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Lavetti K, DeLeire T, Ziebarth NR. How do low-income enrollees in the Affordable Care Act marketplaces respond to cost-sharing? J Risk Insur 2023; 90:155-183. [PMID: 37123030 PMCID: PMC10135398 DOI: 10.1111/jori.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/29/2022] [Indexed: 05/03/2023]
Abstract
The Affordable Care Act requires insurers to offer cost sharing reductions (CSRs) to low-income consumers on the Marketplaces. We link 2013-2015 All-Payer Claims Data to 2004-2013 administrative hospital discharge data from Utah and exploit policy-driven differences in the actuarial value of CSR plans that are solely determined by income. This allows us to examine the effect of cost sharing on medical spending among low-income individuals. We find that enrollees facing lower levels of cost sharing have higher levels of health care spending, controlling for past health care use. We estimate demand elasticities of total health care spending among this low-income population of approximately -0.12, suggesting that demand-side price mechanisms in health insurance design work similarly for low-income and higher-income individuals. We also find that cost sharing subsidies substantially lower out-of-pocket medical care spending, showing that the CSR program is a key mechanism for making health care affordable to low-income individuals.
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Affiliation(s)
- Kurt Lavetti
- Ohio State University, Department of Economics, Arps Hall 433, Columbus, OH 43210, NBER, and IZA Bonn
| | - Thomas DeLeire
- Georgetown University, McCourt School of Public Policy, 37th and O Streets, NW, Washington, DC 20057, NBER, and IZA Bonn
| | - Nicolas R Ziebarth
- Cornell University, Department of Policy Analysis and Management (PAM), 426 Kennedy Hall, Ithaca, NY 14850, and IZA Bonn
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2
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Nie P, Wang L, Dragone D, Lu H, Sousa-Poza A, Ziebarth NR. "The better you feel, the harder you fall": Health perception biases and mental health among Chinese adults during the COVID-19 pandemic. China Econ Rev 2022; 71:101708. [PMID: 35058679 PMCID: PMC8570802 DOI: 10.1016/j.chieco.2021.101708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 07/16/2021] [Accepted: 11/02/2021] [Indexed: 05/05/2023]
Abstract
The health risks of the current COVID-19 pandemic, together with the drastic mitigation measures taken in many affected nations, pose an obvious threat to public mental health. To assess predictors of poor mental health in the context of the COVID-19 pandemic, this study first implements survey-based measures of health perception biases among Chinese adults during the pandemic. Then, it analyzes their relation to three mental health outcomes: life satisfaction, happiness, and depression (as measured by the CES-D). We show that the health overconfidence displayed by approximately 30% of the survey respondents is a clear risk factor for mental health problems; it is a statistically significant predictor of depression and low levels of happiness and life satisfaction. We also document that these effects are stronger in regions that experienced higher numbers of confirmed COVID-19 cases and deaths. Our results offer clear guidelines for the implementation of effective interventions to temper health overconfidence, particularly in uncontrollable situations like the COVID-19 pandemic.
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Affiliation(s)
- Peng Nie
- School of Economics and Finance, Xi'an Jiaotong University, 710061 Xi'an, China
- Institute for Health Care & Public Management, University of Hohenheim, 70599 Stuttgart, Germany
- IZA, Bonn, Germany
| | - Lu Wang
- School of Economics and Finance, Xi'an Jiaotong University, 710061 Xi'an, China
| | | | - Haiyang Lu
- The West Center for Economics Research, Southwestern University of Finance and Economics, Chengdu, China
| | - Alfonso Sousa-Poza
- School of Economics and Finance, Xi'an Jiaotong University, 710061 Xi'an, China
- Institute for Health Care & Public Management, University of Hohenheim, 70599 Stuttgart, Germany
- IZA, Bonn, Germany
| | - Nicolas R Ziebarth
- Department of Economics and Jeb E. Brooks School of Public Policy, Cornell University, USA
- National Bureau of Economic Research, USA
- ZEW Mannheim, Germany
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3
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Kapadia SN, Griffin JL, Waldman J, Ziebarth NR, Schackman BR, Behrends CN. The Experience of Implementing a Low-Threshold Buprenorphine Treatment Program in a Non-Urban Medical Practice. Subst Use Misuse 2022; 57:308-315. [PMID: 34889691 PMCID: PMC8862128 DOI: 10.1080/10826084.2021.2012484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND To respond to the U.S. opioid crisis, new models of healthcare delivery for opioid use disorder treatment are essential. We used a qualitative approach to describe the implementation of a low-threshold buprenorphine treatment program in an independent, community-based medical practice in Ithaca, NY. METHODS We conducted 17 semi-structured interviews with program staff, leadership, and external stakeholders. Then we analyzed these data using content analysis. We used purposeful sampling aiming for variation in job title for program staff, and in organizational affiliation for external stakeholders. RESULTS We found that opening an independent medical practice allowed for low-threshold buprenorphine treatment with less regulatory oversight, but state-certification was ultimately required to ensure financial sustainability. Relying on health insurance reimbursement alone led to funding shortfalls and additional funding sources were also required. The practice's ability to build relationships with licensed substance use treatment programs, community organizations, the legal system, and government agencies in the region differed depending on how much these entities supported a harm reduction philosophy compared to abstinence-based treatment. Finally, expanding the practice to a second location in a different region, co-located with a syringe service program, required adapting to a new cultural and political environment. CONCLUSION The results from this study provide insight about the challenges that independent medical practices might face in delivering low-threshold buprenorphine treatment. They support policy efforts to address the financial burdens associated with providing low-threshold buprenorphine therapy and inform the external relationships that other providers would need to consider when delivering novel treatment models.
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Affiliation(s)
- Shashi N Kapadia
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Judith L Griffin
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,REACH Medical, Ithaca, New York, USA
| | | | - Nicolas R Ziebarth
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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4
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Kapadia SN, Griffin JL, Waldman J, Ziebarth NR, Schackman BR, Behrends CN. A Harm Reduction Approach to Treating Opioid Use Disorder in an Independent Primary Care Practice: a Qualitative Study. J Gen Intern Med 2021; 36:1898-1905. [PMID: 33469774 PMCID: PMC7815286 DOI: 10.1007/s11606-020-06409-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stigma is a barrier to the uptake of buprenorphine to treat opioid use disorder. Harm reduction treatment models intend to minimize this stigma by organizing care around non-judgmental interactions with people who use drugs. There are few examples of implementing buprenorphine treatment using a harm reduction approach in a primary care setting in the USA. METHODS We conducted a qualitative study by interviewing leadership, staff, and external stakeholders at Respectful, Equitable Access to Compassionate Healthcare (REACH) Medical in Ithaca, NY. REACH is a freestanding medical practice that provides buprenorphine treatment for opioid use disorder since 2018. We conducted semi-structured interviews with 17 participants with the objective of describing REACH's model of care. We selected participants based on their position at REACH or in the community. Interviews were recorded, transcribed, and analyzed for themes using content analysis, guided by the CDC Evaluation Framework. RESULTS REACH provided buprenorphine, primary care, and mental health services in a low-threshold model. We identified three themes related to delivery of buprenorphine treatment. First, an organizational mission to provide equitable and low-stigma healthcare, which was a key to organizational identity. Second, a low-threshold buprenorphine treatment approach that was critical, but caused concern about over-prescribing and presented logistical challenges. Third, creation and retention of a harm reduction-oriented workforce by offering value-based work and by removing administrative barriers providers may face elsewhere to providing buprenorphine treatment. CONCLUSIONS A harm reduction primary care model can help reduce stigma for people who use drugs and engage in buprenorphine treatment. Further research is needed to evaluate whether this model leads to improved patient outcomes, can overcome community stakeholder concerns, and is sustainable.
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Affiliation(s)
- Shashi N Kapadia
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA. .,Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Judith L Griffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.,REACH Medical, Ithaca, NY, USA
| | | | - Nicolas R Ziebarth
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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5
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Arni P, Dragone D, Goette L, Ziebarth NR. Biased health perceptions and risky health behaviors-Theory and evidence. J Health Econ 2021; 76:102425. [PMID: 33578326 DOI: 10.1016/j.jhealeco.2021.102425] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/20/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
This paper investigates the role of biased health perceptions as a potential driving force of risky health behaviors. We define absolute and relative health perception biases, illustrate their measurement in surveys and provide evidence on their relevance. Next, we decompose the theoretical effect into its extensive and intensive margin: When the extensive margin dominates, people (wrongly) believe they are healthy enough to "afford" unhealthy behavior. Finally, using three population surveys, we provide robust empirical evidence that respondents who overestimate their health are less likely to exercise and sleep enough, but more likely to eat unhealthily and drink alcohol daily.
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Affiliation(s)
- Stefan Pichler
- Stefan Pichler is a research associate at KOF Swiss Economic Institute, ETH Zurich, in Zurich, Switzerland
| | - Katherine Wen
- Katherine Wen is a PhD student in the Department of Policy Analysis and Management at Cornell University, in Ithaca, New York
| | - Nicolas R. Ziebarth
- Nicolas R. Ziebarth is an associate professor in the Department of Policy Analysis and Management, Cornell University
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7
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Kvasnicka M, Siedler T, Ziebarth NR. The health effects of smoking bans: Evidence from German hospitalization data. Health Econ 2018; 27:1738-1753. [PMID: 30022556 DOI: 10.1002/hec.3798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/22/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
This paper studies the short-term impact of public smoking bans on hospitalizations in Germany. It exploits the staggered implementation of smoking bans over time and across the 16 federal states along with the universe of hospitalizations from 2000 to 2008 and daily county-level weather and pollution data. Smoking bans in bars and restaurants have been effective in preventing 1.9 hospital admissions (-2.1%) due to cardiovascular diseases per day, per 1 million population. We also find a decrease by 0.5 admissions (-6.5%) due to asthma per day, per 1 million population. The health prevention effects are more pronounced on sunny days and days with higher ambient pollution levels.
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Affiliation(s)
- Michael Kvasnicka
- Faculty of Economics and Management, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
- RWI, Essen, Germany
- IZA, Bonn, Germany
| | - Thomas Siedler
- IZA, Bonn, Germany
- Faculty of Economics and Social Sciences, Universität Hamburg, Hamburg, Germany
- DIW, Berlin, Germany
| | - Nicolas R Ziebarth
- IZA, Bonn, Germany
- Policy Analysis and Management (PAM), Cornell University, Ithaca, New York
- DIW, Berlin, Germany
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8
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French EB, McCauley J, Aragon M, Bakx P, Chalkley M, Chen SH, Christensen BJ, Chuang H, Côté-Sergent A, De Nardi M, Fan E, Échevin D, Geoffard PY, Gastaldi-Ménager C, Gørtz M, Ibuka Y, Jones JB, Kallestrup-Lamb M, Karlsson M, Klein TJ, de Lagasnerie G, Michaud PC, O'Donnell O, Rice N, Skinner JS, van Doorslaer E, Ziebarth NR, Kelly E. End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported. Health Aff (Millwood) 2018; 36:1211-1217. [PMID: 28679807 DOI: 10.1377/hlthaff.2017.0174] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.
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Affiliation(s)
- Eric B French
- Eric B. French is a professor of economics at University College London; codirector of the ESRC Centre for the Microeconomic Analysis of Public Policy, Institute for Fiscal Studies; and Research Fellow at the Centre for Economic Policy Research, all in the United Kingdom
| | - Jeremy McCauley
- Jeremy McCauley is a PhD student at University College London
| | - Maria Aragon
- Maria Aragon is a research fellow in the Centre for Health Economics, University of York, in the United Kingdom
| | - Pieter Bakx
- Pieter Bakx is an assistant professor in the Institute of Health Policy and Management, Erasmus University Rotterdam, in the Netherlands
| | - Martin Chalkley
- Martin Chalkley is a professor in the Centre for Health Economics, University of York
| | - Stacey H Chen
- Stacey H. Chen is an associate professor in the National Graduate Institute for Policy Studies, in Tokyo, Japan
| | - Bent J Christensen
- Bent J. Christensen is director of the Dale T. Mortensen Center and a professor in the Department of Economics and Business Economics, Aarhus University, in Denmark
| | - Hongwei Chuang
- Hongwei Chuang is an associate professor in the Graduate School of Economics and Management at Tohoku University, in Sendai, Japan
| | - Aurelie Côté-Sergent
- Aurelie Côté-Sergent is a research professional at the Center for Interuniversity Research and Analysis of Organizations (CIRANO), in Montreal, Quebec
| | - Mariacristina De Nardi
- Mariacristina De Nardi is a professor of economics at University College London; a senior economist and research advisor at the Federal Reserve Bank of Chicago, in Illinois; a research fellow at the Centre for Economic Policy Research, in Paris, France; an international research fellow at the Institute for Fiscal Studies, in London; and a faculty research fellow at the National Bureau of Economic Research, in Cambridge, Massachusetts
| | - Elliott Fan
- Elliott Fan is an assistant professor in the Department of Economics at National Taiwan University, in Taipei
| | - Damien Échevin
- Damien Échevin is a research professor at the Université de Sherbrooke, in Quebec
| | - Pierre-Yves Geoffard
- Pierre-Yves Geoffard is a professor at the Paris School of Economics (CNRS), and a research fellow at the Centre for Economic Policy Research
| | - Christelle Gastaldi-Ménager
- Christelle Gastaldi-Ménager is deputy head of the Department of Studies on Patients and Diseases, National Health Insurance Fund for Salaried Workers, in Paris
| | - Mette Gørtz
- Mette Gørtz is an associate professor in the Department of Economics, University of Copenhagen, in Denmark
| | - Yoko Ibuka
- Yoko Ibuka is an associate professor in the Department of Economics and Management, Tohoku University
| | - John B Jones
- John B. Jones is a senior economist and research advisor at the Federal Reserve Bank of Richmond, in Virginia
| | - Malene Kallestrup-Lamb
- Malene Kallestrup-Lamb is an assistant professor in the Department of Economics and Business Economics, Aarhus University
| | - Martin Karlsson
- Martin Karlsson is a professor of economics at the University of Duisburg-Essen, Germany
| | - Tobias J Klein
- Tobias J. Klein is an associate professor in the Department of Econometrics and Operations Research, Tilburg University, in the Netherlands
| | - Grégoire de Lagasnerie
- Grégoire de Lagasnerie is a health economist at the National Health Insurance Fund for Salaried Workers
| | - Pierre-Carl Michaud
- Pierre-Carl Michaud is a professor in the Department of Applied Economics, HEC Montreal
| | - Owen O'Donnell
- Owen O'Donnell is a professor in the Erasmus School of Economics, Erasmus University Rotterdam, and at the University of Macedonia, in Thessaloniki, Greece
| | - Nigel Rice
- Nigel Rice is a professor in the Centre for Health Economics and Department of Economics and Related Studies, University of York
| | - Jonathan S Skinner
- Jonathan S. Skinner is the James O. Freedman Presidential Professor of Economics in the Department of Economics at Dartmouth and a professor in the Department of Family and Community Medicine, Geisel School of Medicine, and at the Dartmouth Institute for Health Policy and Clinical Practice, all in Hanover, New Hampshire
| | - Eddy van Doorslaer
- Eddy van Doorslaer is a professor in the Institute of Health Policy and Management, Erasmus School of Economics, Erasmus University Rotterdam
| | - Nicolas R Ziebarth
- Nicolas R. Ziebarth is an assistant professor in the Department of Policy Analysis and Management, Cornell University, in Ithaca, New York
| | - Elaine Kelly
- Elaine Kelly is a senior research economist at the Institute for Fiscal Studies, in London
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Pilny A, Wübker A, Ziebarth NR. Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany. J Health Econ 2017; 56:330-351. [PMID: 29248059 DOI: 10.1016/j.jhealeco.2017.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 03/25/2017] [Accepted: 03/31/2017] [Indexed: 06/07/2023]
Abstract
To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time.
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Affiliation(s)
- Adam Pilny
- RWI, Hohenzollernstr. 1-3, 45128 Essen, Germany.
| | - Ansgar Wübker
- Ruhr University Bochum and RWI, Hohenzollernstr. 1-3, 45128 Essen, Germany.
| | - Nicolas R Ziebarth
- Cornell University, Department of Policy Analysis and Management (PAM), 106 Martha Van Rensselaer Hall, Ithaca, NY 14850, USA.
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10
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Dragone D, Ziebarth NR. Non-separable time preferences, novelty consumption and body weight: Theory and evidence from the East German transition to capitalism. J Health Econ 2017; 51:41-65. [PMID: 28040621 DOI: 10.1016/j.jhealeco.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 11/23/2016] [Accepted: 11/26/2016] [Indexed: 06/06/2023]
Abstract
This paper develops a dynamic model to illustrate how diet and body weight change when novel food products become available to consumers. We propose a microfounded test to empirically discriminate between habit and taste formation in intertemporal preferences. Moreover, we show that 'novelty consumption' and endogenous preferences can explain the persistent correlation between economic development and obesity. By empirically studying the German reunification, we find that East Germans consumed more novel Western food and gained more weight than West Germans when a larger variety of food products became readily accessible after the fall of the Wall. The observed consumption patterns suggest that food consumption features habit formation.
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Affiliation(s)
- Davide Dragone
- University of Bologna, Department of Economics, Office 352, Piazza Scaravilli 2, 40126 Bologna, Italy.
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11
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Abstract
This paper assesses the effectiveness of child safety seat laws in the United States. Over the past 35 years, these laws have steadily increased mandatory child safety seat restraint ages. We exploit state-year level variation in the age until which children are required to ride in child safety seats to estimate triple difference models using Fatality Analysis Reporting System (FARS) data from 1975 to 2011. Our findings show that increasing the age thresholds is effective in increasing the actual age of children in safety seats. Across the child-age distribution, restraint rates increase by between 10 and 30 percentage points or by between 50 and 170 percent, in the long run. We also estimate the impact of the child safety seat laws on the likelihood that a child dies in a fatal accident. We find that the laws saved up to 39 children per year. Finally, we find that the laws primarily induce compliant parents to switch from traditional seatbelt use to child safety seat use, with only small effects among parents who do not restrain their children.
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Affiliation(s)
- Lauren E Jones
- Department of Human Sciences at the Ohio State University, Columbus, OH
| | - Nicolas R Ziebarth
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY
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12
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Wagner GG, Ziebarth NR. Inevitable? Doping attitudes among Berliners in 2011: the role of socialist state socialisation and athlete experience. Eur J Public Health 2016; 26:520-2. [PMID: 27056894 DOI: 10.1093/eurpub/ckw046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To design effective and commonly accepted public health policies against performance-enhancing drugs (PED), it is important to understand general population attitudes. This article elicits PED attitudes in the Berlin population and compares response rates of former athletes (N = 496) with those of non-athletes (N = 1686). In addition, exploiting the natural experiment of the division of Germany, by comparing East (N = 687) to West Berliners (N = 1315), the article studies the long-term impact of state socialisation on PED attitudes. Former West German amateur athletes are a statistically significant 6ppt more likely to believe that athletes can be successful without doping. Former GDR amateur athletes are 8ppt more likely to believe that doping is inevitable in professional sports.
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Affiliation(s)
- Gert G Wagner
- 1 Max Planck Institute for Human Development (MPIB), Berlin, Germany 2 DIW Berlin (German Institute for Economic Research) 3 Berlin University of Technology (TUB), Berlin, Germany
| | - Nicolas R Ziebarth
- 3 Berlin University of Technology (TUB), Berlin, Germany 4 Cornell University, Policy Analysis and Management (PAM), 106 Martha van Rensselaer Hall, Ithaca, NY 14853, USA 5 IZA, Bonn, Germany
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13
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Abstract
OBJECTIVE To profile the sick leave landscape in the United States. DATA SOURCES The 2011 Leave Supplement of the American Time Use Survey. STUDY DESIGN Bivariate and multivariate analyses to identify (i) employees without sick pay coverage and (ii) employees who attend work sick. PRINCIPAL FINDINGS Sixty-five percent of full-time employees have sick pay coverage. Coverage rates are below 20 percent for employees with hourly wages below $10, part-time employees, and employees in the hospitality and leisure industry. CONCLUSION Each week, up to 3 million U.S. employees go to work sick. Females, low-income earners, and those aged 25 to 34 years have a significantly elevated risk of presenteeism behavior.
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Affiliation(s)
- Philip Susser
- Policy Analysis and Management (B.S.) (expected graduation in May 2016), Cornell University, New York, NY
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Ziebarth NR. Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care. ACTA ACUST UNITED AC 2013; 14:41-67. [PMID: 24306855 DOI: 10.1007/s10754-013-9138-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
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15
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Frick JR, Ziebarth NR. Welfare-related health inequality: does the choice of measure matter? Eur J Health Econ 2013; 14:431-442. [PMID: 22447634 DOI: 10.1007/s10198-012-0387-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 02/24/2012] [Indexed: 05/31/2023]
Abstract
Using representative microdata from the German Socio-Economic Panel Study (SOEP), we show that the welfare measure choice has a substantial impact on the degree of welfare-related health inequality. To assess the sensitivity of welfare-related health inequality measures, we combine a unique set of income and wealth measures with different subjective, cardinalized, and (quasi-)objective health measures. The influence of the welfare measure is more pronounced when using subjective health measures than when using (quasi-)objective health measures.
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Affiliation(s)
- Joachim R Frick
- DIW Berlin, Socio-Economic Panel Study, Berlin Institute of Technology, Berlin, Germany
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Eibich P, Ziebarth NR. Analyzing regional variation in health care utilization using (rich) household microdata. Health Policy 2013; 114:41-53. [PMID: 23706385 DOI: 10.1016/j.healthpol.2013.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 02/18/2013] [Accepted: 04/19/2013] [Indexed: 01/08/2023]
Abstract
This paper exploits rich SOEP microdata to analyze state-level variation in health care utilization in Germany. Unlike most studies in the field of the Small Area Variation (SAV) literature, our approach allows us to net out a large array of individual-level and state-level factors that may contribute to the geographic variation in health care utilization. The raw data suggest that state-level hospitalization rates vary from 65 to 165 percent of the national mean. Ambulatory doctor visits range from 90 to 120 percent of the national mean. Interestingly, in the former GDR states, doctor visit rates are significantly below the national mean, while hospitalization rates lie above the national mean. The significant state-level differences vanish once we control for individual-level socio-economic characteristics, the respondents' health status, their health behavior as well as supply-side state-level factors.
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Affiliation(s)
- Peter Eibich
- DIW Berlin, Mohrenstrasse 58, 10117 Berlin, Germany; University of Hamburg, Germany.
| | - Nicolas R Ziebarth
- Cornell University, Policy Analysis and Management (PAM), 106 Martha van Rensselaer Hall, Ithaca, NY 14853, United States; DIW Berlin, Germany; IZA Bonn, Germany.
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