Vincenzo Carrieri

Health in the cities: when the neighborhood matters more than income.

Using a rich Italian cross-sectional dataset, we estimate the effect of a neighborhood problems aggregate (including pollution, crime, and noise) on self-assessed health, presence of chronic conditions and limitations in daily activities. We address the self-selection of the residents in their neighborhoods, as well as the possible endogeneity of income with respect to health, through instrumental variable methods and several endogeneity tests. The main novelty is the sound estimation of the neighborhood effect on health using observational data, which has the advantage of providing general results that are not dependent on any experimental design. This allows us to fully compare the neighborhood effect with the traditional socioeconomic determinants of health. Our main findings are that low quality neighborhoods are strongly health damaging. This effect is comparable to the primary/upper secondary education health differential and is even higher than the impact that poor economic circumstances have on health.

Height and subjective well-being in Italy

Using an Italian survey, we investigate the effect of height on individual happiness. We find that a large part of the effect of height on well-being is driven by a positive correlation between height and economic and health conditions. However, for young men the effect of height on happiness persists even after controlling for these variables, implying that height is associated with some psycho-social direct effects on well-being. Consistent with this hypothesis, we find that men care not only about their own height but also about the height of others in their reference group. Well-being is greater for individuals who are taller than other men in their reference group. Results are robust to different definitions of reference group and controlling for a number of other reference group characteristics.

Preventive care: underused even when free. Is there something else at work?

Explaining the rationale of preventive care underuse is a difficult task considering its great benefits for health. Underuse is even more difficult to explain in countries like Italy where preventive care can be obtained for free. In this article we investigate the determinants of prevention underuse with an empirical model based on human capital theory which also includes three factors to which little attention has been paid so far: role played by the General Practitioner (GP), nonmonetary barriers to access and health beliefs. We apply a recursive probit model explaining both recourse to prevention and to the GP which allows us to adequately measure the effect of the latter on the former and to quantitatively compare the determinants of curative and preventive care. We find that the GP plays a minor role in prevention use but that nonmonetary barriers to access and health beliefs are strong determinants of preventive care demand. Finally, we also find support for both Grossmans capital depreciation theory (at younger ages) and Croppers shorter pay-off period theory (at older ages).

Social Comparison and Subjective Well‐Being: Does the Health of Others Matter?

The importance of social comparison in shaping individual utility has been widely documented by subjective well-being literature. So far, income and unemployment have been the main dimensions considered in social comparison. This paper aims to investigate whether subjective well-being is influenced by inter-personal comparison with respect to health. Thus, we study the effects of the health of others and relative health hypotheses on two measures of subjective well-being: happiness and subjective health. Using data from the Italian Health Conditions survey, we show that a high incidence of chronic conditions and disability among reference groups negatively affects both happiness and subjective health. Such effects are stronger among people in the same condition. These results, robust to different econometric specifications and estimation techniques, suggest the presence of some sympathy in individual preferences with respect to health and reveal that other peoples health status serves as a benchmark to assess ones own health condition.

The Income–Health Relationship ‘Beyond the Mean’: New Evidence from Biomarkers

The relationship between income and health is one of the most explored topics in health economics but less is known about this relationship at different points of the health distribution. Analysis based solely on the mean may miss important information in other parts of the distribution. This is especially relevant when clinical concern is focused on the tail of the distribution and when evaluating the income gradient at different points of the distribution and decomposing income-related inequalities in health is of interest. We use the unconditional quantile regression approach to analyse the income gradient across the entire distribution of objectively measured blood-based biomarkers. We apply an Oaxaca-Blinder decomposition at various quantiles of the biomarker distributions to analyse gender differentials in biomarkers and to measure the contribution of income (and other covariates) to these differentials. Using data from the Health Survey for England, we find a non-linear relationship between income and health and a strong gradient with respect to income at the highest quantiles of the biomarker distributions. We find that there is heterogeneity in the association of health to income across genders, which accounts for a substantial percentage of the gender differentials in observed health. Copyright

Insecure, Sick and Unhappy? Well-Being Consequences of Temporary Employment Contracts

Abstract This paper investigates the influences of temporary contracts along several dimensions of well-being (physical and mental health, self-assessed health and happiness) for young Italian workers. Our paper contributes to the literature exploring some new aspects of the relationship between temporary jobs and well-being in a country not frequently analysed in previous literature. We focus on the gender gap in the well-being consequences of non-permanent jobs, the influence of financial support by family in reducing well-being effects caused by temporary contracts and the interaction between gender gap and family support. We find that temporary contracts are damaging in terms of psychological health and happiness mostly for young men and individuals without family economic support. On the other hand, women’s mental health is not affected by temporary contracts and they are even better off in terms of their mental health and well-being when receiving family economic support.

Home Sweet Home? Public Financing and Inequalities in the Use of Home Care Services in Europe†

Income-related inequalities in health care access have been found in several European countries but little is known about the extent of inequalities in the provision of Long Term Care services (LTC). This paper fills this gap: it addresses equity issues related to the provision of home care services across three macro-areas in Europe which are highly heterogeneous in terms of the degree of public financing of LTC and the strength and the social value of family ties. Using cross-country comparative micro-data from SHARE (Survey of Health, Ageing and Retirement in Europe) survey, we estimate and decompose an Erreygers concentration index of the use of both paid domestic help (�unskilled� care) and personal nursing care (�skilled� care), measuring the contribution of income, needs and non-needs factors to overall inequality. We base the decomposition on a bivariate probit model which takes into account the reciprocal interaction between formal and informal home care use. We find evidence of high horizontal inequity in the use of unskilled home care in areas where public financing of LTC is relatively low (Southern Europe) while moderate inequalities emerges in areas where public-private mix of financing is more balanced (Continental Europe). At the same time, we do not detect inequity in Northern Europe characterized by high public spending on universal services equitable for all, including LTC public coverage. In all areas, informal care has been found to be a substitute for paid unskilled care among the poor and this contributes to further skewing the distribution of the use of formal care services towards the rich.

Does the letter matter (and for everyone)? Quasi-experimental evidence on the effects of home invitation on mammography uptake

We exploit regional variation in the availability of breast cancer screening policies and variations in age eligibility criteria across European regions to estimate the causal effect of home invitation on mammography uptake. We link administrative public data about regional breast cancer screening policies from various sources to individual Survey of Health Ageing and Retirement in Europe (SHARE) data. We find that home invitation increases mammography uptakes by almost 20 percentage points. At the same time, we find that home invitation reduces education-related inequalities but increases gradient in the use related to cognitive functions. In addition, significant effects on mammography use are found only when at least 50 per cent of the population is reached by the home invitation. Our results suggest that an exogenous informational shock affects preventive decisions especially among less informed individuals but the effectiveness of invitation is strongly reduced for women who are less able to process information.

Quasi‐Experimental Evidence on the Effects of Health Information on Preventive Behaviour in Europe

We investigate the effect of information on preventive decisions in a quasi-experimental setting arising from the implementation of local breast cancer screening programmes in Europe. To identify the causal effect of invitation on preventive uptake, we link administrative public data on regional screening policies to individual data from the Survey of Health Ageing and Retirement in Europe (SHARE) and exploit regional variation in the availability of screening policies and in age eligibility criteria. We find home invitation increases mammography uptakes by around 24%. Significant effects are found when at least 50% of the population is reached by the invitation letter. The stock of health information and the ability to process the information received seem to play a significant role, as the effects of invitation are higher among low educated and lower among cognitively impaired women.

Inequality of opportunity in health: a decomposition-based approach

This paper presents new decomposition-based approaches to measure inequality of opportunity in health that capture Roemers distinction between circumstances and effort and are consistent with both compensation and reward principles. Our approach is fully nonparametric in the way that it handles differences in circumstances and provides decompositions of both a rank-dependent relative (the Gini coefficient) and a rank-independent absolute inequality index (the variance). The decompositions distinguish the contribution of effort from the direct and indirect (through effort) contribution of circumstances to the total inequality. Our approach is illustrated by an empirical application that uses objectively measured biomarkers as health outcomes and as proxies for relevant effort variables. Using data from the Health Survey for England from 2003 to 2012, we find that circumstances are the leading determinant of inequality in cholesterol, glycated haemoglobin, and in a combined ill-health index whereas effort plays a substantial role in explaining inequality in fibrinogen only.