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Journal of Health Economics

Petter Lundborg, Kaveh Majlesi
Studies on the intergenerational transmission of human capital usually assume a one-way spillover from parents to children. However, children may also affect their parents' human capital. Using exogenous variation in education, arising from a Swedish compulsory schooling reform in the 1950s and 1960s, we address this question by studying the causal effect of children's schooling on their parents' longevity. We first replicate previous findings of a positive and significant cross-sectional relationship between children's education and their parents' longevity...
December 13, 2017: Journal of Health Economics
Nicola Branson, Tanya Byker
We use a natural experiment to estimate the causal impact of a public health intervention aimed at reducing teenage childbearing. The geographic and timing variation in the rollout of the South African National Adolescent Friendly Clinic Initiative (NAFCI) in the early 2000s provides a plausibly exogenous increase in reproductive health knowledge and clinical access for teens. We investigate the causal pathway from the intervention's initial impact on early-teen childbearing to subsequent consequences for later-life outcomes of prime policy interest - education, employment and child health...
December 12, 2017: Journal of Health Economics
John A Nyman, Cagatay Koc, Bryan E Dowd, Ellen McCreedy, Helen Markelova Trenz
This study seeks to simulate the portion of moral hazard that is due to the income transfer contained in the coinsurance price reduction. Healthcare spending of uninsured individuals from the MEPS with a priority health condition is compared with the predicted counterfactual spending of those same individuals if they were insured with either (1) a conventional policy that paid off with a coinsurance rate or (2) a contingent claims policy that paid off by a lump sum payment upon becoming ill. The lump sum payment is set to be equal to the insurer's predicted spending under the coinsurance policy...
December 11, 2017: Journal of Health Economics
Elizabeth L Munnich, Stephen T Parente
Technological changes in medicine have created new opportunities to provide surgical care in lower cost, specialized facilities. This paper examines patient outcomes in ambulatory surgery centers (ASCs), which were developed as a low-cost alternative to outpatient surgery in hospitals. Because we are concerned that selection into ASCs may bias estimates of facility quality, we use predicted changes in federally set Medicare facility payment rates as an instrument for ASC utilization to estimate the effect of location of treatment on patient outcomes...
December 9, 2017: Journal of Health Economics
Yutaro Sakai
This paper presents a new stylized fact about the relationship between income and childhood vaccination. It shows vaccination rates first rise but then fall as income increases. This pattern is observed in WHO country-level panel data, and in US county-level panel and individual-level repeated cross-section data. This data pattern suggests that both low and high-income parents are less likely to follow the standard vaccination schedule, and that such behavior is reflected in the vaccination rate at the population level...
December 8, 2017: Journal of Health Economics
Barış K Yörük
In volume 36 of this journal, using data from the National Longitudinal Study of Youth, 1997 Cohort (NLSY97), Yörük (2014) finds that the false ID laws with scanner provision (FSP laws) significantly reduce underage drinking. In a recent paper, Zheng (2018) argues that analyses based on the NLSY97 data fail falsification exercises and uses data from the Youth Risk Behavior Surveillance System (YRBSS) to estimate the effectiveness of the FSP laws. This paper replies to Zheng (2018) and provides new results from the NLSY97, which show that the FSP laws were effective reducing several indicators of alcohol consumption among minors...
December 8, 2017: Journal of Health Economics
Marlon R Tracey, Solomon W Polachek
Data from the first two waves of the Fragile Family and Child Wellbeing study indicate that infants who look like their father at birth are healthier one year later. The reason is such father-child resemblance induces a father to spend more time engaged in positive parenting. An extra day (per month) of time-investment by a typical visiting father enhances child health by just over 10% of a standard deviation. This estimate is not biased by the effect of child health on father-involvement or omitted maternal ability, thereby eliminating endogeneity biases that plague existing studies...
December 8, 2017: Journal of Health Economics
Anirban Basu, Andrew M Jones, Pedro Rosa Dias
Using data from a major educational reform in England and Wales, we examine heterogeneity in the long-term impacts of the exposure to different secondary schooling systems, characterized by selective early-tracking system versus non-selective comprehensive schooling, on health outcomes and smoking. We adopt a local instrumental variables approach to estimate person-centered treatment (PeT) effects, thereby recovering the full distribution of individual-level causal effects. We find that the transition from a selective early-tracking system to a non-selective one produced, on a fraction of individuals, significantly increased depression and cigarette smoking...
November 24, 2017: Journal of Health Economics
Barton Willage
Average body mass index (BMI) and depression prevalence grew over the last several decades, increasing medical expenditures. There is a strong correlation between obesity and depression but limited evidence on the causal effect of weight on mental health. I use an index of genetic risk for high BMI as a source of exogenous variation in weight to provide novel evidence on the effect of weight on mental health. This is one of the first studies to use genetics as an instrument for BMI and to examine the causal relationship between weight and depression...
November 23, 2017: Journal of Health Economics
Emily Yiying Zheng
In Volume 36 of this journal, Yoruk (2014) uses data from the National Longitudinal Survey of Youth 1997 and finds that false ID laws with scanner provisions have large impacts on binge drinking participation, frequency of alcohol consumption and binge drinking frequency among minors. This paper reexamines how false ID laws with scanner provisions affect underage drinking. I first demonstrate that analyses based on NLSY97 data fail falsification exercises testing for significant pre-intervention effects, and that the estimated effects based on these data are highly sensitive to the inclusion of a lead term and to sample selection, which weakens confidence in the large estimated effects reported in Yoruk (2014)...
November 16, 2017: Journal of Health Economics
Charles Courtemanche, Rusty Tchernis, Benjamin Ukert
This paper aims to identify the causal effect of smoking on body mass index (BMI) using data from the Lung Health Study, a randomized trial of smoking cessation treatments. Since nicotine is a metabolic stimulant and appetite suppressant, quitting or reducing smoking could lead to weight gain. Using randomized treatment assignment to instrument for smoking, we estimate that quitting smoking leads to an average long-run weight gain of 1.8-1.9 BMI units, or 11-12 pounds at the average height. Semi-parametric models provide evidence of a diminishing marginal effect of smoking on BMI, while subsample regressions show that the impact is largest for younger individuals, those with no college degree, and those in the lowest quartile of baseline BMI...
November 16, 2017: Journal of Health Economics
Daniel Howdon, Nigel Rice
This paper uses Hospital Episode Statistics, English administrative data, to investigate the growth in admitted patient health care expenditures and the implications of an ageing population. We use two samples of around 40,000 individuals who (a) used inpatient health care in the financial year 2005/06 and died by the end of 2011/12 and (b) died in 2011/12 and had some hospital utilisation since 2005/06. We use a panel structure to follow individuals over seven years of this administrative data, containing estimates of inpatient health care expenditures (HCE), information regarding individuals' age, time-to-death (TTD), morbidities at the time of an admission, as well as the hospital provider, year and season of admission...
November 15, 2017: Journal of Health Economics
Henry Y Mak
I study a managed health service market where differentiated providers compete for consumers by choosing multiple service qualities, and where copayments that consumers pay and payments that providers receive for services are set by a payer. The optimal regulation scheme is two-sided. On the demand side, it justifies and clarifies value-based reference pricing. On the supply side, it prescribes pay for performance when consumers misperceive service benefits or providers have intrinsic quality incentives. The optimal bonuses are expressed in terms of demand elasticities, service technology, and provider characteristics...
November 5, 2017: Journal of Health Economics
Ori Shai
This study examines the effect of employment on elderly men's health. A typical OLS analysis yields a positive relationship between employment and health for individuals in their sixties. Causality, however, is difficult to infer because healthier individuals are more capable of working than others. To overcome this endogeneity problem, this paper exploits the increase in the full retirement age for men in Israel from sixty-five to sixty-seven in 2004. After this change, the employment rate of men in this age bracket jumped significantly compared to the last cohort that was able to retire at sixty-five...
November 3, 2017: Journal of Health Economics
Emily Oster
Parental fear of vaccines has limited vaccination rates in the United States. I test whether disease outbreaks increase vaccination using a new dataset of county-level disease and vaccination data. I find that pertussis (whooping cough) outbreaks in a county decrease the share of unvaccinated children entering kindergarten. These responses do not reflect changes in the future disease risk. I argue that these facts are best fit by a model in which individuals are both myopic and irrational. This suggests that better promotion of information about outbreaks could enhance the response...
November 2, 2017: Journal of Health Economics
Ethan M J Lieber
In exchange for tax exemptions, Blue Cross and Blue Shield (BCBS) health insurers were expected to provide health insurance to the "bad risks," those for whom coverage was unavailable from other insurers. I present evidence that five years after a BCBS plan converted to for-profit status, the probability of having insurance was 1.4 percentage points higher, a 9% reduction in the uninsured. The increase in coverage does not mask reductions among populations often targeted by public policies. However, there is evidence of increased risk selection which suggests that the bad risks might have been worse off after a conversion...
November 2, 2017: Journal of Health Economics
Tobias Müller, Mujaheed Shaikh
This paper presents evidence on intra-household retirement externalities by assessing the causal effect of spousal retirement on various health behaviors and health status across 19 European countries. We identify partner's and own retirement effects by applying a fuzzy regression discontinuity design using retirement eligibility as exogenous instruments for spousal and own retirement status. We find significant increases in the frequency and intensity of alcohol consumption combined with a significant decrease in moderate physical activities as a response to partner's retirement...
November 2, 2017: Journal of Health Economics
Sebastian Bauhoff, Lisa Fischer, Dirk Göpffarth, Amelie C Wuppermann
Many competitive health insurance markets adjust payments to participating health plans according to their enrollees' risk - including based on diagnostic information. We investigate responses of German health plans to the introduction of morbidity-based risk adjustment in the Statutory Health Insurance in 2009, which triggers payments based on "validated" diagnoses by providers. Using the regulator's data from office-based physicians, we estimate a difference-in-difference analysis of the change in the share and number of validated diagnoses for ICD codes that are inside or outside the risk adjustment but are otherwise similar...
December 2017: Journal of Health Economics
Francesco Decarolis, Andrea Guglielmo
Evidence on insurers' behavior in environments with both risk selection and market power is largely missing. We fill this gap by providing one of the first empirical accounts of how insurers adjust plan features when faced with potential changes in selection. Our strategy exploits a 2012 reform allowing Medicare enrollees to switch to 5-star contracts at anytime. This policy increased enrollment into 5-star contracts, but without risk selection worsening. Our findings show that this is due to 5-star plans lowering both premiums and generosity, thus becoming more appealing for most beneficiaries, but less so for those in worse health conditions...
December 2017: Journal of Health Economics
Tony Han, Kurt Lavetti
The use of risk-adjustment formulae in setting payments to Medicare Advantage (MA) plans reduces the potential for advantageous selection on factors included in the formulae, but can theoretically worsen overall selection if plans are able to target beneficiaries based on excluded factors. Since MA medical risk-adjustment excludes prescription drug utilization, demand for drugs can be exploited by plans to induce advantageous selection. We show evidence that the introduction of Medicare Part D provided a mechanism for MA plans to increase selection, and that consumers responded, increasing MA market shares among beneficiaries taking drugs associated with the strongest advantageous selection incentives...
December 2017: Journal of Health Economics
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