How important are tobacco prices in the propensity to start and quit smoking? An analysis of smoking histories from the Spanish National Health Survey

This paper analyses the effect of tobacco prices on the propensity to start and quit smoking using a pool of the 1993, 1995 and 1997 editions of the Spanish National Health Surveys. The estimates for several parametric models of the hazard rate for starting and quitting suggest that i) The public health measures applied as of 1992 have had a significative effect on both reducing the hazard of starting and increasing the hazard of quitting, ii) Prices have a very weak effect on the hazard of starting in the male population and no significant effect in the female population, iii) The price floor of cigarrettes, proxied by the average price of a pack of black cigarrettes, has a significant effect on the quitting hazard which is robust across specifications and applies to both men and women. The implied price elasticity of the time up to quitting is situated around -1.4.Smoking, taxes, health, care

Unobserved heterogeneity and censoring in the demand for health care

This paper analyses the demand for private health care by Spanish households using a micro budget survey. The methodology used takes care of the three part decision process involved in this type of behaviour, namely the decision to use private health care, how often to do so and how much to spend each time and also the effects of unobserved heterogeneity. Since the theoretical framework corresponds to the Grossman model of health investment, the results also provide a test of the theory when these issues are considered. Finally, the obtained evidence also suggest that the current system of tax deductions for private health care expenditures is regressive.Health, microeconometrics

La economía del tabaco

[ES] Junto a las consideraciones de salud pública que motivan la prevención y el control del tabaquismo, existen argumentos de índole económica que predicen efectos negativos para la economía. El primer grupo de argumentos ha sido adoptado por los movimientos de prevención mientras que los pertenecientes al segundo grupo son utilizados por la industria tabaquera. El objetivo de esta comunicación consiste en analizar críticamente estos argumentos. Por un lado, los argumentos que anuncian una catástrofe económica –que auguran los defensores de los intereses de las tabaqueras– carecen de fundamento. Y tampoco existe una evidencia de que las medidas de restricción generen pérdidas a las empresas implicadas.[EU] Prebentzioa eta tabakismoaren kontrola motibatzen duten osasun publikoaren arloko gogoetarekin batera, ekonomiarentzako ondorio kaltegarriak iragartzen dituzten ekonomia arloko argudioak ere badaude. Lehen saileko argudioak prebentzio munduan dauden eragileek erabiltzen dituzte, bigarren taldekoak ostera, tabakoaren industriak erabiltzen ditu. Artikulu honek, gai honi buruzko argudioak era kritikoan aztertzea du helburu. Tabakoaren industriaren interesen defendatzaileek iragartzen dituzten hondamendi ekonomikoaren argudioek ez daukate oinarririk. Murrizketa neurriek, enpresei galerak sortuko dizkietelari buruz ere, ez dago ebidentziarik.[FR] Á coté des considérations de santé publique qui motivent la prévention et le contrôle du tabagisme, ils existent des arguments de nature économique qui prédisent des effets négatifs pour l’économie, dont les uns sont adoptés par les mouvements de prévention, tandis que les autres sont présentés part l’industrie du tabac. L’objectif de cet exposé est l’analyse critique de ces arguments. D’un coté, les arguments qui annoncent une catastrophe économique –de la part des défenseurs des intérêts de l’industrie du tabac– manquent de fondement. D’autre part, il n’y a pas non plus des preuves qui montrent que les restrictions génèrent des pertes pour les entreprises.[EN] Together with the considerations of public health issues that motivate the prevention and control of nicotine addiction, some economical arguments predict negative effects for the economy. The first group of arguments has been adopted by the prevention movements, whereas the other arguments are used by the tobacco industry. The aim of this review is to make a critical analysis of these arguments. The arguments of an economical catastrophe used by the tobacco industry have any base. There is no evidence that the restrictive measures make a loss for the enterprises in question

Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model for outpatient and inpatient episodes

This paper analyses whether or not tax subsidies to private medical insurance are self-financing by means of a structural approach. We construct a simulation routine based on a microeconometric discrete choice model that allows us to evaluate the impact of premium changes on the utilisation of outpatient and inpatient health care services. We simulate the 1999 Spanish tax reform that abolished the tax deduction for expenditures on private health insurance using a representative sample of the Catalan population. Prior to this reform, foregone tax revenue arising from deductions after the purchase of private insurance amounted to €69.2 M. per year. In contrast, the elimination of the subsidies to private policies is estimated to generate an extra cost for the public sector of about €8.9 M. per year.Health care utilisation, structural modelling, tax reform evaluation

The importance of individual heterogeneity in the decomposition of measures of socioeconomic inequality in health: An approach based on quantile regression

This paper shows how recently developed regression-based methods for the decomposition of health inequality can be extended to incorporate individual heterogeneity in the responses of health to the explanatory variables. We illustrate our method with an application to the Canadian NPHS of 1994. Our strategy for the estimation of heterogeneous responses is based on the quantile regression model. The results suggest that there is an important degree of heterogeneity in the association of health to explanatory variables which, in turn, accounts for a substantial percentage of inequality in observed health. A particularly interesting finding is that the marginal response of health to income is zero for healthy individuals but positive and significant for unhealthy individuals. The heterogeneity in the income response reduces both overall health inequality and income related health inequality.Health inequalities, unobserved heterogeneity, quantile regression

How wide is the gap? An investigation of gender wage differences using quantile regression

In this paper we examine the determinants of wages and decompose the observed differences across genders into the "explained by different characteristics" and "explained by different returns components" using a sample of Spanish workers. Apart from the conditional expectation of wages, we estimate the conditional quantile functions for men and women and find that both the absolute wage gap and the part attributed to different returns at each of the quantiles, far from being well represented by their counterparts at the mean, are greater as we move up in the wage range.Gender wage gap, quantile regression, education

The Evolution of Inequity in the Access to Health Care in Spain: 1987-2001

This paper reports an analysis of the evolution of equity in access to health care in Spain over the period 1987-2001, a time span covering the development of the modern Spanish National Health System. Our measures of access are the probabilities of visiting a doctor, using emergency services and being hospitalised. For these three measures we obtain indices of horizontal inequity from microeconometric models of utilization that exploit the individual information in the Spanish National Health Surveys of 1987 and 2001. We find that by 2001 the system has improved in the sense that differences in income no longer lead to different access given the same level of need. However, the tenure of private health insurance leads to differences in access given the same level of need, and its contribution to inequity has increased over time, both because insurance is more concentrated among the rich and because the elasticity of utilization for the three services has increased too.This paper derives from the project “La dinámica del estado de salud y los factores socieconómicos a lo largo del ciclo vital. Implicaciones para las políticas públicas”, which is supported by the Fundación BBVA. Support from Ministerio de Educación project SEJ2005-09104-C02-02 is thankfully acknowledged

Socio-economic inequalities in health in Catalonia

In this paper we measure the degree of income related inequality in mental health as measured by the GHQ instrument and general health as measured by the EQOL-5D instrument for the Catalan population. We find that income is the main contributor to inequality, although the share of inequality in mental health that can be explained by income is much greater than the corresponding share of inequality in general health. We also find that the variation in demographic structure reduces income related inequality in mental health and in general health. The regional variations in both instruments for health are striking, with the Barcelona districts faring relatively bad with respect to the rest of geographical areas and Lleida being the health region where, all else held equal, the population reports the greatest level of health. A big share of inequality in the two health measures, but specially mental health, is due to the favourable position in both health and income of those who enjoy an indefinite contract with respect to the rest of individuals. We also find that risky working conditions affect both health measures and are able to explain an important share of socio-economic inequality.This paper derives from the project “La dinámica del estado de salud y los factores socieconómicos a lo largo del ciclo vital. Implicaciones para las políticas públicas”, which is supported by the Fundación BBVA

Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model for outpatient and inpatient episodes

This paper develops an empirical strategy to estimate whether subsidies to private medical insurance are self-financing in countries where public and private health insurance coexist. We construct a simulation routine based on a micro econometric discrete choice model that allows us to evaluate the impact of premium changes on the utilisation of outpatient and inpatient health care services. As an application, we simulate the main feature of the 1999 Spanish income tax reform that abolished the individual tax deduction for expenditures on private health insurance. We find evidence suggesting that the fiscal subsidy is far from self-financing. This result is driven by the fact that private medical insurance holders make concurrent use of public services and by the low price elasticity of the demand for policies.We are grateful to Andrew Jones and the YSHE group for useful comments and support. All remaining errors are the only responsibility of the authors. López-Nicolás thanks the Spanish DGES (project PB98- 1058-C03-01) and the Fundación BBVA for financial aid under the project “La dinámica del estado de salud y los factores socieconómicos a lo largo del ciclo vital. Implicaciones para las políticas públicas”. Vera- Hernández gratefully acknowledges financial support from a Marie Curie Fellowship of the European Community program Improving Human Research Potential and the Socioeconomic Knowledge Base under contract HPMF-CT-2001-01206

El discurso de política pública presidencial: Los casos de salud y educación durante los gobiernos de la Concertación (1990-2009)

This article uses Baumgartner and Jones’ policy agenda theoretical and methodological framework to study the Concertación presidents’ May 21 (state of the union) speeches, with an aim towards determining the importance, as well as changes and continuities, that health and education are given in the public policy agenda.Este artículo usa el marco teórico, y la metodología, del policy agenda de Baumgartner y Jones, para estudiar los discursos del 21 de mayo de los presidentes de la Concertación con el objeto de determinar la importancia, los cambios y la continuidad que las áreas de salud y educación poseen en la agenda pública