#HEJC for 17/10/2013

The next #HEJC discussion will take place Thursday 17th October, at 8am London time. Join the Facebook event here. For more information about the Health Economics Twitter Journal Club and how to take part, click here.

The paper for discussion this month is a working paper published by IZA. The authors are Maja Adena and Michal Myck. The title of the paper is:

“Poverty and transitions in health”

Following the meeting, a transcript of the Twitter discussion can be downloaded here.

Links to the article

Direct: http://ftp.iza.org/dp7532.pdf

RePEc: http://ideas.repec.org/p/iza/izadps/dp7532.html

Other: http://www.diw.de/sixcms/detail.php?id=diw_01.c.427201.de

Summary of the paper

My interest in discussing ‘Poverty and transitions in health’ by Adena and Myck was driven by my own curiosity in the area of socio-economic determinants of health and well-being more generally. The income based approach to assessing a country’s progress or assessing welfare within nations has faced sustained criticism from a number of quarters, most notably the Commission on the Measurement of Economic Performance and Social Progress (Stiglitz et al. 2009). Even when it comes to assessing poverty, the method of drawing a relative income poverty threshold has faced further scrutiny, most notably from advocates of a multidimensional poverty approach (Alkire & Foster, 2011).

The paper by Adena and Myck is another critique on the relative income approach on assessing wellness, but in a new light – by investigating the ability of relative income to predict future health outcomes in an older population group. The authors argue that old age poverty is one of the key challenges to developed countries, with the demographics of the over 65 expected to make up almost three in every ten EU citizens by 2060 adding concerns about the sustainability of national pension plans. The authors argue that epidemiological research has so far failed to account for the relationship between material conditions and health in the later stages of life to date.

The data applied to investigate this research question were drawn from 12 European countries from a large (n=29,110) European Panel Survey, the Survey for Health, Aging and Retirement in Europe (SHARE). The percentage of the population aged 50-64 at baseline was 53.23% with the remainder 65 and older. Males accounted for 54.69% of the sample. At baseline Wave 2 of the SHARE dataset (year 2006) was used to predict binary outcomes of good or bad health in Wave 4 of the survey (year 2012), which depended on whether or not an individual was in good or bad health at baseline (Wave 2). Three measures of “material circumstances” were applied to predict three measures of ‘health’ in this study (as well as mortality). The three material circumstances measures were:

  1. Income poverty – 60% of the median equivalised household income
  2. Subjective poverty – having difficulty to “make ends meet” per month
  3. Wealth poverty – bottom tertile of country wealth distributions.

The three health measures were:

  1. Self-assessed health status (SAH) – “fair” or “poor” health status on a five-part scale
  2. Symptoms of poor health (SMT) – poor if they have 3 or more of 12 symptoms measured
  3. Limitations in performing activities of daily living (ADL) – poor if they have 3 or more of 23 ADLs.

The authors’ key findings suggest that the “broader measures” of subjective and wealth poverty are more accurately able to predict negative health outcomes than income poverty (in some cases, no relationship was found between income poverty and health outcomes). People who were in bad health in Wave 2 are also less likely to recover if they are classified as subjective or wealth poor in Wave 4. The most striking finding by Adena and Myck is the probability of death when reported as subjectively poor in Wave 2. The probability of dying is 40.3% higher for men and 58.3% higher for all aged between 50-64 years old. The authors conclude by stating that “improvements in material conditions may not only translate into better quality of life but also living longer”

Discussion points

  • The method of defining health poverty as 3 problems for the health measures SMT and ADL is reported as arbitrary but common. How common is this practice? No reference to other examples in the paper.
  • Should having 3 problems be equivalent irrespective of ‘problem’ under consideration? Might be worth considering literature on ‘core’ poverty methods (Clark & Qizilbash, 2008).
  • Sensitivity analysis considered people with two or more problems: I was expecting an analysis which went higher (i.e. four or more problems), especially for ADL.
  • Sensitivity analysis would have also been useful for the material measures. This paper shows problems with the 60% median relative income threshold, rather than relative income itself.
  • Is the method for defining wealth within a country appropriate for defining “wealth poverty”?
  • While the authors touched on qualitative information contained in Wave 3 in the sensitivity analysis, this could warrant future research as to the drivers of changes in health outcomes over time.
  • Personally, I did not feel the link to Grossman’s (1972) model on health stock was necessary. Felt the results, if properly presented, could stand up on their own merits.
  • Imputation of missing values for income and wealth needed further explanation.
  • Related to Footnote 11: why were the result in Hahn et al. (1995) different than what were found in this study? This requires more detailed consideration.

Can’t join in with the Twitter discussion? Add your thoughts on the paper in the comments below.

#HEJC papers for October 2013

Below is a list of recently published working papers and discussion papers from the field of health economics. If you’d like to discuss one of the papers for a #HEJC meeting, please complete the form at the bottom of the page.

For more information about #HEJC, and to find out about the role of a discussant, click here.

  1. Valuing Health Technology – New Value Spaces For Personal Health Systems To Support Active Aging
  2. Health Consequences of Transitioning to Retirement and Social Participation: Results based on JSTAR panel data
  3. Work Incentives of Medicaid Beneficiaries and The Role of Asset Testing
  4. Use of Bayesian Markov Chain Monte Carlo methods to estimate the EQ-5D utility scores from EORTC QLQ data in myeloma for use in cost effectiveness analysis
  5. Employer-Provided Health Insurance and Job Mobility
  6. Individual Behavior as a Pathway between Early-Life Shocks and Adult Health: Evidence from Hunger Episodes in Post-War Germany
  7. Spousal Health Effects – the Role of Selection
  8. The Changing Role of Government in Financing Health Care: An International Perspective
  9. Impact of Mortality-Based Performance Measures on Hospital Pricing: the Case of Colon Cancer Surgeries
  10. Modeling Area-Level Health Rankings
  11. Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from China’s Essential Medications List Policy
  12. Putting the Patient in Patient Reported Outcomes: A Robust Methodology for Health Outcomes Assessment
  13. The Star Treatment: Estimating the Impact of Star Ratings on Medicare Advantage Enrollments
  14. Financial Literacy and Consumer Choice of Health Insurance: Evidence from Low-Income Populations in the United States
  15. Overcoming Barriers to Health Service Access: A Study of Lucknow Health Facilities Using TQM
  16. A Portfolio Approach to Mortality Shocks and Fertility Choice: Theory and Evidence from Africa
  17. The Wear and Tear on Health: What is the Role of Occupation?
  18. Heterogeneity in Long Term Health Outcomes of Migrants within Italy
  19. Do fixed patent terms distort innovation? Evidence from cancer clinical trials
  20. The Impact of Mothers’ Earnings on Health Inputs and Infant Health
  21. Happy and healthy: a joint model of health and life satisfaction
  22. What Do We Know About Non-Clinical Interventions for Preventable and Treatable Childhood Diseases in Developing Countries
  23. Health Care Reform, Efficiency of Health Insurers, and Optimal Health Insurance Markets
  24. Effects of Compulsory Schooling on Mortality – Evidence from Sweden
  25. Distance as a barrier to health care access in South Africa
  26. Fair Retirement Under Risky Lifetime
  27. Food Prices and Population Health in Developing Countries: An Investigation of the Effects of the Food Crisis using a Panel Analysis
  28. Attributing a monetary value to patients’ time: A contingent valuation approach
  29. How Consumer Price Subsidies affect Nutrition
  30. Insurer Competition and Negotiated Hospital Prices
  31. Equilibria in Health Exchanges: Adverse Selection vs. Reclassification Risk
  32. The Impact of Insurance and HIV Treatment Technology on HIV Testing
  33. Bias in Measuring Smoking Behavior
  34. The Trade and Health Effects of Tobacco Regulations
  35. Does Early Life Exposure to Cigarette Smoke Permanently Harm Childhood Health? Evidence from Cigarette Tax Hikes
  36. The transmission of longevity across generations: The case of the settler Cape Colony
  37. Inequality of Opportunity in Health Care in China: Suggestion on the Construction of the Urban-Rural Integrated Medical Insurance System
  38. Satisfaction of Patients in Health Care: Some Critical Issues with Research Projects that Measure Satisfaction
  39. Adaptability and innovation in healthcare facilities. Lessons from the past for future developments
  40. The Effects of Smoking Bans on Self-Assessed Health: Evidence from Germany
  41. An Empirical Model of Drug Detailing: Dynamic Competition and Policy Implications
  42. Self-Employment and Health: Barriers or Benefits?
  43. Measuring the Full Value-Effect of an Event: The Healthcare Reform Act
  44. Long-Term Care and Lazy Rotten Kids
  45. Comparing Methods for Imputing Employer Health Insurance Contributions in the Current Population Survey
  46. Can Property Values Capture Changes in Environmental Health Risks? Evidence from a Stated Preference Study in Italy and the UK
  47. Who Pays for Obesity? Evidence from Health Insurance Benefit Mandates
  48. US Male Obesity from 1800-2000: A Long Term Perspective
  49. Health Care Costs, Taxes, and the Retirement Decision: Conceptual Issues and Illustrative Simulations
  50. Health Care, Health Insurance, and the Relative Income of the Elderly and Non-Elderly
  51. The Response of Drug Expenditures to Non-Linear Contract Design: Evidence from Medicare Part D
  52. Health Insurance for “Humans”: Information Frictions, Plan Choice, and Consumer Welfare
  53. Perverse Reverse Price Competition: Average Wholesale Prices and Medicaid Pharmaceutical Spending
  54. Is the Affordable Care Act Different from Romneycare? A Labor Economics Perspective
  55. Average Marginal Labor Income Tax Rates under the Affordable Care Act
  56. Conspicuous Consumption, Conspicuous Health, and Optimal Taxation

#HEJC papers for September 2013

Below is a list of recently published working papers and discussion papers from the field of health economics. If you’d like to discuss one of the papers for a #HEJC meeting, please complete the form at the bottom of the page.

For more information about #HEJC, and to find out about the role of a discussant, click here.

  1. A new perspective on the economic valuation of informal care: the well-being approach revisited, by Konstantin Kehl and Stephan Stahlschmidt [RePEc]
  2. An evaluation of HRS sample weights, by Elena Gouskova [RePEc]
  3. Assessing the effects of medical marijuana laws on marijuana and alcohol use: the devil is in the details, by Rosalie Liccardo Pacula, David Powell, Paul Heaton and Eric L Sevigny [RePEc]
  4. Association between obesity and selected morbidities: a study of BRICS, by Ankita Shukla, Kaushalendra Kumar and Abhishek Singh [RePEc]
  5. Barriers to health and the poverty trap, by Yin-Chi Wang and Ping Wang [RePEc]
  6. Changing eating habits – a field experiment in primary schools, by Michèle Belot, Jonathan James and Patrick Nolen [RePEc]
  7. Community effects on elderly health: evidence from CHARLS national baseline, by James P Smith, Meng Tian and Yaohui Zhao [RePEc]
  8. Cost-benefit analysis and distributional weights: an overview, by Matthew D Adler [RePEc]
  9. Crowding out of solidarity? – Public health insurance versus informal transfer networks in Ghana, by Florian Klohn and Christoph Strupat [RePEc]
  10. Demand uncertainty and hospital costs: an application to Portuguese NHS hospitals, by Alvaro Almeida and Joana Cima [RePEc]
  11. Disease incidence and mortality among older Americans and Europeans, by Aida Sole-Auro, Pierre-Carl Michaud, Michael D Hurd and Eileen Crimmins [RePEc]
  12. Do economic crises lead to health and nutrition behaviour responses? Analysis using longitudinal data from Russia, by Zlatko Nikoloski and Mohamed Ihsan Ajwad [RePEc]
  13. Do fertility transitions influence infant mortality declines? Evidence from early modern Germany, by Alan Fernihough and Mark E McGovern [RePEc]
  14. Does changing the legal drinking age influence youth behaviour, by Stefan Boes and Steven Stillman [RePEc]
  15. Does commuting cause stress? The public health implications of traffic congestion, by Murtaza Haider, Kenneth Kerr and Madhav Badami [RePEc]
  16. Does physician dispensing increase drug expenditures? by Boris Kaiser and Christian Schmid [RePEc]
  17. Early-life disease exposure and occupational status: the impact of yellow fever during the 19th century, by Martin Hugo Saavedra [RePEc]
  18. Economic and financial consequences of cancer from patient’s family perspective: a a case study of Punjab, by Inderjeet Singh, Lakhwinder Singh and Parmod Kumar [RePEc]
  19. Evidence for significant compression of morbidity in the elderly U.S. population, by David M Cutler, Kaushik Ghosh and Mary Beth Landrum [RePEc]
  20. First do no harm, then do not cheat: DRG upcoding in German neonatology, by Hendrik Jürges and Juliane Köberlein [RePEc]
  21. Health-related life cycle risks and public insurance, by Daniel Kemptner [RePEc]
  22. Heterogeneity of the effects of health insurance on household savings: evidence from rural China, by Diana Cheung and Ysaline Padieu [RePEc]
  23. Hospital choices, hospital prices and financial incentives to physicians, by Kate Ho and Ariel Pakes [RePEc]
  24. If my blood pressure is high, do I take it to heart? Behavioural impacts of biomarker collection in the health and retirement study, by Ryan D Edwards [RePEc]
  25. Inequality and bi-polarization in socioeconomic status and health: ordinal approaches, by Bénédicte Apouey and Jacques Silber [RePEc]
  26. International fragmentation in the presence of alternative health sector scenario: a theoretical analysis, by Tonmoy Chatterjee and Kausik Gupta [RePEc]
  27. International health economics, by Mark Egan and Tomas J Philipson [RePEc]
  28. Keeping the doctor away: experimental evidence on investment in preventative health products, by Jennifer M Meredith, Jonathan Robinson, Sarah Walker and Bruce Wydick [RePEc]
  29. Lessons from low-cost healthcare innovations for the base-of the pyramid markets: how incumbents can systematically create disruptive innovations, by Aditi Ramdorai and Cornelius Herstatt [RePEc]
  30. Mitigating the effects of low birth weight: evidence from quasi-randomly assigned adoptees, by Brian Beach and Martin Hugo Saavedra [RePEc]
  31. Mobility of capital and health sector: a trade theoretic analysis, by Tonmoy Chatterjee and Kausik Gupta [RePEc]
  32. On the measurement of the (multidimensional) inequality of health distributions, by Jens L Hougaard, Juan D Moreno-Ternero and Lars P Osterdal [RePEc]
  33. Physician beliefs and patient preferences: a new look at regional variation in health care spending, by David Cutler, Jonathan Skinner, Ariel Dora Stern and David Wennberg [RePEc]
  34. Poverty and transitions in health, by Maja Adena and Michal Myck [RePEc]
  35. Recessions, healthy no more? by Christopher J Ruhm [RePEc]
  36. Representativeness of the low-income population in the health and retirement study, by Erik Meijer and Lynn A Karoly [RePEc]
  37. Short- and medium-term effects of informal care provision on health, by Hendrik Schmitz and Matthias Westphal [RePEc]
  38. Smoking outside: the effect of the Irish workplace smoking ban on smoking prevalence among the employed, by Michael Savage [RePEc]
  39. Socioeconomic determinants of child health – empirical evidence from Indonesia, by Subha Mani [RePEc]
  40. Spousal effects in smoking cessation: matching, learning, or bargaining? by Kerry Anne McGeary [RePEc]
  41. Stability of preference against aging and health shocks: a comparison between Japan and the United States, by Hideki Hashimoto, Hidehiko Ichimura and Satoshi Shimuzutani [RePEc]
  42. The causal effect of retirement on mortality: evidence from targeted incentives to retire early, by Hans Bloemen, Stefan Hochguertel and Jochem Zweerink [RePEc]
  43. The child health implications of privatizing Africa’s urban water supply, by Katrina Kosec [RePEc]
  44. The dynamics of pharmaceutical regulation and R&D investments, by Rosella Levaggi, Michele Moretto and Paolo Pertile [RePEc]
  45. The economic impact of non-communicable disease in China and India: estimates, projections and comparisons, by David E Bloom, Elizabeth T Cafiero, Mark E McGovern, Klaus Prettner, Anderson Stanciole, Jonathan Weiss, Samuel Bakkila and Larry Rosenberg [RePEc]
  46. The effect of a constitutional right to health on population health in 157 countries, 1970-2007: the role of democratic governance, by Hiroaki Matsuura [RePEc]
  47. The future of long-term care in Japan, by Matthew A Cole, Robert J R Elliott, Okubo Toshihiro and Eric Strobl [RePEc]
  48. The impact of eliminating a child benefit on birth timing and infant health, by Cristina Borra, Libertad Gonzalez and Almudena Sevilla-Sanz [RePEc]
  49. The role of agents and brokers in the market for health insurance, by Pinar Karaca-Mandic, Roger Feldman and Peter Graven [RePEc]
  50. The socio-economic module of the Berlin Aging Study II (SOEP-BASE): description, structure, and questionnaire, by Anke Böckenhoff, Denise Sassenroth, Martin Kroh, Thomas Siedler, Peter Eibich and Gart G Wagner [RePEc]
  51. Timing of prenatal smoking cessation or reduction and infant birth weight: evidence from the United Kingdom Millenium Cohort Study, by Ji Yan and Peter A Groothuis [RePEc]
  52. Two-period comparison of healthcare demand with income growth and population aging in rural China: implications for adjustment of the healthcare supply and development, by Jacky Mathonnat, Yong He and Martine Audibert [RePEc]
  53. What do wages add to the health-employment nexus? Evidence from older European workers, by Manuel Flores and Adriaan Kalwij [RePEc]