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Journal of Health Economics

Arthur E Attema, Olivier l'Haridon, Gijs van de Kuilen
We investigate univariate and multivariate risk preferences for health (longevity) and wealth. We measure attitudes toward correlation and attitudes toward higher order dependence structures such as cross-prudence and cross-temperance, making use of the risk apportionment technique proposed by Eeckhoudt et al. (2007). For multivariate gains, we find correlation aversion and cross-prudence in longevity and wealth. For losses, we observe correlation seeking and cross-imprudence. We do not find clear evidence for cross-temperance...
December 27, 2018: Journal of Health Economics
Luigi Siciliani, Odd Rune Straume
We provide a model where hospitals compete on quality under fixed prices to investigate how hospital competition affects (i) quality differences between hospitals, and as a result, (ii) health inequalities across hospitals and patient severities. The answer to the first question is ambiguous and depends on factors related to both demand and supply of health care. Whether competition increases or reduces health inequalities depends on the type and measure of inequality. Health inequalities due to the postcode lottery are more likely to decrease if the marginal health gains from quality decrease at a higher rate, whereas health inequalities between high- and low-severity patients decrease if patient composition effects are sufficiently small...
December 21, 2018: Journal of Health Economics
Valentina Tonei
The dramatic increase in the utilization of caesarean section has raised concerns on its impact on public expenditure and health. While the financial costs associated with this surgical procedure are well recognized, less is known on the intangible health costs borne by mothers and their families. We contribute to the debate by investigating the effect of unplanned caesarean deliveries on mothers' mental health in the first nine months after the delivery. Differently from previous studies, we account for the unobserved heterogeneity due to the fact that mothers who give birth through an unplanned caesarean delivery may be different than mothers who give birth with a natural delivery...
December 7, 2018: Journal of Health Economics
Evan Saltzman
I estimate demand for health insurance using consumer-level data from the California and Washington ACA exchanges. I use the demand estimates to simulate the impact of policies targeting adverse selection, including subsidies and the individual mandate. I find (1) own-premium elasticities of -7.2 to -10.6 and insurance coverage elasticities of -1.1 to -1.2; (2) limited response to the mandate penalty amount, but significant response to the penalty's existence, suggesting consumers have a "taste for compliance"; (3) mandate repeal slightly increases consumer surplus because the ACA's price-linked subsidies shield most consumers from premium increases resulting from repeal and some consumers are not compelled to purchase insurance against their will; and (4) mandate repeal decreases consumer surplus if ACA subsidies are replaced with vouchers that expose consumers to premium increases...
December 5, 2018: Journal of Health Economics
Malte Sandner
This paper presents the results of a randomized study of a home visiting program implemented in Germany for low-income, first-time mothers. Besides improving child health and development, a major goal of the program is to improve the participants' economic self-sufficiency and family planning. I use administrative data from the German social security system and detailed telephone surveys to examine the effects of the intervention on maternal employment, welfare benefits, household composition, well-being, and fertility behavior...
December 1, 2018: Journal of Health Economics
Daniel Grossman
Whether place-based welfare programs affect fertility and health outcomes is an understudied question. I estimate the health impacts of the Empowerment Zone (EZ) program-a federal program that gave sizeable grants and tax breaks to certain high-poverty census tracts in selected cities. Using difference-in-differences methods, I find that the EZ program decreased fertility rates by 11 percent and improved birth outcomes. Compositional changes in fertility likely cannot explain changes in infant health. Recent research on the later-life impacts of low birth weight suggest that the health impacts of this program may have substantial long-term benefits...
November 29, 2018: Journal of Health Economics
Nadine Ketel, Edwin Leuven, Hessel Oosterbeek, Bas van der Klaauw
We exploit lottery-determined admission to dental school to estimate the payoffs to the study of dentistry in the Netherlands. Using data from up to 22 years after the lottery, we find that in most years after graduation dentists earn around 50,000 Euros more than they would earn in their next-best profession. The payoff is larger for men than for women but does not vary with high school GPA. The large payoffs cannot be attributed to longer working hours, larger investments while studying (opportunity costs and direct costs), or unpleasant aspects of working as a dentist...
November 17, 2018: Journal of Health Economics
Daniel Avdic, Petter Lundborg, Johan Vikström
High-volume hospitals typically perform better than low-volume hospitals. In this paper, we study whether such patterns reflect a causal effect of case volume on patient outcomes. To this end, we exploit closures and openings of entire cancer clinics in Swedish hospitals which provides sharp and arguably exogenous variation in case volumes. Using detailed register data on more than 100,000 treatment episodes of advanced cancer surgery, our results suggest substantial positive effects of operation volume on survival...
November 15, 2018: Journal of Health Economics
Ausmita Ghosh, Kosali Simon, Benjamin D Sommers
This study examines how subsidized coverage affects prescription drug utilization among low-income non-elderly adults. Using the Affordable Care Act's Medicaid expansions as a source of variation and a national, all-payer pharmacy transactions database, we find that within the first 15 months of new health insurance availability, aggregate Medicaid-paid prescriptions increased 19 percent, amounting to nearly 9 new prescriptions a year, per new enrollee. We find no evidence of reductions in uninsured or privately-insured prescriptions, suggesting that new coverage did not simply substitute for other payment sources...
November 6, 2018: Journal of Health Economics
Susan Ou
I study the causal impact of neighborhoods on body mass index (BMI). Through exploiting variation in the number of years individuals have lived in their neighborhood, using a data set from California, I examine if there exist causal effects of exposure to neighborhoods with high potential effects on one's BMI. The identifying assumption is that there are no unobserved individual level characteristics correlated with both BMI and moving, after controlling for observables. I find evidence that suggests that neighborhoods do not have a causal impact on BMI...
November 5, 2018: Journal of Health Economics
Wei Fu, Feng Liu
We provide evidence for the causal relationship between unemployment insurance (UI) and individuals' smoking behavior using the 1995-2011 Current Population Survey-Tobacco Use Supplement data. Our identification relies on the exploitation of the exogenous variations of the maximum UI weekly benefits across states and over years. Instead of focusing on all unemployed people, we concentrate on those who are eligible for UI benefits. We find that when the maximum UI weekly benefit level increases by $100, smoking cessation increases by approximately 2...
November 3, 2018: Journal of Health Economics
Zachary Olson, Rachel Gardner Clark, Sarah Anne Reynolds
In 2008, Brazil's conditional cash transfer program expanded to cover a wider range of ages. Poor families are now given stipends for their children's school attendance up to age seventeen, whereas prior the maximum age was fifteen. Using a nationally representative household survey, we estimate the impact of this policy on teen fertility with a triple difference analysis on the fertility outcomes of treated cohorts vs. non-treated cohorts based on income eligibility, age eligibility, and timing of program implementation...
November 2, 2018: Journal of Health Economics
Vincenzo Atella, Partha Deb, Joanna Kopinska
This article examines the long term physical and mental health effects of internal migration focusing on a relatively unique migration experience concentrated over a short period between 1950 and 1970 from the South to the North of Italy. We find a positive and statistically significant association between migration, its timing and physical health for migrant females, which we show are likely to represent rural females in both the early and the late cohort. We find less defined evidence of migration-health association for mental health...
November 2, 2018: Journal of Health Economics
Yi Zhang, Martin Salm, Arthur van Soest
We examine the effect of retirement on healthcare utilization in China using longitudinal data. We use a nonparametric fuzzy regression discontinuity design, exploiting the statutory retirement age in urban China as a source of exogenous variation in retirement. In contrast to previous results for developed countries, we find that in China retirement increases healthcare utilization. This increase can be attributed to deteriorating health and in particular to the reduced opportunity cost of time after retirement...
November 2018: Journal of Health Economics
Cathy J Bradley, David Neumark, Lauryn Saxe Walker
We conducted a randomized controlled trial, enrolling low-income uninsured adults in Virginia (United States), to determine whether cash incentives are effective at encouraging a primary care provider (PCP) visit, and at lowering utilization and costs. Subjects were randomized to four groups: untreated controls, and one of three incentive arms with incentives of $0, $25, or $50 for visiting a PCP within six months of group assignment. We used the exogenous variation generated by the experiment to obtain causal evidence on the effects of a PCP visit...
November 2018: Journal of Health Economics
Øystein Hernæs
I evaluate a program aimed at strictly enforcing a requirement that people on long-term sick leave be partly back at work unless explicitly defined as an exception. Employing the synthetic control method, I find that the reform reduced work-hours lost due to sickness absenteeism by 12% in the reform region compared to a comparison unit created by a weighted average of similar regions. The effect is driven by both increased part-time presence of temporary disabled workers and accelerated recovery. Musculoskeletal disorders was the diagnosis group declining the most...
November 2018: Journal of Health Economics
Jing Li
Understanding physicians' decisions when faced with conflicts between their own financial self-interest and patients' economic or health interests is of key importance in health economics and policy. This issue is especially salient in certain medical specialties where less altruistic behavior of physicians can yield significant financial gains. This study examines experimentally measured altruistic preferences of medical students from schools around the U.S., and whether these preferences predict those students' expected medical specialty choice...
November 2018: Journal of Health Economics
Maria Rosales-Rueda
This paper investigates the persistent effects of negative shocks in utero and in infancy on low-income children's health and cognitive outcomes and examines whether timing of exposure matters differentially by skill type. Specifically, I exploit the geographic intensity of extreme floods in Ecuador during the 1997-1998 El Niño phenomenon, which provides exogenous variation in exposure at different periods of early development. I show that children exposed to severe floods in utero, especially during the third trimester, are shorter in stature five and seven years later...
November 2018: Journal of Health Economics
Holger Strulik
In this paper I unify the economic theories of addiction and health deficit accumulation and develop a life cycle theory in which individuals take into account the fact that the consumption of addictive goods reduces their health and longevity. I distinguish two types of addiction: sophisticated and naive. Individuals with sophisticated addiction perfectly control their addiction. Individuals with naive addiction, though otherwise rational and forward looking, fail to fully understand how their addiction develops...
November 2018: Journal of Health Economics
Denise Hammock Clayton
This paper estimates the effect of Medicaid prescription drug spending on mortality. I use the group- and state-specific roll out of Medicaid drug coverage to isolate plausibly exogenous variation in drug expenditures. I find that a $1 increase in Medicaid drug expenditures per resident reduces mortality from internal causes by 2.0 deaths per hundred thousand, a decline of 0.23%. I find relatively large effects for: (1) medically-treated diseases which pose an immediate risk of death, (2) impoverished areas which received a disproportionate share of state Medicaid dollars, and (3) areas with a high ratio of medical to surgical physicians...
October 26, 2018: Journal of Health Economics
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