A Comparison of Alternative Methods to Model Endogeneity in Count Models. An Application to the Demand for Health Care and Health Insurance Choice.

Several estimators have been suggested to tackle the problem of endogenous regressors and selectivity in count regression models. They differ in the structure and the degree of parametrization of the underlying models. The estimation of health services utilization conditional on the choice of different forms of health insurance provides a classical example of such problems. In Switzerland, basic health insurance is mandatory and each individual is insured separately. The insurance premium varies by region of residence but is independent of income and risk. The insured face a minimal annual deductible for ambulatory health services. Annually, they are given a choice of higher deductibles to reduce their insurance premium by a regulated percentage. The choice of a higher deductible sets incentives for a more cautious utilization of health services. Clearly, the choice is made based on expected health service utilization. The effect of the choice of a higher than the minimal deductible on the number of physician visits is analyzed. A matching estimator, a GMM estimator, two-stage method of moments estimators which account for selectivity and endogenous switching count regression models are applied to data from the 1997 Swiss Health Survey. Incentive-induced behavioral changes are disentangled from selection effects. The main finding is that most of the observed lower utilization for individuals with a high insurance deductible is caused by self- selection of individuals into the respective insurance contracts which either differ in their preferences or are healthier in unobserved aspects of their health status.demand for health care and insurance, count models, endogenous regressors

The evolution of income-related inequalities in health care utilization in Switzerland over time

This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization. Looking at each of the four survey years separately the results indicate that by and large, there is little or no inequity in use except with respect to specialist visits which are clearly pro rich distributed as in most other OECD countries. We neither find much significant variation over time despite the fact that the share of health care has grown from close to 8% to more than 11% over this period and that a major reform of the health care system has taken place in 1996health care utilization; inequality

The evolution of income-related health inequalities in Switzerland over time

This paper presents new evidence on income-related health inequality and its development over time in Switzerland. We employ the methods lined out in van Doorslaer and Jones (2003) and van Doorslaer and Koolman (2004) measuring health using an interval regression approach to compute concentration indices and decomposing inequality into its determining factors. Nationally representative survey data for 1982, 1992, 1997 and 2002 are used to carry out the analysis. Looking at each of the four years separately the results indicates the usual positive relationship between income and health, but the distribution is among the least unequal in Europe. No clear trend emerges in the evolution of the inequality indices over the two decades. Inequality is somewhat lower in 1982 and 1992 as compared to 1997 and 2002 but the differences are not significant. The most important contributors to health inequality are income, education and activity status, in particular retirement. Regional differences including the widely varying health care supply, by contrast, do not exert any systematic influenceInequalities in health; concentration index; decomposition analysis

Wählbare Selbstbehalte in der Krankenversicherung der Schweiz: Nachfragesteuerung oder Selektion?

This paper discusses if the choice of a higher deductible in mandatory Swiss health insurance leads to a reduction of health care utilization. A GMM estimator which takes into account the potential endogeneity of the choice of the deductible is used to analyze the number of physician visits. The data from the Swiss Health Survey 2002 allow for a correct modeling of the sequence of choice of the deductible and ensuing health care utilization. Individuals were interviewed at the time of choice of the deductible and six months later. The results indicate that the observed lower number of physician visits among individuals who opted for a high deductible is caused by self-selection of healthier individuals and of individuals with less preference for health care into contracts with high deductibles. An incentive induced behavioral change towards a more parsimonious utilization of health care services cannot be found

The Effect of Health Changes and Long-term Health on the Work Activity of Older Canadians

Using longitudinal data from the Canadian National Population Health Survey (NPHS), we study the relationship between health and employment among older Canadians. We focus on two issues: (1) the possible endogeneity of self- reported health, particularly "justification bias", and (2) the relative importance of health changes and long-term health in the decision to work. The NPHS contains the HUI3, an "objective" health index which has been gaining popularity in empirical work. We contrast estimates of the impact of health on employment using self-assessed health, the HUI3, and a "purged" health measure similar to that employed by Bound et al. (1999) and Disney et al. (2003). A direct test suggests that self-assessed health suffers from justification bias. However, the HUI3 provides estimates that are similar to the "purged" health measure. We also corroborate recent U.S. and U.K. findings that changes in health are important in the work decision.Health; Health Changes; Employment; Older Workers; NPHS

The Effect of Health Changes and Long-term Health on the Work Activity of Older Canadians

Using longitudinal data from the Canadian National Population Health Survey (NPHS), we study the relationship between health and employment among older Canadians. We focus on two issues: (1) the possible problems with self- reported health, including endogeneity and measurement error, and (2) the relative importance of health changes and long-term health in the decision to work. We contrast estimates of the impact of health on employment using self-assessed health, an objective health index contained in the NPHS - the HUI3, and a "purged" health stock measure. Our results suggest that health has an economically significant effect on employment probabilities for Canadian men and women aged 50 to 64, and that this effect is underestimated by simple estimates based on self-assessed health. We also corroborate recent U.S. and U.K. findings that changes in health are important in the work decision.health, health changes, employment, older workers

The evolution of income-related inequalities in health care utilization in Switzerland over time

This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization. Looking at each of the four survey years separately the results indicate that by and large, there is little or no inequity in use except with respect to specialist visits which are clearly pro rich distributed as in most other OECD countries. We neither find much significant variation over time despite the fact that the share of health care has grown from close to 8% to more than 11% over this period and that a major reform of the health care system has taken place in 1996

Disgusting or Innovative-Consumer Willingness to Pay for Insect Based Burger Patties in Germany

Insects represent an excellent source of food due to their density in unsaturated fatty acids, vitamins, and minerals, while their production is associated with lower emissions of greenhouse gases and resource use as compared to other conventional protein sources. In most Western countries, the human consumption of insects is very low and often perceived as culturally inappropriate. In this study, we analyzed the preferences of German consumers for insect-based products to intensify the knowledge about specific consumer segments that are willing to adopt insects into their diet. For this purpose, an online based choice experiment was conducted in 2016, in which respondents chose between an ordinary burger and a burger with a beef burger patty fortified with insect flour. We detect three homogeneous consumer segments in our sample. The largest group of respondents is willing to consume insect-fortified burgers with only a small price discount, while the other respondents had a prohibitively low willingness-to-pay. The readiness of consumers to adopt insects into their diet is strongly related to attitudinal variables, such as preferences for an environmental friendly production method and health aspects. On the other hand, disgust and the aversion towards insects seem to be the main reasons to abstain from eating insects