Do Hispanic immigrants spend less on medical care? Implications of the Hispanic health paradox

ABSTRACT

The literature of the Hispanic heath paradox has found that in the U.S. Hispanic immigrants have better health than U.S. natives, even though they tend to have lower socioeconomic status. The main objective of the current study is to investigate whether Hispanic immigrants also use less medical care goods and services. Main contributions of the article include using a data set of older Americans from the Health and Retirement Study covering the period from 1992 to 2012 as well as using three new measures of health, rather than the more common use of morbidity or mortality. We estimate the impact of relevant factors including health, race, and immigrant status upon five different measures of healthcare usage. Even though Hispanic immigrants do have lower mean levels of most measures of healthcare usage, when controlling for other factors in our regressions we find some evidence of increased healthcare usage for Hispanic immigrants. Increased health care utilization may be one explanation for the Hispanic health paradox.     

Spatial and economic patterns in life expectancy among US States

This study investigates the determinants of gender-specific life expectancy across US states over the period 1995–2007. We employ a production function specification where life expectancy depends on health expenditure, income, education and lifestyle variables, allowing for spatial effects. Empirical results suggest that education attainment and health expenditure are the main factors behind improving longevity, whereas smoking bears a strong negative influence. For robustness purposes, we also use health spending as well as education criteria, apart from geographical ones to model interstate spillovers. In the former case, states with similar health expenditure are ‘neighbors’ and affect positively the life expectancy process. If education is applied instead of health spending together with geographic proximity, the spatial correlation is insignificant, i.e. education ‘neighbors’ do not affect life expectancy. Our findings do not imply significant gender differences regarding health production. The results suggest that health care policy will have to focus on wider economic and social considerations, like education and lifestyle changes, except medical care provision in order to exploit the full potential for life expectancy improvements of the US population.     

New evidence on factors affecting the level and growth of US health care spending

The dual problems of high and rising medical care expenditures and substantial differences in spending across geographic regions have long plagued the US health care system. We provide new evidence to explain why some states and regions of the country spend much more on medical care than others, and why health care spending for the nation as a whole has been growing rapidly over the last several decades. To do this, we estimate a health care spending panel data model using annual data on all 50 states for the period 1993–2009. Our model includes a number of socio-economic, health care provider, lifestyle and environmental variables that past studies indicate may affect the level or growth of aggregate health care spending. We exploit the time effect component of our model to obtain an upper-bound estimate of the effect of advances in medical technology. Our findings indicate that the most important factors influencing the level of spending are availability of providers, income, excessive alcohol consumption, Medicaid coverage, HMO health plans and the proportion of the population elderly and African-American. The principal drivers of growth have been the continual introduction of new medical technologies, and the growth of providers and income.     

Medical technology and the production of health care

This article investigates the factors that determine differences across OECD countries in health outcomes, using data on life expectancy at age 65, over the period 1960 to 2007. We estimate a production function where life expectancy depends on health and social spending, lifestyle variables, and medical innovation. Our first set of regressions include a set of observed medical technologies by country. Our second set of regressions proxy technology using a spatial process. This article also tests whether in the long-run countries tend to achieve similar levels of health outcomes. Our results show that health spending has a significant and mild effect on health outcomes, even after controlling for medical innovation. However, its short-run adjustments do not seem to have an impact on health care productivity. Spatial spill overs in life expectancy are significant and point to the existence of interdependence across countries in technology adoption. Furthermore, nations with initial low levels of life expectancy tend to catch up with those with longer-lived populations.     

收入、收入不均与健康:城乡差异和职业地位的影响

本文使用来自中国9个省的微观面板数据,检验了居民自评健康与家庭人均收入和社区内收入不均之间的相关关系。考虑到中国城乡分割的二元经济社会特征,本文将农村样本和城镇样本分开处理;考虑到中国的社会分层结构,计量方程中引入了代表职业地位的变量及其与收入和收入不均的交互项。在实证结果的基础上,本文讨论了收入、收入不均与健康关系的作用机制。主要结论是:收入与健康的关系、收入不均与健康的关系都存在城乡差异和职业差异,这说明在收入、收入不均与健康的关系中,社会经济地位的影响十分重要。要解决健康不平等问题,关键在于加强对社会经济地位较低者,主要是农村居民和生活在城镇的农民的医疗保障,同时要设法改善农村的基础设施和社会资本,并逐步取消各种造成城乡分割的制度。     

入住养老机构的老年人对医疗服务的评价及影响因素分析

从"局内人"的视角,探讨入住养老机构的老年人对其提供的医疗服务的评价及其影响因素。选择山东省入住养老机构的老年人为总体,采取分层,对公立和私营的养老机构进行两阶段PPS抽样,获得入住养老机构老年人调查数据,通过对他们就医地点选择、就医满意度与人口社会经济变量的统计分析,并结合非参与式观察及半结构式访谈,对问题进行讨论。老年人的教育程度、从事过的职业和婚姻状况对其就医地点选择存在显著差异;而入住养老机构时间、家庭经济条件影响到其在机构内的就医满意度。在医疗条件既定的情况下,影响就医地点选择性和就医满意评价的决定因素是老人的社会经济地位。     

Housing and Health

Deprived housing is recognized as a source of poor health, but there is still little evidence of a causal relationship between housing and health. While existing literature identifies neighborhood effects and the individual dwelling as factors which affect health, it does not offer a joint examination of these factors. Moreover, endogeneity is a concern in analyses of both problems. Thus far, studies addressing endogeneity have done so through experimental design or instrumental variables. The first approach suffers from problems of external validity and the latter from the lack of reliable instruments. We therefore adopt an alternative strategy which considers both sources of endogeneity in order to identify the effects of housing on health by estimating fixed‐effect models. We reveal how housing problems affect health depending on living conditions and socioeconomic status. Our results therefore indicate that living in poor housing is an important short‐term socioeconomic determinant that directly affects health.     

Quality of schooling and inequality of opportunity in health

This paper explores the role of quality of schooling as a source of inequality of opportunity in health. Substantiating earlier literature that links differences in education to health disparities, the paper uses variation in quality of schooling to test for inequality of opportunity in health. Analysis of the 1958 NCDS cohort exploits the variation in type and quality of schools generated by the comprehensive schooling reforms in England and Wales. The analysis provides evidence of a statistically significant and economically sizable association between some dimensions of quality of education and a range of health and health-related outcomes. For some outcomes the association persists, over and above the effects of measured ability, social development, academic qualifications and adult socioeconomic status and lifestyle.     

POOR AND SICK: ESTIMATING THE RELATIONSHIP BETWEEN HOUSEHOLD INCOME AND HEALTH

This study evaluates the effect of the individual's household income on their health at the later stages of working life. A structural equation model is utilized in order to derive a composite and continuous index of the latent health status from qualitative health status indicators. The endogenous relationship between health status and household income status is taken into account by using IV estimators. The findings reveal a significant effect of individual household income on health before and after endogeneity is taken into account as well as a host of other factors known to influence health, including hereditary factors and the individual's locus of control. Importantly, it is also shown that the childhood socioeconomic position of the individual has long lasting effects on health as it appears to play a significant role in determining health during the later stages of working life.     

Health,Social Insurance and Income

Health, a form of human capital, can be defined by longevity and physical wellbeing. Social policy decisions require an understanding of the factors that contribute to the creation of health inequalities. To learn more about socioeconomic variables and health capital, this paper examines the relationship between three key variables: health, social insurance, and income, for the Swedish population. Using a randomized research survey design, data from 3,600 participants of a larger Swedish study, conducted in 2005, was analyzed. A linear model of Three Stage Least Squares was chosen to correct for simultaneous bias in the Health, Social Insurance, and Income (HSI) Model. Findings confirm the importance of socioeconomic, behavioral and environmental factors in explaining health inequalities. The results clearly show men, educated people, nonsmokers, individuals that exercise and youngsters possess higher health status than other people. The dependency on social insurance is mainly caused by poor health; a higher degree of social insurance dependency was offset by income increases due to age and higher professional level.      

A Macroeconomic Analysis of Publicly Funded Health Care

In a general equilibrium, overlapping generations framework this paper examines how the tax-benefit system that underlies the U.S. health care system affects the well-being of different age groups, and the lifetime well-being of different socioeconomic groups, as well as society as a whole. We find that the optimal set and generosity of publicly funded health care programs is sensitive to the social welfare function and to the prices that various agents in society pay for medical care. Social welfare under the current financing system is also compared to alternative financing mechanisms such as Medical Savings Accounts.     

Cities,slums, and child nutrition in Bangladesh

This study uses novel household survey data that are representative of Bangladesh's large cities, and of slum and nonslum areas within the cities, to investigate the effects of demographic and socioeconomic factors on child nutrition status in 2013. The study also decomposes the difference in mean child nutrition status between slum and nonslum areas in 2013, and the increase in mean child nutrition status in slum and nonslum areas from 2006 to 2013. Mother's education attainment and household wealth largely explain the cross‐sectional difference and intertemporal change in mean child nutrition status. Although positive in some cases, the effects of maternal and child health services, and potential health‐protective household amenities, on child nutrition status differ by the type of health facility, household amenity, and urban area (slum or nonslum). Focusing on nutrition‐sensitive programs for slum residents and the urban poor is consistent with the results.     

妇幼保健院规模与妇幼保健水平的关系:基于全国省级面板数据的研究

妇幼保健院在中国医疗卫生领域具有相当特殊的地位。在妇幼保健院对中国妇幼健康水平有积极作用的假设下,采用31个省级地区的面板数据构建实证模型,研究妇幼保健院规模对妇幼保健水平和医疗费用的影响。妇幼保健院床位数与孕产妇死亡率有显著的正相关,对活产数有显著的消极影响,出现这一现象的原因可能是妇幼保健院相对落后的医疗技术条件。同时,妇幼保健院床位数的增长对卫生机构支出存在正向影响,但对于居民家庭人均医疗支出则存在城乡差异。建议应重视妇幼保健院的发展,全面提升妇幼保健院的技术和服务水平,缓解大综型医疗机构接诊压力。     

社会医疗保障改革的福利效应:以中国城镇为例

This paper evaluates Chinese public health insurance reform enforced since 1998 in terms of its welfare effects. We evaluate China health insurance reform since 1998 using the China Health and Nutrition Surveys (CHNS) data with relevant econometric models. The results of empirical studies show that the public health insurance status has significant impact on medical service utilization and expenditure. The reform reduces the positive effect of public health insurance on medical service utilization, meaning the utilization gap is narrowed after the reform. However, the empirical studies find that the medical expenditure growth of the sample individuals in urban China has not been controlled after the Basic Medical Insurance (BMI) program even if a new co-payment is enforced. Two main reasons for this failure might be the rising cost of medical service and physician’s severe moral hazard, while both of them come from no managed care mechanism for medical service providers in China.      

The Long Reach of Childhood Health and Circumstance: Evidence from the Whitehall II Study

We use data from the Whitehall II Study to examine the joint evolution of health status and economic status over the life course. We study the links between health and socioeconomic status in childhood and health and employment status at older ages. We find early life socioeconomic status is significantly associated with health over the life course, even though selection into Whitehall mutes the effects of childhood. In addition, we find that current position in the civil service is not associated with future self-assessed health, but current self-assessed health is significantly associated with promotion in the civil service.     

Estimating a health production function for Sub-Saharan Africa (SSA)

The paper estimates a health production function for Sub-Saharan Africa based on the Grossman (1972 Grossman M 1972 The Demand for Health: A Theoretical and Empirical Investigation, NBER New York ) theoretical model that treats social, economic, and environmental factors as inputs of the production system. In estimating this function, socioeconomic and environmental factors such as income per capita, illiteracy rate, food availability, ratio of health expenditure to GDP, urbanization rate, and carbon dioxide emission per worker are specified as determinants of health status. The parameters of the function are estimated by one-way and two-way fixed and random effects model of panel data analyses. The results of the two-way random effect model suggest that an increase in income per capita, a decrease in illiteracy rate, and an increase in food availability are strongly associated with an improvement in life expectancy at birth. Overall, the results imply that a health policy which may focus on the provision of health services, family planning programs, and emergency aids to the exclusion of other socioeconomic and environmental aspects may do little to improve the current health status of the region.     

INSURANCE‐INDUCED MORAL HAZARD: A DYNAMIC MODEL OF WITHIN‐YEAR MEDICAL CARE DECISION MAKING UNDER UNCERTAINTY

This study quantifies the moral hazard effect of health insurance on medical expenditure by estimating a dynamic model of within‐year medical care consumption that allows for insurance selection, endogenous health transitions, and individual uncertainty about medical care prices in an environment where insurance has nonlinear cost‐sharing features. The results suggest that moral hazard accounts for 53.1%, on average, of total annual medical expenditure when insured. This estimate is significantly different, and generally larger, than that produced by an alternative model that is representative of the annual medical care decision‐making models commonly found in the literature.     

The dynamics of food insecurity and overall health: evidence from the Canadian National Population Health Survey

The paper explores whether the responses to household food insecurity questions in cycles two and three of the Canadian National Population Health Survey help explain the links between socioeconomic status and health at the individual level. Short-term transitions in food insecurity status are correlated with changes in health status. There is some evidence for females but not for males that conditional on current health, current household food insecurity can lead to lower future health status, even in the short run. There is stronger evidence for both males and females that conditional on current household food insecurity status, lower current health status can lead to an increased probability of future household food insecurity.     

GROWTH OF U.S. HEALTH CARE SPENDING

The share of output allocated to health care has more than doubled since 1960. This paper models the growth in this ratio and finds that the increase in the elderly population whose medical spending is heavily subsidized is a key factor behind this growth. Technological change is a symptom of the medical market structure rather than a cause of medical spending growth. The econometric model in the analysis here is based on a micro model composed of two groups. The first group is a healthier group that makes income transfers in order to finance the sicker group's health insurance premiums. In this model, a technical constraint places an upper bound on the healing ability of the medical good. This upper bound changes through an unobservable endogenous process. Estimating the health care model involves using estimation techniques that bypass the need to make any a priori assumptions about the functional form of the regressions or about the distribution of the residuals. The results suggest that technical change cannot indefinitely induce health care spending growth if no subsidies exist that provide full health care coverage with premiums fully paid by the subsidy. If subsidies provide full coverage and pay the entire premium, then new technical discoveries can induce constantly expanding medical expenditures.     

The demand for preventive medical care

The idea that people invest in health capital is an essential part of models of the demand for health, but the investment motives behind health decision are often obscured by other factors. This empirical paper investigates the demand for adult preventive medical care, where the investment motives are relatively clear cut. Several important results demonstrate the usefulness of the approach. First, the analysis finds that annual use of two preventive services decreases with age. Although not the only plausible explanation, the results are consistent with individuals shortens over the lifecycle. Second, schooling is found to be an important determinant of demand, with the more educated much more likely to use the services. Neither lifecycle nor schooling effects are consistently found in studies of the demand for culture care. Finally, the empirical analysis also provides additional evidence on the responsiveness of the demand for preventive care to change in insurance coverage, an important issue for health policy.