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Is treatment “intensity” associated with healthier lifestyle choices? An application of the dose response function

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  • Fichera, Eleonora
  • Emsley, Richard
  • Sutton, Matt

Abstract

Healthy lifestyle choices and doctor consultations can be substitutes or complements in the health production function. In this paper we consider the relation between the number of doctor consultations and the frequency of patient physical activity. We use a novel application of the Dose-Response Function model proposed by Hirano and Imbens (2004) to deal with treatment endogeneity under the no unmeasured confounding assumption. Our application takes account of unobserved heterogeneity and uses dynamic non-linear models for the treatment and outcome variables of interest. Using seven waves of the British Household Panel Survey, we find that higher treatment intensity and frequency of physical activity are inversely related. We show that accounting for both treatment selection and unobserved heterogeneity halves the size of this relationship. An additional doctor consultation is associated with a 0.5 percentage point reduction in the probability of undertaking vigorous physical activity. Our results hold for a sub-sample visiting the doctor for health check-ups, and are shown to be robust using instrumental variables.

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  • Fichera, Eleonora & Emsley, Richard & Sutton, Matt, 2016. "Is treatment “intensity” associated with healthier lifestyle choices? An application of the dose response function," Economics & Human Biology, Elsevier, vol. 23(C), pages 149-163.
    • Handle: RePEc:eee:ehbiol:v:23:y:2016:i:c:p:149-163
    DOI: 10.1016/j.ehb.2016.09.001
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    1. Gary S. Becker, 2007. "Health as human capital: synthesis and extensions -super-1," Oxford Economic Papers, Oxford University Press, vol. 59(3), pages 379-410, July.
    2. Sarah Brown & Alan Duncan & Mark N. Harris & Jennifer Roberts & Karl Taylor, 2015. "A Zero-Inflated Regression Model for Grouped Data," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 77(6), pages 822-831, December.
    3. Kosuke Imai & David A. van Dyk, 2004. "Causal Inference With General Treatment Regimes: Generalizing the Propensity Score," Journal of the American Statistical Association, American Statistical Association, vol. 99, pages 854-866, January.
    4. 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.
    5. Jere R. Behrman & Yingmei Cheng & Petra E. Todd, 2004. "Evaluating Preschool Programs When Length of Exposure to the Program Varies: A Nonparametric Approach," The Review of Economics and Statistics, MIT Press, vol. 86(1), pages 108-132, February.
    6. Paulos Teckle & Matt Sutton, 2008. "How Do the Determinants of Demand for GP Visits Respond to Higher Supply? An Analysis of Grouped Counts," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 144(III), pages 495-513, September.
    7. Udo Schneider & Volker Ulrich, 2008. "The physician-patient relationship revisited: the patient’s view," International Journal of Health Economics and Management, Springer, vol. 8(4), pages 279-300, December.
    8. Cameron, A Colin & Windmeijer, Frank A G, 1996. "R-Squared Measures for Count Data Regression Models with Applications to Health-Care Utilization," Journal of Business & Economic Statistics, American Statistical Association, vol. 14(2), pages 209-220, April.
    9. John Robst & Glenn Graham, 1997. "Access to health care and current health status: do physicians matter?," Applied Economics Letters, Taylor & Francis Journals, vol. 4(1), pages 45-48.
    10. Fichera, Eleonora & Sutton, Matt, 2011. "State and self investments in health," Journal of Health Economics, Elsevier, vol. 30(6), pages 1164-1173.
    11. Jeffrey M. Wooldridge, 2005. "Simple solutions to the initial conditions problem in dynamic, nonlinear panel data models with unobserved heterogeneity," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 20(1), pages 39-54, January.
    12. Jochen Kluve & Boris Augurzky, 2007. "Assessing the performance of matching algorithms when selection into treatment is strong," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 22(3), pages 533-557.
    13. Peter G. Moffatt & Simon A. Peters, 2000. "Grouped zero-inflated count data models of coital frequency," Journal of Population Economics, Springer;European Society for Population Economics, vol. 13(2), pages 205-220.
    14. Chamberlain, Gary, 1984. "Panel data," Handbook of Econometrics, in: Z. Griliches† & M. D. Intriligator (ed.), Handbook of Econometrics, edition 1, volume 2, chapter 22, pages 1247-1318, Elsevier.
    15. Paul Contoyannis & Andrew M. Jones & Nigel Rice, 2004. "The dynamics of health in the British Household Panel Survey," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 19(4), pages 473-503.
    16. Cameron, A Colin & Trivedi, Pravin K, 1993. "Tests of Independence in Parametric Models with Applications and Illustrations," Journal of Business & Economic Statistics, American Statistical Association, vol. 11(1), pages 29-43, January.
    17. Chaloupka, Frank J. & Warner, Kenneth E., 2000. "The economics of smoking," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 29, pages 1539-1627, Elsevier.
    18. A. Colin Cameron & Pravin K. Trivedi, 1986. "Econometric models based on count data. Comparisons and applications of some estimators and tests," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 1(1), pages 29-53, January.
    19. Andrew M. Jones, 2012. "health econometrics," The New Palgrave Dictionary of Economics,, Palgrave Macmillan.
    20. John Robst, 2001. "A note on the relationship between medical care resources and mortality," Applied Economics Letters, Taylor & Francis Journals, vol. 8(11), pages 737-739.
    21. Fernandez-Olano, C. & Hidalgo, J.D. Lopez-Torres & Cerda-Diaz, R. & Requena-Gallego, M. & Sanchez-Castano, C. & Urbistondo-Cascales, L. & Otero-Puime, A., 2006. "Factors associated with health care utilization by the elderly in a public health care system," Health Policy, Elsevier, vol. 75(2), pages 131-139, January.
    22. Terza, Joseph V. & Basu, Anirban & Rathouz, Paul J., 2008. "Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling," Journal of Health Economics, Elsevier, vol. 27(3), pages 531-543, May.
    23. Maria Goddard, 2008. "Quality in and Equality of Access to Healthcare Services in England," Working Papers 040cherp, Centre for Health Economics, University of York.
    24. Eleonora Fichera & James Banks & Matt Sutton, 2014. "Health behaviours and the patient-doctor interaction: The double moral hazard problem," Economics Discussion Paper Series 1415, Economics, The University of Manchester.
    25. Richard Auster & Irving Leveson & Deborah Sarachek, 1969. "The Production of Health, an Exploratory Study," Journal of Human Resources, University of Wisconsin Press, vol. 4(4), pages 411-436.
    26. David M. Cutler & Adriana Lleras-Muney, 2006. "Education and Health: Evaluating Theories and Evidence," NBER Working Papers 12352, National Bureau of Economic Research, Inc.
    27. Or, Zeynep & Wang, Jia & Jamison, Dean, 2005. "International differences in the impact of doctors on health: a multilevel analysis of OECD countries," Journal of Health Economics, Elsevier, vol. 24(3), pages 531-560, May.
    28. Kaestner, Robert & Darden, Michael & Lakdawalla, Darius, 2014. "Are investments in disease prevention complements? The case of statins and health behaviors," Journal of Health Economics, Elsevier, vol. 36(C), pages 151-163.
    29. A. J. Culyer & J. P. Newhouse (ed.), 2000. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, edition 1, volume 1, number 1.
    30. Michela Bia & Alessandra Mattei, 2008. "A Stata package for the estimation of the dose–response function through adjustment for the generalized propensity score," Stata Journal, StataCorp LLC, vol. 8(3), pages 354-373, September.
    31. Morris, Stephen & Sutton, Matthew & Gravelle, Hugh, 2005. "Inequity and inequality in the use of health care in England: an empirical investigation," Social Science & Medicine, Elsevier, vol. 60(6), pages 1251-1266, March.
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    More about this item

    Keywords

    Dose-response function; Non-linear dynamic models; Health behaviours;
    All these keywords.

    JEL classification:

    • C25 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions; Probabilities
    • C35 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions
    • D01 - Microeconomics - - General - - - Microeconomic Behavior: Underlying Principles
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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