Health inequalities by education, income, and wealth: a comparison of 11 European countries and the US

I compare education-, income-, and wealth-related health inequality using data from 11 European countries and the US. The health distributions in the US, England and France are relatively unequal independent of the stratifying variable, while Switzerland or Austria always have relatively equal distributions. Some countries such as Italy dramatically change ranks depending on the stratifying variable.

True health vs. response styles: Exploring cross-country differences in self-reported health

The aim of this paper is to decompose cross-national differences in self-reported general health into parts explained by differences in "true" health, measured by diagnosed conditions and measurements, and parts explained by cross-cultural differences in response styles. The data used were drawn from the Survey of Health, Ageing and Retirement in Europe 2004 (SHARE), using information from 22,731 individuals aged 50 and over from 10 European countries. Self-rated general health shows large cross-country variations. According to their self-reports, the healthiest respondents live in the Scandinavian countries and the least healthy live in Southern Europe. Counterfactual self-reported health distributions that assume identical response styles in each country show much less variation in self-reports than factual self-reports. Danish and Swedish respondents tend to largely over-rate their health (relative to the average) whereas Germans tend to under-rate their health. If differences in reporting styles are taken into account, cross-country variations in general health are reduced but not eliminated. Failing to account for differences in reporting styles may yield misleading results.

Health Insurance Status and Physician-Induced Demand for Medical Services in Germany: New Evidence from Combined District and Individual Level Data

Germany is one of the few OECD countries with a two-tier system of statutory and primary private health insurance. Both types of insurance provide fee-for-service insurance, but chargeable fees for identical services are more than twice as large for privately insured patients than for statutorily insured patients. This price variation creates incentives to induce demand primarily among the privately insured. Using German SOEP 2002 data, I analyze the effects of insurance status and district (Kreis-) level physician density on the individual number of doctor visits. The paper has four main findings. First, I find no evidence that physician density is endogenous. Second, conditional on health, privately insured patients are less likely to contact a physician but more frequently visit a doctor following a first contact. Third, physician density has a significant positive effect on the decision to contact a physician and on the frequency of doctor visits of patients insured in the statutory health care system, whereas, fourth, physician density has no effect on privately insured patients' decisions to contact a physician but an even stronger positive effect on the frequency of doctor visits than the statutorily insured. These findings give indirect evidence for the hypothesis that physicians induce demand among privately insured patients but not among statutorily insured.Supplier-induced demand, Health care utilization

Unemployment, retrospective error, and life satisfaction

I compare current and one-year retrospective data on unemployment in the German SOEP. 13 percent of all unemployment spells are not reported one year later, and another 7 percent are misreported. The ratio of retrospective to current unemployment (as a measure of unemployment salience) has increased in recent years and it is related to the loss in life satisfaction associated with unemployment. Individuals with weak labor force attachment, e.g. women with children or individuals close to retirement, have the largest propensity to underreport unemployment retrospectively. The data are consistent with evidence on retrospective bias found by cognitive psychologists and survey methodologists.

The effect of compulsory schooling on health - evidence from biomarkers

Using data from the Health Survey for England and the English Longitudinal Study on Ageing, we estimate the causal effect of schooling on health. Identification comes from two nation wide increases in British compulsory school leaving age in 1947 and 1973, respectively. Our study complements earlier studies exploiting compulsory schooling laws as source of exogenous variation in schooling by using biomarkers as measures of health outcomes in addition to self-reported measures. We find a strong positive correlation between education and health, both self-rated and measured by blood fibrinogen and C-reactive protein levels. However, we find ambiguous causal effects of schooling on women's self-rated health and insignificant causal effects of schooling on men's self-rated health and biomarker levels in both sexes.Health, Compulsory schooling, Biomarkers, Regression discontinuity

Does ill health affect savings intentions? Evidence from SHARE

This paper uses data from SHARE 2004 to analyze one possible causal pathway of the health-wealth gradient, namely differences in the marginal propensity to save and spend across different health states. Conditional on age and current wealth, I find weak relationships between health and the intended use of a hypothetical windfall gift as well bequest expectations. The overall effect of health on wealth through this link is positive but very small.

Self-assessed health, reference levels, and mortality

The paper studies the relationship between self-assessed health and subsequent mortality in the German Socio-Economic Panel. Specifically, I examine whether socio-economic characteristics of respondents have an effect on mortality, conditional on self-assessed health. Such conditional effects are shown to exist for many covariates, including age, sex, income, and education. These findings question the comparability of self-assessed health across different socio-economic groups.

Health insurance status and physician-induced demand for medical services in Germany: new evidence from combined district and individual level data

Germany is one of the few OECD countries with a two-tier system of statutory and primary private health insurance. Both types of insurance provide fee-for-service insurance, but chargeable fees for identical services are more than twice as large for privately insured patients than for statutorily insured patients. This price variation creates incentives to induce demand primarily among the privately insured. Using German SOEP 2002 data, I analyze the effects of insurance status and district (Kreis-) level physician density on the individual number of doctor visits. The paper has four main findings. First, I find no evidence that physician density is endogenous. Second, conditional on health, privately insured patients are less likely to contact a physician but more frequently visit a doctor following a first contact. Third, physician density has a significant positive effect on the decision to contact a physician and on the frequency of doctor visits of patients insured in the statutory health care system, whereas, fourth, physician density has no effect on privately insured patients' decisions to contact a physician but an even stronger positive effect on the frequency of doctor visits than the statutorily insured. These findings give indirect evidence for the hypothesis that physicians induce demand among privately insured patients but not among statutorily insured.

Health Insurance Status and Physician-Induced Demand for Medical Services in Germany: New Evidence from Combined District and Individual Level Data

Germany is one of the few OECD countries with a two-tier system of statutory and primary private health insurance. Both types of insurance provide fee-for-service insurance, but chargeable fees for identical services are more than twice as large for privately insured patients than for statutorily insured patients. This price variation creates incentives to induce demand primarily among the privately insured. Using German SOEP 2002 data, I analyze the effects of insurance status and district (Kreis-) level physician density on the individual number of doctor visits. The paper has four main findings. First, I find no evidence that physician density is endogenous. Second, conditional on health, privately insured patients are less likely to contact a physician but more frequently visit a doctor following a first contact. Third, physician density has a significant positive effect on the decision to contact a physician and on the frequency of doctor visits of patients insured in the statutory health care system, whereas, fourth, physician density has no effect on privately insured patients' decisions to contact a physician but an even stronger positive effect on the frequency of doctor visits than the statutorily insured. These findings give indirect evidence for the hypothesis that physicians induce demand among privately insured patients but not among statutorily insured.supplier-induced demand, health care utilization

What Can Go Wrong Will Go Wrong: Birthday Effects and Early Tracking in the German School System

At the age of ten German pupils are given a secondary school track recommendation which largely determines the actual track choice. Track choice has major effects on the life course, mainly through labor market outcomes. Using data from the German PISA extension study, we analyze the effect of month of birth and thus relative age on such recommendations. We find that younger pupils are less often recommended to and actually attend Gymnasium, the most attractive track in terms of later life outcomes. Flexible enrolment and grade retention partly offset these inequalities and the relative age effect dissipates as students age.educational tracking, month of birth effects