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    Marti, Joachim and Richards, Michael R. 2016. Smoking Response to Health and Medical Spending Changes and the Role of Insurance. Health Economics, p. n/a.


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Heterogeneity in the smoking response to health shocks by out-of-pocket spending risk

  • Michael R. Richards (a1) and Joachim Marti (a2)
  • DOI: http://dx.doi.org/10.1017/S1744133114000152
  • Published online: 06 May 2014
Abstract
Abstract

An existing literature demonstrates that adverse changes to health can lead to improvements in health behaviors. Although the exact explanations for these empirical findings are debated, some posit that individuals learn about their true health risks through health shocks. Updated health risk information can then induce changes in health behaviors. While we follow a learning framework, we argue that past work has neglected the role of health insurance and medically related financial risk within this decision making context. Using longitudinal data from 11 European countries, we investigate the impact of a new cardiovascular (CV) health shock on smoking decisions among older adults and examine whether personal exposure to medical spending risk influences the smoking response. We then explore two potential mechanisms for this link: larger updates to health risk beliefs and higher medical expenditures to incentivize behavior change. We find that CV shocks impact the propensity to smoke, with relatively more impact among individuals with high financial risk exposure to medical spending. We also see larger increases in out-of-pocket expenditures following a shock for this group – consistent with the latter mechanism for behavior change.

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Corresponding author
*Correspondence to: Michael R. Richards, Postdoctoral Research Associate, University of Pennsylvania, Wharton School, Leonard Davis Institute of Health Economics Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104 USA. Email: mirich@wharton.upenn.edu
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G. Anderson (2007), ‘From ‘Soak the Rich’ to ‘Soak the Poor’: recent trends in hospital pricing’, Health Affairs, 26(3): 780789.

G. F. Anderson , B. K. Frogner and U. E. Reinhardt (2007), ‘Health spending in OECD countries in 2004: an update’, Health Affairs, 26(5): 14811489.

V. Atella , M. Brunetti and N. Maestas (2012), ‘Household portfolio choices, health status and health care systems: a cross-country analysis based on SHARE’, Journal of Banking & Finance, 36: 13201335.

P. Babiarz , R. Widdows and T. Yilmazer (2013), ‘Borrowing to cope with adverse health events: liquidity constraints, insurance coverage, and unsecured debt’, Health Economics, 22(10): 11771198.

L. R. Brawley , W. J. Rejeski and A. C. King (2003), ‘Promoting physical activity for older adults: the challenges for changing behavior’, American Journal of Preventive Medicine, 25(3, Supplement 2): 172183.

F. Breyer and S. Felder (2006), ‘Life expectancy and health care expenditures: a new calculation for Germany using the costs of dying’, Health Policy, 75(2): 178186.

J. Cawley and C. Meyerhoefer (2012), ‘The medical care costs of obesity: an instrumental variables approach’, Journal of Health Economics, 31: 219230.

A. Clark and F. Etilé (2002), ‘Do health changes affect smoking? Evidence from British panel data’, Journal of Health Economics, 21: 533562.

D. Dave and R. Kaestner (2009), ‘Health insurance and ex ante moral hazard: evidence from Medicare’, International Journal of Health Care Finance and Economics, 9: 367390.

M. De Nardi , E. French and J. B. Jones (2010), ‘Why do the elderly save? The role of medical expenses’, Journal of Political Economy, 118(1): 3975.

W. Demark-Wahnefried , N. M. Aziz , J. H. Rowland and B. M. Pinto (2005), ‘Riding the crest of the teachablem: promoting long-term health after the diagnosis of cancer’, Journal of Clinical Oncology, 23(24): 58145830.

I. Ehrlich and G. S. Becker (1972), ‘Market insurance, self-insurance, and self-protection’, Journal of Political Economy, 80(4): 623648.

T. Falba (2005), ‘Health events and the smoking cessation of middle aged americans’, Journal of Behavioral Medicine, 28(1): 2133.

E. A. Finkelstein , J. Cohen and W. Dietz (2009), ‘Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates’, Health Affairs (web exclusive), 28(5): w822w831.

V. R. Fuchs (1999), ‘Health care for the elderly? How much? Who will pay for it?’, Health Affairs, 18(1): 1121.

D. Grembowski , D. Patrick , P. Diehr , M. Durham , S. Beresford , E. Kay and J. Hecht (1993), ‘Self-efficacy and health behavior among older adults’, Journal of Health and Social Behavior, 34: 89104.

T. Jappelli , L. Pistaferri and G. Weber (2007), ‘Health care quality, economic inequality, and precautionary saving’, Health Economics, 16: 327346.

P. Jha , C. Ramasundarahettige , V. Landsman , B. Rostron , M. Thun , R. N. Anderson , T. McAfee and R. Peto (2013), ‘21st-century hazards of smoking and benefits of cessation in the United States’, New England Journal of Medicine, 368(4): 341350.

P. Keenan (2009), ‘Smoking and weight change after new health diagnoses in older adults’, Archives of Internal Medicine, 169(3): 237242.

A. Khwaja , F. Sloan and S. Chung (2006a) ‘The effects of spousal health on the decision to smoke: evidence on consumption externalities, altruism, and learning within the household’, Journal of Risk and Uncertainty, 32: 1735.

A. Khwaja , F. Sloan and S. Chung (2006b) ‘Learning about individual risk and the decision to smoke’, International Journal of Industrial Organization, 24: 683699.

B. Koszegi and A. Szeidl (2013), ‘A model of focusing in economic choice’, Quarterly Journal of Economics, 128(1): 53104 (ahead of print).

L. Liaropoulos , O. Siskou , D. Kaitelindou , M. Theodorou and T. Katostaras (2008), ‘Informal payments in public hospitals in Greece’, Health Policy, 87(1): 7281.

S. S. Lim , T. Vos , A. D. Flaxman , G. Danaei , K. Shibuya and H. Adair-Rohani , et al. (2012), ‘A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010’, Lancet, 380(9859): 22242260.

K. R. Lorig , D. S. Sobel , A. L. Stewart , B. W. J. Brown , A. Bandura , P. Ritter , V. M. Gonzalez , D. D. Laurent and H. R. Holman (1999), ‘Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalizations: a randomized trial’, Medical Care, 37(1): 514.

E. Meara , C. White and D. M. Cutler (2004), ‘Trends in medical spending by age, 1963–2000’, Health Affairs, 23(4): 176183.

O. Paccagnella , V. Rebba and G. Weber (2013), ‘Voluntary private health insurance among the over 50s in Europe’, Health Economics, 22(3): 289315.

K. A. Paez , L. Zhao and W. Hwang (2009), ‘Rising out-of-pocket spending for chronic conditions: a ten-year trend’, Health Affairs, 28(1): 1525.

M. G. Palumbo (1999), ‘Uncertain medical expenses and precautionary saving near the end of the life cycle’, Review of Economic Studies, 66(2): 395421.

D. P. Rice and N. Fineman (2004), ‘Economic implications of increased longevity in the United States’, Annual Review of Public Health, 25: 457473.

C. Schoen , R. Osborn , D. Squires , M. M. Doty , R. Pierson and S. Applebaum (2010), ‘How health insurance design affects access to care and costs, by income, in eleven countries’, Health Affairs, 29(12): 23232334.

M. Schoenbaum (1997), ‘Do smokers understand the mortality effects of smoking? Evidence from the Health and Retirement Survey’, American Journal of Public Health, 87(5): 755759.

S. A. Schroeder (2007), ‘We can do better – improving the health of the american people’, New England Journal of Medicine, 357: 12211228.

L. Siciliani and R. Verzulli (2009), ‘Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE’, Health Economics, 18: 12951306.

O. Siskou , D. Kaitelindou , V. Papakonstantinou and L. Liaropoulos (2008), ‘Private health expenditure in the Greek health care system: where truth ends and the myth begins’, Health Policy, 88(2–3): 282293.

J. P. Smith (1999), ‘Health bodies and thick wallets: the dual relation between health economic status’, Journal of Economic Perspectives, 13(2): 145166.

V. K. Smith , D. H. J. Taylor , F. A. Sloan , F. R. Johnson and W. H. Desvousges (2001), ‘Do smokers respond to health shocks?’, Review of Economics and Statistics, 83(4): 675687.

R. Sturm (2002), ‘The effects of obesity, smoking, and drinking on medical problems and costs’, Health Affairs, 21(2): 245253.

L. Sundmacher (2012), ‘The effect of health shocks on smoking and obesity’, European Journal of Health Economics, 13: 451460.

K. E. Thorpe (2005), ‘The rise in health care spending and what to do about it’, Health Affairs, 24(6): 14361445.

W. Viscusi (1990), ‘Do smokers underestimate risks?’, Journal of Political Economy, 98(6): 12531269.

N. D. Weinstein (1987), ‘Unrealistic optimism about susceptibility to health problems: conclusions from a community-wide sample’, Journal of Behavioral Medicine, 10(5): 481500.

D. Yach , C. Hawkes , L. Gould and K. J. Hofman (2004), ‘The global burden of chronic diseases: overcoming impediments to prevention and control’, Journal of the American Medical Association, 291(21): 26162622.

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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
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