IDEAS home Printed from https://ideas.repec.org/p/ces/ceswps/_7209.html
   My bibliography  Save this paper

Physician Density and Infant Mortality: A Semiparametric Analysis of the Returns to Health Care Provision

Author

Listed:
  • Helge Liebert
  • Beatrice Mäder

Abstract

This paper investigates the effect of physicians on infant mortality, stillbirths and the incidence of common childhood diseases. We construct a new panel data set covering German municipalities from 1928 to 1936 based on historical sources. The endogeneity of health care supply is addressed by using the expulsion of Jewish physicians from health insurance schemes by the Nazi government in 1933 as a source of exogenous variation in regional physician density. The results indicate substantial mortality effects due to changes in physician density. One additional physician per 1,000 of population reduces infant mortality by 23% and stillbirths by 16%. We find similar negative effects for gastrointestinal diseases and the incidence of measles, influenza and bronchitis. To investigate diminishing returns to health care provision, we develop a semiparametric control function approach. Our results indicate that the marginal returns to physicians are highly nonlinear and decreasing.

Suggested Citation

  • Helge Liebert & Beatrice Mäder, 2018. "Physician Density and Infant Mortality: A Semiparametric Analysis of the Returns to Health Care Provision," CESifo Working Paper Series 7209, CESifo.
  • Handle: RePEc:ces:ceswps:_7209
    as

    Download full text from publisher

    File URL: https://www.cesifo.org/DocDL/cesifo1_wp7209.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Lavy, Victor & Strauss, John & Thomas, Duncan & de Vreyer, Philippe, 1996. "Quality of health care, survival and health outcomes in Ghana," Journal of Health Economics, Elsevier, vol. 15(3), pages 333-357, June.
    2. Cameron,A. Colin & Trivedi,Pravin K., 2013. "Regression Analysis of Count Data," Cambridge Books, Cambridge University Press, number 9781107667273, January.
    3. Petra Moser & Alessandra Voena & Fabian Waldinger, 2014. "German Jewish ?migr?s and US Invention," American Economic Review, American Economic Association, vol. 104(10), pages 3222-3255, October.
    4. Hertz, Erica & Hebert, James R. & Landon, Joan, 1994. "Social and environmental factors and life expectancy, infant mortality, and maternal mortality rates: Results of a cross-national comparison," Social Science & Medicine, Elsevier, vol. 39(1), pages 105-114, July.
    5. Aakvik, Arild & Holmas, Tor Helge, 2006. "Access to primary health care and health outcomes: The relationships between GP characteristics and mortality rates," Journal of Health Economics, Elsevier, vol. 25(6), pages 1139-1153, November.
    6. Badi H. Baltagi & Dong Li, 2002. "Series Estimation of Partially Linear Panel Data Models with Fixed Effects," Annals of Economics and Finance, Society for AEF, vol. 3(1), pages 103-116, May.
    7. Fabian Waldinger, 2010. "Quality Matters - the Expulsion of Professors and Ph.D. Student Outcomes in Nazi Germany," CEP Discussion Papers dp0985, Centre for Economic Performance, LSE.
    8. Joseph P. Newhouse & Lindy J. Friedlander, 1980. "The Relationship between Medical Resources and Measures of Health: Some Additional Evidence," Journal of Human Resources, University of Wisconsin Press, vol. 15(2), pages 200-218.
    9. Robinson, Peter M, 1988. "Root- N-Consistent Semiparametric Regression," Econometrica, Econometric Society, vol. 56(4), pages 931-954, July.
    10. Fabian Waldinger, 2012. "Peer Effects in Science: Evidence from the Dismissal of Scientists in Nazi Germany," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 79(2), pages 838-861.
    11. Fabian Waldinger, 2016. "Bombs, Brains, and Science: The Role of Human and Physical Capital for the Creation of Scientific Knowledge," The Review of Economics and Statistics, MIT Press, vol. 98(5), pages 811-831, December.
    12. Douglas Almond & Joseph J. Doyle & Amanda E. Kowalski & Heidi Williams, 2010. "Estimating Marginal Returns to Medical Care: Evidence from At-risk Newborns," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(2), pages 591-634.
    13. David Cutler & Angus Deaton & Adriana Lleras-Muney, 2006. "The Determinants of Mortality," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 97-120, Summer.
    14. Jonathan Gruber & Nathaniel Hendren & Robert M. Townsend, 2014. "The Great Equalizer: Health Care Access and Infant Mortality in Thailand," American Economic Journal: Applied Economics, American Economic Association, vol. 6(1), pages 91-107, January.
    15. Douglas Almond & Joseph J. Doyle, 2011. "After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays," American Economic Journal: Economic Policy, American Economic Association, vol. 3(3), pages 1-34, August.
    16. Farahani, Mansour & Subramanian, S.V. & Canning, David, 2009. "The effect of changes in health sector resources on infant mortality in the short-run and the long-run: A longitudinal econometric analysis," Social Science & Medicine, Elsevier, vol. 68(11), pages 1918-1925, June.
    17. Fabian Waldinger, 2010. "Quality Matters: The Expulsion of Professors and the Consequences for PhD Student Outcomes in Nazi Germany," Journal of Political Economy, University of Chicago Press, vol. 118(4), pages 787-831, August.
    18. Andrew Goodman-Bacon, 2018. "Public Insurance and Mortality: Evidence from Medicaid Implementation," Journal of Political Economy, University of Chicago Press, vol. 126(1), pages 216-262.
    19. Bhargava, Alok & Docquier, Frédéric & Moullan, Yasser, 2011. "Modeling the effects of physician emigration on human development," Economics & Human Biology, Elsevier, vol. 9(2), pages 172-183, March.
    20. Cooper, J.K. & Heald, K. & Samuels, M., 1977. "Affecting the supply of rural physicians," American Journal of Public Health, American Public Health Association, vol. 67(8), pages 756-759.
    21. repec:dau:papers:123456789/11393 is not listed on IDEAS
    22. John Mullahy, 1997. "Instrumental-Variable Estimation Of Count Data Models: Applications To Models Of Cigarette Smoking Behavior," The Review of Economics and Statistics, MIT Press, vol. 79(4), pages 586-593, November.
    23. Pascaline Dupas, 2011. "Health Behavior in Developing Countries," Annual Review of Economics, Annual Reviews, vol. 3(1), pages 425-449, September.
    24. Lisa Chauvet & Flore Gubert & Sandrine Mespl�-Somps, 2013. "Aid, Remittances, Medical Brain Drain and Child Mortality: Evidence Using Inter and Intra-Country Data," Journal of Development Studies, Taylor & Francis Journals, vol. 49(6), pages 801-818, June.
    25. Kim, Kwangkee & Moody, Philip M., 1992. "More resources better health? A cross-national perspective," Social Science & Medicine, Elsevier, vol. 34(8), pages 837-842, April.
    26. Heckman, James J. & Robb, Richard Jr., 1985. "Alternative methods for evaluating the impact of interventions : An overview," Journal of Econometrics, Elsevier, vol. 30(1-2), pages 239-267.
    27. Joseph V. Terza & Donald S. Kenkel & Tsui‐Fang Lin & Shinichi Sakata, 2008. "Care‐giver advice as a preventive measure for drinking during pregnancy: zeros, categorical outcome responses, and endogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 17(1), pages 41-54, January.
    28. Windmeijer, F A G & Silva, J M C Santos, 1997. "Endogeneity in Count Data Models: An Application to Demand for Health Care," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(3), pages 281-294, May-June.
    29. Dyer,Christopher, 1989. "Standards of Living in the Later Middle Ages," Cambridge Books, Cambridge University Press, number 9780521272155.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Tamara Bischof & Boris Kaiser, 2021. "Who cares when you close down? The effects of primary care practice closures on patients," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2004-2025, September.
    2. Nadine Geiger & Sebastian Wichert, 2019. "Birth in times of war - An investigation of health, mortality and social class using historical clinical records," CESifo Working Paper Series 7593, CESifo.
    3. Cristina Borra & Jerònia Pons-Pons & Margarita Vilar-Rodríguez, 2020. "Austerity, healthcare provision, and health outcomes in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 409-423, April.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Liebert, Helge & Mäder, Beatrice, 2016. "The impact of regional health care coverage on infant mortality and disease incidence," Economics Working Paper Series 1620, University of St. Gallen, School of Economics and Political Science.
    2. Liebert, H. & Mäder, B., 2016. "Marginal effects of physician coverage on infant and disease mortality," Health, Econometrics and Data Group (HEDG) Working Papers 16/17, HEDG, c/o Department of Economics, University of York.
    3. Liebert, Helge & Mäder, Beatrice, 2022. "Physicians and the Production of Health: Returns to Health Care during the Mortality Transition," IZA Discussion Papers 15220, Institute of Labor Economics (IZA).
    4. Cemal Eren Arbatlı & Gunes Gokmen, 2023. "Human capital transfers and sub-national development: Armenian and Greek legacy in post-expulsion Turkey," Journal of Economic Growth, Springer, vol. 28(1), pages 1-43, March.
    5. Barbara Biasi & Petra Moser, 2018. "Effects of Copyrights on Science - Evidence from the US Book Republication Program," Working Papers 18-06, New York University, Leonard N. Stern School of Business, Department of Economics.
    6. Liu, Xianda & Hou, Wenxuan & Main, Brian G.M., 2022. "Anti-market sentiment and corporate social responsibility: Evidence from anti-Jewish pogroms," Journal of Corporate Finance, Elsevier, vol. 76(C).
    7. Becker, Sascha O. & Ferrara, Andreas, 2019. "Consequences of forced migration: A survey of recent findings," Labour Economics, Elsevier, vol. 59(C), pages 1-16.
    8. Sascha O. Becker, 2022. "Forced displacement in history: Some recent research," Australian Economic History Review, Economic History Society of Australia and New Zealand, vol. 62(1), pages 2-25, March.
    9. Remi Jedwab & Noel D. Johnson & Mark Koyama, 2019. "Negative shocks and mass persecutions: evidence from the Black Death," Journal of Economic Growth, Springer, vol. 24(4), pages 345-395, December.
    10. Ina Ganguli & Fabian Waldinger, 2024. "War and Science in Ukraine," Entrepreneurship and Innovation Policy and the Economy, University of Chicago Press, vol. 3(1), pages 165-188.
    11. Arun Advani & Bansi Malde, 2018. "Credibly Identifying Social Effects: Accounting For Network Formation And Measurement Error," Journal of Economic Surveys, Wiley Blackwell, vol. 32(4), pages 1016-1044, September.
    12. Myra Mohnen, 2022. "Stars and Brokers: Knowledge Spillovers Among Medical Scientists," Management Science, INFORMS, vol. 68(4), pages 2513-2532, April.
    13. Ganguli, Ina, 2014. "Immigration & Ideas: What Did Russian Scientists 'Bring' to the US?," SITE Working Paper Series 30, Stockholm School of Economics, Stockholm Institute of Transition Economics.
    14. Hornung, Erik, 2019. "Diasporas, diversity, and economic activity: Evidence from 18th-century Berlin," Explorations in Economic History, Elsevier, vol. 73(C), pages 1-1.
    15. Jinlin Liu & Karen Eggleston, 2022. "The Association between Health Workforce and Health Outcomes: A Cross-Country Econometric Study," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 163(2), pages 609-632, September.
    16. Sebastian Hoenen & Christos Kolympiris, 2020. "The Value of Insiders as Mentors: Evidence from the Effects of NSF Rotators on Early-Career Scientists," The Review of Economics and Statistics, MIT Press, vol. 102(5), pages 852-866, December.
    17. Moser, Petra & Biasi, Barbara, 2018. "Effects of Copyrights on Science - Evidence from the US Book Republication Program," CEPR Discussion Papers 12651, C.E.P.R. Discussion Papers.
    18. George J. Borjas & Kirk B. Doran & Ying Shen, 2018. "Ethnic Complementarities after the Opening of China: How Chinese Graduate Students Affected the Productivity of Their Advisors," Journal of Human Resources, University of Wisconsin Press, vol. 53(1), pages 1-31.
    19. Becker, Sascha O. & Mukand, Sharun & Yotzov, Ivan, 2022. "Persecution, pogroms and genocide: A conceptual framework and new evidence," Explorations in Economic History, Elsevier, vol. 86(C).
    20. repec:hal:spmain:info:hdl:2441/65v9ag2jfn865abjgaljmq2qi9 is not listed on IDEAS
    21. J. M. C. Santos Silva & Silvana Tenreyro, 2022. "The Log of Gravity at 15," Portuguese Economic Journal, Springer;Instituto Superior de Economia e Gestao, vol. 21(3), pages 423-437, September.

    More about this item

    Keywords

    infant mortality; physicians; health care supply; childhood diseases; semiparametric IV;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • N34 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - Europe: 1913-

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ces:ceswps:_7209. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Klaus Wohlrabe (email available below). General contact details of provider: https://edirc.repec.org/data/cesifde.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.