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Health Care Organization and Outcomes: International Evidence

Paper Session

Sunday, Jan. 7, 2018 10:15 AM - 12:15 PM

Marriott Philadelphia Downtown, Meeting Room 405
Hosted By: International Health Economics Association
  • Chair: David Bishai, Johns Hopkins University

Waiting for Surgery: Effects on Health and Labor Supply

Ingrid Huitfeldt
Statistics Norway
Mark Votruba
Case Western Reserve University
Venke Furre Haaland
University of Stavanger
Anna Godøy
University of California-Berkeley


In universal health care systems, patients often face significant wait times for treatment when capacity constraints are binding. In this paper, we estimate the effects of wait time for orthopedic surgery (days from referral to surgery) on health and labor market outcomes, using microdata covering all publicly funded orthopedic surgeries in Norway referred in 2010 and 2011. As the system assigns higher priority to more urgent cases, naive OLS estimates linking observed wait times to individual patient outcomes could reflect selection bias. Our identification strategy exploits quasi-random variation in wait times for surgery generated by the idiosyncratic variation in system congestion at the time of a specific patient’s entry into the queue. Precisely, we instrument a patient’s wait time by the average wait time of other patients queued for the same procedure at the same hospital around the same time. We find that longer wait times for surgery significantly increase health related work absence: For every 10 days spent waiting for surgery, sick leave in the two years following referral increases by about 3 days. Moreover, longer wait times do not appear to have any lasting health implications.

Is Preventive Care Worth the Cost? Evidence From Mandatory Checkups in Japan

Karen Eggleston
Stanford University
Toshiaki Iizuka
University of Tokyo
Katsuhiko Nishiyama
Mizuho Information & Research Institute
Brian Chen
University of South Carolina


Using unique individual-level panel data, we investigate whether preventive care triggered by health checkups is worth the cost. We exploit the fact that the health of individuals just below and above a clinical threshold is similar, whereas treatments differ according to the checkup signals they receive. We find that people respond to health signals by increasing medical care utilization. However, we find no evidence that additional care is cost effective; neither physical measures nor predicted risks of diabetes complications improve in the 3-5 years after the index checkup. For efficient use of medical resources, careful examination of cost effectiveness is essential.

Does a Government Public Transfer Program Crowd Out Intergenerational Transfers? Evidence From South Korea

Kanghyock Koh
Ulsan National Institute of Science and Technology
Hyunjoo Yang
Korea Development Institute


Government public transfers through welfare programs are widely used to tackle elderly poverty. These programs often influence the level of pre-existing support from family members, and might displace such private support. In this paper, we analyze the effects of a new old-age pension program on intergenerational financial transfers in South Korea. Applying various empirical approaches, we find robust evidence that money transfers from adult children to parents was completely crowded out after the introduction of the public transfer program. We find little evidence for alternative hypotheses for crowding-out effects, such as the effects of endogenous change in living arrangement as a substitute for financial support, the endogenous labor supply of the elderly, and the global financial crisis. The results imply that the effectiveness of government antipoverty programs through public transfers could be dampened by a reduction in intergenerational transfers.

Earnings Gaps for Conspicuous Characteristics: Evidence From Indonesia

Inas Kelly
City University of New York-Queens College and NBER
Nazmul Ahsan
Saint Louis University


Recent research has begun to analyze the effects of height on earnings in Indonesia, a developing country with a large population. Little has been done on the potential effects of other measures of health, such as weight, waist circumference, and hip circumference on earnings. Carefully accounting for selection into the workforce and the potential endogeneity of our health variables, we use the Indonesia Family Life Survey (IFLS) to identify this effect and conduct Oaxaca-Blinder decompositions to identify possible discrimination. We compare these results to those using less conspicuous health measures such as blood pressure, lung capacity, diabetes, and cholesterol.
R. Vincent Pohl
University of Georgia
Martin Gaynor
Carnegie Mellon University
David Bishai
Johns Hopkins University
JEL Classifications
  • I0 - General