Donald S. Kenkel

Health Behavior, Health Knowledge, and Schooling

The positive correlation between schooling and good health is well documented. One explanation is that schooling helps people choose healthier life-styles by improving their knowledge of the relationship between health behaviors and health outcomes. That is, schooling improves the households allocative efficiency in producing health. This empirical study uses direct measures of health knowledge to test this explanation. Part of the relationship between schooling and the consumption of cigarettes, alcohol, and exercise is explained by differences in health knowledge. However, most of schoolings effects on health behavior remain after differences in knowledge are controlled for.

Valuing health for policy : an economic approach

Preface 1: Overview George Tolley, Donald Kenkel, Robert Fabian. 2: Framework for Valuing Health Risks Mark Berger, Glenn Blomquist, Donald Kenkel, George Tolley. 3: Cost of Illness Approach Donald Kenkel 4: Contingent Valuation of Health Donald Kenkel, Mark Berger, Glenn Blomquist. 5: Household Health Production, Property Values, and the Value of Health Richard Clemmer, Donald Kenkel, Robert Ohsfeldt, William Webb. 6: The Qualy Approach Robert Fabian 7: Issues in Questionnaire Design Robert Fabian, George Tolley. 8: Empirical Results from Household Personal Interviews Michael Brien, Donald Kenkel, Austin Kelly, Robert Fabian. 9: Empirical Results from Mail Questionnaires Wallace Wilson 10: Defining and Measuring Health over Life Lyndon Babcock, Anthony Bilotti. 11: The Quantity and Quality of Life: A Conceptual Framework Sherwin Rosen 12: Modeling of Choices with Uncertain Preferences Charles Kahn 13: Design of Contingent Valuation Approaches to Serious Illness Robert Fabian, Lyndon Babcock, Anthony Bilotti, George Tolley. 14: Future Directions for Health Value Research George Tolley, Robert Fabian. 15: State-of-the-Art Health Values George Tolley, Donald Kenkel, Robert Fabian. 16: The Use of Health Values in Policy George Tolley, Donald Kenkel, Robert Fabian, David Webster. References Contributors Index

Valuing Changes in Health Risks: A Comparison of Alternative Measures*

Essential to efficient provision of health, safety, and the environment is correct valuation of risks to human health. In a world of scarcity difficult decisions concerning tradeoffs between health and other desirables are unavoidable. In this paper we develop a model of health investment under uncertainty which yields a general expression for values of changes in risks to human health. The preference-based values of morbidity risks and mortality risks are ex ante dollar equivalents of changes in expected utility associated with risk changes. The preference-based values are related to two alternative measures, costs of illness and preventive expenditures, which are thought to be lower bounds on the value of risk reductions. We demonstrate that these alternative measures are not even special cases of the more general measure and that the size relationships among the three measures are complex. Also, we derive the relationship between the willingness to pay for risk changes and the consumer surpluses associated with health changes which occur with certainty. The next section contains a brief review of the approaches to valuing changes in health.

The Roles of High School Completion and Ged Receipt in Smoking and Obesity

We analyze data from the National Longitudinal Survey of Youth 1979 on high school completion, smoking, and obesity. First, we investigate whether GED recipients differ from other high school graduates in their smoking and obesity behaviors. Second, we explore whether the relationships between schooling and these health‐related behaviors are sensitive to controlling for background and ability measures. Third, we estimate instrumental variables models. Our results suggest that the returns to high school completion may include less smoking but the health returns to GED receipt are much smaller. We find little evidence that high school completion is associated with less obesity.

Consumer Health Information and the Demand for Medical Care

This paper is an empirical investigation of consumer health information. Using a new direct measure of information, the econometric approach treats both information and physician visits as endogenous variables when estimating the demand for medical care. The results show that information increases the probability that a consumer uses medical care, but that conditional on use the quantity of care consumed is not related to information. The results contradict specific implications of models where physicians can create or induce demand for their own services. Several results suggest that poorly informed consumers tend to underestimate the productivity of medical care in treating illness. Copyright 1990 by MIT Press.

The demand for preventive medical care

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

Private Profits and Public Health: Does Advertising of Smoking Cessation Products Encourage Smokers to Quit?

We study the impact of smoking cessation product advertising. To measure potential exposure, we link survey data on magazine‐reading habits and smoking behavior with an archive of print advertisements. We find that smokers who are exposed to more advertising are more likely to attempt to quit and to successfully quit. While some increased quitting involves product purchases, we find that product advertisements also prompt cold turkey quitting. Identifying the causal impact of advertising is difficult because advertisers target consumers. Although reverse causality could bias our estimates upward, our baseline results are not sensitive to a series of checks.

Excise tax avoidance: The case of state cigarette taxes

We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20% smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes.

Do drunk drivers pay their way? A note on optimal penalties for drunk driving.

This paper uses a simple framework to describe optimal penalties for drunk driving, and reviews available data to judge current policies against this standard. The analysis suggests that policies should be designed so that the penalties paid by drunk drivers equal the value of the increased risks drunk drivers impose on others. Current penalties appear to be too lenient, implying that current levels of drunk driving are too high.

Iron Supplementation of Young Children: Learning from the New Evidence:

High iron needs and low-iron diets combine to make early childhood one of the highest risk periods for iron deficiency. Recommendations for iron supplementation for this age group have been based on positive effects on anemia and child development. In contrast, the evidence regarding growth and morbidity outcomes has been equivocal, with some evidence of risk. The new evidence from Nepal and Zanzibar is reviewed, and possible interpretations are discussed. The Zanzibar trial found significant adverse effects in the overall population with poor malaria services and substantial benefit to iron-deficient children (the majority) in an area where access to treatments was provided. Cost-effectiveness analysis suggests that targeting supplements to iron-deficient children in Zanzibar may not increase costs (relative to universal supplementation) and would increase benefit. Operations research is needed to test this. We conclude with three options for maximizing the benefits and minimizing the risks of iron supplements.