Advances in health economics and health services research最新文献

英文中文

The Effect of Education on Health Behavior after Screening for Colorectal Cancer 教育对结直肠癌筛查后健康行为的影响

Advances in health economics and health services research

Pub Date : 2017-05-20 DOI: 10.1108/S0731-219920170000025007

E. Aas, T. Iversen, G. Hoff

Abstract Misinterpretation of a negative test results in health screening may initiate less preventive effort and more future lifestyle-related disease. We predict that misinterpretation occurs more frequently among individuals with a low level of education compared with individuals with a high level of education.The empirical analyses are based on unique data from a randomized controlled screening experiment in Norway, NORCCAP (NORwegian Colorectal Cancer Prevention). The dataset consists of approximately 50,000 individuals, of whom 21,000 were invited to participate in a once only screening with sigmoidoscopy. For all individuals, we also have information on outpatient consultations and inpatient stays and education. The result of health behaviour is mainly measured by lifestyle-related diseases, such as COPD, hypertension and diabetes type 2, identified by ICD-10 codes.The results according to intention-to-treat indicate that screening does not increase the occurrence of lifestyle related diseases among individuals with a high level of education, while there is an increase for individuals with low levels of education. These results are supported by the further analyses among individuals with a negative screening test.

对健康筛查中阴性检测结果的误解可能会减少预防工作，并导致更多的未来生活方式相关疾病。我们预测，与受教育程度高的个体相比，受教育程度低的个体更容易发生误解。实证分析基于挪威NORCCAP(挪威结直肠癌预防)随机对照筛选实验的独特数据。该数据集由大约50,000人组成，其中21,000人被邀请参加一次乙状结肠镜检查。对于所有个人，我们也有门诊咨询和住院和教育的信息。健康行为的结果主要通过与生活方式有关的疾病来衡量，如慢性阻塞性肺病、高血压和2型糖尿病，这些疾病由ICD-10代码确定。意向治疗的结果表明，高教育水平人群筛查不增加生活方式相关疾病的发生，而低教育水平人群筛查增加生活方式相关疾病的发生。这些结果得到了对筛查试验呈阴性的个体的进一步分析的支持。

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引用次数: 3

Birth Spacing and Educational Outcomes 出生间隔与教育成果

Advances in health economics and health services research

Pub Date : 2017-05-20 DOI: 10.1108/S0731-219920170000025001

E. Hill, David J. G. Slusky

Virtually all parents want their children to succeed academically. How to achieve this goal, though, is far from clear. Specifically, the temporal spacing between adjacent births has been shown to affect educational outcomes. While many of these studies have produced substantial and statistically significant results, these results have been relatively narrow in their application due to data limitations. Using Colorado birth certificates matched to schooling outcomes, we investigate the relationship between birth spacing and educational attainment. We instrument birth spacing with a previous pregnancy that did not result in a live birth. We find no overall effect of spacing on either the first or second children’s grade 3-10 test scores. Stratifying by the sexes of the children, we find that when the first child is a boy and the second a girl, an extra year of spacing increases the first child’s math, reading, and writing test scores by 0.07-0.08 SD, while there is no impact on the second child. This is the first study to do such an analysis using matched large scale birth and elementary to high school administrative data, and to leverage a very large data set to stratify our results by the sexes of the children. .

几乎所有的父母都希望他们的孩子在学业上取得成功。然而，如何实现这一目标还远不清楚。具体而言，相邻分娩之间的时间间隔已被证明会影响教育结果。虽然这些研究中的许多都产生了实质性的、具有统计学意义的结果，但由于数据限制，这些结果的应用范围相对较窄。使用科罗拉多州与学校教育结果相匹配的出生证明，我们调查了出生间隔与教育程度之间的关系。我们用没有活产的前一次怀孕来计算生育间隔。我们发现，无论是第一个孩子还是第二个孩子，间隔对3-10年级的考试成绩都没有总体影响。根据孩子的性别分层，我们发现，当第一个孩子是男孩，第二个孩子是女孩时，多间隔一年会使第一个孩子的数学、阅读和写作考试成绩提高0.07-0.08标准差，而对第二个没有影响。这是第一项使用匹配的大规模出生和小学到高中管理数据进行此类分析的研究，并利用一个非常大的数据集按儿童性别对我们的结果进行分层。

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引用次数: 3

Causal Effects of Maternal Schooling on Child Immunization in India 印度母亲学校教育对儿童免疫的因果影响

Advances in health economics and health services research

Pub Date : 2017-05-20 DOI: 10.1108/S0731-219920170000025003

P. De

Abstract Child immunization is widely recognized as a cost-effective preventive medicine. Unfortunately, in India about 50% of the eligible children aged 12–23 months miss some essential vaccination. Though a positive association between maternal education and markers of child health like immunization has been long established, the literature has struggled to find a causal relationship, mainly because education is inextricably correlated with other socioeconomic variables like income. In this chapter, I propose a new instrument for women’s education in India using the following facts. First, due to lack of sanitary facilities in schools, particularly rural schools, large number of girls drop out of school once they reach puberty. Second, age at menarche is largely determined by biological factors and not social factors. Together, age at menarche can explain variations in schooling, yet be independent of outcome variables like child immunization. I find that additional years of maternal schooling (conditional on strictly positive years of schooling) do increase the probability of complete immunization of children.

摘要儿童免疫接种被广泛认为是一种具有成本效益的预防药物。不幸的是，在印度，约50%的12-23个月符合条件的儿童错过了一些必要的疫苗接种。尽管母亲教育与免疫等儿童健康标志物之间的正相关关系早已确立，但文献一直难以找到因果关系，主要是因为教育与收入等其他社会经济变量密不可分。在本章中，我利用以下事实为印度的妇女教育提出了一个新的工具。首先，由于学校，特别是农村学校缺乏卫生设施，大量女孩一旦进入青春期就辍学。其次，月经初潮的年龄在很大程度上是由生物因素决定的，而不是社会因素。总之，初潮年龄可以解释学校教育的变化，但与儿童免疫等结果变量无关。我发现，额外的母亲教育年限（以严格的正教育年限为条件）确实会增加儿童完全免疫的可能性。

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引用次数: 3

Unemployment Insurance and Physical Activity 失业保险与体育活动

Advances in health economics and health services research

Pub Date : 2017-05-20 DOI: 10.1108/S0731-219920170000025008

J. Cylus

Unemployment insurance (UI) reduces the opportunity cost of leisure, but it is unknown whether this additional leisure time is physically active. To obtain unbiased estimates of the effect of UI on physically active leisure participation, I exploit changes in UI program legislation across US states and time. Using nationally representative monthly data between 2003 and 2010 from the Behavioral Risk Factor Surveillance System (BRFSS) and the American Time Use Survey (ATUS), I find evidence that both state UI eligibility expansions and increases in maximum allowable state UI benefits coincide with greater probability of physical activity among the recently unemployed. Based on point estimates, state UI eligibility expansions increased the probability of physical activity participation by 8–10 percentage points among the unemployed with less than a high school education, while a 10% increase in the maximum allowable state UI benefit increased the probability of physical activity by 0.3 to 0.6 percentage points among the unemployed who have completed high school or some college.

失业保险（UI）降低了休闲的机会成本，但尚不清楚这额外的休闲时间是否是体力活动。为了对UI对体育休闲参与的影响进行公正的估计，我利用了美国各州和时间对UI计划立法的变化。利用行为风险因素监测系统（BRFSS）和美国时间使用调查（ATUS）在2003年至2010年间提供的具有全国代表性的月度数据，我发现有证据表明，州UI资格的扩大和最高允许州UI福利的增加都与最近失业者更大的体育活动概率相吻合。根据积分估计，州UI资格的扩大使受过高中以下教育的失业者参加体育活动的概率增加了8-10个百分点，而最高允许的州UI福利增加10%，则使完成高中或大学学业的失业者进行体育活动的可能性增加了0.3至0.6个百分点。

引用次数: 1

Educational Heterogeneity in the Association between Smoking Cessation and Health Information 戒烟与健康信息之间的教育异质性

Advances in health economics and health services research

Pub Date : 2017-05-20 DOI: 10.1108/S0731-219920170000025006

D. Lillard

Abstract I investigate the well-known educational gradient in smoking. It is well established that, at least in recent decades, people with higher levels of education are less likely to smoke and, conditional on being a smoker, are more likely to quit than are people with less education. Using longitudinal data on lifetime smoking histories, I explore whether the educational gradient changes when one accounts for differences in the amount of information smokers have about the health risks associated with smoking. At the core of the analysis is a new way to measure not only the flow of information a person receives but also a person’s stock of information in any year. I construct measures of the stock and flow of information with consumer magazine articles that discuss cigarette smoking and health. To calculate exposure, I predict individuals’ reading of particular magazines and link predicted exposure to data on individual smoking status in every year of life. The analysis sample includes many individuals who started smoking in the 1930s and 1940s – well before scientific evidence had accumulated. After replicating the education gradient in terms of smoking cessation, I show that it is mostly explained by the interaction between educational attainment and the stock of knowledge individuals possess. The findings suggest that education affects whether and how a stock of health risk information induces people to quit smoking.

摘要我调查了众所周知的吸烟教育梯度。众所周知，至少在近几十年来，受教育程度较高的人吸烟的可能性较小，而且在成为吸烟者的条件下，比受教育程度较低的人更有可能戒烟。利用终身吸烟史的纵向数据，我探讨了当考虑到吸烟者对吸烟相关健康风险的信息量差异时，教育梯度是否会发生变化。分析的核心是一种新的方法，不仅可以测量一个人在任何一年中收到的信息流，还可以测量一个个人的信息存量。我用讨论吸烟和健康的消费者杂志文章构建了信息存量和流动的衡量标准。为了计算暴露量，我预测了个人对特定杂志的阅读量，并将预测的暴露量与个人一生中每年吸烟状况的数据联系起来。分析样本包括许多在20世纪30年代和40年代开始吸烟的人——早在科学证据积累之前。在复制了戒烟方面的教育梯度后，我发现这主要是由教育程度和个人拥有的知识存量之间的相互作用来解释的。研究结果表明，教育会影响健康风险信息库是否以及如何诱导人们戒烟。

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引用次数: 7

Effects of Maternal Work Incentives on Teen Drug Arrests. 母亲工作激励对青少年毒品逮捕的影响。

Advances in health economics and health services research

Pub Date : 2017-01-01 DOI: 10.1108/s0731-219920170000025004

Hope Corman, Dhaval Dave, Ariel Kalil, Nancy E Reichman

Purpose: This study exploits differences in the implementation of welfare reform across states and over time in the United States in the attempt to identify causal effects of welfare reform on youth arrests for drug-related crimes between 1990 and 2005, the period during which welfare reform unfolded.

Methodology: Using monthly arrest data from the U.S. Federal Bureau of Investigation's Uniform Crime Reports, we estimate the effects of welfare reform implementation on drug-related arrests among 15-17 year olds in the United States between 1990 and 2005. We use a difference-in-differences (DD) approach that exploits the implementation of welfare reform across states and over time to estimate effects for teens exposed to welfare reform.

Findings: The findings, based on numerous different model specifications, suggest that welfare reform had no statistically significant effect on teen drug arrests. Most estimates were positive and suggestive of a small (3%) increase in arrests.

Originality/value: This study investigated the effects of a broad-based policy change that altered maternal employment, family income, and other family characteristics on youth drug arrests.

目的:本研究利用美国各州和不同时期福利改革实施的差异，试图确定福利改革对1990年至2005年期间青少年因毒品犯罪被捕的因果影响，这是福利改革展开的时期。方法:使用美国联邦调查局统一犯罪报告的月度逮捕数据，我们估计了1990年至2005年期间福利改革实施对美国15-17岁青少年毒品相关逮捕的影响。我们使用差异中的差异(DD)方法，利用各州和各时期福利改革的实施来估计福利改革对青少年的影响。研究结果:基于众多不同模型规格的研究结果表明，福利改革对青少年毒品逮捕没有统计学上的显著影响。大多数估计都是积极的，表明逮捕人数小幅增加(3%)。原创性/价值:本研究调查了一项广泛的政策变化对青少年毒品逮捕的影响，该政策改变了母亲的就业、家庭收入和其他家庭特征。

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引用次数: 5

Adolescent girls' preferences for HPV vaccines: a discrete choice experiment. 青春期女孩对HPV疫苗的偏好:一个离散选择实验。

Advances in health economics and health services research

Pub Date : 2014-08-27 DOI: 10.1108/S0731-219920140000024002

Derek S. Brown, C. Poulos, F. Johnson, Linda Chamiec-Case, Mark L. Messonnier

PURPOSETo measure adolescent girls' preferences over features of human papillomavirus (HPV) vaccines in order to provide quantitative estimates of the perceived benefits of vaccination and potential vaccine uptake.DESIGN/METHODOLOGY/APPROACHA discrete choice experiment (DCE) survey was developed to measure adolescent girls' preferences over features of HPV vaccines. The survey was fielded to a U.S. sample of 307 girls aged 13-17 years who had not yet received an HPV vaccine in June 2008.FINDINGSIn a latent class logit model, two distinct groups were identified--one with strong preferences against vaccination which largely did not differentiate between vaccine features, and another that was receptive to vaccination and had well-defined preferences over vaccine features. Based on the mean estimates over the entire sample, we estimate that girls' valuation of bivalent and quadrivalent HPV vaccines ranged between $400 and $460 in 2008, measured as willingness-to-pay (WTP). The additional value of genital warts protection was $145, although cervical cancer efficacy was the most preferred feature. We estimate maximum uptake of 54-65%, close to the 53% reported for one dose in 2011 surveillance data, but higher than the 35% for three doses in surveillance data.RESEARCH LIMITATIONS/IMPLICATIONSWe conclude that adolescent girls do form clear opinions and some place significant value on HPV vaccination, making research on their preferences vital to understanding the determinants of HPV vaccine demand.ORIGINALITY/VALUEDCE studies may be used to design more effective vaccine-promotion programs and for reassessing public health recommendations and guidelines as new vaccines are made available.

目的测量青春期女孩对人乳头瘤病毒(HPV)疫苗特征的偏好，以便对疫苗接种的感知益处和潜在的疫苗摄取提供定量估计。设计/方法/方法采用离散选择实验(DCE)调查来衡量青春期女孩对HPV疫苗特征的偏好。这项调查在2008年6月对美国307名13-17岁的女孩进行了抽样调查，这些女孩尚未接种HPV疫苗。在潜在类别logit模型中，确定了两个不同的群体——一个对疫苗接种有强烈偏好，在很大程度上没有区分疫苗特征;另一个接受疫苗接种，对疫苗特征有明确的偏好。根据整个样本的平均估计值，我们估计2008年女孩对二价和四价HPV疫苗的估值在400美元至460美元之间，以支付意愿(WTP)衡量。保护生殖器疣的额外价值为145美元，尽管宫颈癌疗效是最受欢迎的特征。我们估计最大吸收量为54-65%，接近2011年监测数据中报告的一次剂量的53%，但高于监测数据中三次剂量的35%。研究局限性/意义我们的结论是，青春期女孩确实形成了明确的观点，有些人对HPV疫苗接种非常重视，因此研究她们的偏好对于了解HPV疫苗需求的决定因素至关重要。original /VALUEDCE研究可用于设计更有效的疫苗推广方案，并在新疫苗问世时重新评估公共卫生建议和指南。

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引用次数: 29

Gender differences in risk attitudes. 风险态度的性别差异。

Advances in health economics and health services research

Pub Date : 2014-08-27 DOI: 10.1108/S0731-219920140000024003

L. Warshawsky-Livne, L. Novack, A. Rosen, S. Downs, J. Shkolnik-Inbar, J. Pliskin

PURPOSEA rich literature has documented gender-based differences in health care utilization and outcomes. The role of risk attitude in explaining the variations is limited at best. This study examines gender differences in health utilities and risk attitudes.METHODOLOGYData on 13 health states were collected from 629 students via questionnaires at the Ben-Gurion University of the Negev in 2005. From each respondent, we assessed utilities for a subset of health states, using Time Trade-Off and Standard Gamble. A risk attitude coefficient was calculated for each respondent as a function of their utilities for all outcomes assessed. The risk coefficient derived from a closed-form utility model for men was compared to that of women using the t-statistic.FINDINGSThere was a statistically significant difference in the risk attitudes of men and women. Men had a concave utility function, representing risk aversion, while women had a near linear utility function, suggesting that women are risk neutral. PRACTICAL/SOCIAL IMPLICATIONS: Differences in risk attitude may be an important contributor to gender-based disparities in health services utilization. More research is needed to assess its full impact on decision-making in health care.

目的:大量文献记录了医疗保健利用和结果的性别差异。风险态度在解释这些变化方面的作用充其量是有限的。本研究考察了卫生设施和风险态度方面的性别差异。方法2005年在内盖夫本-古里安大学通过问卷调查从629名学生中收集了13个健康州的数据。从每个受访者中，我们使用时间权衡和标准赌博来评估健康状态子集的效用。对每个被调查者的风险态度系数作为其效用对所有评估结果的函数进行了计算。使用t统计量对男性和女性的风险系数进行比较，风险系数来源于封闭式实用新型。研究结果男性和女性的风险态度有统计学上的显著差异。男性的效用函数为凹形，代表风险厌恶，而女性的效用函数为近线性，表明女性是风险中性的。实际/社会影响:风险态度的差异可能是造成保健服务利用方面基于性别差异的一个重要因素。需要更多的研究来评估其对卫生保健决策的全面影响。

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引用次数: 24

Pesticides and health: a review of evidence on health effects, valuation of risks, and benefit-cost analysis. 农药与健康:关于健康影响的证据审查、风险评估和效益成本分析。

Advances in health economics and health services research

Pub Date : 2014-08-27 DOI: 10.1108/S0731-219920140000024006

D. Tago, Henrik Andersson, Nicolas Treich

DESIGN/METHODOLOGY/APPROACHThis study presents literature reviews for the period 2000-2013 on (i) the health effects of pesticides and on (ii) preference valuation of health risks related to pesticides, as well as a discussion of the role of benefit-cost analysis applied to pesticide regulatory measures.FINDINGSThis study indicates that the health literature has focused on individuals with direct exposure to pesticides, i.e. farmers, while the literature on preference valuation has focused on those with indirect exposure, i.e. consumers. The discussion highlights the need to clarify the rationale for regulating pesticides, the role of risk perceptions in benefit-cost analysis, and the importance of inter-disciplinary research in this area.ORIGINALITY/VALUEThis study relates findings of different disciplines (health, economics, public policy) regarding pesticides, and identifies gaps for future research.

设计/方法/方法本研究综述了2000-2013年期间关于(i)农药对健康的影响和(ii)与农药有关的健康风险偏好评估的文献，并讨论了应用于农药监管措施的效益-成本分析的作用。研究结果表明，健康文献主要关注农药直接接触者，即农民，而偏好评估文献主要关注农药间接接触者，即消费者。讨论强调有必要澄清管制农药的基本原理，风险观念在效益-成本分析中的作用，以及在这一领域进行跨学科研究的重要性。原创性/价值本研究将不同学科(卫生、经济学、公共政策)关于农药的发现联系起来，并确定了未来研究的空白。

引用次数: 111

How should the health benefits of food safety programs be measured? 如何衡量食品安全项目对健康的益处?

Advances in health economics and health services research

Pub Date : 2014-01-01

V Kerry Smith, Carol Mansfield, Aaron Strong

Purpose: This chapter reports estimates of consumers' preferences for plans to improve food safety.

Design/methodology/approach: The plans are distinguished based on whether they address the ex ante risk of food borne illness or the ex post effects of the illness. They are also distinguished based on whether they focus on a public good--reducing risk of illness for all consumers or allowing individual households to reduce their private risks of contracting a food borne pathogen.

Findings: Based on a National Survey conducted in 2007 using the Knowledge Network internet panel, our findings indicate consumers favor ex ante risk reductions and are willing to pay approximately $250 annually to reduce the risk of food borne illness. Moreover, they prefer private to public approaches and would not support efforts to reduce the severity of cases of illness over risk reductions.

Originality/value: This study is the first research that allows a comparison of survey respondents' choices between public and private mechanisms for ex ante risk reductions.

目的:本章报告了消费者对改善食品安全计划的偏好估计。设计/方法/方法:计划的区别在于它们是针对食源性疾病的事前风险还是针对疾病的事后影响。它们的区别还在于它们是否注重公共利益——减少所有消费者的疾病风险，还是允许个别家庭减少感染食源性病原体的私人风险。研究结果:根据2007年使用知识网络互联网小组进行的一项全国调查，我们的研究结果表明，消费者倾向于事先降低风险，并愿意每年支付约250美元来降低食源性疾病的风险。此外，他们更喜欢私人方法而不是公共方法，并且不会支持减少疾病严重程度而不是减少风险的努力。原创性/价值:这项研究是第一个允许比较调查对象在公共和私人机制之间选择事前风险降低的研究。

引用次数: 0

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