Health economics最新文献

Long-term services in the home are predominately provided by family or friends, with a growing proportion of individuals receiving formal care, or paid care by a professional, or a combination of both. However, the relative benefits to the care recipient of who provides the care are largely unknown. A person's use of formal and family care is affected by factors that also may affect their outcomes, complicating the estimation of any causal relationship. Using the 2002–2018 Health and Retirement Study (HRS), we examine three types of home-based care combinations: family only, formal only, and both formal and family care. We use an instrumental variables strategy, using family structure as instruments for both formal care and the combination of formal and family care, to estimate the plausibly causal impact of the care provider on self-reported mental and physical health outcomes. We find that, once the endogeneity of the care provider is accounted for, having both formal and family care leads to better self-rated health, mobility and lower depression compared to people receiving family care only. Receiving formal care only does not affect care recipient outcomes compared to receiving family care only. These results are robust to several sensitivity analyses, including different instrument specifications, subsamples of care recipients that do not have a spouse/partner, among women care recipients, and changing the timing of the measurement of the outcomes. These findings are important to consider as we strive to best meet the growing demand for person-centered, high-quality long-term care in the least restrictive setting possible.

We study the impact of gun-purchase waiting periods on suicide rates using county-level mortality data from 1991–2019. We find that waiting periods are associated with a reduction in both firearm and overall suicide rates of approximately 5% and 2%, respectively. Novelly, we find that counties that are within 50 miles from a state without a waiting period experience no statistically significant reduction in suicides. Our findings reveal that the decrease in suicides under a waiting period is driven by counties that are more than 50 miles from a non-restricted neighboring state.

Many health indicators are bounded, that is, their values lie between a lower and an upper bound. Inequality measurement with bounded variables faces two normative challenges well-known in the health inequality literature. One is that inequality rankings may or may not be consistent across admissible attainment and shortfall representations of the variable. The other is that the set of maximum-inequality distributions for bounded variables is different from the respective set for variables with no upper bound. Therefore, the ethical criteria for ranking maximum-inequality distributions with unbounded variables may not be appropriate for bounded variables. In a novel proposal, we justify an axiom requiring maximum-inequality distributions of bounded variables to be ranked equally, irrespective of their means. Then, our axiomatic characterization naturally leads to indices that measure inequality as an increasing function of the observed proportion of maximum attainable inequality for a given mean. Additionally, our inequality indices rank distributions consistently when switching between attainment and shortfall representations. In our empirical illustration with three health indicators, a starkly different picture of cross-country inter-temporal inequality emerges when traditional inequality indices give way to our proposed normalized inequality indices.

Measuring health disparities is key to monitoring health systems, but hitherto disparities in the individual risk people face about their future health has been neglected. This paper integrates individual health risk into income-related health inequality measurement. We develop a rank dependent health inequality index that considers inequalities in each individual's expected future health and the dispersion of their future health prospects. It is useful when a social planner wants to account for risk averse preferences in the assessment of income-related inequalities of future health prospects. The empirical application using Australian longitudinal data highlights that neglecting individual risk underestimates income-related inequalities in future health prospects since the poor not only face worse expected future health, but also faced greater dispersion in their future health prospects compared to the rich.

This paper extends current knowledge about inequality of opportunity in body mass in Australia. Drawing on 2013 and 2017 Household, Income, and Labour Dynamics in Australia survey data, our empirical strategy comprises of mean-based and unconditional quantile regression techniques. We find that inequality of opportunity accounts for a non-trivial share of body mass inequality. Our results based on waist-to-height ratio reveal estimates of 10%–14%, which are much larger than previously published estimates based on body mass index (BMI). Our estimates are lower-bound values based on 13 observable circumstance variables. Relaxing the homogeneity assumption, for instance, increases estimates by 1.7–3 percentage points. Applying the Shapley–Shorrocks decomposition procedure, age and parents' socio-economic status are identified as leading circumstance factors. This finding is refined when quantiles of the body mass distribution are evaluated. Age's role is diminished at the clinically risky upper quantiles. By contrast, parents' socio-economic status is the single most important circumstance factor at the upper quantiles. Investigating by gender groups, inequality of opportunity is greater among women than men, with parents' socio-economic status playing a critical role in this disparity. Taking a life course perspective, circumstances' influence shows weakening over time, while effort is more impactful at later life stages. Overall, our findings underscore that anti-obesity campaigns should tackle early life social inequality, in addition to empowering personal responsibility later in life.

Having a child with a disability undoubtedly affects parents in many ways, including their well-being. However, the specific mental health trajectories of parents, differentiated by the severity of impairments and parental roles, remain under-explored. We investigate the mental-health effects of having a child with a disability. Using individual-level register data from Sweden, we exploit the epidemiological features of Cerebral Palsy (CP) to estimate causal effects. Results show that prescriptions for mental-health disorders increase after the birth of a child with CP. While fathers are more likely to be dispensed anti-anxiety medications, dispensed medications for anti-depressants increase for mothers. Further, the effects are larger for parents of children with severe impairments but do not differ across parental characteristics. Our findings highlight the need for support and assistance for families with children with disabilities.