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Health Economics

Petri Böckerman, John Cawley, Jutta Viinikainen, Terho Lehtimäki, Suvi Rovio, Ilkka Seppälä, Jaakko Pehkonen, Olli Raitakari
This paper contributes to the literature on the labor market consequences of obesity by using a novel instrument: genetic risk score, which reflects the predisposition to higher body mass index (BMI) across many genetic loci. We estimate instrumental variable models of the effect of BMI on labor market outcomes using Finnish data that have many strengths, for example, BMI that is measured rather than self-reported, and data on earnings and social income transfers that are from administrative tax records and are thus free of the problems associated with nonresponse, reporting error or top coding...
September 21, 2018: Health Economics
Mark E McGovern
About 200 million children globally are not meeting their growth potential, and as a result will suffer the consequences in terms of future outcomes. I examine the effects of birth weight on child health and growth using information from 66 countries. I account for missing data and measurement error using instrumental variables and adopt an identification strategy based on siblings and twins. I find a consistent effect of birth weight on mortality risk, stunting, wasting, and coughing, with some evidence for fever, diarrhoea, and anaemia...
September 21, 2018: Health Economics
Matthew Lang, T Clay McManus, Georg Schaur
We provide evidence that average mental, physical, and general health worsens for employed workers in local U.S. labor markets exposed to greater import competition from China. The effects are greatest for mental health. Moving a region from the 25th to 75th percentiles of import exposure corresponds to a 7.8% increase in the morbidity of poor mental health, adding about 3 days of poor mental health per year for the average adult. Concurrently, the ability to afford health care decreases. Our results complement documented consequences of import competition on labor markets and temporary business cycle shocks on health outcomes...
September 19, 2018: Health Economics
Holger Strulik
This paper proposes a new framework to discuss self-control problems in the context of life-cycle health and longevity. Individual decisions are conceptualized as the partial control of impulsive desires of a short-run self by a rationally forward-looking long-run self. The short-run self strives for immediate gratification through consumption of health-neutral and unhealthy goods. The long-run self reflects the long-term consequences of unhealthy behavior on health outcomes and longevity and invests time and money to improve current and future health...
September 14, 2018: Health Economics
Terence C Cheng, Jing Li, Rhema Vaithianathan
We use novel longitudinal data from 19 monthly waves of the Singapore Life Panel to examine the short-term dynamics of the effects health shocks have on household health and nonhealth spending and income by the elderly. The health shocks we study are the occurrence of new major conditions such as cancer, heart problems, and minor conditions (e.g., diabetes and hypertension). Our empirical strategy is based on an event study approach that exploits unanticipated changes in health status through the diagnosis of new health conditions...
September 10, 2018: Health Economics
Gil Shapira, Ina Kalisa, Jeanine Condo, James Humuza, Cathy Mugeni, Denis Nkunda, Jeanette Walldorf
Pay-for-performance programs are introduced in an increasing number of low- and middle-income countries with the goal of reducing maternal and child mortality and morbidity through increased health service utilization and quality. Although most programs incentivize formal health providers, some constraints to utilization might be better alleviated by incentivizing other actors in the health care system. This paper presents results from a randomized controlled trial set to evaluate the effects of two incentive schemes that were introduced on top of Rwanda's national Performance-Based Financing program at the health facility level...
August 29, 2018: Health Economics
Aspen Gorry, Devon Gorry, Sita Nataraj Slavov
We utilize panel data from the Health and Retirement Study to investigate the impact of retirement on physical and mental health, life satisfaction, and health care utilization. Because poor health can induce retirement, we instrument for retirement using eligibility for Social Security and employer-sponsored pensions and coverage by the Social Security earnings test. We find strong evidence that retirement improves reported health, mental health, and life satisfaction. In addition, we find evidence of improvements in functional limitations in the long run...
August 23, 2018: Health Economics
Claudio Lucifora, Daria Vigani
We investigate the causal impact of retirement on health care utilization using SHARE data for 10 European countries. We show that the number of doctor's visits and the probability of visiting a doctor more than four times a year (our measures of health care utilization) increase after retirement. The increase in health care utilization is found to depend mainly on the years spent in retirement, suggesting that adjustment may take time. We find evidence of heterogeneous effects by gender and across different patterns of time use prior to retirement (i...
August 21, 2018: Health Economics
Ning Neil Yu, Xi Zhu
In developing a theory of medical insurance and health behavior with bequest motive, we discover that whether ex ante moral hazard or the opposite occurs hinges upon the differential effects of health behavior on morbidity and mortality. Providing insurance can encourage healthy living by making longevity more affordable. We test the theory utilizing a unique experiment of China introducing the new cooperative medical scheme, unique in its long-term credibility necessary for our proposed channel. This scheme reduced cigarette use by around 9%...
August 20, 2018: Health Economics
Tomoki Fujii
We study the differential impacts of public and private sources of health spending on health outcomes using a triple difference approach. We find that private health spending has on average a higher health-promoting effect than public health spending. This result is robust with respect to the choice of outcome measure and covariates in the regression and driven primarily by the countries with ineffective governments. Once we restrict our sample to countries with effective governments, private health spending is found to be no better than public health spending in improving the health outcome...
August 15, 2018: Health Economics
Conor Lennon
Theory suggests that the medical costs of obesity should be passed on to obese workers, in the form of lower wages, whenever health coverage is a part of employee compensation. In contrast to existing work on this topic, this paper illustrates that the medical expenditures caused by obesity among working adults are relatively small and that wage offsets should therefore be difficult to detect. The paper supports this claim by exploiting the variation provided by the Affordable Care Act's employer mandate. Findings suggest that obese workers tend to bear the approximate cost of their medical expenditures via lower wages...
August 9, 2018: Health Economics
Vincenzo Carrieri, Andrew M Jones
This paper presents new decomposition-based approaches to measure inequality of opportunity in health that capture Roemer's distinction between circumstances and effort and are consistent with both compensation and reward principles. Our approach is fully nonparametric in the way that it handles differences in circumstances and provides decompositions of both a rank-dependent relative (the Gini coefficient) and a rank-independent absolute inequality index (the variance). The decompositions distinguish the contribution of effort from the direct and indirect (through effort) contribution of circumstances to the total inequality...
August 9, 2018: Health Economics
Thomas C Buchmueller, Léontine Goldzahl
In 2004, France introduced a national program of organized breast cancer screening. The national program built on preexisting local programs in some, but not all, départements. Using data from multiple waves of a nationally representative biennial survey of the French population, we estimate the effect of organized screening on the percentage of women obtaining a mammogram. The analysis uses difference-in-differences methods to exploit the fact that the program was targeted at women in a specific age group: 50 to 74 years old...
August 6, 2018: Health Economics
Grace Arnold, Briggs Depew
School starting age has been shown to have long-run effects that persist throughout adolescence and into adulthood. Using variation from state-level school starting age laws in the United States, we find that males who are older when they enter school are more likely to have higher levels of self-reported health later in life. We are largely able to rule out education and labor market outcomes as significant channels for this finding. Building from the previous studies that have found conflicting evidence on the effect of school starting age on educational attainment and labor market outcomes in the United States, we find that school starting age decreases the likelihood of high school completion among males but has no significant effect for females...
August 3, 2018: Health Economics
Guy David, Philip Saynisch, Spencer Luster, Aaron Smith-McLallen, Ravi Chawla
Accreditation of providers helps resolve the pervasive information asymmetries in health care markets. However, meeting accreditation standards typically involves flexibility in implementation, leading to heterogeneity in performance. For example, the patient-centered medical home (PCMH) is a leading model for recognizing high-performing primary care practices. Flexibility in PCMH implementation allows for varying degrees of emphasis on processes designed to enhance medication adherence. To assess the impact of the PCMH on adherence, we combine 6 years of detailed patient claims data with a novel dataset containing detailed practice-level PCMH attributes...
August 2, 2018: Health Economics
Aditi P Sen, Thomas DeLeire
Private insurance market risk pools are likely to be directly affected by expansions of public insurance, in turn affecting premiums. We investigate the effects of Medicaid expansion on private health insurance markets using data on the plans offered through the health insurance "Marketplaces" (also known as Exchanges) established by the Affordable Care Act. We employ geographic matching to compare premiums for private plans in neighboring counties that straddle expansion and nonexpansion states and find that premiums of Marketplace plans are 11% lower in Medicaid expansion states, controlling for demographic and health characteristics as well as measures of health care access...
July 30, 2018: Health Economics
Shooshan Danagoulian
Wellness programs constitute central components of disease prevention efforts under the Affordable Care Act and are likely to remain a component of employer provided health insurance. This paper evaluates the impact of such programs on medical utilization 4 to 7 years after enrollment in the plan. Using a unique suited data provided by a large private employer, I analyze medical expenditure and utilization for individuals enrolled in a wellness plan. The analysis compares expenditures and visits between wellness members and nonmembers who are matched through propensity score methods...
July 30, 2018: Health Economics
Fengping Tian, Jiti Gao, Ke Yang
This paper investigates the variation in the effects of various determinants on the per capita health-care expenditure. A total of 28 Organisation for Economic Co-operation and Development countries are studied over the period 1990-2012, employing an instrumental variable quantile regression method for a dynamic panel model with fixed effects. The results show that the determinants of per capita health-care expenditure growth, involving the growth of lagged health spending, of per capita gross domestic product (GDP), of physician density, of elderly population, of life expectancy, of urbanization, and of female labor force participation, do vary with the conditional distribution of the health-care expenditure growth, while the changing patterns are dissimilar...
July 26, 2018: Health Economics
Michele Bisceglia, Roberto Cellini, Luca Grilli
In several countries, health care services are provided by public and/or private subjects, and they are reimbursed by the government, on the basis of regulated prices (in most countries, diagnosis-related group). Providers take prices as given and compete on quality to attract patients. In some countries, regulated prices differ across regions. This paper focuses on the interdependence between regional regulators within a country: It studies how price setters of different regions interact, in a simple but realistic framework...
July 25, 2018: Health Economics
Julie Shi, Yi Yao, Gordon Liu
Reforming the payment system of public health insurance from fee-for-service to more efficient alternative schemes has become an urgent policy issue in developing countries. Using a large sample of administrative data drawn from China, we examine a variety of econometric models for predicting the medical expenditures of individuals. We show that the standard ordinary least squares model performs relatively well compared with other models. We then propose two alternative payment schemes on risk-adjusted capitation...
July 25, 2018: Health Economics
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