on the dynamics of demand for leisure and the production of health our article develops and estimates a structural model of household health production that jointly determines the demand for leisure and the demand for consumption for elderly males we use a stochastic dynamic programming framework based on the assumption that an individual maximizes lifetime utility subject to budget and time constraints and a health production function by choosing hours of leisure and levels of consumption of health related and health neutral goods and services moreover we use a very comprehensive health index that combines four scales measuring a variety of dimensions in the quality of life the euler equations derived from our model are estimated using data from six biennial panels of the retirement history survey

determinants of women s health status and health care utilization in a developing country a latent variable approach a latent variable representation of health is used in a system that determines health and various indicators of health and health care utilization for nicaraguan women estimates differ somewhat from standard estimates they imply that women s schooling increases health care utilization literate women report less disease incidence women s childhood backgrounds affect their adult health and health care utilization and general resources favor childbirth related care but women s full income favors general care the most significant result is that several important characteristics usually associated with development women s schooling household resources and women s labor force participation have inverse or no associations with women s health health status is hypothesized to be important in developing countries both as a direct indicator of welfare and because of its possible impact on productivity health care utilization also is of interest both because of its relation to health status and because it is a particular manifestation of demand and supply for a 1 modem service work on the determinants of health status and health care utilization in developing economies however is flawed because true health status is not directly observable the indicators of health status that have been used in empirical studies anthropometric measures days ill self reported or clinical disease records inputs such as nutrients and health care utilization indicesare imperfect indicators of underlying health status and generally do not give a congruent representation of that status thereby they may not measure adequately health status and their use may lead to biases in estimates and incorrect interpretations we use a latent variable methodology for the first time to explore health status and health care utilization in a developing country this approach employs systematic relations between various indicators of health status and health status itself and between health status and various related outcomes so that it is possible to estimate the determinants of health status and control for health status in other relations even though health status is not directly observed by using this methodology we obtain more satisfactory estimates of the determinants of health status and of health care utilization in a developing country context than previous estimates using direct but imperfect proxies this should improve the empirical bases for evaluating health and related policies in the developing world i latent variable model of health status and health care utilization in the human capital tradition of analysis of health individual health status is viewed as determined by individual demand factors given supply prices environment age and resources including genes health care utilization is a derived demand for a service which is used to produce better health to incorporate the latent variable representation of the unobserved health status we assume that the demand supply health status and health care utilization interactions as well as the relation of other health indicators to health status can be represented by the following linear system of relations

determinants of child mortality health and nutrition in a developing country abstract child health and nutrition status are important determinants of adult productivities and earnings and thus are an important channel of intergenerational socioeconomic mobility building upon economic models of household behavior we investigate the determinants of child mortality and health and nutrition status in regions defined by the degree of urbanization in the developing country of nicaragua and offer some policy suggestions our estimates suggest that determinants differ significantly across regions income is not an important factor there is an inverse relation with number of siblings and there are positive associations with calorie intake schooling except in the relatively low income rural areas the availability of refrigeration and the quality of sewage systems

demand for health insurance and precautionary motives for savings among the elderly abstract this paper examines whether or not the elderly have precautionary motives for savings against uncertain and potentially large medical costs i analyze the relationship between purchases of actuarially unfair health insurance and the individual s ability to self insure in order to create a complete model of this behavior the government programs of medicare and medicaid are also incorporated into the analysis the major results from this paper are that individuals do tend to behave in a manner that is consistent with precautionary behavior and that even among those who do not hold private insurance most act in a manner consistent with their being over insured by medicare

evaluation of the subjective probabilities of survival in the health and retirement study in the health and retirement study respondents were asked about the chances they would live to 75 or to 85 we analyze these responses to determine if they behave like probabilities of survival if their averages are close to average probabilities in the population and if they have correlations with other variables that are similar to correlations with actual mortality outcomes we find that generally they do behave like probabilities and that they do aggregate to population probabilities most remarkable however is that they covary with other variables in the same way actual outcomes vary with the variables for example respondents with higher socioeconomic status give higher probabilities of survival whereas respondents who smoke give lower probabilities we conclude that these measures of subjective probabilities have great potential use in models of intertemporal decision making under uncertainty

the underground economies tax evasion and information distortion list of contributors preface introduction edgar l feige part i the meaning measurement and policy implications of the underground economies 1 the meaning and measurement of the underground economy edgar l feige 2 information distortions in social systems the underground economy and other observer subject policymaker feedbacks robert r alford and edgar l feige 3 policy illusion macroeconomic instability and the unrecorded economy robert t mcgee and edgar l feige 4 how large or small should the underground economy be bruno frey part ii the underground economy in western developed nations measurement in different laboratories 5 monetary perspective on underground economic activity in the united states richard d porter and amanda s bayer 6 the unrecorded economy and the national income accounts in the netherlands a sensitivity analysis g a a m broesterhuizen 7 assessing the underground economy in the united kingdom michael o higgins 8 the underground economy in the federal republic of germany a preliminary assessment enno langfeldt 9 the underground economy in sweden ingemar hansson 10 the irregular economy of italy a survey of contributions bruno contini 11 the hidden economy in norway with special emphasis on the hidden labor market arne jon isachsen and steiner strom 12 canada s underground economy rolf mirus and roger s smith 13 the underground economy in france philippe barthelemy part iii the underground economy under central planning 14 the soviet second economy in a political and legal perspective f j m feldbrugge 15 second economy and socialism the hungarian experience istvan r gabor bibliography

the incidence of medicare abstract the medicare program transfers nearly 300 billion annually from taxpayers to beneficiaries this paper considers the incidence of such transfers in the context of a life cycle model with uncertainty about future health care expenditures we find the distributional consequences of the medicare program are roughly neutral in dollar terms households living in high income neighborhoods pay more in taxes but they also receive more in benefits these dollar flows however ignore the insurance value of the medicare system given the incomplete insurance coverage of lower income elderly households prior to the medicare program the money metric benefits to lower income groups exceed the dollar flows suggesting that medicare redistributes more than a simple accounting exercise would suggest

expanding the life cycle model precautionary saving and public policy one of the key puzzles in understanding saving behavior is not so much why people save the title of this session but why people don t save according to the familiar life cycle model households should accumulate wealth to provide for their retirement consumption the surprising result from the data is the sizable fraction of the population who have accumulated so little even among those nearing retirement given that earnings will almost surely decline when households retire such behavior can imply poor living standards for the elderly some might interpret the low wealth accumulation as being evidence of myopia irrationality or a failure of households to enforce mental accounting richard thaler 1994 while others might view the low level of wealth accumulation as evidence of high individual rates of time preference determining the underlying causes of low wealth is crucial for public policies that seek to alleviate low aggregate saving rates in the united states as well as policies that seek to buttress the adequacy of financial resources for the elderly in this paper we outline what we believe to be the causes of why many people do not save we conclude by speculating about government policies that may be most effective at encouraging saving much of the research examining levels of consumption saving and wealth as well as their responsiveness to policy has been done using a life cycle model with the simplifying assumption of perfect certainty alan auerbach and laurence kotlikoff 1987 for example developed a model with 55 overlapping generations of individual lifecycle households each with empirically plausible age earnings profiles and utility parameters and used the model to address tax policy and demographic issues in a regime in which all households are identical within a generation and all generations know future earnings and interest rates more recently a line of inquiry has examined the effects of uncertainty on saving generally in the context of highly stylized models this research has shown that in these models uninsured earnings uncertainty can alter optimal saving behavior in a variety of important ways for a partial review of this precautionary saving literature see hubbard et al 1994 in two recent papers hubbard et al 1993 1994 we have combined these two strands of the literature by examining the implications of a life cycle model of consumption saving and wealth accumulation subject to what we think are the three most important sources of uninsured idiosyncratic risk facing households uncertainty about earnings medical expenses and length of life our intent has been to create a realistic model in which families live for many periods working for part of their lives and retiring later in life to parameterize the uncertainty facing families we estimate tdiscussants christopher carroll federal reserve board john b shoven stanford university laurence kotlikoff boston university

life cycle responses to health insurance status this paper studies the lifetime effects of exogenous changes in health insurance coverage e g medicare ppaca termination of employer provided plans on the dynamic optimal allocation consumption leisure health expenditures status health and wealth and welfare we solve simulate and structurally estimate a parsimonious life cycle model with endogenous exposure to morbidity and mortality risks and exogenous health insurance by varying coverage we identify the marginal effects of insurance when young and or when old on allocations statuses and welfare our results highlight positive effects of insurance on health wealth and welfare as well as mid life substitution away from healthy leisure in favor of more health expenses caused by peaking wages and accelerating health issues

health as a family matter do intra household education externalities matter for maternal and child health abstract this paper is concerned with the role of education as a determinant of health care choices the central premise of the paper is that utilisation of health services is determined not solely by an individual s own education but rather by a notion of effective education which incorporates the educational attainment of other household members the paper sets out a general framework for representing intra household education externalities and proposes a number of specific hypotheses concerning the way in which the education of different household members affects health care choices these hypotheses are tested on data from mozambique focusing on maternity services child immunisations and child malnutrition we draw four major conclusions from the analysis first while maternal education seems to be the education variable of primary importance for the health service and malnutrition variables under consideration the education of other household members does have a significant and sometimes larg

uncertain medical expenses and precautionary saving near the end of the life cycle this paper introduces a dynamic structural model of household consumption decisions in which elderly families consider the effects of uncertain future medical expenses when deciding current levels of consumption the model with uncertain medical expenses implies a potentially important role for precautionary saving incentives to explain slow rates of dissaving among elderly americans during retirement rather than just simulating the stochastic dynamic model preference parameters are estimated using panel data on health wealth and expenditures for retired families the health uncertainty model predicts consumption levels closer to observed expenditures than a life cycle model with uncertain longevity however elderly families typically dissave their financial assets more slowly than even the baseline health uncertainty model predicts is optimal

an econometric analysis of income tax evasion and its detection this article presents an econometric analysis of income tax evasion and its detection based on individual level data drawn from the internal revenue service 1982 and 1985 taxpayer compliance measurement programs i specify a model consisting of two equations the first measures the extent of evasion the second the fraction of evasion detected the empirical analysis explores the effects of income the marginal tax rate and various socioeconomic characteristics on filer evasion behavior and it assesses the variability in detection rates among irs examiners finally i use the empirical estimates to construct new estimates of the income tax gap the new estimates are very close to the previous irs estimates

a model of the demand for longevity and the value of life extension we specify a demand function for longevity or quantity of life along with corresponding demand functions for indicators of quality of life and a value of health and life extension function we show that the demand for health must be derived in conjunction with that for longevity and the related consumption plan and that all choices depend on initial individual endowments and terminal conditions our comparative dynamics predictions indicate that optimal health and longevity are increasing functions of endowed wealth rather than necessarily current income that improvements in opportunities to produce health can accentuate the differences between endowed health and attained longevity levels and that the value individuals ascribe to their health may be increasing over a good portion of their life cycle we use this model to analyze observed empirical variations in levels and trends of life expectancy and in exposure to health risks across different population groups

approaches for estimating noncompliance examples from federal taxation in the united states crime and underground economic activity are a fact of life around the world most societies attempt to control these activities through the expenditure of resources on monitoring prosecution punishment and educational programmes gathering statistics about who is engaging in illegal or underground activity the frequencies with which various crimes or underground transactions are occurring and the severity or magnitude of these acts is crucial for making good decisions regarding our allocation of resources in this area unfortunately in general it is very difficult to obtain accurate information about these issues this is partly because the individuals engaged in such activities wish not to be identified and often take actions to avoid detection and partly because by their very nature the activities tend not to generate economic accounting legal demographic or other cultural records the fact that it is difficult to obtain accurate information about the activities however does not in any way imply that we should not make a concerted effort to try to obtain the best information we can i believe the cost associated with attempting to determine the extent and nature of these activities is in most circumstances well below the expected benefit which includes the likelihood of improved decisionmaking by relevant government personnel and the general public as a result i also believe the debate about developing estimates of illegal or underground economic activity should primarily focus on practical issues related to how best to go about developing estimates that are as reliable as possible in this short article i shall discuss the measurement of noncompliance with laws and regulations my particular area of expertise and shall not discuss the measurement of other kinds of hidden economic behaviours such as informal contracting unmeasured home production and grey market activities in particular i shall discuss three approaches for estimating the aggregate amount of noncompliance with respect to a specific law or regulation i intensive data collection for a focused subsample of the population ii detection controlled estimation and iii the comparision of estimates generated by distinct datasets and models for each i shall describe in general terms what the approach is and how it is implemented review limitations of the approach and present an example of the application of the approach to the measurement of tax noncompliance in the united states my discussion shall necessarily be short and i refer the interested reader to a variety of original research publications for more details especially about the specific examples

moral hazard and the demand for health services a matching estimator approach we estimate the impact of extra health insurance coverage beyond a national health system on the demand for several health services traditionally the literature has tried to deal with the endogeneity of the private extra insurance decision by finding instrumental variables since a priori instrumental variables are hard to find we take a different approach we focus on the most common health insurance plan in portugal adse which is given to all civil servants and their dependents we argue that this insurance is exogenous i e not correlated with the beneficiaries health status this identifying assumption allows us to estimate the impact of having adse coverage on the demand for three different health services using a matching estimator technique the health services used are number of visits number of blood and urine tests and the probability of visiting a dentist results show large positive effects of adse coverage for number of visits and tests among the young 18 30 years old but only the latter is statistically significantly different from zero the effects represent 21 8 and 30 of the average number of visits and tests for the young on the contrary we find no evidence of moral hazard on the probability of visiting a dentist

the rand health insurance experiment three decades later we re present and re examine the analysis from the famous rand health insurance experiment from the 1970s on the impact of consumer cost sharing in health insurance on medical spending we begin by summarizing the experiment and its core findings in a manner that would be standard in the current age we then examine potential threats to the validity of a causal interpretation of the experimental treatment effects stemming from different study participation and differential reporting of outcomes across treatment arms finally we re consider the famous rand estimate that the elasticity of medical spending with respect to its out of pocket price is 0 2 emphasizing the challenges associated with summarizing the experimental treatment effects from non linear health insurance contracts using a single price elasticity

uncertain lifetime life protection and the value of life saving abstract the analytic innovation is treating life s end as uncertain and life expectancy as partly the product of individuals efforts to self protect against mortality and morbidity risks the demand for self protection is modeled in a stochastic life cycle framework under alternative insurance options the model helps explain the trend and systematic diversity in life expectancies across different population groups as well as the wide variability in reported value of life saving estimates the analysis yields a closed form solution for individuals value of life saving that is estimable empirically it reflects the impacts of specific personal characteristics and alternative insurance options on both life expectancy and its valuation

shadow economies size causes and consequences using various methods the size of the shadow economy in 76 developing transition and oecd countries is estimated average size varies from 12 percent of gdp for oecd countries to 23 percent for transition countries and 39 percent for developing countries increasing taxation and social security contributions combined with rising state regulations are driving forces for the increase of the shadow economy especially in oecd countries according to some findings corruption has a positive impact on the size of the shadow economy and a growing shadow economy has a negative effect on official gdp growth

your retirement and my health behavior evidence on retirement externalities from a fuzzy regression discontinuity design this paper presents evidence on intra household retirement externalities by assessing the causal effect of partner s retirement on own health behaviour in europe we identify partner s retirement effects by applying a fuzzy regression discontinuity rd framework using retirement eligibility as an exogenous instrument for partner s retirement status using data from the survey of health ageing and retirement in europe share we find that while partner s retirement increases own physical activity it also increases smoking by up to 7 cigarettes a day and increases alcohol intake by 1 2 drinks per day furthermore we find that physical activity increases only for individuals that are themselves retired pointing toward compensated effects that arise due to husband s and wife s retirement being complements similarly an increase in alcohol intake is observed only if the individuals are themselves retired and an increase in smoking is only observed if the partner is a smoker suggesting mutual positive externalities and leisure complementarities

are americans saving optimally for retirement we solve each household s optimal saving decisions using a life cycle model that incorporates uncertain lifetimes uninsurable earnings and medical expenses progressive taxation government transfers and pension and social security benefits with optimal decision rules we compare household by household wealth predictions from the life cycle model using a nationally representative sample we find making use of household specific earnings histories that the model accounts for more than 80 percent of the 1992 cross sectional variation in wealth fewer than 20 percent of households have less wealth than their optimal targets and the wealth deficit of those who are undersaving is generally small

labor market institutions taxation and the underground economy abstract the paper aims at qualifying the links between labor market institutions taxation tax monitoring and underground economic activity the proposed model is a continuous time matching model with one commodity roduced either overground or underground underground economic activity arises because of partial compliance with regulations and tax contributions imposed by the government vacancies and workers search are directed at a specific labor market workers are heterogenous in the subjective cost they face when operating in the irregular sector analytical and numerical investigations suggest that interactions between regular and irregular activities can affect standard results of policy interventions in that respect the paper supports the view that policies aiming at increasing individuals benefits of participating in the regular sector are more desirable than a deterrence policy

does medicare save lives health insurance characteristics shift at age 65 as most people become eligible for medicare we measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends the age profiles of admissions and comorbidities for these patients are smooth at age 65 suggesting that the severity of illness is similar on either side of the medicare threshold in contrast the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities implying that patients over 65 receive more services we estimate a nearly 1 percentage point drop in 7 day mortality for patients at age 65 equivalent to a 20 reduction in deaths for this severely ill patient group the mortality gap persists for at least 9 months after admission

the effects of health insurance and self insurance on retirement behavior this paper provides an empirical analysis of the effects of employer provided health insurance medicare and social security on retirement behavior using data from the health and retirement study we estimate a dynamic programming model of retirement that accounts for both saving and uncertain medical expenses our results suggest that medicare is important for understanding retirement behavior and that uncertainty and saving are both important for understanding the labor supply responses to medicare half the value placed by a typical worker on his employer provided health insurance is the value of reduced medical expense risk raising the medicare eligibility age from 65 to 67 leads individuals to work an additional 0 074 years over ages 60 69 in comparison eliminating 2 years worth of social security benefits increases years of work by 0 076 years

the demand for episodes of treatment in the health insurance experiment abstract this paper analyzes claims data from the rand health insurance experiment which were grouped into episodes of treatment the insurance plans in the experiment have coinsurance and a cap on out of pocket spending using new statistical techniques to adjust for the increased sickliness of those who exceed the cap the effects of coinsurance on cost per episode and number of episodes are estimated cost sharing reduced the number of episodes but had little effect on cost per episode people in the experiment responded myopically as their current insurance status changed through the year the price elasticity of spending was about 0 2 throughout the range of coinsurance studied when data permit it the study of episodes complements analyses of annual medical spending by revealing more about how decisions to spend are made within the year

health and other asset holdings despite clear evidence of correlations between financial and medical statuses and decisions most models treat financial and health related choices separately this article bridges this gap by proposing a tractable dynamic framework for the joint determination of optimal consumption portfolio holdings health investment and health insurance we solve for the optimal rules in closed form and capitalize on this tractability to gain a better understanding of the conditions under which separation between financial and health related decisions is sensible and of the pathways through which wealth and health determine allocations welfare and other variables of interest such as expected longevity or the value of health furthermore we show that the model is consistent with the observed patterns of individual allocations and provide realistic estimates of the parameters that confirm the relevance of all the main characteristics of the model

the aggregate effects of health insurance evidence from the introduction of medicare this paper investigates the effects of market wide changes in health insurance by examining the single largest change in health insurance coverage in american history the introduction of medicare in 1965 i estimate that the impact of medicare on hospital spending is over six times larger than what the evidence from individual level changes in health insurance would have predicted this disproportionately larger effect may arise if market wide changes in demand alter the incentives of hospitals to incur the fixed costs of entering the market or of adopting new practice styles i present some evidence of these types of effects a back of the envelope calculation based on the estimated impact of medicare suggests that the overall spread of health insurance between 1950 and 1990 may be able to explain about half of the increase in real per capita health spending over this time period

measuring income tax evasion using bank credit evidence from greece we document that in semiformal economies banks lend to tax evading individuals based on the bank s assessment of the individual s true income this observation leads to a novel approach to estimate tax evasion we use microdata on household credit from a greek bank and replicate the bank underwriting model to infer the banks estimate of individuals true income we estimate that 43 45 of self employed income goes unreported and thus untaxed for 2009 this implies 28 2 billion of unreported income implying forgone tax revenues of over 11 billion or 30 of the deficit our method innovation allows for estimating the industry distribution of tax evasion in settings where uncovering the incidence of hidden cash transactions is difficult using other methods primary tax evading industries are professional services medicine law engineering education and media we conclude with evidence that contemplates the importance of institutions paper trail and political willpower for the persistence of tax evasion jel codes g21 h22 h24 h26 p37

the distribution of lifetime medicare benefits taxes and premiums evidence from individual level data abstract the absence of individual level data linking earnings histories to the receipt of medicare benefits has hampered the study of the program s distributional properties data developed by the social security administration for an early cohort of medicare beneficiaries includes both earnings records and medicare payment records and thus overcomes this limitation for this early cohort lifetime benefits and taxes are found to rise with lifetime earnings but taxes rise more rapidly resulting in redistribution from higher to lower earning beneficiaries lifetime benefits in the top decile of the earnings distribution are 19 higher than in the bottom decile but taxes and premiums are four times higher in the top than in the bottom decile once taxes and premiums are subtracted net benefits in the top decile are 79 of net benefits in the bottom decile

the effects of health wealth and wages on labour supply and retirement behaviour this paper estimates a life cycle model of labour supply retirement and savings behaviour in which future health status and wages are uncertain individuals face a fixed cost of work and cannot borrow against future labour pension or social security income the method of simulated moments is used to match the life cycle profiles of labour force participation hours worked and assets that are estimated from the data to those that are generated by the model the model establishes that the tax structure of the social security system and pensions are key determinants of the high observed job exit rates at ages 62 and 65 removing the tax wedge embedded in the social security earnings test for individuals aged 65 and older would delay job exit by almost one year by contrast social security benefit levels health and borrowing constraints are less important determinants of job exit at older ages for example reducing social security benefits by 20 would cause workers to delay exit from the labour force by only three months

the value of life and the rise in health spending over the past half century americans spent a rising share of total economic resources on health and enjoyed substantially longer lives as a result debate on health policy often focuses on limiting the growth of health spending we investigate an issue central to this debate is the growth of health spending a rational response to changing economic conditions notably the growth of income per person we develop a model based on standard economic assumptions and argue that this is indeed the case standard preferences of the kind used widely in economics to study consumption asset pricing and labor supply imply that health spending is a superior good with an income elasticity well above one as people get richer and consumption rises the marginal utility of consumption falls rapidly spending on health to extend life allows individuals to purchase additional periods of utility the marginal utility of life extension does not decline as a result the optimal composition of total spending shifts toward health and the health share grows along with income in projections based on the quantitative analysis of our model the optimal health share of spending seems likely to exceed 30 percent by the middle of the century

healthy bodies and thick wallets the dual relation between health and economic status there is abundant evidence of a quantitatively large association between many measures of economic status including income and wealth and a variety of health outcomes such as mortality or morbidity however considerable and often heated debate remains especially across disciplines about the direction of causation and about why the association arises although medical scientists are often convinced that the dominant if not exclusive pathway is that variation in socioeconomic status produces health disparities they are increasingly debating among themselves about why low economic status might lead to poor health at least for modern industrial countries 1 the old standby arguments the less well to do have access to less or lower quality medical care or a stronger pattern of deleterious personal behaviors have been rejected as insufficient instead a series of intriguing competing theories have arisen that emphasize long term impacts of early childhood or even inter uterine environmental factors the cumulative effects of prolonged exposures to individual stressful events or reactions to macro societal factors such as rising levels of income inequality a common link is that each theory attempts to document the physiological processes through which low economic status leads to poorer health while these scientific questions are extremely important this research has taken place with little input from economists economists are now making contributions about the alternative pathway the impact poor health may have on economic resources poor health may restrict a family s capacity to earn income or to accumulate assets by limiting work or by raising medical expenses at a minimum this work should provide a caution against exaggerating the magnitude of causation from economic status to health outcomes but the potential contribution runs deeper as people age the evolving variation in individual health outcomes may offer additional statistical information to estimate parameters of household savings and consumption behavior that so far have proven to be somewhat elusive thus incorporating health uncertainty and risk into economic models should eventually enrich our understanding of basic tenets of household behavior the first section of this paper documents the size of the association between health and one prominent economic status measure household wealth section two deals with how health influences economic status by sketching out reasons why health may alter household savings and eventually wealth and then providing estimates of the empirical magnitude of these effects section three shifts attention to the alternative pathway the links between economic status and health and summarizes 2major controversies and evidence surrounding these issues

the demand for health and health concerns after 30 years michael grossman s seminal model stressed that health production requires both goods and time yet recent empirical health research focuses primarily on personal medical care to the exclusion of other inputs to health future research should place greater emphasis on the roles of non medical consumption goods population level inputs and time in producing health capital improved information technology will allow researchers to dissect how education promotes efficiency in combining goods and time to produce health economic analyses of child health which is the antecedent of adult health must proceed in tandem with medical advances in understanding health development in childhood

survival versus consumption we develop an indirect method to estimate utility and willingness to pay wtp for reductions in the risk of death at various ages using a life cycle model of consumption we assume that an individual sets his consumption level each year so as to maximize his expected lifetime utility alternative assumptions about opportunities for borrowing and annuities characterize two polar types of societies in our robinson crusoe case an individual must be entirely self sufficient and annuities are not available in our perfect markets case an individual can borrow against future earnings and purchase actuarially fair annuities we show that under these assumptions wtp is the sum of livelihood discounted expected future earnings and consumer surplus to illustrate our methods we derive wtp for an average financially independent american man under plausible assumptions the model is calibrated to 1978 earnings e g 18 000 per year for men aged 45 54 with at least some income in the robinson crusoe case wtp increases from 500 000 at age 20 to a peak of 1 250 000 at age 40 and declines to 630 000 at age 60 in the perfect markets case age variations are less pronounced wtp is 1 050 000 at age 20 peaks at 1 070 000 at age 25 and declines to 600 000 at age 60 these results suggest that individuals value risks to their lives at several times the pro rata share of their future earnings

life expectancy and old age savings rich people women and healthy people live much longer than their poor male and sick counterparts two extremes taken from our analysis of single people in the assets and health dynamics of the oldest old ahead dataset illustrate this point an unhealthy 70 year old male at the twentieth percentile of the permanent income distribution expects to live only 6 more years that is to age 76 in contrast a healthy 70 year old woman at the eightieth percentile of the permanent income distribution expects to live 16 more years thus making it to age 86 such significant differences in life expectancy could all else equal lead to significant differ ences in saving behavior a related observation is that people with high permanent incomes keep large amounts of assets until very late in life table 1 also based on the

measuring literacy some extensions of the basu foster framework abstract this note builds further on the ideas of basu and foster 1998 and is concerned to advance the measurement of literacy taking due note of its positive external effects in a simple economical and interpretation friendly fashion

what did medicare do the initial impact of medicare on mortality and out of pocket medical spending abstract we study the impact of the introduction of one of the major pillars of the social insurance system in the united states the introduction of medicare in 1965 our results suggest that in its first 10 years the establishment of universal health insurance for the elderly had no discernible impact on elderly mortality however we find a substantial reduction in the elderly s exposure to out of pocket medical expenditure risk specifically we estimate that the introduction of medicare was associated with a 40 decline in out of pocket spending for the top quartile of the out of pocket spending distribution a stylized expected utility framework suggests that the welfare gains from such reductions in risk exposure alone may be sufficient to cover almost two fifths of the costs of medicare these findings underscore the importance of considering the direct insurance benefits from public health insurance programs in addition to any indirect benefits from an effect on health

fertility and child mortality in cote d ivoire and ghana this article examines individual household and community characteristics that may affect fertility in contemporary cote d lvoire and ghana and the relationship between child mortality and fertility it was not possible to reject the null hypothesis that child mortality is exogenous treating child mortality as exogenous fertility responds directly to child mortality but by a smaller proportion than estimated in studies of east asia and latin america increases in female education and urbanization are likely to contribute to declines in fertility in both countries but economic growth without these structural changes is not yet strongly related to lower fertility

a model of declining health and retirement the declining u s average retirement age has been difficult to reconcile with cross section evidence that poor health is a primary cause of early retirement this paper reconciles those observations by building a grossman type model of investment in health distinguished from its predecessor by a more formal treatment of initial conditions a discontinuous mid life increase in health investment retirement is shown in general to be part of the optimal investment strategy time series productivity increases are shown to lower the optimal retirement age while varying health endowments and depreciation rates are shown to be able to account for cross section retirement age variations

literacy and intrahousehold externalities abstract the size of the intrahousehold externality created when a literate household member provides literacy services to illiterate members is estimated in this paper using a model of children s height for age in papua new guinea this externality appears to be large these results support the use of a new measure of literacy developed by basu and foster 1998 to take account of the gains when illiterates live in households where at least one person is literate regional rankings change when the new measure of literacy is used suggesting that policies guided by the usual measure of adult literacy may overlook an important pathway for human development

how social security and medicare affect retirement behavior in a world of incomplete markets this paper provides an empirical analysis of how the u s social security and medicare insurance system affect the labor supply of older males in the presence of incomplete markets for loans annuities and health insurance we estimate a detailed dynamic programming dp model of the joint labor supply and social security acceptance decision focusing on a sample of males in the low to middle income brackets whose only pension is social security the dp model delivers a rich set of predictions about the dynamics of retirement behavior and comparisons of actual vs predicted behavior show that the dp model is able to account for wide variety of phenomena observed in the data including the pronounced peaks in the distribution of retirement ages at 62 and 65 the ages of early and normal eligibility for social security benefits respectively we identify a significant fraction of health insurance constrained individuals who have no form of retiree health insurance other than medicare and who can only obtain fairly priced private health insurance via their employer s group health plan the combination of significant individual risk aversion and a long tailed pareto distribution of health care expenditures implies that there is a significant security value for these individuals to remain employed until they are eligible for medicare coverage at age 65 overall our model suggests that a number of heretofore puzzling aspects of retirement behavior can be viewed as artifacts of particular details of the social security rules whose incentive effects are especially strong for lower income individuals and those who do not have access to fairly priced loans annuities and health insurance

consumption and investment demand when health evolves stochastically abstract the health capital model of grossman 1972 is extended to account for uncertainty in the rate at which a stock of health depreciates two general versions of the model are contemplated one with a fully functioning financial market and the other in its absence the comparative dynamics of the feedback form of the consumption and health investment demand functions are studied in these general settings where it is shown that the key to deriving refutable results is to determine how a parameter or state variable affects the expected lifetime marginal utilities of health and wealth to add further reach to the results a simplified stochastic control problem is explicitly solved yielding estimable structural feedback demand functions