Top PDF Three Essays on Public Policy and Health

Three Essays on Public Policy and Health

Three Essays on Public Policy and Health

The medical field has studied the link between primary care supply and health. In general, primary care helps to prevent illness and death (Macinko, Shi, and Starfield, 2005) and counties with greater availability of primary care resources, as measured by being in the top 25 th percentile of resources, tend to have lower mortality rates (Macinko et al, 2005). In the economic literature, Robst and Graham (2005) find that people living in designated Health Professional Shortage Areas have worse self-reported health. More recently, Li (2014) looks at how the effects of local doctors attenuate with distance in the early 2000s. She finds that distance may limit access even within counties. In addition, when comparing doctors of equal travel distance those located within state had a greater impact on mortality rates than those located just over the border. Bailey and Goodman-Bacon (2015) find that the establishment Community Health Centers in the 1960s and 1970s led to a decline in mortality of 2% for people over the age of 50. This program was aimed at disadvantaged populations and staffed mainly by nurses and social workers.
Show more

134 Read more

Three Essays in Health Economics

Three Essays in Health Economics

Over the past several decades there has been an increased prevalence of both adult and childhood obesity in American society. This has received significant attention from researchers and governmental agencies, as there are both public health concerns and financial consequences associated with this condition. Obesity is associated with an increased risk for heart disease, stroke, type-2 diabetes, arthritis, and certain forms of cancer—all of which are serious (and costly) conditions. It has been estimated that medical expenditures associated with obesity account for 9% of all national medical expenditures in a given year. Nearly half of this bill is paid for by the government through Medicare and Medicaid expenditures, which translates to a higher tax bill for all tax-paying citizens. Moreover, it has been estimated that obese individuals who are Medicare (Medicaid) participants cost on average $1,486 ($864) more per year than their healthy weight counterparts (Finklestein et al. 2003).
Show more

169 Read more

Health and the economy: three essays

Health and the economy: three essays

certainly be the case in poor countries as shown by Case (2001) in her paper on the health e¤ects of changes in the pension system in South-Africa. She showed that households who pooled their resources and had one or more recipients of the new and improved pension scheme, had health bene…ts from the additional income which was shared by all. However, the evidence is very mixed and weak when it comes to rich, developed countries. As we have noted throughout, there are potentially serious concerns of simultaneity when estimating the e¤ect of income on health. A few recent papers have made some serious attempts at tackling these issues. Frijters et al. (2005) investigates whether there was an improvement in Self-Assessed Health of East Germans after the reuni…cation of 1990. They view the reuni…cation as a natural experiment where East Germans experienced rapidly increasing real household incomes while the former West Germans did not. Frijters et al. employ a …xed e¤ects technique and …nd a positive, but very small health e¤ect of increased income. They were able to attribute approximately 5% of the changes in SAH over the period to changes in income. Adda et al. (2008) construct an individual dynamic model where they test whether permanent income shocks a¤ect a number of health measures. They use cohort wide income shocks related to changes in the macro economic environment which can plausibly be regarded as exogenous to cohort health. They …nd that negative shocks increase mortal- ity, but have little or no e¤ect on SAH, blood pressure, cardiovascular condition, respiratory condition or mental health.
Show more

111 Read more

Three Essays in Trade and Health.

Three Essays in Trade and Health.

(1998) respectively. Next, I develop copula-based models that consider the joint distri- bution of different national interest rates. This allows attention to be given to the nature of the jointness or correlation between these interest rates. I allow for the correlation to be state-dependent and depend on market conditions at any point in time. This is analogous to the regime-switches in the above models. Copula models use a copula to tie together two marginal probability functions that may (or may not) be related to one an- other. The copula method offers an alternative approach to representing the multivariate distribution in terms of its dependent marginals. In this paper, I utilize many nonlinear and nonparametric techniques for assessing the dynamic linkages in international interest rates. These methods show the level of integration within the market and stress the level to which policy makers have the ability to independently influence their home country’s interest rate.
Show more

143 Read more

Three essays in environmental health

Three essays in environmental health

in the dual penalty allows for an informative of variable selection process, since it derives the significance of the shock impact at different points in the height distribution. I contrast the results across models that exclude and then include smoothed latitude-longitude components to allow for better control for the additional geographical information. This strategy has not been used before in the literature, and can potentially benefit environmental shock research. Primary results from the fixed effects models suggest that children exposed to the shock have a height-for-age reduced by 0.15 standard deviations. Although not very large, this estimate is larger than the one from a less accurate spatial identification of exposed children, where all children in the WR are considered as exposed. This suggests resolution of mea- surement error on account of noise in the exposure variable. In contrast to typical findings in this literature, boys are actually worse off than girls. This is likely on account of very young male children being less resilient than girls. There is also evidence of exposed, younger children being worse off than older ones, a finding common in child health literature, since younger children are more likely to suffer from malnutrition outcomes like stunting. Using the quantile specification, the following is observed. First, the impact is more negative in the lower tail than in the higher tail. Second, after including location by smoothing on latitude and longitude, I see increased negative coefficient for all quantiles, where the differ- ence across the coefficients with and without location information is significant for the lower quantiles. Finally, the model with GPS coordinates also exhibits a greater disparity between weaker and stronger children, so that weaker children are significantly worse off, than if we were to leave out this information. This strategy allows for deriving this increased negative coefficient, thus resolving any measurement error in the exposure variable in the absence of location measures.
Show more

108 Read more

Three essays in health economics

Three essays in health economics

The efficacy of antibiotics cannot be taken for granted. Bacteria evolve and develop mech- anisms to resist the antibiotics that are used to combat them. Over the course of the last 20 years, antibiotic resistance has become an increasingly alarming issue due to the com- bination of two major factors: a sharp increase in antibiotic consumption and a shortage of new antibiotics to replace those which have become ineffective. Today, it is estimated that over 2 million U.S. residents acquire antibiotic-resistant infections in a given year, and that these infections result in more than 23,000 annual deaths (CDC 2013). Mortality from MRSA (methicillin-resistant Staphylococcus aureus), which is just one of many microorgan- isms that have developed resistance to antibiotics, exceeds mortality due to asthma, homicide, or HIV/AIDS (Klevens et al. 2007, CDC 2015). The economic impact of antibiotic resistance, while difficult to measure, is likely to be huge: estimates of the cost of antibiotic resistance range from 55 billion USD per year for the U.S. economy alone to 100 trillion USD for the world economy until 2050 (CDC 2013, O’Neill 2014). In response to this growing problem, many influential institutions, among them the World Health Organization and the Centers for Disease Control and Prevention, have issued reports and called for action to combat the rise in antibiotic resistance (WHO 2014, CDC 2013).
Show more

103 Read more

Three Essays in Health Economics

Three Essays in Health Economics

We further examine whether college parents value information from various sources differently. We focus on three information sources: disease prevalence rate, newspaper, and web searches. We create composite information measures according to the expected sign of each single measure by averaging the z-scores of information from the same source. Information is treated as a harmful signal if its expected impact on MMR non-uptake rate is positive. Likewise, information is regarded as a safe signal if its expected sign is negative. The impact of news count is inconclusive. More media attention may help the mass to understand the origin and consequence of the controversy, which lead to a negative impact on MMR non-uptake rate. But it may result in a positive impact on the MMR non-uptake rate by providing more chance for biased readers to selectively test their hypothesis especially when most of the news presents a mix of scientific evidence, words from authorities, and personal stories. Luckily, the impact of news count in Table 2.6 is trivial and insignificant. And we find that grouping it into either a safe (in Table C2) or a harmful signal (in Table 2.7) does not affect our results.
Show more

146 Read more

Three Essays in Health Economics

Three Essays in Health Economics

Information on smoking behavior is from the Current Population Survey To- bacco Use Supplements (CPS-TUS) for years 1998 to 2003 and 2006 to 2007. 8 The Current Population Survey is a nationally representative, monthly house- hold survey of labor force participation. The monthly survey often includes sets of supplemental questions on particular topic such as health, schooling, fertility, and immigration. Periodically, respondents are asked a series of questions about smoking and other tobacco-related behaviors as part of the Tobacco Use Supple- ment, which is sponsored by the National Cancer Institute and the Centers for Disease Control. The CPS-TUS is a repeated cross section of individuals useful for describing smoking behavior of Americans over time. Individuals who have smoked at least 100 cigarettes in their entire life are identified as current or for- mer smokers and are asked a series of follow-up questions about smoking behavior. The smoking measures used in this paper are self and proxy reports of smoking at least some days and smoking every day.
Show more

131 Read more

Three Essays on Health Economics

Three Essays on Health Economics

Other studies exploit the discontinuity of retirement status around the official retirement age set by governments. If this discontinuity of retirement is significant, and all factors but retirement are smooth around the official retirement, RDD (regression discontinuity design) may have the potential to identify the short-term causal effects of retirement on health. For example, Johnston and Lee (2009) uses a RDD based on the discontinuity at age 65 in the probability of retirement in England to estimate the impact of retirement on subjective and objective health. Their results indicate that retirement increases an individual’s sense of well-being and their mental health. In German pension system, 60 is the pension eligibility age for women, for unemployment and partial retirement, and for severely disabled people; age 65 is the standard pension age. Using a RDD and two pension ages as cutoffs, Eibich (2015) identifies the causal effects of retirement on health and the mechanisms behind the effects, and finds that retirement improves subjective health status and mental health, while reduces outpatient care utilization. Relieving from work- related stress, increased sleep duration, as well as frequent physical activities seem to be key mechanisms through which retirement affects health. However, since the retirement behavior is voluntary in developed counties relative to developing countries, sometimes the discontinuity of retirement status of developed countries is not sharp enough to apply RDD approach. In addition, there may have other significant changes around retirement age for elderly. For example, age 65 is also the Medicare eligibility cutoff in the U.S. This health insurance availability may confound, or cause impact of the retirement to be biased upward.
Show more

121 Read more

Three essays in Health and Labour Economics

Three essays in Health and Labour Economics

This paper adds to the existing literature in the following ways. First, to our knowledge, this is the first comprehensive assessment of the National Child Measurement Programme feedback which costs around £1 million each year for sending letters alone. 46 We take into account both potential intended and unintended consequences of the programme, i.e. adiposity- related outcomes, outcomes related to behavioural lifestyle changes as well as potential adverse effects of the programme. This wide range of outcomes allows us to get a full picture of how the NCMP works. Second, our particular research design and unique data on the dates of the NCMP school visits in combination with a large sample size allows us to draw causal conclusions. Third, our findings contribute into the literature on tailored information interventions. Over the past decade, this type of intervention has become increasingly popular as it has been shown to lead to improved persuasive outcomes in terms of attitude, behavioural intention and behaviour change. Finally, as we find some adverse effects of sending feedback letters, we also contribute to the broader behavioural, economic, public policy and political literature and debates on unintended consequences of policies on consumers/voters when an action or policy meant to bring one set of reaction but inadvertently creates incentives that lead to another set of unexpected costs and adverse effects. 47
Show more

193 Read more

Three Essays about Health and Welfare.

Three Essays about Health and Welfare.

be controlled in the regression, estimates are still biased with unobservable characteristics. For instance, high ability women can bring more resources to the marriage through a high level of social capital and extensive social networks, which may simultaneously enhance their power and their capacities to invest more on children in ways unobservable by econometricians. This case would lead to an overestimate of the impact of mothers’ power on child outcomes. The second concern is the heterogeneity in the quality of children. Women having high quality children tend to gain more respect from husband and parent in-laws, and therefore to have more voice in family issues. In this case, the reverse causality is a threat to consistency. The third concern involves social norms or custom-based gender discrimination. In societies with patrilocal marriage and patrilineal kinship and inheritance, women are limited to the domestic sphere and have less bargaining power. In the meantime, these regions tend to have stronger preferences for sons and to allocate more resources to sons. In this situation, mother’s power measurement would be negatively correlated with child outcomes, and the ordinal least squares (OLS) estimates will have negative signs and be underestimated. All these selection dynamics may cause the OLS estimate to be biased and inconsistent. Therefore, the central task for the empirical study is to identify sources of women’s power which vary exogenously. That is, I need an instrument which is strongly correlated with women’s bargaining power within the family but not with their decision to invest in child health.
Show more

128 Read more

Three essays on the economics of immigration and health

Three essays on the economics of immigration and health

Notes - The plotted curve reports the predicted low birth weight differences between 3rd generation Mexicans and white natives for each level of selection on health at migration, assuming that the intergenerational correlation in health ρ is equal to 0.35 and the effect of maternal health on birth weight, γ, is equal to 0.75 (baseline). The scenario considered assumes that Mexicans fully assimilate in behaviors but incorporates the estimated effect on birth weight of the observed socioeconomic differences between second-generation Mexicans and white natives (less than full socioeconomic assimilation, µ M X 2 = −0.1). The lower dashed line (y = −0.001) describes the observed
Show more

137 Read more

Three Essays on Health and Labor Markets

Three Essays on Health and Labor Markets

Ruhm (2000) uses state-level aggregate data for the 1972-1991 period and employs state unemployment rates as the primary proxy for macroeconomic conditions. He finds that state unemployment rates are negatively related with total mortality and with eight of ten sources of fatalities, with suicides as one important exception. Ruhm (2003) examines relationships between individual-level data from the 1972-1981 National Health Interview Survey (NHIS) and state level unemployment rates, and finds that physical health deteriorates as the economy expands. Ruhm (2005) also uses individual-level data for the 1987-2000 period, and state-level measures of economic conditions (employment rate, weekly working hours, and personal income). He concludes that smoking and excess weight decline during temporary economic downturns because of increases in physical activity. To sum up, Ruhm finds that recessions are good for health. However, when mental health is also taken into account, the opposite results are found by Davalos and French (2011) — increases in the average state unemployment rate cause people’s health-related quality of life (HRQL), which is measured by physical and mental health summary scores, to decline.
Show more

79 Read more

Three Essays on the Economics of Health Reform.

Three Essays on the Economics of Health Reform.

Despite these definitional differences, Michigan’s minimum MLR rule resembles the ACA’s rule in several ways that should affect the actions of insurers. Both establish a minimum MLR that applies nearly universally, and the relative stringency of the minimum is similar; both rules have minimums that are 5-10 percentage points lower than the average prevailing loss ratio (America's Health Insurance Plans 2011; Harrington 2013). Both rules also have an enforcement mechanism; under the ACA, insurers must pay a rebate if their MLRs fall below the minimum, while, under Michigan’s rule, insurers are forbidden from offering plans that do not meet the requirements. Most importantly for generalization of these results to the ACA, both rules contain features that facilitate tacit collusion. First, the ACA’s mandated minimum can serve as a focal point. Second, the law’s explicit public reporting requirements for MLRs should reduce information asymmetries between insurers more than Michigan’s rule does, thus further lowering the cost of maintaining a colluding equilibrium over time.
Show more

146 Read more

Three Essays On Mortality, Health, And Migration

Three Essays On Mortality, Health, And Migration

5,000 families, and now follows their descendants as well. The outcome of interest is a binary variable indicating whether or not an individual resides in a different state than in the previous wave. Thus multiple moves between waves, which occur every two years, are not captured by the data. Health measures, which are the control variables of interest, are collected for heads of households and their spouses, so the analyses are limited to only these individuals. For most of its history, the PSID has collected information about self-rated health status, a classic health measures used in the social sciences. However, starting in 1999, the survey also began to include more detailed information about disability and chronic conditions, which is the reason the analysis starts at this point. Activities of daily living (ADL) were reported, and respondents were also asked to state if they had ever been diagnosed with a host of chronic and acute conditions. All the health measures are summarized in Table 3.1.
Show more

96 Read more

Three Essays in Applied Health Economics

Three Essays in Applied Health Economics

I use Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from the Centers for Medicare and Medicaid Services to test for differences in benefit design for opioids across MA-PDPs and SA-PDPs. These data contain detailed informa- tion on the universe of Part D formularies and plans, including the list of covered drugs on each formulary, utilization management rules corresponding to each formulary-drug combination, and the level of cost-sharing associated with each plan-drug combination. For formulary-drug combinations that have a quantity limit restriction, the data contain both the quantity limit amount and the days limit; for example, 90 tablets within 30 days. I use data from 2008, 2009, 2011, 2013, and 2015. These data years represent a period of significant change in the medical community’s perception of safe opioid prescribing levels; between 2009 and 2011, researchers documented a heightened risk of adverse health events linked to high daily dosages of opioids, particularly among the elderly (Dunn et al., 2010; Saunders et al., 2010; Bohnert et al., 2011).
Show more

170 Read more

Three Essays on Fiscal Competition and Public Policy

Three Essays on Fiscal Competition and Public Policy

My main empirical strategy is (i) to provide evidence on the existence of provincial tax competition in China along with the validation of the three basic hypotheses stated in the previous section; and (ii) to shed some light on the mechanism through which tax competition is actually conducted in the Chinese context. I first follow the existing literature setting up a dynamic spatial lag model to identify the competing behaviors of provinces, and then discuss a structural model as a way to unveil the mechanism for competition I laid out in the previous section. Before proceeding, I need to make two explicit assumptions. First, given that the statutory tax rate is fixed across provinces in China, I assume that the relevant tax rate is the average effective tax rate (AETR). Second, in line with the existence of a multilevel local government structure in China, I refer to the provincial government as a single entity that represents and captures all the competing behaviors of subnational governments in that particular province. This is justified because under China’s highly centralized political system, provincial governments maintain absolute powers in appointing local officials and deciding major local activities in their domains. In addition, besides the central government, the authority for establishing development zones is only legally assigned to provincial governments, which are also responsible for approving any setups of development zones at the sub-provincial level. 63
Show more

118 Read more

Three essays on public health insurance, quality, access and cost of health care

Three essays on public health insurance, quality, access and cost of health care

We expect Part D to affect physicians’ prescribing pattern. Physicians are not directly reimbursed for their prescribing behavior. However, there are reasons to expect physicians’ prescribing be- havior to change after the introduction of Part D. First, a physician’s reputation may be partly determined by how well they take their patients’ needs into account. This may include both the ability to attend to their patients’ health needs, and their ability to best tailor treatment plans to a patient’s financial circumstances. This may in turn provides a disincentive to under- prescribe drugs where patients do not get necessary medications they can afford under Part D, or to overprescribe drugs to the extent where the costs exceed the benefits. 6 As the patients’ agent, physicians should maximize patient utility subject to a budget constraint. As we discussed earlier, Part D lowers the average out-of-pocket cost per prescription for Medicare beneficiaries through decreased copayments for each prescription filled. The reduced copayments for prescrip- tion drugs should lead to an increase in prescriptions. Additionally, plans can create their own formularies to encourage the prescription of generic drugs. Last but not the least, the adoption of Part D coincided with many drug patent expirations. This resulted in increases in the number of available generic drugs (Hoadley, 2012). For the reasons above, we expect to see changes in the prescribing patterns measured by number of prescription drugs (especially generic drugs) physi- cians prescribe to their elderly patients after the introduction of Part D. 7 We also expect Part D
Show more

140 Read more

Three Essays in Health Policy Evaluation.

Three Essays in Health Policy Evaluation.

The overwhelming number of deaths that CHCs could have prevented occurred among adults ages 50 and older. This group not only comprised a large share of U.S. deaths (80 to 88 percent from 1960 to 1988), but many of these deaths would have been responsive to the provision of primary care. CHCs could reduce mortality rates by increasing early detection of health problems, providing free or highly subsidized medications to treat conditions (not covered by Medicare or Medicaid in most cases, Finkelstein and McKnight 2008; Davis and Schoen 1978: 55), and increasing awareness about Medicare (Chay et al. 2011) and Medicaid, both of which could increase access to life-saving hospital treatments. Similarly, CHCs’ outreach and follow-up efforts could have had important effects on the management of common, fatal, chronic conditions like hypertension that required consistent and long-term use of medication. Finally, CHCs may have reduced the mortality of community members who did not use their medical services by reducing emergency room crowding, lowering the incidence of infectious disease, and spreading health information. For all of these reasons, we do expect CHCs to have large effects on mortality rates of older adults.
Show more

282 Read more

Three essays at the intersection of public policy and women's reproductive health and well-being

Three essays at the intersection of public policy and women's reproductive health and well-being

However, simply pooling the data from the three interview periods and estimating a logit or probit model may result in biased estimates. In particular, such a model may be vulnerable to unobserved heterogeneity from time-invariant factors. For example, each teenager in the sample is confronted with a set of socioeconomic factors unique to the city she lives in, such as the local unemployment rate, housing, food, and clothing costs, availability of post-high school training, and community attitudes toward non-marital births, all of which may affect the likelihood that she receives parental support. In addition, the study‘s theoretical framework demonstrates the importance of controlling for geographic variation in policies affecting pregnant and parenting teens. These socio- economic and policy factors are unlikely to vary between the first and third waves of Fragile Families data, but may vary greatly between cities in different parts of the country. Such time-invariant, fixed factors may be termed a ―city effect.‖ Controlling for this city effect not only accounts for these factors in the analysis, it also may help control for any endogeneity bias caused by omitted time-invariant, city-specific factors.
Show more

202 Read more

Show all 10000 documents...