Health Economics Articles PDF

Almond, D. (2006), “Is the 1918 Influenza Pandemic Over? Long-Term Effects of In Utero Influenza Exposure in the Post-1940 U.S. Population,” Journal of Political Economy, 114(4), 672-712 - This paper uses the 1918 influenza pandemic as a natural experiment for testing the fetal origins h...

Almond, D. (2006), “Is the 1918 Influenza Pandemic Over? Long-Term Effects of In Utero Influenza Exposure in the Post-1940 U.S. Population,” Journal of Political Economy, 114(4), 672-712 - This paper uses the 1918 influenza pandemic as a natural experiment for testing the fetal origins hypothesis which discusses undernutrition in the womb during middle to late pregnancy causes improper fetal growth, which in turn, causes a predisposition to certain diseases in adulthood. - As census micro data identify both the place and quarter of birth of respondents, these can be linked to the timing and geographic variation in influenza infection. The second approach uses geographic variation to identify within-cohort differences in fetal exposure to the pandemic. In order to bias estimates, omitted factors would have to follow the same abrupt and idiosyncratic patterns as the pandemic. - It concludes that prenatal exposure to the 1918 influenza pandemic had large negative effects on adult economic outcomes This study concludes that the full impact of congenital characteristics may not be immediately observed and therefore may go undetected. That fetal health may be at the fulcrum of this relationship suffers no shortage of policy implications Almond, D., Chay, K., Lee, D. (2005), “The Costs of Low Birth Weight,” Quarterly Journal of Economics, 120(3), 1035-83 - This paper addresses Low birth weight (LBW) infants experience severe health and developmental difficulties that can impose large costs on society. However, estimates of the return to LBW-prevention from cross-sectional associations may be biased by omitted variables, such as genetic factor - Their approach to address it was compare the hospital costs, health at birth, and infant mortality rates between heavier and lighter infants from all twin pairs born in the United States. We also examine the effect of maternal smoking during pregnancy? the leading risk factor for LBW in the United States? on health among single on births after controlling for detailed background characteristics - They concluded that their were some important limitations in the scope of their analysis, first was there was other factors that go into low birth weight so they cannot rule out the possibility that their findings were the execption and not the rule. Second their outcomes focus on outcomes focus on the status of the infant at birth, or shortly thereafter. Therefore, they could cannot make any conclusions about the relation between LBW (or birth weight more generally) and longer run outcomes. The relatively small effects that we find for early infant health status suggest that previous studies' findings of significant impacts of birth weight later on Artman, Oosterbeek, and Van Der Klaauw (2022), “Do Doctors Improve the Health Care of Their Parents? Evidence from Admission Lotteries,” American Economic Journal: Applied Economics, 14(3), 164-184. - This paper tries to assess the importance of unequal access to medical expertise and services, we estimate the causal effects of having a child who is a doctor on parents’ mortality and health care use bu the use of data from parents of almost 22,000 participants in admission lotteries to medical school in the Netherlands. - The key outcome variable of the research is the direction of lowering the doctors’ parents, in the analysis they consider total health care costs, different types of health care use, and various hospital diagnoses and medication use - The results of the research are: We document that parents have lower mortality rates and lower health care costs when their child is a doctor. When restricting the population to parents of college graduates, differences become smaller but remain significant. Our findings show that having a child who is a doctor has no impact on parents’ longevity, while effects on parents’ health care use and costs are mostly not significantly different from zero. The results do not change when splitting the sample by gender of the child or by the distance between the homes of parent and child and some of what is found is driven by selection Our results imply that there are no important spillovers from the medical expertise and connections from doctors to their parents. This suggests that the health care system provides high-quality health care and information to all parents. Behrman, J., Kohler, H., Jensen, V., Pedersen, D., Petersen, I., Bingley, P., Christensen, K. (2011), “Does More Schooling Reduce Hospitalization and Delay Mortality? New Evidence Based on Danish Twins,” Demography, 48, 1347–1375 - This study addresses the schooling-health-gradient issue with twins methodology, using rich data from the Danish Twin Registry linked to population-based registries to minimize random and systematic measurement error biases. They address these 4 following questions: 1. What are the cross-sectional associations between schooling attainment and hospitalization and mortality for Danish adults? 2. What are the estimated causal impacts of schooling on hospitalization and mortality for these individuals when the monozygotic (MZ) or identical twin design is used to control for unobserved family endowments? 3. To what extent do these within MZ twins estimated impacts differ from what cross-sectional associations suggest? 4. To what extent do within MZ and withinDZ (dyzygotic, or fraternal) twin estimates differ, as they will if individual-specific endowments (as contrasted with common family endowments) are important?  - We are interested in simple reduced-form relations between schooling and health-related behaviors and outcomes because we are interested in schoolings total or gross associations with, and effects on, health-related behaviors and outcomes - They imply, in summary, strong negative associations between schooling attainment and hospitalization per year during 1980-2002 and hospitalizations per year up to two years before death and mortality by 2003 for both males and females for both the 1921-1935 and 1936-1950 birth cohorts. However, our estimates also question the standard inference from other, similar estimates that these strong negative associations reflect important direct causal effects of schooling. Instead, schooling seems primarily to serve as a marker for parental family and individual-specific endowments that are uncontrolled in the usual estimates. Black, S., Devereux, P., Salvanes, K. (2007), “From the Cradle to the Labor Market? The Effect of Birth Weight on Adult Outcomes,” Quarterly Journal of Economics, 122(1), 409-39 - Lower birth weight babies have worse outcomes, both shortrun in terms of one-year mortality rates and longer run in terms of educational attainment and earnings. But is this relationship causal? - By applying within twin techniques using an unusually rich dataset from Norway, we examine the effects of birth weight on both short-run and long-run outcomes for the same cohorts. Therefore, we take a twin fixed effect approach to estimation. That is, our sample is composed of twin pairs and we included dummy variables for each birth in the regression. Denoting the first-born twin as “1” and the second-born as “2,” - We find that birth weight does matter; despite short-run twin fixed effects estimates that are much smaller than OLS estimates, the effects on longer-run outcomes such as adult height, IQ, earnings, and education are significant and similar in magnitude to OLS estimates. It is not clear why twin fixed effects estimates are so much smaller than OLS estimates for short-run but not for adult outcomes. It may be that some omitted variables that are correlated with short-run outcomes may be less correlated with long-run Case, A., Fertig, A., Paxson, C. (2005), “The Lasting Impact of Childhood Health and Circumstance” Journal of Health Economics, 24, 365-389 - We quantify the lasting effects of childhood health and economic circumstances on adult health, employment and socioeconomic status, using data from a birth cohort that has been followed from birth into middle age - Controlling for parental income, education and social class, children who experience poor health have significantly lower educational attainment, poorer health, and lower social status as adults. Childhood health and circumstance appear to operate both through their impact on initial adult health and economic status, and through a continuing direct effect of prenatal and childhood health in middle age.  - Overall, our findings suggest more attention be paid to health as a potential mechanism through which intergenerational transmission of economic status takes place: cohort members born into poorer families experienced poorer childhood health, lower investments in human capital and poorer health in early adulthood, all of which are associated with lower earnings in middle age—the years in which they themselves become parents. Our evidence suggests a potentially important role for all three models introduced earlier. Consistent with life-course models of health, childhood health conditions have a lasting impact on health and socioeconomic status in middle adulthood. Consistent with the fetal origins hypothesis, the uterine environment appears to play a significant role as a health determinant in middle age. The impact of the uterine environment is not reduced by controls for childhood health, educational attainment, health in early adulthood, or socioeconomic status Case, A., Lubotsky, D., Paxson, C. (2002), “Economic Status and Health in Childhood: The Origins of the Gradient,” American Economic Review, 92(5), 1308–1334 - Using several large, nationally representative data sets, we find that children’s health is positively related to household income, and that the relationship between household income and children’s health status becomes more pronounced as children grow older - We have shown that the relationship between income and health status observed for adults has antecedents in childhood. A family’s long-run average income is a powerful determinant of children’s health status, one that works in part to protect children’s health upon the arrival of chronic conditions. The health of children from families with lower incomes erodes faster with age, and these children enter adulthood with both lower socioeconomic status and poorer health. Chay, K. and Greenstone, M. (2003), “The Impact of Air Pollution on Infant Mortality: Evidence from Geographic Variation in Pollution Shocks Induced by A Recession,” Quarterly Journal of Economics, 118(3), 1121-67 - They discuss, the 1981–1982 recession induced substantial variation across sites in air pollution reductions.This is used to estimate the impact of total suspended particulates (TSPs) on infant mortality. Further focusing on infant rather than adult - They used a “quasi-experimental” approach uses the sharp variation across sites in TSPs reductions from 1980 –1982. There is evidence that this design may signicantly reduce the omitted variables problem. With the potential of for censoring bias, and we use the substantial variation in air quality changes during the 1981–1982 recession to estimate the effects of particulates pollution on infant mortality - We find that a 1-percent reduction in TSPs results in a 0.35 percent decline in the infant mortality rate at the county level, implying that 2500 fewer infants died from 1980–1982 than would have in the absence of the TSPs reductions. Most of these effects are driven by fewer deaths occurring within one month of birth, suggesting that fetal exposure is a  potential pathophysiologic mechanism. The analysis also reveals nonlinear effects of TSPs pollution and greater sensitivity of black infant mortality at the county level. Chen, Persson, and Polyakova (2022), “The Roots of Health Inequality and the Value of Intrafamily Expertise,” American Economic Journal: Applied Economics, 14(3), 185-223. - In the context of Sweden, we show that having a doctor in the family raises preventive health investments throughout the life cycle, improves physical health, and prolongs life. we estimate the causal impact of having a health professional in the family on health behaviors and health outcomes. - Two quasi-experimental research designs—medical school admission lotteries and variation in the timing of medical degrees—support a causal interpretation of these effects. - One view of our results is that they emphasize the limits of government intervention. Sweden equalizes the supply side of health care, providing cheap and universal access to inpatient and specialized care, prenatal care, primary care, prescription drugs, and vaccines; yet, substantial inequality remains. Our results indicate that this remaining inequality could stem in part from demand-side factors: decisions that individuals make outside of the health care system, such as whether to undertake beneficial lifestyle investments, whether to take prescribed drugs, whether to take up vaccines, and whether to cease tobacco use during pregnancy. A more positive interpretation of our findings is that they suggest that a policy able to mimic what health professionals do for their family members would have the potential to make a substantial dent in population health and to reduce health inequality. Clark, D. and Royer, H. (2013), “The Effect of Education on Adult Mortality and Health: Evidence from Britain,” American Economic Review, 103(6), 2087–2120 - There is a strong, positive, and well-documented correlation between education and health outcomes. In this paper, we attempt to understand to what extent this relationship is causal. - Our approach exploits two changes to British compulsory schooling laws that generated sharp across-cohort differences in educational attainment. Using regression discontinuity methods, exploiting quasi-experimental variations in education - We find the reforms did not affect health although the reforms impacted educational attainment and wages. Our results suggest caution as to the likely health returns to educational interventions focused on increasing educational attainment among those at risk of dropping out of high school, a target of recent health policy efforts. Currie, J. and Stabile, M. (2003), “Socioeconomic Status and Child Health: Why is the Relationship Stronger for Older Children?” American Economic Review, 93(5), 1813-1823 - Discussing the relationship between socioeconomic status and child health - We examine these hypotheses using a panel of data on Canadian children from the National Survey of Children and Youth (NLSCY). We confirm that the results of Case et al. (2002) hold using a sample of Canadian children, despite the existence of universal health insurance coverage for doctor and hospital services in Canada. - We find that the gradient steepens in cross section, and that this result is robust to controls for cohort effects. However, we find little evidence that the long-term effects of health shocks on future health are different for high-SES and low-SES children, even though in the short run, low-SES children suffer greater health losses than high-SES children after the arrival of a health shock. Instead, we provide evidence which suggests that the cross-sectional relationship between health, family income (or maternal education), and age arises primarily because low-income children are more likely to be subject to health shocks. Currie, J. and Walker, R. (2011), “Traffic Congestion and Infant Health: Evidence from E-ZPass,”American Economic Journal: Applied Economics, 3(1), 65-90. - We exploit the introduction of electronic toll collection, (E-ZPass), which greatly reduced both traffic congestion and vehicle emissions near highway toll plazas. We study the effect of E-ZPass, and thus the sharp reductions in local traffic congestion, on the health of infants born to mothers living near toll plazas. - We provide the first estimates of the effect of improvements in traffic congestion on infant health. We show that E-ZPass reduced the incidence of prematurity and low birth weight in the vicinity of toll plazas by 6.7–9.1 percent and 8.5–11.3 percent, respectively. These are large but not implausible effects given the correlations between proximity to traffic and birth outcomes found in previous studies. For example, Slama et al. (2007) measure levels of PM2.5 (particulates less than 2.5 microns in diameter) associated with traffic and find that mothers in the highest quartile of exposure had a risk of birth weight less than 3,000 grams that was 1.7 times higher than mothers in the lowest quartile of exposure. - Our results are robust across a variety of specifications, providing reassuring evidence on the credibility of the research design. Our results suggest that policies intended to curb traffic congestion can have significant health benefits for local populations in addition to the more often cited benefits in terms of reducing travel costs. Figlio, D., Guryan, J., Karbownik, K., Roth, J. (2014), “The Effects of Poor Neonatal Health on Children’s Cognitive Development,” American Economic Review, 104(12), 3921-3955. - We make use of a new data resource—merged birth and school records for all children born in Florida from 1992 to 2002—to study the relationship between birth weight and cognitive development. - Using singletons as well as twin and sibling fixed effects models, we make use of a major new data source which can help fill these gaps in the literature. We match all births in Florida from 1992 to 2002 to subsequent schooling records for those remaining in the state to attend public school. Comparing across a range of demographic and socioeconomic dimensions allows us to address both the stability of results across background and the degree to which parental inputs and early health are complements or substitutes. - we find that the effects of early health on cognitive development are essentially constant through the school career; that these effects are similar across a wide range of family backgrounds; and that they are invariant to measures of school quality. We conclude that the effects of early health on adult outcomes are therefore set very early. Lleras-Muney, A. (2005). "The Relationship between Education and Adult Mortality in the United States," Review of Economic Studies, 72(1), 189—221 - I follow synthetic cohorts using successive U.S. censuses to estimate the impact of educational attainment on mortality rates. The purpose of this paper is to determine whether education has a causal effect on health, in particular on mortality - I use compulsory education laws from 1915 to 1939 as instruments for education. I address this issue using a unique quasi-natural experiment: between 1915 and 1939, at least 30 states changed their compulsory schooling laws and child labour laws. If compulsory schooling laws forced people to get more schooling than they would have chosen otherwise, and if education increases health, then individuals who spent their teens in states that required them to go to school for more years should be relatively healthier and live longer - The results suggest that education has a causal impact on mortality, and that this effect is perhaps larger than has been previously estimated in the literature. Lundborg, P., Rooth, D., and Alex-Petersen, J. (2022), “Long-Term Effects of Childhood Nutrition: Evidence from a School Lunch Reform,” Review of Economic Studies, 89, 876–908 - We study the long-term impact of a policy-driven change in childhood nutrition. For this purpose, we evaluate a program that rolled out nutritious school lunches free of charge to all pupils in Swedish primary schools between 1959 and 1969.  - We estimate the impact of the program on children’s economic, educational, and health outcomes throughout life. We estimate the impact of the program by using newly collected historical data on its gradual implementation across municipalities in Sweden between 1959 and 1969. During this period, 265 municipalities introduced the program, with a roughly equal number of municipalities per year. We have linked the historical data to administrative records that cover the population of primary school pupils. Using a difference-in-differences design, we estimate the impact on a broad range of outcomes taken from income and education registers, the military enlistment register, the medical birth register, and hospitalization and mortality registers. - Our results show that the school lunch program generated substantial long-term benefits, where pupils exposed to the program during their entire primary school period have 3% higher lifetime income. The effect was greater for pupils that were exposed at earlier ages and for pupils from poor households, suggesting that the program reduced socioeconomic inequalities in adulthood. Exposure to the program also had substantial effects on educational attainment and health, which can explain a large part of the effect of the program on lifetime income. Meghir, C., Palme, M. and Simeonova, E. (2018), “Education and Mortality: Evidence from a Social Experiment,” American Economic Journal: Applied Economics, 10(2), 234–256 - We examine the effects on mortality and health due to a major Swedish educational reform that increased the years of compulsory schooling - Using the gradual phase-in of the reform between 1949 and 1962 across municipalities, we estimate insignificant effects of the reform on mortality in the affected cohort. From the confidence intervals, we can rule out effects larger than 1–1.4 months of increased life expectancy We use two estimation strategies. First, a difference-in-differences (DiD) approach that compares changes in mortality outcomes across cohorts in municipalities that implemented the reform compared to those that did not. Since we use 14 years of gradual implementation across the (approximately) 1,000 municipalities, we have many such comparisons, leading to very high levels of precision. The second approach, a regression discontinuity (RD), exploits the cutoff date for assigning a child to a schoo year. In the calendar year when the reform is implemented, the children born before January 1 are assigned to the pre-reform system, while those born after that date are assigned to the school year that first implements the reform. In all cases, the econometric approach is based on a Cox proportional hazard model for lifetime duration. - We find no significant impacts on mortality for individuals of low socioeconomic status backgrounds, on deaths that are more likely to be affected by behavior, on hospitalizations, and consumption of prescribed drugs Oreopoulos, P., Stabile, M., Walld, R., Roos, L. (2008), “Short-, Medium-, and Long-Term Consequences of Poor Infant Health: An Analysis Using Siblings and Twins,” Journal of Human Resources, 43(1), 88-138 - Discussing the short, medium and long term affects of poor infant health - We use adininistrative data on a sample of births between 1978 and I9S5 to investigate the short-, medium-, and long term consequences of poor infant health. First, we use a large sample of both siblings and twins, second we use a variety of measures of infant heutih. and finally, we track children through their schooling years and into the Inhor force. - Our findings offer several advances to the existing literature on the effects of early infant health on subsequent health, education, and labor force attachment. Our findings suggest that poor infant health predicts both mortality within one year, and mortality up to age 17. We also find that infant health is a strong predictor of educational and labor force outcomes. In particular, infant health is found to predict both high school completion and welfare takeup and length. Roseboom, T., van der Meulen, J., Ravelli, A., Osmond, C., Barker, D., Bleker, O. (2001), “Effects of Prenatal Exposure to the Dutch Famine on Adult Disease in Later Life: An Overview,” Molecular and Cellular Endocrinology, 185(2001),93-98 - Discussing the effects of prenatal exposure to the dutch famine on adult disease in later life - We compared the exposed babies with babies born before or conceived after the famine period, whom we grouped as unexposed - We found indications that undernutrition during gestation affects health in later life. The effects on undernutrition, however, depend upon its timing during gestation and the organs and systems developing during that critical time window. Furthermore, our findings suggest that maternal malnutrition during gestation may permanently affect adult health without affecting the size of the baby at birth. This may imply that adaptations that enable the fetus to continue to grow may nevertheless have adverse consequences of improved nutrition of pregnant women will be underestimated if these are solely based on the size of the baby at birth. Van Kippersluis, H., O’Donnell, O., and Van Doorslaer, E., (2011), “Long Run Returns to Education: Does Schooling Lead to an Extended Old Age?” Journal of Human Resources, 46(4), 695–721 - The purpose of this paper is to establish whether education has a causal impact on mortality in old age using exogenous variation in education that comes from a compulsory.schooling law introduced in the Netherlands in 1928. - All analyses are done separately for males and females. Year of birth (cohort) determines whether the individual is exposed to the reform, so sorting around the threshold is absent.  We therefore have a discrete running-vadable Fuzzy Regression Discontinuity setup (Lee and Card 2008) and the appropriate estimator is parametdc Two Stage Least Squares (2SLS), in which years of education is instrumented by the reform. Under the standard assumptions of RDD (Hahn, Todd, and Van der Klaauw 2001; Van der Klaauw 2002), this provides an estimate of the Local Average Treatment Effect (LATE) of an additional year of education on mortality for individuals in the first cohort exposed to the reform that were induced to stay at school. - The reform provides a powerful instrument, significantly raising years of schooling, which, in turn, has a significant and robust negative effect on mortality. For men surviving to age 81, an extra year of schooling is estimated to reduce the probability of dying before the age of 89 by almost three percentage points relative to a baseline of 50 percent.