Assessing Horizontal Equity in Medication Treatment Among Elderly Mexicans: Which Socioeconomic Determinants Matter Most?

Many low- and middle-income countries are currently undergoing a dramatic epidemiological transition, with an increasing disease burden due to degenerative noncommunicable diseases. Inexpensive medication treatment often represents a cost-effective means to prevent, control or cure many of these health conditions. Using micro data from the 2001 Mexican Health and Aging Study, we assess horizontal inequity in medication treatment among older Mexicans before the introduction of Popular Health Insurance in Mexico. In doing so, we investigate the role of various dimensions of socioeconomic status for obtaining indicated medication treatment within a comparatively fragmented health care system that features relatively high out-of-pocket expenditures. Our empirical analysis suggests health insurance coverage as a key socioeconomic determinant of indicated medication use with large and statistically significant positive effects on take-up. The effects of insurance status thereby clearly dominate any other possible effects of socioeconomic status on medication treatment. Our results thus highlight the importance of access to reliable health care and comprehensive coverage for rational medication use in the management of degenerative diseases. In light of this evidence, we expect that recent Mexican health care reforms, which expand health insurance coverage to the previously uninsured population, will alleviate socioeconomic gradients in medication treatment among older people in need.

Modelling socioeconomic and health determinants of health care use: A semiparametric approach

This paper suggests bivariate semiparametric index models as a tool for modelling the interplay of socioeconomic and health characteristics in determining health care utilisation. These models allow for a fully nonparametric relationship between socioeconomic status, health care need and care utilisation. The only parametric restriction imposed is that multiple socioeconomic and health indicators can be aggregated into two distinct indices that measure the broader concepts of socioeconomic status and health care need, respectively. We demonstrate the usefulness of this class of models based on an illustrative empirical example. The estimations highlight complex interactions of socioeconomic status and health care need in determining care use, which may be difficult to grasp via standard parametric modelling approaches.

Socioeconomic and Health Determinants of Health Care Utilization Among Elderly Europeans: A Semiparametric Assessment of Equity, Intensity and Responsiveness for Ten European Countries

This paper investigates the interplay of socioeconomic and medical determinants of health care utilization among elderly Europeans from ten countries. Using novel strictly comparable cross-national data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study exploits recent semi- and nonparametric estimation methods to illustrate how individual socioeconomic status and health determine health care utilization in different institutional settings. Our flexible estimation method allows for the use of multiple health measures to adjust for individual differences in health care need without sacrificing cross-national comparability of the resulting estimates. Within countries, we find only a small, if any, socioeconomic gradient. Moreover, all health systems appear to be reasonably responsive to differences in care need. At the same time, we find considerable variation in treatment intensity across countries, which we cannot fully explain by differences in health care need.

Who wears the trousers? A semiparametric analysis of decision power in couples

Decision processes among couples depend on the balance of power between the partners, determining the welfare of household members as well as household outcomes. However, little is known about the determinants of power. The collective model of household behavior gives an operational definition of decision power. We argue that important aspects of this concept of power are measurable through self-assessments of partners’ say. Using such a measure, we model balance of power as an outcome of the interplay between both partners’ demographic, socioeconomic, and health characteristics. Advancing flexible, yet parsimonious empirical models is crucial for the analysis, as both absolute status as well as relative position in the couple might potentially affect the balance of power, and gender-asymmetries may be important. Appropriately, we advance semiparametric double index models that feature one separate index for each spouse, which interact nonparametrically in the determination of power. Based on data from the Mexican Health and Aging Study (MHAS), we find education and employment status to be associated with more individual decision power, especially for women. Moreover, health and income have independent effects on the distribution of power. We also show that contextual factors are important determinants of decision power, with women in urban couples featuring more decision power than their rural counterparts.

Who wears the trousers? A semiparametric analysis of decision power in couples

Decision processes among couples depend on the balance of power between the partners, determining the welfare of household members as well as household outcomes. However, little is known about the determinants of power. The collective model of household behavior gives an operational definition of decision power. We argue that important aspects of this concept of power are measurable through self-assessments of partners' say. Using such a measure, we model balance of power as an outcome of the interplay between both partners' demographic,socioeconomic, and health characteristics. Advancing flexible, yet parsimonious empirical models is crucial for the analysis, as both absolute status as well as relative position in the couple might potentially affect the balance of power, and gender-asymmetries may be important. Appropriately, we advance semiparametric double index models that feature one separate index for each spouse, which interact nonparametrically in the determination of power.Based on data from the Mexican Health and Aging Study (MHAS), we find education and employment status to be associated with more individual decision power,especially for women. Moreover, health and income have independent effects on the distribution of power. We also show that contextual factors are important determinants of decision power, with women in urban couples featuring more decision power than their rural counterparts.

Smooth it Like the “Joneses?” Estimating Peer-Group Effects in Intertemporal Consumption Choice

Recent theoretical contributions have suggested peer-group effects as a potential explanation for several puzzles in macroeconomics, but their empirical relevance for intertemporal consumption choice is an open question. We derive an extension of the standard life-cycle model that allows for consumption externalities. In this framework, we propose a social multiplier approach to distinguish true externalities from merely correlated effects. Estimating our model using US panel data, we find strong predictable co-movement of household consumption within peer groups. Although much of this co-movement reflects correlated effects only, there is statistically significant evidence for moderate consumption externalities across several plausible peer-group specifications.

Do the "Joneses" really matter? Peer-group versus correlated effects in intertemporal consumption choice

Recent theoretical contributions have suggested consumption externalities, or peergroup effects, as a potential explanation for some of the puzzles in macroeconomics and finance. However, the empirical relevance of peer effects for intertemporal consumption choice is a completely open question. To shed some light on the issue, we derive an extension of the standard life-cycle model that allows for consumption externalities. The analysis is complicated by the challenge of disentangling actual peer effects from merely correlated effects operating through common features or shocks within peer groups. We show how to conduct reliable inference under these circumstances based on within-group equilibrium conditions that give rise to a social multiplier. This approach can be understood as an adaptation of Manski's "reflection problem framework" to the case of dynamic models with endogenous regressors. We estimate our model using US panel data from the PSID. While there is strong predictable consumption co-movement within peer groups, the evidence for true consumption externalities vanishes once correlated effects are adequately accounted for.Consumption, Life-Cycle Model, Peer Effects, Reflection Problem

Assessing Horizontal Equity in Medication Treatment Among Elderly Mexicans: Which Socioeconomic Determinants Matter Most?

Many low- and middle-income countries are currently undergoing a dramatic epidemiological transition, with an increasing disease burden due to degenerative noncommunicable diseases. Inexpensive medication treatment often represents a cost-effective means to prevent, control or cure many of these health conditions. Using micro data from the 2001 Mexican Health and Aging Study, we assess horizontal inequity in medication treatment among older Mexicans before the introduction of Popular Health Insurance in Mexico. In doing so, we investigate the role of various dimensions of socioeconomic status for obtaining indicated medication treatment within a comparatively fragmented health care system that features relatively high out-of-pocket expenditures. Our empirical analysis suggests health insurance coverage as a key socioeconomic determinant of indicated medication use with large and statistically significant positive effects on take-up. The effects of insurance status thereby clearly dominate any other possible effects of socioeconomic status on medication treatment. Our results thus highlight the importance of access to reliable health care and comprehensive coverage for rational medication use in the management of degenerative diseases. In light of this evidence, we expect that recent Mexican health care reforms, which expand health insurance coverage to the previously uninsured population, will alleviate socioeconomic gradients in medication treatment among older people in need

Education and Male-Female Differences in Later-Life Cognition: International Evidence From Latin America and the Caribbean

This study explores the role of early-life education for differences in cognitive functioning between men and women aged 60 and older from seven major urban areas in Latin America and the Caribbean. After documenting statistically significant differences in cognitive functioning between men and women for six of the seven study sites, I assess the extent to which these differences can be explained by prevailing male-female differences in education. I decompose predicted male-female differences in cognitive functioning based on various statistical models for later-life cognition and find robust evidence that male-female differences in education are a major driving force behind cognitive functioning differences between older men and women. This study therefore suggests that early-life differences in educational attainment between boys and girls during childhood have a lasting impact on gender inequity in cognitive functioning at older ages. Increases in educational attainment and the closing of the gender gap in education in many countries in Latin America and the Caribbean may thus result in both higher levels and a more gender-equitable distribution of later-life cognition among the future elderly in those countrie

Socioeconomic and Health Determinants of Health Care Utilization Among Elderly Europeans: A Semiparametric Assessment of Equity, Intensity and Responsiveness for Ten European Countries

This paper investigates the interplay of socioeconomic and medical determinants of health care utilization among elderly Europeans from ten countries. Using novel strictly comparable cross-national data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study exploits recent semi- and nonparametric estimation methods to illustrate how individual socioeconomic status and health determine health care utilization in different institutional settings. Our flexible estimation method allows for the use of multiple health measures to adjust for individual differences in health care need without sacrificing cross-national comparability ofthe resulting estimates. Within countries, we find only a small, if any, socioeconomic gradient. Moreover, all health systems appear to be reasonably responsive to differences in care need. At the same time, we find considerable variation in treatment intensity across countries, which we cannot fully explain by differences in health care need