期刊-NBER美国国民经济研究局-2009number1_36页_1mb

NBER Reporter Summary - 2009 Number 1

Core Content

The NBER Reporter for 2009 Number 1 highlights various research topics within the NBER Program in Health Economics, focusing on the determinants and consequences of health-related behaviors such as obesity, substance use, and alcohol consumption, as well as the impact of health insurance and education on health outcomes.

Main Topics and Key Findings

1. The Economics of Obesity

• Childhood Obesity: Fast-food advertising on television is linked to increased childhood and adolescent obesity. A ban on such advertising could reduce obesity rates by 18% among children (3–11) and 14% among adolescents (12–18).
• Tax Deductibility: Eliminating the tax deductibility of fast-food advertising would result in smaller declines in obesity rates but reduce costs for moderate consumers.
• Health Insurance and Obesity: Obese individuals in private insurance plans have higher expected health plan payouts compared to those of normal weight. However, no significant differences are found for those with public coverage.
• Health Care Cost Externality: Adult obesity imposes an external cost of approximately $150 on the non-obese. Obese workers with employer-sponsored insurance may experience lower cash wages due to increased healthcare costs.
• Body Composition Measures: Fat-free body mass is consistently associated with higher wages, suggesting that more accurate measures of body composition can provide better insights into health and economic outcomes.

2. The Economics of Substance Use

• Cigarette Smoking: Price increases explain a significant portion of changes in smoking behavior among high school seniors. A 10% increase in cigarette prices is estimated to reduce SIDS deaths by about 7%.
• Alcohol Consumption: Alcohol taxes and regulations have a measurable impact on consumption and related outcomes. A 1% increase in drinking days is associated with a 0.4% increase in total mortality.
• Illegal Drugs: Demand functions for illegal drugs like cocaine and heroin are estimated using emergency room data and arrestee data. Higher drug prices (due to penalties and enforcement) are associated with reduced participation among heavy users.

3. Schooling and Health

• Formal Education: Years of schooling are strongly correlated with better health outcomes, including lower rates of low birthweight and infant mortality.
• Natural Experiment in Taiwan: Extending compulsory education from 6 to 9 years in 1968 led to improved infant health outcomes, with a 11% reduction in infant mortality.
• Health Insurance and Education: The return on education in terms of health is estimated to be about half of the return on earnings, indicating that education policies can significantly impact population health.

4. National Health Insurance (NHI)

• Taiwan’s NHI Experience: The introduction of NHI in 1995 reduced postneonatal mortality among infants of farmers by 11%, with larger impacts for less educated mothers and in rural areas.
• Canada vs. U.S.: Differences in infant mortality and life expectancy between the U.S. and Canada are influenced by cultural and behavioral factors, not solely by healthcare systems. The U.S. has higher survival rates for cancer and low-birthweight infants due to better access to high-level technology and treatment.
• Medicare and Health Behavior: Medicare eligibility is associated with a 20% reduction in AMI mortality for severely ill patients. However, it may also lead to moral hazard by reducing preventive behaviors among the elderly.

5. Unemployment and Health

• Recession Impact: A 1% decrease in unemployment is associated with a 1.3% increase in AMI mortality, especially among younger adults. This highlights the complex relationship between economic conditions and health outcomes.
• Economic Growth Effects: While economic growth can have negative health effects, it does not imply that recessions should be encouraged. Physicians should be aware of increased risks during periods of economic expansion.

Key Information

• NBER is a private, nonprofit research organization founded in 1920, focusing on objective quantitative analysis of the American economy.
• The 2009 Reporter introduces a new format that includes links to full research papers and abstracts on the NBER website.
• Public Policy Implications: The studies suggest that price-based interventions, such as taxes on unhealthy products, can be effective in reducing harmful behaviors like smoking, drinking, and drug use.
• Health Insurance: The role of health insurance in shaping health behaviors and outcomes is significant, particularly in influencing obesity, healthcare costs, and preventive care.
• Education and Health: There is a strong causal link between education and better health outcomes, especially in developing countries. Policies that improve educational attainment can have substantial health benefits.
• Moral Hazard: The introduction of health insurance may lead to reduced preventive behaviors and increased risky health choices, especially among the elderly.

Conclusion

The NBER Program in Health Economics explores a wide range of health-related economic issues, emphasizing the role of price, policy, and behavioral factors in shaping health outcomes. The studies highlight the importance of targeted interventions such as taxation, health insurance reforms, and education policies in improving public health. The new format of the NBER Reporter enhances accessibility to research findings and encourages further exploration of these critical economic and health issues.