aging and inequality in income and health in our earlier work we used data from the national health interview survey nhis to examine life cycle patterns in health status and in the joint distribution of health status and income deaton and paxson 1998 in this paper we summarize and extend those results and provide new evidence from the panel study of income dynamics psid both surveys contain a measure of household income and collect information on an ordinal measures of self reported health status srhs that ranges from 1 excellent to 5 poor section i concerns problems related to the measurement of inequality in health section ii presents evidence from the two surveys on health and income inequality this abstract was borrowed from another version of this item

longitudinal determinants of end of life wealth inequality abstract inequality in wealth among elderly households and in particular the prevalence of very low wealth holdings can be an important consideration in the design of social insurance programs this paper examines the incidence and determinants of low levels of financial and total wealth using repeated cross sections of the health and retirement study hrs and a small longitudinal sample of hrs respondents observed both at age 65 and shortly before death most of those who report very low wealth holdings at the end of their life had little wealth at the traditional retirement age of 65 there is strong persistence over time in reports of very low wealth and more generally relatively little evidence that wealth is drawn down in the first 15 years of retirement the age specific probability of reporting low wealth increases slowly after age 65 low lifetime earnings are strongly predictive of low wealth at retirement and at the end of life the post retirement onset of a major medical condition and for married women the loss of their spouse are both associated with small increases in the probability of reporting very low wealth but they account for a small fraction of low wealth outcomes low levels of wealth accumulation before age 65 rather than gaps in the safety net after 65 or rapid spend down of accumulated assets appear to be the primary determinant of low levels of wealth just before death

deriving distributional weights for qalys through discrete choice experiments this paper presents the first attempt to use a discrete choice experiment to derive distributional weights for quality adjusted life years qalys based on characteristics age and severity of the beneficiaries a novel approach using the hicksian compensating variation is applied advantages include derivation of weights for qalys not just for life or life years saved and investigation of the impact of the size of the health gain by allowing the gain to be traded against other characteristics results suggest one would generally not weight qalys except in a small number of specific cases and in those cases the weights are relatively small methodological challenges are highlighted as is a future research agenda

eliciting people s preferences for the distribution of health a procedure for a more precise estimation of distributional weights in order to incorporate distributional concerns into cost effectiveness analysis it would be useful to elicit distributional weights that express people s valuation of marginal health gains at various levels of health distributional preferences are commonly elicited either through a person trade off pto or a gain trade off gto technique an inherent problem of the gto is that it is based on the valuation of non marginal health gains in practice many contributions using the pto also focus on non marginal health gains this paper demonstrates that the failure to distinguish appropriately between marginal and non marginal health gains may lead to seriously misleading estimates of distributional weights moreover the paper proposes a methodology for utilising information obtained through non marginal analysis more efficiently in order to obtain more reliable estimates of distributional weights the methodology was successfully applied in an empirical study of age weights

the effect of income on mortality evidence from the social security notch abstract legislation in the 1970s created a notch in social security payments with those born after january 1 1917 receiving sharply lower benefits using restricted use versions of the national mortality detail file combined with census data we use this quasi experiment to examine the income mortality link in an elderly population estimates from difference in difference and regression discontinuity models show the higher income group has a statistically significantly higher mortality rate contradicting the previous literature we also found that younger cohorts responded to lower incomes by increasing postretirement work effort suggesting that moderate employment has beneficial health effects for the elderly

means testing versus universal provision in poverty alleviation programs this paper contrasts the use of means tested and universal schemes in the alleviation of poverty using a class of poverty measures the authors illustrate the trade off from the fact that means testing is costly to both the government and the claimant while universal provision entails a leakage to the nonpoor the paper provides numerical as well as analytical results copyright 1990 by the london school of economics and political science

the direction of developing country trade empirical evidence of differences between south south and south north trade abstract declining market opportunities in northern markets led to views that greater south south trading might provide an alternative growth stimulus this paper analyses the characteristics of south south trade in manufactures and recent changes in the level of such trade to help clarify the potential of greater self reliance within the south south south trade is found to be more intensive in the use of both physical and human capital hence less rational from the static comparative advantage viewpoint than south north trade there is indirect but strong evidence that exporting countries with greatest orientation towards the south are those with greater distortions less rapid movements up the ladder of comparative advantage and weaker export performance finally it is observed that the recent boom in south south trade is largely explained by simple market size effects very rapid growth of rich oil exporters and the faster gnp growth of developing compared to developed countries the paper concludes that while south south trade of about the present magnitude one of greater developing country exports is certainly rational there is little evidence to support views that greater south south trade should be especially promoted arguments of dynamic comparative advantage may favor south south trade but so far these have been more speculative and not yet well researched empirically

learning and the time interdependence of costa rican exports abstract exports may enhance learning through production induced learning by doing learning to export by doing and flows of information from customers we provide evidence on the learning effects of export destination for costa rica for 1955 through 1980 we examine granger causality results and export trends to determine relationships between exports to the central american common market cacm the rest of the south and the north increasing exports to the cacm appear to promote learning in machinery leather and intermediate manufactures we also find that the cacm redirects some exports away from northern markets probably with damaging consequences

determinants of the structure of u s foreign trade 1958 1976 abstract the heckscher ohlin model with three direct factor inputs is borne out for u s net exports of manufactures in annual cross section regressions for 1958 1976 the coefficient on unskilled labor became significantly more negative over the period and there is evidence that the negative sign on physical capital may reflect the inclusion of natural resource industries further analysis based upon 1960 and 1970 census years suggests the importance as well of skill and technological variables calculations of the total factor requirements of u s trade uphold the leontief paradox for 1958 but not for 1972

the long term impact of military service on health evidence from world war ii and korean war veterans during the world war ii and korean war era the u s military freely distributed cigarettes to overseas personnel and provided low cost tobacco products on domestic military bases in fact even today the military continues to sell subsidized tobacco products on its bases using a variety of instrumental variables approaches to deal with nonrandom selection into the military and into smoking we provide substantial evidence that cohorts with higher military participation rates subsequently suffered more premature mortality more importantly we show that a large fraction 35 to 79 percent of the excess veteran deaths due to heart disease and lung cancer are attributable to military induced smoking

estimating the effect of income on health and mortality using lottery prizes as an exogenous source of variation in income a vast literature has established a strong positive relation between income and health status and a negative relation with mortality this paper studies the effects of income on health and mortality using only the part of income variation due to a truly exogenous factor monetary lottery prizes of individuals the findings are that higher income causally generates good health and that this effect is of a similar magnitude as when traditional estimation techniques are used a 10 percent income increase improves health by about 4 5 percent of a standard deviation

the determinants of vote intentions in portugal this paper offers new insights on theinteractions between economics and politicsin portugal we use two unexplored datasets consisting of monthly polls on voteintentions for the main political partiesin portugal and responses to a consumersurvey containing a battery of questions oneconomic evaluations the analysis coversthe interval from 1986 to 2001 we findthat 1 right wing governments arepenalized for higher inflation while theleft wing ones are not 2 left winggovernments are more penalized forincreases in the unemployment rate 3 voters base their evaluations ofincumbents performances on perceptions ofpast and current economic conditions rather than on expected future economicoutcomes

the pervasive effects of family on entrepreneurship toward a family embeddedness perspective families and businesses have often been treated as naturally separate institutions whereas we argue that they are inextricably intertwined long term changes in family composition and in the roles and relations of family members have produced families in north america that are growing smaller and losing many of their previous role relationships such transformations in the institution of the family have implications for the emergence of new business opportunities opportunity recognition business start up decisions and the resource mobilization process we suggest that entrepreneurship scholars would benefit from a family embeddedness perspective on new venture creation d 2003 elsevier science inc all rights reserved

income inequality and health status in the united states evidence from the current population survey several recent studies have identified an association between income inequality and aggregate health outcomes this has been taken to be evidence that inequality is detrimental to individual health we use data from the 1995 99 march current population survey to examine the effect of income inequality on individual health status for both the general population and those individuals in poverty we find no consistent association between income inequality and individual health status our results contradict recent claims that the psychosocial effects of income inequality have dramatic consequences for individual health outcomes

does health insurance reduce illness related worker absenteeism the objective of this article is to examine whether having health insurance reduces illness related absenteeism among older workers a nationally representative sample of 1780 workers in the united states aged 52 64 are drawn from the 2004 2006 health and retirement study hrs binary logistic regressions and censored tobit models are estimated for workers likelihood of missing work days due to illness and the number of illness related work days missed respectively while explicitly addressing the possibility of insurance selection effects the findings suggest that over a 12 month period older workers without health insurance are as likely as insured workers to miss work days due to illness and there are no differences in the number of days missed between insured and uninsured workers however there is strong evidence that poor baseline health onset of new diseases and longer hospitalization significantly increase an older worker s absenteeism at work these results suggest that having health ins

inter vivos transfers and bequests in three oecd countries reforms reducing the generosity of pensions have distributional effects on future generations if individuals care about their descendants welfare but only affect elderly individuals if bequests are the unintentional result of precautionary savings and safety net programmes such as unemployment insurance may displace sources of private help such as that provided by living parents to their children in need this paper provides comparable measures of how expected bequests and transfers vary with cumulated parental earnings in the united states west germany and the united kingdom the strength of bequest motives is empirically very weak in the available data private inter vivos transfers which appear to depend on the recipients economic situation are partly crowded out by public unemployment insurance programmes together involuntary bequests and intentional inter vivos transfers appear to be an important channel of intergenerational inequality transmission and strengthen substantially the relationship between an individual s and his parents economic status ernesto villanueva

determinants of healthcare spending a state level analysis within the high and rising level of healthcare spending for the us as a whole is substantial variation in spending across states yet relatively little attention has been given to the empirical analysis of interstate differences in aggregate healthcare expenditures and therefore little empirical evidence exists at the state level to guide policymakers using data for all 50 states for the year 1998 we estimate an empirical model that includes structural and reduced form healthcare spending equations and a health production function to assess the significance size and relative importance of factors that prior research indicates may play an important role in explaining interstate variation in medical care expenditures and the main pathways through which they operate our results indicate higher levels of healthcare spending for state populations with higher income less education fewer uninsured residents less healthy lifestyles larger proportion of elderly residents greater availability of medical

should income transfers be targeted or universal insights from public pension influences on elderly mortality in canada 1921 1966 we investigate the impact of canada s means tested and universal public pension programs on the mortality rates of age groups eligible for pension benefits for the period 1921 1966 we find that only the universal program significantly reduced pension eligible age group mortality rates the implied social value of the mortality risk reduction from this program is one tenth of the value per statistical life associated with contemporary government policy meaning that canadians did not need to place a high value on the life of a senior to justify the higher cost of the universal program jel classification i3 j1 on analyse l impact des regimes de rentes universels et de ceux qui impliquent une enquete sur la situation de fortune sur les taux de mortalite des groupes d ge eligibles aux prestations de retraite pour la periode 1921 1966 on decouvre que seulement les regimes universels reduisent de maniere significative les taux de mortalite des groupes d ge eligibles la valeur sociale implicite de la reduction du risque de mortalite attribuable a un tel regime est egale a un dixieme de la valeur de la vie statistique associee aux politiques contemporaines des gouvernements voila qui signifie que les canadiens n ont pas a attribuer une grande valeur a la vie d un aine pour justifier le cout plus eleve du programme universel

the dynamics of health in the british household panel survey this paper considers the dynamics of a categorical indicator of self assessed health using eight waves 1991 1998 of the british household panel survey bhps our analysis has three focal points the relative contributions of state dependence and heterogeneity in explaining the dynamics of health the existence and consequences of health related sample attrition and the investigation of the effects of measures of socioeconomic status with a particular focus on educational attainment and income to investigate these issues we use dynamic panel ordered probit models there is clear evidence of health related attrition in the data but this does not distort the estimates of state dependence and of the socioeconomic gradient in health the models show strong positive state dependence and heterogeneity accounts for around 30 of the unexplained variation in health copyright 2004 john wiley sons ltd

a model of longevity fertility and growth abstract economic and demographic outcomes are determined jointly in a dynamic general equilibrium model of longevity fertility and growth reproductive agents in overlapping generations mature safely through two periods of life and face an endogenous probability of surviving for a third period given this probability each agent maximises her expected lifetime utility by choosing consumption and the number of children child bearing is costly in the sense that time must be spent on child rearing activities rather than on production or education the model produces multiple development regimes which yield different predictions about life expectancy fertility timing of births and educational investment depending on initial conditions these predictions accord strongly with the empirical evidence on demography and development

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

income related inequality in life years and quality adjusted life years abstract we estimate the income related inequality in sweden with respect to life years and quality adjusted life years qalys we use a large data set from sweden with over 40 000 individuals followed up for 10 16 years to estimate the survival and quality adjusted survival in different income groups for both life years and qalys we discover inequalities in health favouring the higher income groups for men women in the youngest age group 20 29 years the number of qalys is 43 7 45 7 in the lowest income decile and 47 2 49 0 in the highest income decile

the effect of pensions on longevity evidence from union army veterans this study uses changes in pension laws for union army veterans as a natural experiment to estimate the causal effect of pensions on longevity and to examine potential pathways underlying such a relationship we examine the effects of the pension laws of 1907 and 1912 which granted old age pensions to union army veterans life expectancy for veterans who received such a pension increased by 0 5 years and 2 7 years respectively the effect of veteran pensions on longevity was large across wealth groups and size of city pensions reduced mortality for both acute and non acute causes of death

cognitive abilities and portfolio choice we study the relation between cognitive abilities and stockholding using the recent survey of health ageing and retirement in europe share which has detailed data on wealth and portfolio composition of individuals aged 50 in 11 european countries and three indicators of cognitive abilities mathematical verbal fluency and recall skills we find that the propensity to invest in stocks is strongly associated with cognitive abilities for both direct stock market participation and indirect participation through mutual funds and retirement accounts since the decision to invest in less information intensive assets such as bonds is less strongly related to cognitive abilities we conclude that the association between cognitive abilities and stockholding is driven by information constraints rather than by features of preferences or psychological traits

comorbidities and the willingness to pay for health improvements we show that the willingness to pay for health improvements increases with the severity and probability of occurrence of comorbidities this result which is obtained under mild restrictions on the shape of the utility function has important implications for cost benefit studies applied to health care in particular it implies that the discrimination of the elderly believed to be implicit in cost benefit analysis is less of a problem than commonly thought

the determinants of mortality mortality rates have fallen dramatically over time starting in a few countries in the 18th century and continuing to fall today in just the past century life expectancy has increased by over 30 years at the same time mortality rates remain much higher in poor countries with a difference in life expectancy between rich and poor countries of also about 30 years this difference persists despite the remarkable progress in health improvement in the last half century at least until the hiv aids pandemic in both the time series and the cross section data there is a strong correlation between income per capita and mortality rates a correlation that also exists within countries where richer better educated people live longer we review the determinants of these patterns over history over countries and across groups within countries while there is no consensus about the causal mechanisms we tentatively identify the application of scientific advance and technical progress some of which is induced by income and facilitated by education as the ultimate determinant of health such an explanation allows a consistent interpretation of the historical cross country and within country evidence we downplay direct causal mechanisms running from income to health

the insurance value of medical innovation abstract economists think of medical innovation as a valuable but risky good producing health benefits but increasing financial risk for consumers and healthcare payers this perspective overlooks how innovation can lower physical risks borne by healthy patients facing the prospect of future disease we present an alternative framework that accounts for all these sources of value and links them to the value of healthcare insurance we show that any innovation worth buying reduces overall risk and generates positive insurance value on its own we conduct a stylized numerical exercise to assess the potential empirical significance of our insights our calculations suggest that conventional methods meaningfully understate the value of historical health gains and disproportionately undervalue treatments for the most severe illnesses where physical risk to consumers is the costliest these calculations also suggest that the value of physical insurance from new technologies may exceed the financial spending risk that they pose

can a small social pension promote labor force participation evidence from the colombia mayor program one of the primary motivations behind the establishment of noncontributory pension programs is to allow beneficiaries to retire from the labor force yet as with other unconditional cash transfer schemes their aggregate effects may be more complex using panel data and instrumental variable techniques this paper shows that the effect of one such program colombia mayor has been to raise the labor force participation of relatively younger male beneficiaries this increase occurred precisely in the occupations with characteristics that are likely to require some up front investment the paper concludes that the transfer effectively loosened the liquidity constraints to remaining in these occupations however no such effect is found among women or older beneficiaries

worker absence and productivity evidence from teaching a significant amount of work time is lost each year due to worker absence but evidence on the productivity losses from absenteeism remains scant due to difficulties with identification we use uniquely detailed data on the timing duration and cause of absences among teachers to address many of the potential biases from the endogeneity of worker absence our analysis indicates that worker absences have large negative impacts the expected loss in daily productivity from employing a temporary substitute is on par with replacing a regular worker of average productivity with one at the 10th 20th percentile of productivity

mortality health status and wealth in this paper we use the two waves of the british retirement survey 1988 1989 and 1994 to quantify the relationship between socioeconomic status and health outcomes we find that even after conditioning on the initial health status wealth rankings are important determinants of mortality and the evolution of the health indicator in the survey for men aged 65 moving from the 40th percentile to the 60th percentile in the wealth distribution increases the probability of survival by between 1 0 and 1 9 percentage points depending on the measure of wealth used a similar effect is found for women of between 1 1 and 1 3 percentage points in the process of estimating these effects we control for nonrandom attrition from our sample

are some lives more valuable an ethical preferences approach we develop a theoretical model of the ethical preferences of individuals combining individual social welfare functions and random utility theory the model is applied by conducting a choice experiment regarding safety enhancing road investments that target different age groups and road user types the relative value of a saved life is found to decrease with age such that the present value of a saved life year is almost independent of age at a pure rate of time preference of a few percent moreover a saved pedestrian is consistently valued higher than a saved car driver of the same age

average earnings and long term mortality evidence from administrative data in this paper we exploit a unique database that merges longitudinal earnings data on pennsylvanian workers with national death records to study the detailed nature of the corre lation between earnings and mortality we find that the estimates typically reported in the lit erature which are based on single years of earn ings data are likely to understate substantially the strength of the association between income and mortality in particular relative to a single year of earnings the average of earnings over a six year period predicts a 70 percent greater impact of income on mortality in addition con trolling for the mean level of earnings over a period we find that greater earnings volatility is associated with higher mortality we also examine the lag structure of the rela tionship between earnings and mortality we

a median voter model of health insurance with ex post moral hazard abstract one of the main features of health insurance is moral hazard as defined by pauly pauly m v 1968 the economics of moral hazard comment american economic review 58 531 537 people face incentives for excess utilization of medical care since they do not pay the full marginal cost for provision to mitigate the moral hazard problem a coinsurance can be included in the insurance contract but health insurance is often publicly provided having a uniform coinsurance rate determined in a political process is quite different from having different rates varying in accordance with one s preferences as is possible with private insurance we construct a political economy model in order to characterize the political equilibrium and answer questions like under what conditions is there a conflict in society on what coinsurance rate should be set and which groups of individuals will vote for a higher and lower than equilibrium coinsurance rate respectively we also extend our basic model and allow people to supplement the coverage provided by the government with private insurance then we answer two questions who will buy the additional coverage and how do the coinsurance rates people are now faced with compare with the rates chosen with pure private provision

socioeconomic inequality of access to healthcare does choice explain the gradient equity of access is a key policy objective in publicly funded healthcare systems however observed inequalities of access by socioeconomic status may result from differences in patients choices using data on non emergency coronary revascularisation procedures in the english national health service we found substantive differences in waiting times within public hospitals between patients with different socioeconomic status up to 35 difference or 43 days between the most and least deprived population quintile groups using selection models with differential distances as identification variables we estimated that only up to 12 of these waiting time inequalities can be attributed to patients choices of hospital and type of treatment heart bypass versus stent residual inequality after allowing for choice was economically significant patients in the least deprived quintile group benefited from shorter waiting times and the associated health benefits were worth up to 850 per person

trade policy and distortions in intra asian trade this paper analysis wheather the level of tariffs and non tariff barriers affect the pattern of inter industry trade within asia the heckscher ohlin theorem is based on the assumption of efficient resource allocation however markets in many developing countries protect the domestic production by trade barriers we would therefore expect the pattern of production and trade not to reflect comparative advantages perfectly it is found that import charges and non tariff barriers have a significant positive impact on capital intensities in net export

the changing dis utility of work we study how changes in the distribution of occupations have affected the aggregate non pecuniary costs and benefits of working the physical toll of work is less now than in 1950 with workers shifting away from occupations in which people report experiencing tiredness and pain the emotional consequences of the changing occupation distribution vary substantially across demographic groups work has become happier and more meaningful for women but more stressful and less meaningful for men these changes appear to be concentrated at lower education levels

causal effects of health shocks on consumption and debt quasi experimental evidence from bus accident injuries abstract endogeneity between health and wealth presents a challenge for estimating causal effects of health shocks using a quasi experimental design comprising exogenous shocks sustained as bus accident injuries in india with controls drawn from travelers on the same bus routes one year later i present new evidence of causal effects on consumption and debt using primary household survey data i find that households faced with shock related expenditures are able to smooth consumption on food housing and festivals with small reductions in educational spending debt was the principal mitigating mechanism households used leading to significantly larger levels of indebtedness

modelling the take up of means tested benefits the case of housing benefits in the united kingdom official estimates of housing benefit take up rates suggest that up to two million families in the united kingdom ma y not be receiving the help with their housing costs to which they ar e entitled the authors interest in the take up of means tested bene fits is therefore motivated by two concerns the first is the governm ent revenue implications of a change to benefit entitlement levels t he second relates to the welfare of individuals who fail to claim the ir entitlement to benefit in this paper the authors investigate the relationship between the take up of means tested housing benefit in dividual socioeconomic characteristics and the level of entitlement copyright 1987 by royal economic society

a theory of time preference grant a taylor this article proposes that people generally prefer present consumption to future consumption because their expected utility from consumption eventually falls as their mental and physical abilities eventually decline with age moreover contrary to the ubiquitous intertemporal formulation with a constant rate of time preference and contrary to three recent theories of time preference that predict decreasing discounting as people age this article asserts that discounting increases over the life cycle this hypothesis is supported by data from the panel study of income dynamics as well as evidence from numerous previous studies jel d91 1 introduction despite the almost universal assumption of time preference in models of intertemporal choice an adequate explanation of why people discount the future has not been provided 1 olsen and bailey 1981 make a convincing case for positive time preference by contradiction i e without time preference models of intertemporal choice do not yield predictions consistent with observed behavior but they do not explain why individuals would rationally discount the future 2 three recent studies have attempted to provide the explanation rogers 1994 argues that societies that discount the future at a rate of about 2 will be the long run survivors in an evolutionary fitness situation 3 posner 1995 argues that discounting occurs because individuals have multiple selves that is people are weighting their present consumption far more heavily than their future consumption because the present self and the future self are in some meaningful sense separate persons 92 becker and mulligan 1997 argue that discounting occurs because of a rational defective recognition of future utilities 730 but as will be shown these three theories are inconsistent with empirical evidence on consumption over the life cycle in at least one important aspect this article constructs and empirically supports a new theory of time preference the hypothesis is that people do not have an intrinsic preference for present consumption relative to future consumption instead the instantaneous utility function also known as the felicity function is expected to vary with age just as people s physical and mental abilities vary with age in other words the ability to enjoy consumption eventually deteriorates over the life cycle along with other abilities this life cycle view of the expected utility function causes people to rationally devalue consumption in periods of low expected felicity that is discount future consumption perhaps this is what is meant by the cliche don t wait until you are too old to enjoy it moreover this causes individuals implicit discount rates to vary systematically with age 4 in fact this provides the testable implication of the theory the standard specification of intertemporal preferences holds the discount rate constant over th e life cycle 5 to be more precise in the early stage of the life cycle the capacity to enjoy consumption may be expected to rise hence a young individual s discount rate may be negative figure 1 illustrates this possibility with a hypothetical adult life cycle marginal felicity function for a given level of consumption u sub c c a c denotes consumption and a denotes age and its corresponding discount rate function rho a the vast majority of wealth is held by older people that is those in the declining stage of their abilities thus the preference for present consumption over future consumption appears to hold in the aggregate this view of intertemporal preferences may at first seem inconsistent with practically all dynamic analyses which are based on the notion of stationary utility on further consideration however the hypothesis is quite consistent with modern consumer theory since becker 1965 it has been widely accepted that households derive utility from commodities that are produced with market goods combined with household time and skills i

the evolution of medical spending risk how has the economic risk of health spending changed over time for u s households we describe trends in aggregate health spending in the united states and how private insurance markets and public insurance programs have changed over time we then present evidence from consumer expenditure survey microdata on how the distribution of household spending on health that is out of pocket payments for medical care plus the household s share of health insurance premiums has changed over time this distribution has shifted up over time households spend more on medical care and insurance than they used to but for the purposes of measuring change in risk it is not the mean but the dispersion of this distribution that is of interest we consider two measures of dispersion that serve as proxies for household risk the standard deviation of the distribution of household health spending and the ratio of the 90th percentile of spending to the median the so called 90 50 gap we find surprisingly that neither has increased despite the rapid rise in aggregate health spending this conclusion holds true for broad subgroups of the population for example the nonelderly as a group but not for some narrowly defined subgroups for example low income families with children we next consider how much risk households should face from the perspective of economic efficiency household risk may not have changed much over the past several decades but do we have any evidence that this level represents either too much or too little risk finally we discuss implications for public policy in particular for current debates over expanding health insurance coverage to the uninsured

mortality effects of regulatory costs and policy evaluation criteria this article concerns the cost benefit of policies designed to reduce risks of mortality in specific instances the author points out that risk regulations directly reduce risk but they may produce offsetting risk increases regulated risks generate a substitution effect as individuals risk averting actions will diminish recognition of these effects alters benefit cost criteria and the value of life estimates pertinent to policy analysis particularly expensive risk regulations may be counterproductive the expenditure level that will lead to the loss of one statistical life equals the value of life divided by the marginal propensity to spend on health regulations with a cost of 30 million to 70 million per life saved will on balance have a net adverse effect on mortality because of these linkages excerpt

beyond ses a resource model of political participation this paper develops a resource model of political participation the resources considered are time money and civic skills those communications and organizational capacities that are essential to political activity these skills are not only acquired early in life but developed in the nonpolitical institutional settings of adult life the workplace organizations and churches and synagogues these resources are distributed differentially among groups defined by socioeconomic status a two stage least squares analysis shows these resources have powerful effects on overall political activity thus explaining why socioeconomic status has traditionally been so powerful in predicting participation we disaggregate overall activity into three kinds of acts those that involve giving time those that entail donating money and voting each requires a different configuration of resources resulting in different patterns of stratification across various political acts

wealth health and child development evidence from administrative data on swedish lottery players we use administrative data on swedish lottery players to estimate the causal impact of substantial wealth shocks on players own health and their children s health and developmental outcomes our estimation sample is large virtually free of attrition and allows us to control for the factors conditional on which the prizes were randomly assigned in adults we find no evidence that wealth impacts mortality or health care utilization with the possible exception of a small reduction in the consumption of mental health drugs our estimates allow us to rule out effects on 10 year mortality one sixth as large as the crosssectional wealth mortality gradient in our intergenerational analyses we find that wealth increases children s health care utilization in the years following the lottery and may also reduce obesity risk the effects on most other child outcomes including drug consumption scholastic performance and skills can usually be bounded to a tight interval around zero overall our findings suggest that in affluent countries with extensive social safety nets causal effects of wealth are not a major source of the wealth mortality gradients nor of the observed relationships between child developmental outcomes and household income jel codes i10 i14 j24

moving through the political participation hierarchy a focus on personal values this study empirically explores the determinants of political participation using data from the european social survey we investigate the relationship between political participation and personal values using the schwartz 1992 values inventory a political participation hierarchy is theorized and activities are categorized into four levels of participation none weak medium and strong based on the cost of participating and how unconventional the activity is empirical analysis points to individuals who are more open to change and more self transcendent being more likely to participate sub sample analysis contrasting east and west europe suggests that the role for personal values is more subdued in the east with respect to moving individuals from not participating to at least voting furthermore the use of a generalized ordered logit model in this study illustrates the complex nature of many of the determinants of political participation in particular we find that the influence of the maj

cost of living real wages and real incomes in thirteen canadian cities 1900 1950 price indices for thirteen canadian cities for 1900 to 1950 demonstrate large regional differences in cost of living until 1914 after 1914 regional price levels converged before the war western canadian cities had the highest cost of living after 1920 cities in ontario had the highest cost of living accounting for these trends in regional costs of living reveals that regional real wage and real income structures have been present and stable since at least 1901 thus regional wage and income disparities are long standing and persistent features of the canadian economy cout de la vie salaires reels et revenus reels dans treize villes canadiennes les indices de prix pour treize villes canadiennes entre 1900 et 1950 montrent qu il y avait de fortes differences dans le cout de la vie jusqu en 1914 apres 1914 il y a convergence des niveaux de prix regionaux avant la guerre les villes de l ouest canadien avaient le cout de la vie le plus eleve apres 1920 des villes de l ontario vont avoir le plus haut cout de la vie si l on tient compte de ces tendances regionales dans les niveaux du cout de la vie il appert que des structures de salaires et de revenus reels ont ete en place et stables depuis 1901 donc les disparites regionales de salaires et de revenus sont des caracteristiques deja anciennes et persistantes de l economie canadienne

should social security benefits be means tested social security retirement benefits distort the saving decisions of workers who are rational enough to save for their future since the implicit rate of return in an unfunded social security program is less than the marginal product of capital the resulting decline in saving causes a welfare loss the present paper examines the conditions under which the welfare loss could be reduced by replacing the current universal social security program with a means tested program that pays benefits only to those individuals with little or no other retirement income or assets every society must solve the problem of supporting those individuals who become too old to work but have not made adequate provision for their own old age by saving when they were young at the present time the major industrial countries of the world have responded to this problem by creating social security programs that tax the working population and use the proceeds to provide a universal benefit to all retirees regardless of their financial condition this universal provision of social security benefits distorts the saving decisions of those workers who are rational enough to plan for the future since the implicit rate of return that taxpayers get on their this research is part of the nber study of the government budget and the private economy a more complete version of this paper with some numerical calculations is available as nber working paper no 1775 feldstein 1985b i am grateful to gilbert metcalf for assistance with the calculations presented in this paper and for helpful discussions for a discussion of the effect of promised retirement benefits on the savings of employees see feldstein 1974 1982 barro 1974 1978 has discussed an interesting

the general validity of the heckscher ohlin theorem despite a number of attempts to extend it the heckscher ohlin theorem remains woefully restricted in terms of the generality of the assumptions needed for its proof in its traditional form as a statement about the commodity composition of trade the theorem is valid only in the highly abstract environment of the two factor two good twocountry model that has been the mainstay of trade theory for half a century a weaker version of the theorem involving the factor content of trade rather than its commodity composition has been proved for any number of factors goods and countries but this generality has so far been bought only at the cost of other and perhaps equally restrictive assumptions 2 the purpose of this paper is to provide statements and proofs of the heckscher ohlin h o theorem that are more general than those currently available the approach taken is similar to that used in my 1980 article for an extension of the theory of comparative advantage in terms of correlations between autarky prices and trade in section i i lay out the assumptions on which the analysis is based these assumptions provide the outlines of a reasonably general model in which there may be any numbers of goods and factors and in which factor prices may be equalized or not trade impediments in the form of tariffs or export taxes are permitted though transportation costs are not 3 in section ii i discuss the difficulty of inferring the factor content of trade in a world of unequal factor prices and i provide several alternative definitions of that concept for use later in the paper these together with the assumptions of section i are used in section iii to prove a theorem on the value at autarky prices of the factor content of trade in section iv this theorem is used to prove a first corollary that makes a more direct statement about the pattern of trade it says that worldwide there must be a negative correlation between the factor content of trade by factor and country and the corresponding autarky factor prices it is precisely these autarky factor prices that constitute the ohlin measure of factor scarcity therefore the corollary provides a formal statement of the general idea that countries tend to export the services of those factors which they have in relative abundance and it may be regarded as a generalization of the factor content version of the h o theorem finally a generalization of the commodity version of the theorem is proved in section v the concept of a covariance is generalized university of michigan i have benefitted greatly from the comments of paul degrauwe wolfgang mayer michael mussa carl simon and robert stern as well as others who participated in seminars at the universities of michigan chicago and cincinnati and at the national bureau of economic research an anonymous referee also made valuable comments with additional goods and factor price equalization the theorem runs afoul of the indeterminacy of production and trade noted by paul samuelson 1953 and james melvin 1968 without factor price equalization trade impediments and intermediate production can cause reversals of the pattern of trade as shown in my 1979 article if additional factors and countries are also added it becomes difficult even to state the theorem let alone to prove it 2melvin stated such a theorem for the three good two factor case and jaroslav vanek 1968 proved it for the general case but only by assuming factor price equalization trent bertrand 1972 and jon harkness 1979 were able to drop the factor price equalization assumption but replaced it with restrictions on consumption of either goods or factors by country of origin it is unclear to me however that these restrictions can ever be met in a model that is otherwise plausible harkness 1978 has also used the factor content version of the theorems as the motivation for a regression equation relating commodity trade to factor intensities this bears some resemblance to my analysis below in section v see however james anderson 1981 and edward leamer and harry bowen 1981 who have criticized his result with a reply by harkness 1981 3for ease of exposition i do not allow here for transportation costs these were included in an earlier version of this paper following the technique in my 1980 article

inequality aversion in income health and income related health abstract based on a survey of a sample of the general public we estimate inequality aversion across income health and bivariate income health inequality aversion is domain specific mean inequality aversion is greater for income than for health but the underlying distributions of aversion attitudes differ with a highly bi modal distribution of inequality aversion values for health in which nearly half the participants display very low aversion and nearly half display very high aversion aversion to income related health inequality is greater than that to income or health alone consistent with previous literature we find only weak associations between aversion attitudes and individual characteristics the magnitude of the estimates implies potentially large gains in welfare from reducing inequality in these domains

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

trade patterns in developing countries 1964 82 this paper presents a regression analysis of import and export shares of gdp for 14 commodity and service categories in 55 developing countries over the period 1964 82 explanatory variables include gnp per capita population domestic capacity utilization the effective exchange rate and oecd real gnp for exports among other findings it is shown that countries trade patterns are not closely related to their growth performance and that developing countries on average run surpluses of exports over non capital goods imports on merchandise trade the current commodity surplus is required to offset imports of capital goods and a structural deficit on factor and non factor service trade

an experimental study of expressive voting in this paper we report results of an initial attempt to test the theory of expressive voting our experiment involves requiring subjects to vote between receiving a in cash or having b donated to charity on their behalf across subjects we vary the probability that their vote will decide which disbursement is made as the probability of being decisive is lowered the opportunity cost of giving expression to charitable sentiment decreases hence the likelihood of voting in accordance with such sentiment is expected to increase we find weak support for the hypothesis but the results do not replicate when we alter the parameter settings limitations of our design are discussed

income productivity in china on the role of health this study provides empirical evidence regarding the income productivity of health human capital in china we appeal to concepts from human capital theory to support a basic model that treats health as a form of human capital in the income production process our model examines the economic return at the household level from the health of its individual members we estimate this with a longitudinal sample drawn from the china health and nutrition survey chns allowing us to exploit within variation in health and income to address possible unobservables biasing estimates of the impact of health on income in the simple cross sectional setting household income is strongly influenced by the health of its members particularly in rural areas these findings could have important implications for health and economic policy making aimed at reducing the long standing urban rural economic gap and more comprehensively insuring the rural population against health and economic risk

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

how to measure the economic impact of vector borne diseases at country level vector borne diseases vbds are widespread in less developed countries and reemerging in developed ones available economic studies agree that vbds have significant effects on countries economic outcomes and affirm that a systematic evaluation of such effects is crucial for the efficient allocation of resources to health related priorities this paper provides a comparative assessment of available methodologies for measuring the economic impact of vbds at national level we review both macroeconometric and micro based approaches and examine advantages and disadvantages of current methods we conclude by suggesting possible areas for future research

uncertain health and survival effects on end of life consumption this article analyzes the impact of health and survival uncertainty on the saving and consumption decisions of retirees a dynamic programming approach is used to model the household s planning problem the utility parameters are estimated using panel data we find that a fall into poor health raises the marginal utility from consumption simulations are used to indicate the effects of falling into poor health and loss of spouse they reveal a large transfer from the healthy to the sick partner and a strong dependence of saving on the survivor benefits suggesting that concern about the surviving spouse is an important motive for saving

measurement of health state utilities for economic appraisal health status measurement for use in economic appraisal of health care programmes is reviewed in this paper with particular emphasis on utility measurement a framework for economic appraisal is presented displaying the various components that must be measured and showing how the three forms of analysis cost effectiveness analysis cost benefit analysis and cost utility analysis relate to the framework and to each other one of the components in the framework is health status it can be measured using ad hoc numeric scales willingness to pay receive or health state utilities the determination of health state utilities is reviewed covering the following issues alternative sources of utilities health state descriptions multi attribute utility approach determination of appropriate subjects utility aggregation and accuracy three measurement techniques for health state utilities are described in detail rating scale standard gamble and time trade off the use of these methods is described for both chronic and temporary health states and for both health states considered better than death and those considered worse than death

economic evaluation of services for a national health scheme the case for a fairness based framework in this paper we argue that the usual framework for evaluating health services may need modification in the context of a national health scheme nhs some costs and benefits may need to be ignored or discounted others included at face value and some transfer payments included in the decision algorithm in contrast with the standard framework we argue that economic evaluation in the context of an nhs should focus on social transfers between taxpayers and beneficiaries and that the nature and scope of these transfers is determined by the level of social generosity some of the implications of a modified framework are illustrated with a re examination of i costs and transfer payments ii unrelated future costs iii moral hazard and iv the rule that marginal costs should equal marginal benefits we argue that an explicitly fairness based framework is needed for the evaluation of services in an nhs in contrast the usual welfare economic theoretic framework facilitates the sidelining of issues of fairness

health status and portfolio choice causality or heterogeneity abstract this paper explores the role of unobserved individual characteristics in the health assets and health portfolio correlations we apply various econometrics models to a unique longitudinal dataset with rich information that allows for the exploitation of four different health indices our findings show strong cross sectional correlations between health and both financial and non financial assets but these correlations seem to be mainly driven by heterogeneity as the correlations largely disappear in the fixed effects model adverse health shocks however are found to motivate a safer portfolio choice even after individual fixed effects are controlled for a result consistent with the prediction made by the background risk theory our findings suggest that health shocks shift investment from risky assets toward other financial assets but keep the total financial assets unchanged

inheritances intergenerational transfers and the accumulation of health research on inheritances has largely focused on the motives of the bequeathing regardless of the motivations of the giving generation prior to death wealth is transferred and this additional money may have an impact on the receiving generation in particular inheritances may be correlated with individuals health for several reasons first there may be a causal effect inheritances provide additional financial resources allowing recipients to purchase inputs to health and health care a large literature on socioeconomic status ses and health investigates the effect of financial resources on health second inheritances may signal the overall strength of a dynasty this dynastic strength would manifest itself in both better health and more ability to leave a bequest inheritances could be associated with better health because parents who will eventually bequeath wealth to their children may have disproportionately higher ses which improves the health outcomes of the children third bequests and a bequest motive may signal a stronger interest in one s child this reminder to the child could improve his emotional well being this paper

the integration of claims to health care a programming approach the paper contributes to the use of social choice and welfare theory in health economics by developing and applying the integration of claims framework to health care rationing related to sen s critique of neo classical welfare economics the integration of claims framework recognises three primitive sources of claim consequences deontology and procedures a taxonomy is presented with the aid of which it is shown that social welfare functions reflecting these claims individually or together can be specified some of the resulting social choice rules can be regarded as generalisations of health maximisation and all have normative justifications though the justifications may not be universally acceptable the paper shows how non linear programming can be used to operationalise such choice rules and illustrates their differential impacts on the optimal provision of health care following discussion of relations to the capabilities framework and the context in which rationing occurs the paper concludes that the integration of claims provides a viable framework for modelling health care rationing that is technically rigorous general and tractable as well as being consistent with relevant moral considerations and citizen preferences

recent trends in trade among developing countries this paper presents the early results of empirical work on trade among developing countries the main conclusion is that non fuel trade among developing countries excluding capital surplus oil exporters remained a remarkably stable share of their total trade between 1963 and 1977 this constancy does however conceal two opposing trends the share of manufactures exported to developing countries has been falling sharply while that of non fuel primary commodities has been rising the latter largely because of the demands of the newly industrializing countries four particular points emerge from the evidence i there is no obvious sign of a bias against trade among developing countries except whatever effect their own commercial policies may have ii the more inward looking countries tend to send a higher proportion of their exports to other developing countries and regional integration strengthens this effect iii exports of manufactures to developing countries are much more capital intensive than those to industrialized countries and iv exports to developing country markets may not be the vital first stage for capital goods exports that is sometimes supposed

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

the unobserved pattern of material hardship and health among older americans this paper investigates the relationship between self reported health and material hardship among older americans differently from income based measures material hardship provides a more specific description of the concrete adversities faced by the elderly we have used the last six waves of the health and retirement study to explore the relative contributions of state dependence unobserved heterogeneity and time specific shocks on reporting poor health experiencing food insecurity and medication cutbacks we have used a latent markov model to estimate a multivariate non linear system of equations for panel data allowing time varying unobserved heterogeneity our results reveal a high state dependence of both health and material hardship conditions estimated trajectories reveal that pathways of material hardship are associated differently with health material hardship is also spread across its dimensions

trade strategy in medium term adjustment abstract trade strategy is prominent in current discussions of stabilization and adjustment the orientation of trade strategy can be categorized according to revealed trade performance or characteristics of incentive structures or the nature of the main policy instruments the record of trade stratedy in developing countries has been richer and more complex than currently fashionable dichotomous categorizations in terms of inward or outward orientation suggest many trade strategy and policy issues remain unsettled these include the effects and optimal timing of import liberalization the appropriate instruments for export promotion trade policy concomitants of productivity change and interactions with microeconomic experience and policies among others more country specific and industry specific empirical research is necessary

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