Mark Stabile

What Do Self-Reported, Objective, Measures of Health Measure?

Survey reports of the incidence of chronic conditions are considered by many researchers to be more objective, and thus preferable, measures of unobserved health status than self-assessed measures of global well being. In this paper we evaluate this hypothesis by attempting to validate these “objective, self-reported” measures of health. Our analysis makes use of a unique data set that matches a variety of self-reports of health with respondents’ medical records. We find that these measures are subject to considerable response error resulting in large attenuation biases when they are used as explanatory variables.

Short, Medium, and Long Term Consequences of Poor Infant Health: An Analysis Using Siblings and Twins

We use administrative data on a sample of births between 1978 and 1985 to investigate the short-, medium-, and long-term consequences of poor infant health. Our findings offer several advances to the existing literature on the effects of early infant health on subsequent health, education, and labor force attachment. First, we use a large sample of both siblings and twins, second, we use a variety of measures of infant health, and finally, we track children through their schooling years and into the labor force. Our findings suggest that poor infant health predicts both mortality within one year, and mortality up to age 17. We also find that infant health is a strong predictor of educational and labor force outcomes. In particular, infant health is found to predict both high school completion and welfare takeup and length.

Child Health and Young Adult Outcomes

Research has shown a strong connection between birth weight and future outcomes. We ask how health problems after birth affect outcomes using data from public health insurance records for 50,000 children born between 1979 and 1987 in the Canadian province of Manitoba. We compare children to siblings born an average of three years apart. We find that health problems in early childhood are significant predictors of young adult outcomes. Early physical health problems are linked to outcomes primarily because they predict later health. Early mental health problems have additional predictive power even conditional on future health and health at birth.

Estimating Price Elasticities When There is Smuggling: The Sensitivity of Smoking to Price in Canada

A central parameter for evaluating tax policies is the price elasticity of demand for cigarettes. But in many countries this parameter is difficult to estimate reliably due to widespread smuggling, which significantly biases estimates using legal sales data. An excellent example is Canada, where widespread smuggling in the early 1990s, in response to large tax increases, biases upwards the response of legal cigarette sales to price. We surmount this problem through two approaches: excluding the provinces and years where smuggling was greatest; and using household level expenditure data on smoking. These two approaches yield a tightly estimated elasticity in the range of -0.45 to -0.47. We also show that the sensitivity of smoking to price is much larger among lower income Canadians. In the context of recent behavioral models of smoking, whereby higher taxes reduce unwanted smoking among price sensitive populations, this finding suggests that cigarette taxes may not be as regressive as previously suggested. Finally, we show that price increases on cigarettes do not increase, and may actually decrease, consumption of alcohol; as a result, smuggling of cigarettes may have raised consumption of alcohol as well.

How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations

The impact of private finance on publicly funded health care systems depends on how the relationship between public and private finance is structured. This essay first reviews the experience in five nations that exemplify different ways of drawing the public/private boundary to address the particular questions raised by each model. This review is then used to interpret aggregate empirical analyses of the dynamic effects between public and private finance in OECD nations over time. Our findings suggest that while increases in the private share of health spending substitute in part for public finance (and vice versa), this is the result of a complex mix of factors having as much to do with cross-sectoral shifts as with deliberate policy decisions within sectors and that these effects are mediated by the different dynamics of distinctive national models. On balance, we argue that a resort to private finance is more likely to harm than to help publicly financed systems, although the effects will vary depending on the form of private finance.

Private insurance subsidies and public health care markets: evidence from Canada

In this study I examine the effects of government subsidies to employer-provided health insurance on the decision to purchase insurance, and on utilization of publicly funded health services. Using unique variation in tax subsidies across Canadian provinces as an instrument, I estimate the effects of these subsidies on the demand for supplemental health insurance and their extended effects on the decision to use publicly-funded health services. My results show that government subsidies through tax exemptions have significant effects on the decision to purchase insurance. Furthermore, additional insurance policies lead to moral hazard in the use of publicly funded health services.

Do Child Tax Benefits Affect the Well-Being of Children? Evidence from Canadian Child Benefit Expansions

We exploit changes in child benefits in Canada to study the impact of family income on child and family well-being. Using variation in child benefits across province, time, and family type, we study outcomes spanning test scores, mental health, physical health, and deprivation measures. The findings suggest that child benefit programs had significant positive effects on test scores, maternal health, and mental health, among other measures. We find strong and interesting differences in the effects of benefits by child sex: benefits have stronger effects on educational outcomes and physical health for boys, and on mental health outcomes for girls. (JEL I12, I31, I38, J13)

Health Care Cost Containment Strategies Used In Four Other High-Income Countries Hold Lessons For The United States

Around the world, rising health care costs are claiming a larger share of national budgets. This article reviews strategies developed to contain costs in health systems in Canada, England, France, and Germany in 2000-10. We used a comprehensive analysis of health systems and reforms in each country, compiled by the European Observatory on Health Systems and Policies. These countries rely on a number of budget and price-setting mechanisms to contain health care costs. Our review revealed trends in all four countries toward more use of technology assessments and payment based on diagnosis-related groups and the value of products or services. These policies may result in a more efficient use of health care resources, but we argue that they need to be combined with volume and price controls--measures unlikely to be adopted in the United States--if they are also to meet cost containment goals.

Do stimulant medications improve educational and behavioral outcomes for children with ADHD

We examine the effects of a policy change in the province of Quebec, Canada which greatly expanded insurance coverage for prescription medications. We show that the change was associated with a sharp increase in the use of stimulant medications commonly prescribed for ADHD in Quebec relative to the rest of Canada. We ask whether this increase in medication use was associated with improvements in emotional functioning or academic outcomes among children with ADHD. We find little evidence of improvement in either the medium or the long run. Our results are silent on the effects on optimal use of medication for ADHD, but suggest that expanding medication in a community setting had little positive benefit and may have had harmful effects given the average way these drugs are used in the community.

Socioeconomic status and child health: what is the role of health care, health conditions, injuries and maternal health?

There is a persistent relationship between socioeconomic status and health that appears to have its roots in childhood. Not only do children in families with lower income and with mothers with lower levels of education have worse health on average than those with greater socioeconomic advantage, but also the gradient appears to steepen with age. This study contributes to the literature on the relationship between socioeconomic status and child health by testing the hypothesis that the increasing effect of family income on childrens health with age relates to the childrens use of health care services. It also investigates the role of specific health conditions, injuries or maternal health in explaining the steepening gradient. Drawing on a nationally representative survey from Canada, the National Longitudinal Survey of Children and Youth from the period 1994/95-2008/09, this study provides further evidence of a steepening socioeconomic gradient in child health with age. It finds that accounting for health care use does not explain the steepening gradient and that the protective effect of income appears to be greater for those who had contact with the health system, in particular with regard to physician care and prescription drug use.