The evolution of the disability-adjusted life year (DALY)

The disability-adjusted life year (DALY) is a summary health measure that combines mortality and morbidity into a single measure as a way to estimate global disease burden and the effectiveness of health interventions. We review the methodological progression of the DALY, focusing on how the use of life expectancy estimates, disability weights, age weighting, and discounting has evolved since the first DALY reports were published in 1993. These changes have generally improved the metric but have made it difficult for researchers to interpret, compare, and conduct DALY studies.     

Converting retirement benefit into a life care annuity with graded benefits*

This paper deals with life care annuities, i.e. bundled products comprising a life annuity and long-term care insurance. It aims to assess the cost of converting retirement benefit into a life care annuity with graded benefits using a pre-existing public pay-as-you-go pension scheme. With this objective in mind, we present an actuarial method based on array calculus for valuing this type of life care annuity. The health dynamics of the annuitant rely on a reversible illness-death multistate framework. The paper contains a numerical example in which mortality and disability assumptions are based on data from the USA and Australia, although this should be viewed simply as an illustration. In addition, in order to check the coherence of these data, we compute life expectancy for both healthy and dependent persons, and then for dependent persons in each of the states of dependence. The effect of ruling out the recovery assumption on the annuity’s cost is also assessed. The analysis provides valuable insights into how much it would cost to introduce these annuities and enables us to make some policy recommendations to help ensure that this combined pension scheme has a good actuarial design.     

Health insurance reform: The impact of a Medicare buy-in

The steady-state general equilibrium and welfare consequences of a Medicare buy-in program, optional for those aged 55–64, is evaluated in a calibrated life-cycle economy with incomplete markets. Incomplete markets and adverse selection create a potential welfare improving role for health insurance reform. We find that adverse selection eliminates any market for a Medicare buy-in if it is offered as an unsubsidized option to individual private health insurance. The subsidy needed to bring the number of uninsured to less than 5 percent of the target population could be financed by an increase in the labor income tax rate of just 0.03–0.18 percent depending on how the program is implemented.     

Purchasing natural personal care products in the era of fake news? The moderation effect of brand trust

Natural personal care products are gaining popularity due to their benefits in terms of health and well-being. However, consumers are wary of these products and are guided by the fake news circulating about them. Since natural product consumption offers several personal and environmental benefits, it would be worthwhile to understand consumers’ tendency to let fake news influence their consumption decisions. Accordingly, the current study examined the association of fake news and purchasing behaviour towards natural personal care products, utilising Stimulus-Organism-Behaviour-Consequence (SOBC) as the theoretical framework. The study proposed openness to change as the stimulus, perceived benefits and perceived risks as organismic internal states, purchase intentions as the behaviour, and the propensity of believing and acting on fake news as the consequence, which is further associated with system trust. The model was tested by analysing data collected from 390 existing consumers, considering the moderation effect of brand trust and controlling the effect of age and gender. The findings confirmed that openness to change is associated with perceived benefits and risks. Furthermore, perceived benefits and system trust are associated with purchase intentions, which are, in turn, associated with the propensity of believing and acting on fake news. The study presents several novel contributions to theory and practice.     

Effects of Firm Size,Financial Leverage and R&D Expenditures on Firm Earnings: An Analysis Using Quantile Regression Approach

As documented in the literature, the effects of firm size, financial leverage, and R&D expenditures on firm earnings are inclusive. Our hypothesis is that the inconsistent empirical results of such effects may be driven by the regression models implemented in data analysis. Using the quantile regression (QR) approach developed by Koenker and Basset (1978), this study analyses S&P 500 firms from 1996 to 2005. We find that the effects of firm size, financial leverage and R&D expenditures on firm earnings differ considerably across earnings quantiles. Comparing the results from the QR approach with those from the ordinary least squares (OLS) and least absolute deviation (LAD) methods, this study further explains the puzzling relationship between firm size, financial leverage, R&D expenditures and firm earnings.     

A prospective analysis of labour market status and self-rated health in the UK and Russia

Comparing prospective data from the UK and Russia, this paper analyzes whether the association of labour market status, and particularly unemployment, with subsequent health varies by the level of state protection provided to the unemployed. While the UK's unemployment welfare regime is classified as providing minimal protection, the Russian regime is sub-protective. Employing Cox duration analysis upon data from the Russian Longitudinal Monitoring Survey and the British Household Panel Survey for the period 2000–2007, this study finds that labour market status and economic circumstances independently predicted individual-level declines in self-rated health and, contrary to expectations, the associations of unemployment with health decline were similarly sized in the two countries.     

Welfare costs of reclassification risk in the health insurance market

We assess the quantitative importance of reclassification risk in the US health insurance market. Reclassification risk arises because the health conditions of individuals evolve over time, while a typical health insurance contract only lasts for one year. Thus, a change in the health status can lead to a significant change in the health insurance premium. We measure welfare gains from introducing explicit insurance against this risk in the form of guaranteed renewable health insurance contracts. We find that in the current institutional environment individuals are well-sheltered against reclassification risk and they only moderately gain from having access to these contracts. More specifically, we show that employer-sponsored health insurance and public means-tested transfers play an important role in providing implicit insurance against reclassification risk. If these institutions are removed, the average welfare gains from having access to guaranteed renewable contracts exceed 4% of the annual consumption.     

The U.S. health care expenditure: evidence from 2001 to 2009

This study utilizes state-level data from 2001 to 2009 to estimate the impact of the 2007 financial crisis upon health care expenditures. Higher death rates are consistently found to have a positive and statistically significant impact on health expenditures. While mental health and COPD are not generally found to impact expenditures, increases in the percentage of the population diagnosed with cholesterol and obesity tend to increase health expenditures. Increases in health expenditures slowed considerably after the financial crisis. Even though recessions (high unemployment rates) are generally found to have a positive impact on health expenditures, the post-financial crisis time period is estimated to have much lower health expenditures than in other time periods. Our results can be used to give insight into the conditions under which the slower rate of increase in health expenditures can be expected to increase. More research will be needed to be able to more completely explore not only the reasons for these changes in health expenditures but also whether they are likely to continue into the future.     

Health and cosmetics: Investigating consumers’ values for buying organic personal care products

In investigating consumers’ intentions to re-purchase organic personal care products (PCP), this study extends the theory of planned behaviour by including perceived value dimensions as the antecedents of attitude in the model. The findings revealed that most of the hypothesised relationships linking the consumer perceived value constructs (namely, health, safety, hedonic and environmental) with attitude towards the rebuying of organic PCP, were supported. Also, better product knowledge about organic PCP would lead to more positive attitudes towards re-purchasing the product. In contrast, social value was not important in predicting attitude. Similarly, the influence of subjective norm on rebuying intention was not supported. In terms of ranking of importance with regards to prediction of re-purchasing intention, attitude was the most important predictor followed by perceived behavioural control, product knowledge, hedonic value, environmental value and safety value.