A. Olken; Arianna Ornaghi; Sudarno Sumarto |
| Abstract: | To assess ways to achieve widespread health insurance coverage with financial solvency in developing countries, we designed a randomized experiment involving almost 6,000 households in Indonesia who are subject to a nationally mandated government health insurance program. We assessed several interventions that simple theory and prior evidence suggest could increase coverage and reduce adverse selection: substantial temporary price subsidies (which had to be activated within a limited time window and lasted for only a year), assisted registration, and information. Both temporary subsidies and assisted registration increased initial enrollment. Temporary subsidies attracted lower-cost enrollees, in part by eliminating the practice observed in the no subsidy group of strategically timing coverage for a few months during health emergencies. As a result, while subsidies were in effect, they increased coverage more than eightfold, at no higher unit cost; even after the subsidies ended, coverage remained twice as high, again at no higher unit cost. However, the most intensive (and effective) intervention – assisted registration and a full one-year subsidy – resulted in only a 30 percent initial enrollment rate, underscoring the challenges to achieving widespread coverage. |
| JEL: | I13 O15 |
| Date: | 2019–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26204&r=all |
| By: | Ji-Yeun Rim; Caroline Tassot |
| Abstract: | Universal social protection (USP) is becoming high priority in many developing countries’ agendas. However, information on what has worked well – and not so well – is limited. This study reviews a wide range of recent country experiences with universal health coverage (UHC) financing and implementation in order to draw lessons and help governments elaborate policies for USP and the extension of social protection. It looks at different pathways and delivery and financing challenges to universalism in health coverage and takes a close look at equity issues. It concludes with some key takeaways from UHC implementation and its implications for USP. One important message of this study is that while the UHC experience cannot be mechanically transposed to the USP agenda, a number of lessons can be drawn. Moreover, the benefits in terms of coverage and equity of better integrating USP and UHC appear tremendous. |
| Keywords: | Burkina Faso, equity, Ghana, India, Indonesia, Kyrgyzstan, universal health coverage, universal social protection |
| JEL: | D63 H51 H55 I38 |
| Date: | 2019–09–04 |
| URL: | http://d.repec.org/n?u=RePEc:oec:dcdaab:20-en&r=all |