Joanna Kopinska

Body Weight, Eating Patterns, and Physical Activity: The Role of Education

In this article, we empirically study the role of education attainment on individual body mass index (BMI), eating patterns, and physical activity. We allow for endogeneity of schooling choices for females and males in a mean and quantile instrumental variables framework. We find that completion of lower secondary education has a significant positive impact on reduction of individual BMI, containment of calorie consumption, and promotion of physical activity. Interestingly, these effects are heterogeneous across genders and distributions. In particular, for BMI and calorie expenditure, the effect of education is significant for females and is more pronounced for women with high body mass and low physical activity. On the other hand, the effect of education on eating patterns is significant mainly for males, being more beneficial for men with elevated calorie consumption. We also show that education attainment is likely to foster productive and allocative efficiency of individuals in the context of BMI formation. Given that the literature suggests that education fosters development of cognition, self-control, and a variety of skills and abilities, in our context it is thus likely to promote lifetime preferences and means of individuals, which in turn enable them to achieve better health outcomes. Education also provides exposure to physical education and to school subjects enhancing individual deliberative skills, which are important factors shaping calorie expenditure and intake. Finally, we show that in the presence of strong socioeconomic inequalities in BMI, education is likely to have a pronounced impact on healthy BMI for the disadvantaged groups, represented in our framework by females.

The impact of cost-sharing schemes on drug compliance in Italy: evidence based on quantile regression

ObjectivesIn this article we investigate the causal effect of cost-sharing schemes on compliance with statins in a quantile regression framework.MethodsWe use the health search CSD-LPD data, a longitudinal observational dataset containing computer-based patient records collected by Italian general practitioners. We exploit a series of natural experiments referring to several introductions of co-payment schemes in some of the Italian regions between 2000 and 2009. We adopt an extended difference-in-differences approach to provide quantile estimates of the impact of co-payments on compliance.ResultsWe find that (i) introduction of co-payments hurts residents of regions with worse quality and provision of health care; (ii) within these regions, co-payments were particularly harmful for high compliers; (iii) gender, clinical history and geographic residence are important determinants of compliance among poor compliers; (iv) compliance decreases with the potency and dosage of statins, particularly for poor compliers.ConclusionsIn the presence of inefficient health-care provision, co-payments are harmful for drug compliance, and this is especially true for patients who are originally good compliers.

Body Weight of Italians: The Weight of Education

In this paper we empirically study the relationship between education attainment and Body Mass Index (BMI), using as theoretical reference an energy balance model. Our data consist of individual level data from eight waves of the Italian survey on life-styles. We use Quantile Regression (QR) technique to study the impact of education along the whole distribution of the BMI and provide evidence that the effect of education on BMI is greater in magnitude for the overweight and the obese. This effect is reinforced (three times greater) once we account for the endogeneity of some of the determinants of BMI (IVQTE). Finally, we adopt a model specification that allows us to test if education is likely to affect BMI indirectly, through channels such as the adoption of better life styles (healthier diet and more sport activities). Results seem to confirm this hypothesis, and this may reveal an important information for policymakers.

Against All Odds: The Contribution of the Healthcare Sector to Productivity. Evidence from Italy and UK from 2004 to 2011

We assess the productivity growth of the English and Italian healthcare systems over the period from 2004 to 2011. The English (NHS) and the Italian (SSN) healthcare systems share many similar features, facilitating comparison: basic founding principles, financing, organization, management, and size. We measure productivity growth as the rate of change in outputs over the rate of change in inputs. We find that the overall NHS productivity growth index increased by 10% over the whole period, at an average of 1.39% per year, while SSN productivity increased overall by 5%, at an average of 0.73% per year. Differential growth reflects different policy objectives. In England, the NHS focused on increasing activity, reducing waiting times and improving quality. Italy focused more on cost containment and rationalized provision, in the hope that this would reduce unjustified and inappropriate provision of services.

The “Double Expansion of Morbidity” Hypothesis: Evidence from Italy

The last few decades have been characterized by an increase in the number of years lived in bad health, lending support to the “Expansion of Morbidity” hypothesis. In this paper we propose the “Double Expansion of Morbidity” (DEM) hypothesis, arguing that not only life expectancy gains have been transformed into years lived in “bad health”, but also, due to an earlier onset of chronic diseases, the number of years spent in “good health” is actually reduced. Limited to the Italian case, we present and discuss a set of empirical evidence confirming the DEM hypothesis. In particular, we find that from 2004 to 2014 the average number of years spent with chronic conditions in Italy increased by 7.2 years 2.3 years of which are due to an increase in life expectancy and 4.9 years due to a reduction in the age of onset of chronic conditions. Compared with 2004, in 2014, this phenomenon generated extra public health expenditure of nearly 6.3 billion euros. We discuss the policy implications of these findings.

Modeling Public Health Care Expenditure Using Patient Level Data: Empirical Evidence from Italy

In this work we present some results obtained with a unique database of patient level data collected through GPs. The availability of such data opens new scenarios and paradigms for the planning and management of the health care system and for policy impact evaluation studies. The dataset, representative of the Italian population, contains detailed information on prescribed drugs, laboratory tests, outpatient visits and hospitalizations of more than 2 millions patients, managed by 900 GPs overtime. This pool of registers has produced a stock of information on about 25 millions of medical diagnosis, 100 millions of laboratory and diagnostic tests, 10 millions of blood pressure measurements and 50 millions of drug prescriptions. Using this novel dataset we analyze the expenditures of the Italian NHS over time, across age and geographical areas for the period from 2004 to 2011.

The Role of Parental Cognitive Aging in the Intergenerational Mobility of Cognitive Abilities

This paper studies intergenerational transmission of cognitive abilities from parents to children, highlighting the role of parental cognitive ageing measured during adulthood, net of their cognitive abilities measured in adolescence. We investigate the life-cycle of parental cognitive abilities on offspring’s cognitive abilities within the British National Child Development Study (NCDS). We find that children benefit not only from the stock of cognitive abilities their mothers and fathers hold as adolescents, but also from cognitive evolution their parents achieve as adults. Furthermore, we find that favourable parental cognitive ageing is particularly important for low ability offspring, pointing to a potential role of cognition in delivering more effective mitigation and nurturing. When analysing three subsequent generations, we find that the transmission of late parental cognition is strong in the offspring with high education origins, in particular for the those in the upper tail of the cognitive abilities distribution. We quantify the economic impact of the cognitive ageing transmission, and find that one standard deviation increase in late parental cognition can be approximated to an average of 1.7% increase in offspring earnings.