moral hazard adverse selection and health expenditures a semiparametric analysis theoretical models predict asymmetric information in health insurance markets may generate inefficient outcomes due to adverse selection and moral hazard however previous empirical research has found it difficult to disentangle adverse selection from moral hazard in health care consumption we propose a two step semiparametric estimation strategy to identify and estimate a canonical model of asymmetric information in health care markets with this method we can estimate a structural model of demand for health care we illustrate this method using a claims level data set with confidential information from a large self insured employer we find significant evidence of moral hazard and adverse selection

voter preferences and state regulation of smoking i introduction tobacco taxation and smoking restrictions are two areas of regulation for which states have maintained a high level of control relative to the federal government 1 given this flexibility states have established a wide range of restrictions on smoking in areas such as government workplaces restaurants bars shopping malls indoor arenas and hospitals 2 although most states restrict smoking in hospitals there is considerable variation among states in restrictions in other areas in the 1998 99 period of this study about two thirds of states restricted smoking in restaurants whereas only four states restricted smoking in bars what has led to variation in smoking restrictions across states in a democratic society one would expect voter preferences to play an instrumental role in determining which policies are enacted and which are not this article provides the first empirical exploration of whether state level smoking restrictions are consistent with preferences of the citizenry taking into account both voting behavior and the role of smoking status in influencing whether an individual votes specifically we examine whether voters preferences for smoking restrictions in restaurants bars malls indoor sporting events and hospitals are consistent with state level restrictions on smoking in each of these public areas 3 our research draws on public choice models of policy making by state and local governments voters preferences typically play a central role because voting affects legislators incentives to support regulations 4 public choice research also finds that nonvoter factors may influence state and local policy making 5 in the case of smoking regulations public health advocates or tobacco industry lobbyists might influence regulatory policies the specific building block of our analysis of state restrictions on smoking is information on individuals voting behavior which we link to their smoking status and preferences over smoking restrictions our analysis uses measures of political pressure that account for individual preferences as well as their voting behavior to examine the possible role of interest group pressures we also control for nonvoter influences on smoking regulation including the proportion of the state population who smoke measures of state ideology and size of the tobacco industry with the exception of smoking in bars there is majority support for smoking restrictions unsurprisingly smokers are less supportive of restrictions than are nonsmokers nonetheless even smokers demonstrate a high level of support for many restrictions smokers are also less likely to vote than are nonsmokers even after controlling for other demographic factors the lower voting rate diminishes voter opposition to antismoking regulation but is usually not critical in view of the substantial support that most smoking restrictions have among smokers the political pressure indices for restrictions on smoking in each public area are generally significantly related to the probability that a state restricts smoking in that public area the nonvoter factors such as the smoking rate in the state and tobacco s role in the state economy are rarely influential policy debates over the desirability of smoking restrictions emphasize possible health risks due to exposure to environmental tobacco smoke ets and effects on business profitability the primary argument for expanding smoking restrictions is to protect workers and customers from exposure to ets 6 as our results show voters are generally supportive of smoking restrictions in public areas which would thereby protect workers as well as themselves and other customers however there is a substantial controversy over the extent of health risks associated with exposure to ets the basis for the push by the u s occupational and safety health administration osha for increased smoking restrictions to protect workers is the highly controversial u

the relationship between the markets for health insurance and medical malpractice insurance this article evaluates the interdependence of medical malpractice insurance markets and health insurance markets prior research has addressed the performance of these markets individually without specifically quantifying the extent to which they are linked increasing levels of health insurance losses could increase the scale of potential malpractice claims boosting medical malpractice losses or could embody an improvement in medical care quality which will reduce malpractice losses our results for a state panel data set from 2002 to 2009 demonstrate that health insurance losses are negatively related to medical malpractice insurance losses an additional dollar of health insurance losses is associated with a 0 01 0 05 reduction in medical malpractice losses these findings have potentially important implications for assessments of the net cost of health insurance policies

supply side and demand side cost sharing in deregulated social health insurance which is more effective abstract microeconomic theory predicts that if patients are fully insured and providers are paid fee for service utilization of medical services exceeds the efficient level moral hazard effect in switzerland both demand side and supply side cost sharing have been introduced to mitigate this problem analyzing a panel dataset of about 160 000 adults we find both types of cost sharing to be effective in curtailing the use of medical services however when moral hazard mitigation is traded off against risk selection the minimum deductible supply side cost sharing option ranks first followed by the medium deductible demand side alternative making the supply side option somewhat more effective

do informal risk sharing networks crowd out public voluntary health insurance evidence from vietnam many governments in low income countries have promoted voluntary health insurance schemes in recent years with the principal aim of improving access to services amongst those working in the informal economy few attempts to understand demand for such schemes exist particularly in light of the importance of informal social security arrangements for many households a model of demand for health insurance is developed reflecting this context and estimated using data from vietnam the results show that informal financial networks may crowd out government promoted health insurance implications for theory and policy are discussed

the role of income and health risk in the choice of health insurance evidence from australia abstract health insurance choice is investigated using individual data from australia where all people faced a common limited set of possible health insurance policies the data cover two separate regimes one in which insurance choice was for a more generous level of coverage and one in which the choice was a more dramatic one between insurance and no insurance coverage in determining health insurance choice the results indicate a major role for income a major role for premium notably in the first regime and a minor role for observed factors related to health risk aside from age and sex

incentive effects in the demand for health care a bivariate panel count data estimation this paper contributes in three dimensions to the literature on health care demand first it features the first application of a bivariate random effects estimator in a count data setting to permit the efficient estimation of this type of model with panel data second it provides an innovative test of adverse selection and confirms that high risk individuals are more likely to acquire supplemental add on insurance third the estimations yield that in accordance with the theory of moral hazard we observe a much lower frequency of doctor visits among the self employed and among mothers of small children copyright 2002 john wiley sons ltd

hips and hearts the variation in incentive effects of insurance across hospital procedures the separate identification of effects due to incentives selection and preference heterogeneity in insurance markets is the topic of much debate in this paper we investigate the presence and variation in moral hazard across health care procedures the key motivating hypothesis is the expectation of larger causal effects in the case of more discretionary procedures the empirical approach relies on an extremely rich and extensive dataset constructed by linking survey data to administrative data for hospital medical records using this approach we are able to provide credible evidence of large moral hazard effects but for elective surgeries only

tax incidence when individuals are time inconsistent the case of cigarette excise taxes abstract one of the most cogent criticisms of excise taxes is their regressivity with lower income groups spending a much larger share of their income on goods such as cigarettes than do higher income groups we argue that traditional quantity based measures of incidence are only appropriate under a very restrictive time consistent model of consumption of sin goods a model that is much more consistent with existing evidence on smoking decisions is a time inconsistent formulation where excise taxes on cigarettes serve a self control function that is valued by smokers who would like to quit but cannot this self control function benefits lower income groups more since they have a significantly higher price sensitivity of smoking calibrations show that as a result cigarette taxes are much less regressive than previously assumed and are even progressive for a wide variety of parameter values

a microeconometric model of the demand for health care and health insurance in australia this paper develops a model for interdependent demand for health insurance and health care under uncertainty to throw light on the issue of insurance induced distortions in the demand for health care services the model is used to empirically analyse the determinants of the choice of health insurance type and seven types of health care services using micro level data from the 1977 78 australian health survey econometric implementation of the model involves simultaneously issues of discreteness of choice selectivity and stochastic dependence between health insurance and utilization health status appears to be more important in determining health care service use than health insurance choice while income appears to be more important in determining health insurance choice than in determining health care service use for a broad range of health care services both moral hazard and self selection are found to be important determinants of utilization of health care services

modeling usage of medical care services the medical expenditure panel survey data 1996 2000 we explore the determinants of usage of six different types of health care services using the medical expenditure panel survey meps data years 1996 2000 we apply a number of models for univariate count data including semiparametric semi nonparametric and finite mixture models we find that the complexity of the model that is required to fit the data well depends upon the way in which the data is pooled across sexes and over time and upon the characteristics of the usage measure pooling across time and sexes is almost always favoured but when more heterogeneous data is pooled it is often the case that a more complex statistical model is required

the impact of private hospital insurance on the utilization of hospital care in australia abstractwe use the australian national health survey to estimate the impact of private hospital insurance on the propensity for hospitalization as a private patient we account for the potential endogeneity of supplementary private hospital insurance purchases and calculate moral hazard based on a difference of means estimator we decompose the moral hazard estimate into a diversion component that is due to an insurance induced substitution away from public patient care towards private patient care and an expansion component that measures a pure insurance induced increase in the propensity to seek private patient care our results suggest that on average private hospital insurance causes a sizable and significant increase in the likelihood of hospital admission as a private patient however there is little evidence of an expansion effect the treatment effect of private hospital insurance on private patient care is driven almost entirely by the substitution away from public patient care towards private

taxing and regulating vices we study the optimal taxation and regulation of sin goods goods that are enjoyable to consume but also create future negative health consequences within a setting in which individuals are time inconsistent and thus consume too much regulation makes the consumption of sin goods less pleasurable and taxation involves administrative and compliance costs in contrast to previous literature we find that regulation can be beneficial even when corrective taxes are available and individuals are homogeneous moreover despite the inefficiencies associated with the use of both instruments the consumption of the sin good might fall short of the first best the results are robust to consumers heterogeneity

environmental innovation and environmental performance abstract by estimating a simultaneous panel data model of environmental innovation and toxic air pollution this paper identifies bi directional causal links between the two we study a panel of 127 manufacturing industries over the period 1989 2004 pollutant emissions are an implicit measure of policy stringency and environmental patent counts are used to measure environmental innovation after accounting for the joint endogeneity we find that environmental innovation is an important driver of reductions in us toxic emissions conversely we find that tightened pollution targets induce environmental innovation however our estimates indicate that the environmental policy multiplier the proportionate contribution of induced innovation to long run emission reduction is small

lifetime earnings and the vietnam era draft lottery evidence from social security administrative records errata the randomly assigned risk of induction generated by the draft lottery is used to construct estimates of the effect of veteran status on civilian earnings these estimates are not biased by the fact that certain types of men are more likely than others to service in the military social security administrative records indicate that in the early 1980s long after their service in vietnam had ended the earnings of white veterans were approximately 15 percent less than the earnings of comparable nonveterans copyright 1990 by american economic association

a long march perspective on tobacco use in canada in this paper we present a model of tobacco demand in canada with a view to establishing if price and tax policy on the one hand or educational regulatory and demographic influences on the other have been primarily responsible for the substantial drop in consumption since 1980 we address some methodological and econometric issues that have escaped the attention of some analysts to this point using data for the period 1972 2000 we find that non price developments have had a strong deterrent effect and that the price elasticity of demand is now lower than even the recently obtained low estimates propose these findings have strong public policy content jel classification i12 c13 c22 une perspective de longue haleine sur l usage du tabac au canada dans ce memoire on presente un modele de la demande de tabac au canada en vue d etablir laquelle des deux strategies d une part la politique de prix et d imposition de taxes et d autre part les influences de l education de la reglementation ainsi que les changements demographiques a ete davantage responsable de la chute importante dans la consommation du tabac depuis 1980 le texte examine certains problemes methodologiques et econometriques qui ont jusqu ici echappea l attention des analystes a l aide de donnees pour la periode 1972 2000 on montre que les facteurs qui n ont rien a voir avec le prix ont eu un fort effet dissuasif et que l elasticite de la demande par rapport au prix est maintenant plus faible que les faibles elasticites suggerees par certaines etudes recentes ces resultats ont une grande importance pour la politique publique

why understanding smoking bans is important for estimating their effects california s restaurant smoking bans and restaurant sales i introduction a voluminous literature has sought to quantify the effect of smoking bans typically on the quantity of smoking but also on the performance of affected businesses 1 various time periods have been explored types of bans considered locales examined and specifications employed nonetheless the majority of studies share two common failings first smoking bans of a given type e g a restaurant ban are treated as homogenous when in fact such bans have been enacted at various jurisdictional levels municipality county or state at various times in various orders and in various combinations with other types of smoking bans and with similar bans at other jurisdictional levels second empirical specifications do not adequately control for preexisting trends in the dependent variable as a result many studies arrive at fundamentally wrong conclusions we illustrate these points in an investigation of how california s restaurant smoking bans have affected restaurant sales we analyze the effect of smoking bans on restaurant sales for two reasons first the issue plays a role in the policy debate more than 150 studies many published in refereed journals and others in consulting reports undertaken for municipalities have explored whether smoking bans help or hinder restaurants scollo and lal 2005 yet few of these studies properly account for the effects of preexisting trends or changes in trends for the closely related question of ban endogeneity or for ban heterogeneity second restaurant sales data are very rich well measured available by municipality by quarter and over an extended period therefore we can identify effects that would be obscured by cruder data e g periodic survey responses enabling us to draw lessons applicable to studies of the effect of other types of smoking bans e g workplace bans in other dimensions e g smoking prevalence we investigate 267 california municipalities for which the california state board of equalization provides quarterly taxable restaurant sales 2 we begin by employing naive specifications which treat bans as homogenous and control simplistically for trends representative of those typically estimated in the literature the results of our naive specifications indicate that smoking bans have a large negative effect on restaurant revenues however when we examine municipal and state bans separately we find a positive association between municipal bans and restaurant sales and a negative association between the state ban and restaurant sales finally when we control properly for preexisting trends in the dependent variable we find no substantial evidence of any causal relationship running from either municipal bans or the state ban to restaurant sales thus we reach two main conclusions the first is that california s municipal restaurant smoking bans are endogenous in a critical way restaurant sales growth or something correlated with restaurant sales growth appears to cause restaurant bans not vice versa the second is that because communities are heterogenous one must analyze the effect of a ban taking into account the level at which the ban was enacted pooling data and treating smoking bans as homogenous as many studies do is inappropriate cities that impose bans on themselves are likely to differ systematically from those that have bans forced on them by a higher jurisdiction county or state relatedly analyzing and or instrumenting for smoking bans using state level data again as many studies do may fail to capture the relevant variation when the bans have force at a lower level of jurisdiction e g a municipal ban our analysis although focused on restaurant bans and sales has implications for the more extensive literature on how smoking bans influence smoking behavior most importantly it demonstrates the crucial nature of identifying and controlling for trends in the dependent variable whether restaurant revenue as in our data set or smoking rates

a dynamic analysis of the demand for health insurance and health care we find that asymmetric information is important for the uptake of supplementary private health insurance and health care utilization we use dynamic panel data models to investigate the sources of asymmetric information and distinguish short run selection effects into insurance from long run selection effects short run selection effects i e responses to shocks are adverse but small in size also long run effects driven by differences in for example preferences and risk aversion are small but we find some evidence for multidimensional asymmetric information for example mental health causes advantageous selection estimates of health care utilization models suggest that moral hazard is not important

a theoretical rationale for an inelastic demand for health care abstract this paper provides a theoretical rationale for the empirical finding that the demand for health care is inelastic using wagstaff bull econ res 38 1986 93 version of grossman j polit econ 80 1972 223 human capital model of the demand for health the paper develops a criterion to identify restrictions on the basics of the model i e on the utility and health production functions for the purpose of realizing an inelastic demand for health care

an econometric model of the two part decision process in the demand for health the decision to contact a physician and the decision about how often to contact a physician are determined by different decisionmakers we introduce a negative binomial distributed hurdle model that specifies the two stages of the decisionmaking process as different stochastic processes while at the same time taking care of the discrete nature of the data empirical results are based on a cross section of the west german socioeconomic panel specification tests reveal that the two stages of the process need to be treated as two distinct processes this in turn implies that ignoring this distinction leads to serious misinterpretation

reassessing the integration of european electricity markets a fractional cointegration analysis this study extends existing literature on the assessment of electricity market integration in europe by developing and testing hypotheses on the convergence of electricity wholesale prices and adopting a time varying fractional cointegration analysis in addition the potential impacts of some special events that may affect system capacity new interconnection market coupling increase in share of intermittent generation on spot and forward markets are considered and evaluated daily spot prices from february 2000 to march 2013 of nine european electricity spot markets apx uk apx nl belpex epex fr epex de ipex nordpool omel and ote and month ahead prices in four markets french british german and dutch from november 2007 to december 2012 are investigated results show that unit root tests which are generally used in the literature to test market integration are inadequate for assessing electricity spot market convergence because spot prices are found to be fractionally integrated and mean reverting time series furthermore spot price behaviour and their association with different markets change over time reflecting changes in the eu electrical system one month ahead prices by contrast were found to have become more resilient to shocks and to follow more stable trends

cigarette tax revenues and tobacco control in japan the hypotheses of non addiction myopia and rational addiction are tested using annual quarterly and monthly data changes in the prices of japanese cigarettes can be viewed as exogenous from the point of view of consumer behaviour because the japanese government controls cigarette prices the empirical results of this paper support the addiction hypothesis the short run and long run price elasticities range from 0 338 to 0 421 and from 0 679 to 0 686 respectively thus increases in tax revenues in the long run are likely to be smaller than those in the short run as a result tax increases would be an effective means of curbing smoking and reducing its social cost furthermore the debt compensation programmes for the japan railway and the national forestry will not go according to plan unless revenues are increased in the future

can higher cigarette taxes improve birth outcomes abstract this study examines whether higher state cigarette taxes can be used to improve birth outcomes data on the outcomes of interest are taken from the 1989 1992 natality detail files generating a sample of roughly 10 5 million births the results suggest that smoking participation among pregnant women declines and average birth weights rise when excise taxes are increased these results can be used to form an instrumental variables estimate of the impact of smoking on birth weight this estimate is remarkably close to numbers from a random assignment clinical trial the smoking participation price elasticity is estimated to be 0 5

long run relations in european electricity prices this paper analyses the interdependencies existing in wholesale electricity prices in six major european countries the results of a robust multivariate long run dynamic analysis reveal the presence of four highly integrated central european markets france germany the netherlands and austria the trend shared by these four electricity markets appears to be common also to gas prices but not to oil prices the existence of a common long term dynamics among electricity prices and between electricity prices and gas prices can be explained by the similarity of the market design across europe and by the same marginal generation technology since standard unit root and cointegration tests are not robust to the peculiar characteristics of electricity prices time series we also develop a battery of robust inference procedures that should assure the reliability of our results copyright 2009 john wiley sons ltd

estimating the moral hazard effect of supplemental medical insurance in the demand for prescription drugs by the elderly almost all persons over the age of 65 are insured under the medicare program for inpatient drug consumption this national insurance plan does not however generally cover the purchase of outpatient prescription drugs rx in 1992 more than onethird of all outpatient drug expenditures in the united states were incurred by medicare enrollees yet approximately 50 percent of the elderly did not have any coverage for this type of treatment daniel waldo 1994 in response to this and other gaps in medicare coverage private firms have offered insurance instruments specifically designed to fill such voids commonly known as medigap policies in addition to this form of financial protection contingent upon state of residency and economic status elderly persons may qualify and obtain coverage for rx through medicaid or a state sponsored drug program however even with these incomeand wealth sensitive options many relatively poor elderly are faced with significant outof pocket drug expenditures coverage is concentrated among those elderly with income over 200 percent of poverty and those below the poverty line stephen long 1994 the most vulnerable elderly seem to be protected from the financial hardship of excessive rx expenses through medicaid coverage but private supplemental insurance is potentially too expensive for seniors near the poverty line to alleviate this burden 11 states currently offer some form of rx insurance that is targeted at those elderly or disabled persons who are relatively poor but do not qualify for medicaid at the national level policymakers and interest groups have advocated adding coverage to the medicare program to assess such programmatic changes an accurate forecast of the potential change in rx usage is needed in this paper we use a 1990 sample of medicare enrolled pennsylvanians who may have private medigap insurance or coverage under the state s rx program to estimate the amount by which the rx demand of the average individual would change in the presence of insurance coverage ceteris paribus such a residual increase in the consumption of a medical commodity has been labeled the moralhazard effect of health insurance the estimation of this effect requires a nonstandard regression technique because insurance coverage for rx and those types of treatments that are complementary or substitutable for prescriptions may be endogenously determined those persons with a higher demand for drugs are more likely to demand supplemental insurance for rx coulson and terza department of economics pennsylvania state university university park pa 16802 neslusan division of economic research at the social security administration 4301 connecticut avenue n w washington dc 20008 stuart department of health policy and administration pennsylvania state university university park pa 16802 funding for survey design and implementation used in this research was supported by grants from the pew charitable trusts and the health care financing administration grant no 88 01439 001 the views expressed herein are not necessarily endorsed by either these agencies or the social security administration 1the now repealed medicare catastrophic coverage act of 1988 as well as many of the recent healthcare reform proposals would have provided for outpatient rx coverage for the elderly 122

cross border integration in the european electricity market evidence from the pricing behavior of norwegian and swiss exporters abstract this paper examines the electricity market integration process in two european areas based on the pricing behavior of norwegian and swiss exporters the aim is to gain evidence for the period after the adoption of the second legislative package 2003 the pricing behavior of norwegian exporters indicates that the wholesale markets for denmark and sweden are highly integrated moreover results are fully compatible with the existence of a very competitive marketplace for electricity this clearly contrasts with the evidence provided by swiss exporters in this last case analysis revealed differences in pricing to market behavior between italy france and germany which indicates that exporters take advantage of international market segmentation and divergences between market structures this outcome provides a reasonable explanation as to why price differences between countries cannot be fully attributed to transmission costs as has been claimed in previous research we also found cross country convergence in levels of markups and in pricing to market behavior of the swiss exporters for the first part of the period that was analyzed the evidence is fully consistent with an initial impulse toward market integration originated by reforms implemented at the beginning of the last decade

do workplace smoking bans reduce smoking in recent years workplace smoking policies have become increasingly prevalent and restrictive using data from two large scale national surveys we investigate whether these policies reduce smoking our estimates suggest that workplace bans reduce smoking prevalence by 5 percentage points and daily consumption among smokers by 10 percent although workers with better health habits are more likely to work at firms with smoking bans estimates from systems of equations indicate that these results are not subject to an omitted variables bias the rapid increase in bans can explain all of the recent drop in smoking among workers relative to nonworkers

an econometric model of health care utilization and health insurance in switzerland abstract this paper presents a preliminary econometric analysis on how different alternative plans affect the utilization of health care services in switzerland the data come from the 1992 1993 swiss health survey shs we briefly describe some institutional aspects of the swiss health system which prevailed at the time of the shs with particular emphasis on health insurance plans and payment system of providers we estimate a simultaneous two equation model containing latent variables in order to compare the probability of having at least one inpatient stay given that the insured has used some medical treatment for those who have purchased only a basic insurance plan and those who have purchased a supplemental insurance

demand for medical care by the elderly a finite mixture approach summary in this article we develop a finite mixture negative binomial count model that accommodates unobserved heterogeneity in an intuitive and analytically tractable manner this model the standard negative binomial model and its hurdle extension are estimated for six measures of medical care demand by the elderly using a sample from the 1987 national medical expenditure survey the finite mixture model is preferred overall by statistical model selection criteria two points of support adequately describe the distribution of the unobserved heterogeneity suggesting two latent populations the healthy and the ill whose fitted distributions diaer substantially from each other 1997 by john wiley sons ltd

bad habits and the endogenous timing of urges i present a theory of harmful addiction in which giving in to an unwanted urge i e consumption delays the recurrence of urges in the short run but increases their long run frequency the theory offers new predictions as to how the frequency levels cue dependence and temporal consistency of consumption evolve during habituation while uniquely capturing near term substitution in demand across time new welfare implications for restrictions on consumption and on marketing are also addressed

private health insurance and utilization of health services in chile this paper analyses the choice of private health insurance in chile and how this relates to the utilization of health services the results show the importance of some demographics on the insurance decision particularly age gender and marital status socio economic factors such as education income employment status and zone of residence all influence the probability of purchasing private insurance the relevance of these determinants is confirmed using a simulation analysis with four representative decision makers this simulation also provides evidence of a positive selection into private insurance although this would be driven by the different criteria used to set premiums under private and public insurance schemes the potential linkage between utilization of health services and private health insurance is examined using a simultaneous two equation framework two measures of utilization are estimated outpatient health services and length of stay in hospital a number of explanatory variables s

flexible discrete choice demand models consistent with utility maximization an application to health care demand policies a considerable literature has developed to estimate the economic determinants of health care provider choice one important goal of this literature has been the estimation of price elasticities of health care demand particularly in rural areas of developing countries where debates continue regarding appropriate levels of user fees in government health facilities world bank accurate estimation of price elasticities is crucial to evaluating the trade offs between health promotion and revenue generation in rural areas where poorly funded government clinics are often consumers only accessible health care choices however the exact empirical implementation of demand estimation with discrete data has be

semi parametric estimation of hurdle regression models with an application to medicaid utilization this paper develops a semi parametric estimation method for hurdle two part count regression models the approach in each stage is based on laguerre series expansion for the unknown density of the unobserved heterogeneity the semi parametric hurdle model nests poisson and negative binomial hurdle models which have been used in recent applied literature the empirical part of the paper evaluates the impact of managed care programmes for medicaid eligibles on utilization of health care services using a key utilization variable the number of doctor and health centre visits health status measures and age seem to be more important in determining health care utilization than other socio economic and enrollment variables the semi parametric approach is particularly useful for the analysis of overdispersed individual level data characterized by a large proportion of non users and highly skewed distribution of counts for users 1997 john wiley sons ltd

measuring market integration and estimating policy impacts on the swiss electricity market abstract we investigate market integration in central western european electricity markets with a focus on switzerland we propose a structural microeconometric approach to measuring the degree of market integration taking advantage of unilateral demand and supply shocks such as the generation from volatile renewable resources the unavailability of generation units and national holidays these exogenous events affect electricity prices in switzerland and allow estimating the level of market integration by disentangling their effects in congested and non congested situations exploiting information on congested and non congested situations in parametric instrumental variable estimation permits simulating hypothetical non congested swiss electricity prices in historically congested situations our approach allows considering the non linear nature of level shifts of congestion and disentangling it from the structurally different interplay of demand and supply in respective situations using data on hourly electricity prices and its determinants regarding switzerland and neighboring countries from 2015 and 2016 we find that an expansion of interconnector capacity at the german austrian swiss border could decrease swiss electricity prices substantially in a more attenuated way the same holds true for the french swiss and the italian swiss border for switzerland as a whole prices in congested situations are about 17 higher than hypothetical non congested prices

estimation of limited dependent variable models with dummy endogenous regressors applied economists have long struggled with the question of how to accommodate binary endogenous regressors in models with binary and nonnegative outcomes i argue here that much of the difculty with limited dependent variables comes from a focus on structural parameters such as index coefcients instead of causal effects once the object of estimation is taken to be the causal effect of treatment several simple strategies are available these include conventional two stage least squares multiplicative models for conditional means linear approximation of nonlinear causal models models for distribution effects and quantile regression with an endogenous binary regressor the estimation strategies discussed in the article are illustrated by using multiple births to estimate the effect of childbearing on employment status and hours of work

heterogeneous impact of the seguro popular program on the utilization of obstetrical services in mexico 2001 2006 a multinomial probit model with a discrete endogenous variable objective we evaluated the impact of seguro popular sp a program introduced in 2001 in mexico primarily to finance health care for the poor we focused on the effect of household enrollment in sp on pregnant women s access to obstetrical services an important outcome measure of both maternal and infant health

the mechanisms of policy diffusion local policy adoptions provide an excellent opportunity to test among potential mechanisms of policy diffusion by examining three types of antismoking policy choices by the 675 largest u s cities between 1975 and 2000 we uncover robust patterns of policy diffusion yielding three key findings first we distinguish among and find evidence for four mechanisms of policy diffusion learning from earlier adopters economic competition among proximate cities imitation of larger cities and coercion by state governments second we find a temporal component to these effects with imitation being a more short lived diffusion process than the others third we show that these mechanisms are conditional with larger cities being better able to learn from others less fearful of economic spillovers and less likely to rely on imitation

risk beliefs and smoking behavior i introduction more people die from smoking each year than from any other consumption activity these risks arise from consumer choices in a market context as a result whether consumers are cognizant of the attendant hazards is a central concern in assessing whether there is a market failure and the extent of such a failure influencing people s risk beliefs has been a primary focus of many government interventions in this market including warnings requirements and public information campaigns public opinion poll data provide some insight into general trends in smoking risk beliefs but do little to resolve the more fundamental concern of whether people underestimate the risks posed by cigarettes typical questions ask respondents if cigarette smoking is one of the causes of lung cancer or whether smoking is harmful 1 these general measures of risk awareness provide a useful historical perspective on smoking risk beliefs but do not make it possible to determine whether the public perceives the risk accurately recognizing that smoking is harmful does not imply that the perceived risk level is as great as the actual risk the first exploration of the adequacy of risk beliefs was in viscusi 1990 1992 which examined the adequacy of lung cancer risk beliefs using a quantitative risk question 2 the 1985 national survey used in these studies asked respondents how many smokers out of 100 would get lung cancer because they smoke people generally overestimate the risks of getting lung cancer due to smoking these risk beliefs in turn affect the decision to smoke in the expected manner at least for this risk component which has been the most prominent smoking risk since the 1964 surgeon general report linking smoking and lung cancer the empirical evidence does not indicate a market failure notwithstanding these results a variety of puzzles remain do smokers also perceive the other hazards of cigarettes such as the total mortality risk of smoking if they understand the risk of death do they also properly assess how much life expectancy will be lost due to their premature mortality even if there is such a general understanding on average for the population are there major pockets of ignorance the difference between the smoking and the nonsmoking populations is striking the current u s smoking population is less well educated and has lower income levels than the non smoking population a possible explanation for this difference is that the higher education levels of nonsmokers enable them to obtain a better understanding of the hazards of smoking leading to lower smoking rates among the better educated such differences in risk beliefs have never been analyzed previously due to the absence of smoking risk belief surveys that include such demographic information in this article we exploit the more refined capabilities of two large data sets a 1997 national survey of smoking risk beliefs and a 1998 survey undertaken in massachusetts each of these surveys includes several quantitative risk perception measures as well as much more comprehensive data on background characteristics than in the 1985 survey analyzed in viscusi 1990 1992 in section ii we introduce the survey data and provide an overview of smoking risk beliefs irrespective of the risk measure there is a pronounced tendency to overestimate the risk level compared to objective scientific measures of the risk these results contrast with the frequently expressed claim in the literature that cigarette smokers are the victims of companies advertising 3 according to this alternative view companies have allegedly designed their advertising strategies to exploit potential irrationalities in order to foster higher rates of smoking section iii explores the determinants of these risk beliefs yielding some intriguing results better educated respondents do have more accurate beliefs but because people generally overestimate the risks of smoking the greater accuracy is reflected in a lower assessment of the risks

endogeneity in semiparametric binary response models this paper develops and implements semiparametric methods for estimating binary response binary choice models with continuous endogenous regressors it extends existing results on semiparametric estimation in single index binary response models to the case of endogenous regressors it develops a control function approach to account for endogeneity in triangular and fully simulataneous binary response models the proposed estimation method is applied to estimate the income effect in a labor market participation problem using a large micro data set from the british fes the semiparametric estimator is found to perform well detecting a significant attenuation bias the proposed estimator is contrasted to the corresponding probit and linear probability specifications jel c14 c25 c35 j22

the extent of european power markets abstract there is an ongoing debate on the degree of integration of european wholesale power markets a major task of the european union is the creation of a common market in europe and a common power market is an important part of this goal the literature analyzing the degree of integration of european energy markets is growing and provides mixed results we add to this literature by using national holidays as exogenous demand shocks to measure integration of european energy markets our main findings indicate that integration of european wholesale energy markets has increased with regard to germany and austria as well as belgium and the netherlands

smoke free air laws cigarette prices and adult cigarette demand i introduction according to the centers for disease control and prevention cdc 2002a cigarette smoking is responsible for more than 430 000 premature deaths each year in the united states as such it represents the single largest cause of preventable deaths in the united states the cdc 2002b estimates that more than 46 million adults in the united states were current smokers in 2000 representing nearly one quarter of the total u s adult population a goal of a major health initiative healthy people 2010 is to reduce smoking prevalence among adults to 12 by 2010 if that goal is to be met a better understanding of the impact public policy plays on adult cigarette demand is needed adult per capita consumption of cigarettes in the united states reached a peak of 4 345 in 1963 and began declining in 1964 the year in which the first surgeon general s report on the health consequences of cigarette smoking was published u s department of health and human services dhhs 1991 at the same time substantial progress was made in reducing the prevalence of adult smoking in the united states according to the national health interview surveys the prevalence of current smoking declined from 42 4 in 1964 to 23 5 in 1999 however the decline in prevalence was much more modest in the 1990s than it was in the previous two and a half decades between 1990 and 1999 the prevalence of cigarette smoking among adults declined by only 2 percentage points much of the progress in curtailing cigarette smoking in the united states can be attributed to the campaign to reduce tobacco use u s dhhs 1991 the public health campaign to reduce tobacco related death and disease in the united states began in the mid 1960s following the release of the first surgeon general s report which causally linked cigarette smoking to lung cancer and a host of other detrimental diseases although consumer education and information dissemination where the mainstay early in the campaign against tobacco the arena shifted to public policy interventions by the 1980s both state and federal governments began increasing cigarette excise taxes and imposing restrictions on smoking in public places and other worksites the implementation of higher excise taxes and stronger smoke free air restrictions continues at all levels of government into the mid 2000s since january 1 2002 37 states and the district of columbia have implemented or passed higher cigarette excise tax rates as of march 18 2005 state excise tax rates on cigarettes ranged from a low of 0 03 per pack in the state of kentucky to 2 46 in rhode island in addition since 1998 when california became the first state to ban smoking in all restaurants and bars numerous other states have followed suit new york massachusetts delaware and rhode island have banned smoking in workplaces restaurants and bars whereas connecticut and maine have banned smoking in all bars and restaurants this article examines the impact of enacting stronger smoke free air restrictions and increasing cigarette prices which will occur as a consequence of cigarette excise tax increases on adult smoking propensity and intensity in the united states unlike previous studies however this article employs a modified two part model of demand in which a generalized linear model glm is employed to yield unbiased elasticity estimates for conditional cigarette demand while controlling for the possibility that smoking sentiment at the state level influences both antismoking policy enactment and changes in smoking behavior as such it provides among the most accurate estimates of the impact of cigarette prices and smoke free air laws on the demand for cigarettes among adults in the united states ii brief review of previous studies numerous econometric studies on the determinants of adult cigarette demand have been published over the past three decades

electricity wholesale market prices in europe convergence abstract this paper tests the hypothesis that the ongoing restructuring process in the european electricity sector has led to a common european market for electricity based on a principal component analysis pca of wholesale electricity prices in 2002 2006 we reject the assumption of full market integration for several pairs of countries the weaker hypothesis of bilateral convergence is accepted based on unit root tests kpss and adf and a convergence test based on filtered pairwise price relations this indicates that the efforts to develop a single european market for electricity were so far only partially successful we show that the daily auction prices of scarce cross border transmission capacities are insufficient to explain the persistence of international price differentials empirically our findings confirm the insufficiency of explicit capacity auctions as stated in the theoretical literature

the effect of patient s asymmetric information problem on elderly use of medical care it has been proposed that the patient s relative ignorance about medicine asymmetry of information between doctor and patient should place a patient in a disadvantaged position when purchasing medical care even if rapidly developing information technologies can enhance the patient s access to health information a patient doesn t have enough ability to understand interpret and evaluate it so the doctor s effort at sincerely helping patient understand and utilize health information by effective communication with patient might improve the patient s asymmetric information problem and affect the patient s use of medical care by way of its being a source of patient s solid trust on doctor this research seeks to determine whether a doctor s effort mentioned earlier can affect the elderly use of medical care this study used data from a survey sample of people aged more than 65 living in seoul and chuncheon korea the results suggest the doctor s effort level has a statistically significant positive

integration and shock transmissions across european electricity forward markets abstract new results are presented relating to the integration of the french german british dutch and spanish power markets at day ahead week ahead one month ahead and two month ahead lead times overall there is evidence of market integration increasing over time despite an underlying inefficiency in each market with respect to the forward and spot price convergence the spatial analysis on a financial dimension is undertaken using causality tests cointegration and impulse response techniques for both price levels and volatilities in general we find less influence of the size and proximity of neighbouring markets than other studies more integration at baseload than peak and surprisingly less integration in forwards than spot prices

health care insurance and the contract choice effect i introduction it is well known that consumers anticipate some aspects of their medical care consumption examples include obstetrical services dental procedures vision care outpatient mental health services and minor elective surgery so that medical care demand anticipation influences the choice of health insurance coverage in turn the characteristics of the chosen plan set the degree of cost sharing and therefore the net price that the consumer faces which is given by the percentage of cost sharing times the gross price of medical care this net price influences the consumer s actual demand for the broad range of medical services 1 in this way insurance choice is influenced by particular anticipated utilization and actual general utilization is influenced by the selected insurance plan health insurance choice and medical service demand are interdependent although this interdependence has been noted in the literature few researchers have attempted to model it 2 and none have explicated its implications for consumer demand behavior and the ensuing econometric analysis of medical care demand we do so in this article using an intertemporal model that highlights the role of expectations in the insurance choice medical care demand interaction under uncertainty we show that the medical care demand response to a change in its gross price consists of two separate components the standard neoclassical demand effect and an insurance contract choice effect when the gross price of medical care changes the net price to the consumer is altered for a fixed degree of cost sharing however a change in the gross price can prompt a change in the intended choice of health plan causing a change in the degree of cost sharing for example if the gross price of medical care rises our consumer may choose to pay a higher premium for an insurance policy that is more generous one that has a lower cost sharing percentage in this case the net price which first increased exogenously would now decrease endogenously the health insurance contract choice effect can play an important role in determining the consumer s observable demand response to a change in the gross price of medical care the standard medical care demand curve could be less responsive because of it and econometric studies of the price elasticity of medical care that ignore it which is typically the case in the literature would produce estimates that are erroneous furthermore although somewhat remote the contract choice effect opens the door to a perverse outcome a medical care demand curve that is upward sloping this could occur when the contract choice effect is very strong ii the model we consider an individual consumer who faces a single period two stage planning problem in the first stage the consumer makes an ex ante choice of insurance plan at the time this choice is made he knows his income for the period all prices including the gross price of medical care and his current health status however he is uncertain about his future health status in the second stage during which health status uncertainty is resolved the consumer makes ex post decisions about purchases of medical care and other goods in the first stage the consumer chooses from a variety of health insurance policies with varying characteristics the simplest has a deductible of some amount e g 250 per person 750 per family a percentage cost share e g consumer pays 20 the insurance provider 80 of each episode and a cap on total dollar outlay beyond which the insurer pays 100 of remaining expenses other policies place more emphasis on co payments e g consumer pays 20 to a physician for an office visit the insurance provider pays the balance of the negotiated cost and some policies combine all of these elements co pays for office visits 20 80 cost shares for hospital stays different mixes of percentage cost shares depending on services that are out of network in network but not preferred provider and so on

incentive and selection effects of medigap insurance on inpatient care the medicare program which provides insurance coverage to the elderly in the united states does not protect them fully against high out of pocket costs for this reason private supplementary insurance named medigap has been available to cover medicare gaps this paper studies how medigap affects the utilization of inpatient care separating the incentive and selection effects of supplementary insurance for this purpose we use two alternative estimation methods a standard recursive bivariate probit and a discrete multivariate finite mixture model we find that estimated incentive effects are modest and quite similar across models there seems to be very significant selection with the presence of both adversely and advantageously selected individuals stemming from the multidimensional nature of residual heterogeneity

the unintended consequences of countermarketing strategies how particular antismoking measures may shift consumers to more dangerous cigarettes countermarketing or efforts to reduce consumption of certain products has become common in categories such as tobacco junk food fossil fuels and furs countermarketing has a particularly long history in the tobacco industry efforts to reduce smoking have included excise taxes that increase the cost of consumption smoke free restrictions that make consumption less convenient and antismoking advertising campaigns that highlight the dangers of tobacco use this article presents an analysis of the relative effectiveness of these different strategies we find that cigarette excise taxes are the most effective tool for reducing overall cigarette sales followed by antismoking advertising smoke free restrictions are not found to have a significant effect on cigarette sales we also investigate how these various policy tools induce product substitution this issue is of considerable importance because some countermarketing techniques may potentially shift consumers to more dangerous higher nicotine and

count data models with variance of unknown form an application to a hedonic model of worker absenteeism we examine an econometric model of counts of worker absences due to illness in a sluggishly adjusting hedonic labor market we compare three estimators that parameterize the conditional variance least squares poisson and negative binomial pseudo maximum likelihood to generalized least squares gls using nonparametric estimates of the conditional variance our data support the hedonic absenteeism model semiparametric gls coefficients are similar in sign magnitude and statistical significance to coefficients where the mean and variance of the errors are specified ex ante in our data coefficient estimates are sensitive to a regressor list but not to the econometric technique including correcting for possible heteroskedasticity of unknown form

welfare cost and health insurance a disaggregated approach using duality theory and australian data the present study draws on the fundamental duality between consumer expenditure and utility to provide a hicksian measure of the welfare cost or moral hazard arising from health insurance in australia the theoretical approach is empirically applied to a homogeneous set of medical services associated with diagnosis of the upper gastrointestinal tract viz barium meal radiology the empirical results indicate that the welfare loss represents 1 3 of the total expenditures and 1 5 of the health insurance rebates on barium meal radiology for the year 1984 85 sensitivity analysis indicates that the welfare loss in relatively invariant to changes in the coinsurance rate when the latter takes on values of less than 0 5

a bivariate zero inflated count data regression model with unrestricted correlation abstract this paper proposes a computationally simple bivariate zero inflated count data regression model with an unrestricted correlation pattern an application to data with excess of zeros on the demand for health services is given

smoking bans maternal smoking and birth outcomes an important externality of smoking is the harm it might cause to those who do not smoke this paper examines the impact on birth outcomes of children of female workers who are aected by smoking bans in the workplace analyzing a 2004 law change in norway that extended smoking restrictions to bars and restaurants we find that children of female workers in restaurants and bars born after the law change saw significantly lower rates of being born below the very low birth weight vlbw threshold and were less likely to be born pre term using detailed data on smoking status during pregnancy we find that relative to the control group most of the benefits arise from changes in smoking behavior of the mother the eect of second hand smoke exposure on birth outcomes in this formulation appears to be quite small however we find suggestive evidence of substituting behavior i e a greater likelihood of smoking at home among fathers since children born to male workers in restaurants and bars after this law change appear to have slightly worse outcomes using individual tax data we find that the law change did not result in changes in earnings or employment opportunities for those aected thus suggesting that the eects seen are likely a direct result of changes in smoke exposure in utero using a twins based analysis we link very low birth weight status to adult labor force participation and suggest that via the improvements in birth weight alone the smoking restriction law in norway could result in a 0 2 percentage point increase in full time employment by age 28

the choice of medical providers in rural benin a comparison of discrete choice models in this paper we estimate three different discrete choice models of provider choice using data from the rural district of ouidah in benin these three model are multinomial logit ml 2 independent multinomial probit imp 3 multinomial probit mp a comparison of imp and mp allows us to reject the independence assumption between providers furthermore the cross price elasticities computed from the restrictive specifications ml and imp are dramatically different from those computed from the more general one mp these results cast some doubt on the validity of the previous findings and policy recommendations that are typically based on the ml specification

hmo plans self selection and utilization of health care services this study examines the effect of health maintenance organizations hmos on the use of health care services among the privately insured nonelderly population to consider jointly the possible self selection bias and high frequency of zero observations in the applied utilization measures we accommodate the endogeneity of health plan choice decisions in the censored regression model using data from the 2000 medical expenditure panel survey we find strong evidence for favourable self selection into hmo plans health maintenance organization enrollment is found to encourage greater use of office based and hospital outpatient services overall satisfaction with the quality of care among hmo members is relatively low compared to that among nonhmo members these findings suggest that more effort is needed to develop management strategies in hmos in order to contain the moral hazard in utilization and assure the quality of service provided within the network of hmo providers

finishing high school and starting college do catholic schools make a difference in this paper we consider two measures of the relative effectiveness of public and catholic schools finishing high school and starting college these measures are potentially more important indicators of school quality than standardized test scores in light of the economic consequences of obtaining more education single equation estimates suggest that for the typical student attending a catholic high school raises the probability of finishing high school or entering a four year college by thirteen percentage points in bivariate probit models we find almost no evidence that our single equation estimates are subject to selection bias

measuring the impact of market coupling on the italian electricity market abstract this paper evaluates the impact on the italian electricity market of replacing the current explicit auction mechanism with market coupling maximising the use of the cross border interconnection capacity market coupling increases the level of market integration and facilitates the access to low cost generation by consumers located in high cost generation countries thus it is expected that a high priced area such as italy could greatly benefit from the introduction of this mechanism in this paper the welfare benefits are estimated for 2012 under alternative market scenarios employing the optimal dispatch model elfo the results of the simulations suggest that the improvement in social surplus is likely to be significant especially when market fundamentals are tight