Health Economics

O'Donnell, Owen; Jones, Andrew

doi: 10.1002/hec.1515pmid: 19688771

O'Donnell, Owen; Jones, Andrew

doi: 10.1002/hec.1512pmid: 19582755

We examine the physical and mental health effects of providing care to an elderly mother on the adult child caregiver. We address the endogeneity of the selection in and out of caregiving using an instrumental variable approach, using the death of the care recipient and sibling characteristics. We also carefully control for baseline health and work status of the adult child. We explore flexible specifications, such as Arellano–Bond estimation techniques. Continued caregiving over time increases depressive symptoms and decreases self‐rated health for married women and married men. In addition, the increase in depressive symptoms is persistent for married women. While depressive symptoms for single men and women are not affected by continued caregiving, there is evidence of increased incidence of heart conditions for single men, and that these effects are persistent. Robustness checks indicate that these health changes can be directly attributable to caregiving behavior, and not due to a direct effect of the death of the mother. The initial onset of caregiving has modest immediate negative effects on depressive symptoms for married women and no immediate effects on physical health. Negative physical health effects emerge 2 years later, however, suggesting that there are delayed effects on health that would be missed with a short recall period. Initial caregiving does not affect health of married men. Published in 2009 by John Wiley & Sons, Ltd.

O'Donnell, Owen; Jones, Andrew

doi: 10.1002/hec.1533pmid: 19634124

This article is focused on children providing and financing long‐term care for their elderly parent. The aim of this work is to highlight the interactions that may take place among siblings when deciding whether or not to become a caregiver. We look at families with two children using data from the Survey of Health, Ageing and Retirement in Europe; our sample contains 314 dependent elderly and their 628 adult children. In order to identify the interactions between siblings, we have specified a two‐person discrete game model. To estimate this model, without invoking the ‘coherency’ condition, we have added an endogenous selection rule to solve the incompleteness problem arising from multiplicity or absence of equilibrium. Our empirical results suggest that the three classical effects identified by Manski could potentially explain the observed correlation between the siblings' caregiving behaviour. Correlated effects alone appear to be weak. Contextual interactions and endogenous interactions reveal cross‐effects. The asymmetric character of the endogenous interactions is our most striking result. The younger child's involvement appears to increase the net benefit of caregiving for the elder one, whereas the elder child's involvement decreases the net benefit of caregiving for the younger child. Copyright © 2009 John Wiley & Sons, Ltd.

O'Donnell, Owen; Jones, Andrew

doi: 10.1002/hec.1475pmid: 19353528

The current air quality limit values for airborne pollutants in the UK are low by historical standards and are at levels that are believed not to harm health. We assess whether this view is correct. We examine the relationship between common sources of airborne pollution and population mortality for England. We use data at local authority level for 1998–2005 to examine whether current levels of airborne pollution, as measured by annual mean concentrations of carbon monoxide, nitrogen dioxide, particulate matter less than 10 µm in diameter (PM10) and ozone, are associated with excess deaths. We examine all‐cause mortality and deaths from specific cardiovascular and respiratory causes that are known to be exacerbated by air pollution. The panel nature of our data allows us to control for any unobserved time‐invariant associations at local authority level between high levels of air pollution and poor population health and for common time trends. We estimate multi‐pollutant models to allow for the fact that three of the pollutants are closely correlated. We find that higher levels of PM10 and ozone are associated with higher mortality rates, and the effect sizes are considerably larger than previously estimated from the primarily time series studies for England. Copyright © 2009 John Wiley & Sons, Ltd.

O'Donnell, Owen; Jones, Andrew

doi: 10.1002/hec.1535pmid: 19644964

This paper proposes an empirical implementation of the concept of inequality of opportunity in health and applies this to data from the UK National Child Development Study. Drawing on the distinction between circumstance and effort variables in John Roemer's work on equality of opportunity, circumstances are proxied by parental socio‐economic status and childhood health; effort is proxied by health‐related lifestyles and educational attainment. Stochastic dominance tests are used to detect inequality of opportunity in the conditional distributions of self‐assessed health in adulthood. Two alternative approaches are used to measure inequality of opportunity. Econometric models are estimated to illuminate and quantify the triangular relationship between circumstances, effort and health. The results indicate the existence of a considerable and persistent inequality of opportunity in health. Circumstances affect health in adulthood both directly and through effort factors such as educational attainment. This indicates that, while the influence of some unjust circumstances can only be tackled during childhood, the implementation of complementary educational policies may be of paramount importance. Copyright © 2009 John Wiley & Sons, Ltd.

O'Donnell, Owen; Jones, Andrew

doi: 10.1002/hec.1537pmid: 19634153

This study estimates the effect of job loss on health for near elderly employees based on longitudinal data from the Health and Retirement Study. Previous studies find a strong negative correlation between unemployment and health. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason – the closure of their previous employers' business. I find no causal effect of exogenous job loss on various measures of physical and mental health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality. Copyright © 2009 John Wiley & Sons, Ltd.

O'Donnell, Owen; Jones, Andrew

doi: 10.1002/hec.1536pmid: 19644938

An incentive program for general practitioners to encourage systematic and igh‐quality care in chronic disease management was introduced in Australia in 1999. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect. This paper evaluates the impact of the incentive program on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a bivariate probit model to control for the self‐selection process of practices into the program. The study finds that the incentive program increased the probability of an HbA1c test being ordered by 20 percentage points and that participation in the program is facilitated by the support of Divisions of General Practice. Copyright © 2009 John Wiley & Sons, Ltd.