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The impact of changes in county public health expenditures on general health in the population

Published online by Cambridge University Press:  13 February 2014

Timothy T. Brown ,
Maria S. Martinez-Gutierrez  and
Bahar Navab
Timothy T. Brown*
Affiliation:
School of Public Health, University of California, Berkeley, CA, USA
Maria S. Martinez-Gutierrez
Affiliation:
School of Public Health, University of California, Berkeley, CA, USA
Bahar Navab
Affiliation:
School of Public Health, University of California, Berkeley, CA, USA
*
*Correspondence to: Timothy T. Brown, University of California, 50 University Hall, MC7360, Berkeley, CA 94720-7360, USA. Email: Timothy.Brown@berkeley.edu
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Abstract

We estimate the effect of changes in the per capita expenditures of county departments of public health on county-level general health status. Using panel data on 40 counties in California (2001–2009), dynamic panel estimation techniques are combined with the Lewbel instrumental variable technique to estimate an aggregate demand for health function that measures the causal cumulative impact that per capita public health expenditures have on county-level general health status. We find that a $10 long-term increase in per capita public health expenditures would increase the percentage of the population reporting good, very good or excellent health by 0.065 percentage points. Each year expenditures were increased would result in ∼24,000 individuals moving from the ‘poor or fair health’ category to the ‘good, very good or excellent health’ category across these 40 counties. In terms of the overall impact of county public health departments on general health status, at current funding levels, each annual expenditure cycle results in over 207,000 individuals being in the ‘good, very good or excellent’ categories of health status rather than the ‘poor or fair’ categories.

Type
Articles
Information
Health Economics, Policy and Law , Volume 9 , Issue 3 , July 2014 , pp. 251 - 269
Copyright
© Cambridge University Press 2014 

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References

Angrist, J. D. and Pischke, J. S. (2009), Mostly harmless econometrics: an empiricist’s companion, New Jersey: Princeton University Press.CrossRefGoogle Scholar
Badawi, G., Gariepy, G. and Schmitz, N. (2012), ‘Self-rated health in diabetes: should the question be the first administered?’, Diabetes Research and Clinical Practice, 97: e27–e30.CrossRefGoogle ScholarPubMed
Barger, S. D. and Muldoon, M. F. (2006), ‘Hypertension labeling was associated with poorer self-rated health in the Third US National Health and Nutrition Examination Survey’, Journal of Human Hypertension, 20: 117–123.CrossRefGoogle ScholarPubMed
Baum, C. F., Schaffer, M. E. and Stillman, S. (2010), ivreg2: Stata module for extended instrumental variables/2SLS, GMM and AC/HAC, LIML and k-class regression. http://ideas.repec.org/c/boc/bocode/s425401.html [30 January 2014].Google Scholar
Bazzi, S. and Clemens, M. A. (2013), ‘Blunt instruments: avoiding common pitfalls in identifying the causes of economic growth’, American Economic Journal: Macroeconomics, 5: 152–186.Google Scholar
Block, S. A. (2007), ‘Maternal nutrition knowledge versus schooling as determinants of child micronutrient status’, Oxford Economic Papers, 59: 330–353.CrossRefGoogle Scholar
Blundell, R. and Bond, S. (1998), ‘Initial conditions and moment restrictions in dynamic panel data models’, Journal of Econometrics, 87: 115–143.CrossRefGoogle Scholar
Bopp, M., Braun, J., Gutzmiller, F. and Faeh, D. (2012), ‘Health risk or resource? Gradual and independent association between self-rated health and mortality persists over 30 years’, PLoS One, 7(2): 1–10.CrossRefGoogle ScholarPubMed
Bowling, A. and Windsor, J. (2008), ‘The effects of question order and response-choice on self-rated health status in the English Longitudinal Study of Ageing (ELSA)’, Journal of Epidemiology & Community Health, 62: 81–85.CrossRefGoogle ScholarPubMed
Brown, T. T. (2014), ‘How effective are public health departments at preventing mortality?’, Economics and Human Biology, http://dx.doi.org/10.1016/j.ehb.2013.10.001 [30 January 2014]CrossRefGoogle ScholarPubMed
Bun, M. J. G. and Windmeijer, F. (2010), ‘The weak instrument problem of the system GMM estimator in dynamic panel data models’, Econometrics Journal, 13: 95–126.CrossRefGoogle Scholar
California Health Interview Survey (2011), AskCHIS, http://ask.chis.ucla.edu/main/default.asp [30 January 2014].Google Scholar
California State Controller’s Office (2011), Counties Annual Report, http://www.sco.ca.gov/ard_locrep_counties.html [30 January 2014].Google Scholar
Chan, Y. (2005), Location, Transport, and Land Use: Modelling Spatial-Temporal Information, New York: Springer.Google Scholar
Choi, I. (2001), ‘Unit root tests for panel data’, Journal of International Money and Finance, 20: 249–272.Google Scholar
Clarke, P. M. and Ryan, C. (2006), ‘Self-reported health: reliability and consequences for health inequality measurement’, Health Economics, 15: 645–652.CrossRefGoogle ScholarPubMed
Community Health Rankings & Roadmaps: A Healthier Nation, County by County (2012), http://www.countyhealthrankings.org/Google Scholar
Crossley, T. F. and Kennedy, S. (2002), ‘The reliability of self-assessed health status’, Journal of Health Economics, 21: 643–658.CrossRefGoogle ScholarPubMed
Denny, K. and Oppedisano, V. (2013), ‘The surprising effect of larger class sizes: evidence using two identification strategies’, Labour Economics, 23: 57–65.CrossRefGoogle Scholar
DeSalvo, K. B., Bloser, N., Reynolds, K., He, J. and Muntner, P. (2006), ‘Mortality prediction with a single general self-rated health question: a meta-analysis’, Journal of General Internal Medicine, 21: 267–275.CrossRefGoogle ScholarPubMed
Drichoutis, A. C., Nayga, R. M. Jr and Lazaridis, P. (2012), ‘Food away from home expenditures and obesity among older Europeans: are there gender differences?’, Empirical Economics, 42: 1051–1078.Google Scholar
Eide, E. R. and Showalter, M. H. (2011), ‘Estimating the relation between health and education: what do we know and what do we need to know?’, Economics of Education Review, 30: 778–791.CrossRefGoogle Scholar
Emran, M. S. and Shilpi, F. (2012), ‘The extent of the market and stages of agricultural specialization’, Canadian Journal of Economics, 45: 1125–1153.CrossRefGoogle Scholar
Erwin, P. C., Greene, S. B., Mays, G. P., Ricketts, T. C. and Davis, M. V. (2011), ‘The association of changes in local health department resources with changes in state-level health outcomes’, American Journal of Public Health, 101: 609–615.CrossRefGoogle ScholarPubMed
Granger, C. W. J. and Newbold, P. (1974), ‘Spurious regressions in econometrics’, Journal of Econometrics, 2: 111–120.CrossRefGoogle Scholar
Grembowski, D., Bekemeier, B., Conrad, D. and Kreuter, W. (2010), ‘Are local health department expenditures related to racial disparities in mortality?’, Social Science & Medicine, 71: 2057–2065.CrossRefGoogle ScholarPubMed
Huang, H. C., Lin, Y.-C. and Yeh, C.-C. (2009), ‘Joint determinations of inequality and growth’, Economics Letters, 103: 163–166.CrossRefGoogle Scholar
Huang, T.-H. and Xie, Z. (2013), ‘Population and economic growth: a simultaneous equation perspective’, Applied Economics, 45: 3820–3826.CrossRefGoogle Scholar
Idler, E., Russell, L. and Davis, D. (2000), ‘Survival, functional limitations, and self-rated health in the NHANES I Epidemiological Follow-Up Study, 1992’, American Journal of Epidemiology, 152: 874–883.CrossRefGoogle ScholarPubMed
Imai, K., Gregg, E. W., Chen, Y. J., Zhang, P., de Rekeneire, N. and Williamson, D. F. (2008), ‘The association of BMI with functional status and self-rated health in US adults’, Obesity, 16: 402–408.CrossRefGoogle ScholarPubMed
Integrated Health Interview Series (2012), Minnesota Population Center and State Health Access Data Assistance Center, http://www.ihis.us [30 January 2014].Google Scholar
Jyhlä, M. (2009), ‘What is self-rated health and why does it predict mortality? Towards a unified conceptual model’, Social Science & Medicine, 69: 307–316.Google Scholar
Kelly, I. R., Dave, D. M., Sindelar, J. L. and Gallo, W. T. (2012), ‘The impact of early occupational choice on health behaviors’, Review of Economics of the Household, doi: 10.1007/s11150-012-9166-5Google ScholarPubMed
Kelly, I. R. and Markowitz, S. (2009), ‘Incentives in obesity and health insurance’, Inquiry, 46: 418–443.CrossRefGoogle ScholarPubMed
Lee, S. and Grant, D. (2009), ‘The effect of question order on self-rated general health status in a multilingual survey context’, American Journal of Epidemiology, 169: 1525–1530.Google Scholar
Levin, A., Lin, C.-F. and Chu., C.-S. J. (2002), ‘Unit root tests in panel data: asymptotic and finite-sample properties’, Journal of Econometrics, 108: 1–24.Google Scholar
Lewbel, A. (2012), ‘Using heteroscedasticity to identify and estimate mismeasured and endogenous regressor models’, Journal of Business & Economic Statistics, 30: 67–80.CrossRefGoogle Scholar
Macinko, J., de Oliveira, V. B., Turci, M. A., Guanais, F. C., Bonolo, P. F. and Lima-Costa, M.F. (2011), ‘The influence of primary care and hospital supply on ambulatory care-sensitive hospitalizations among adults in Brazil, 1999–2007’, American Journal of Public Health, 101: 1963–1970.Google Scholar
Mays, G. P. and Smith, S. A. (2011), ‘Evidence links increases in public health spending to declines in preventable deaths’, Health Affairs, 30: 1585–1593.CrossRefGoogle ScholarPubMed
Newey, W. K. and West, K. D. (1987), ‘A simple, positive semi-definite, heteroskedasticity and autocorrelation consistent covariance matrix’, Econometrica, 55: 703–708.Google Scholar
Okosun, I. S., Choi, S., Matamoros, T. and Dever, G. E. (2001), ‘Obesity is associated with reduced self-rated general health status: evidence from a representative sample of white, black, and Hispanic Americans’, Preventive Medicine, 32: 429–436.CrossRefGoogle ScholarPubMed
Petersen, M. A. (2009), ‘Estimating standard errors in finance panel data sets: comparing approaches’, Review of Financial Studies, 22: 435–480.CrossRefGoogle Scholar
Phillips, P. C. B. and Perron, P. (1988), ‘Testing for a unit root in time series regression’, Biometrika, 75: 335–346.CrossRefGoogle Scholar
Pietiläinen, O., Laaksonen, M., Rahkonen, O. and Lahelma, E. (2011), ‘Self-rated health as a predictor of disability retirement – the contribution of ill-health and working conditions’, PLoS One, 6: e25004.Google Scholar
Prosper, M. H., Moczulski, V. L. and Qureshi, A. (2009), ‘Obesity as a predictor of self-rated health’, American Journal of Health Behavior, 33: 319–329.CrossRefGoogle ScholarPubMed
RAND (2012), Bridged-race Postcensal Population Estimates by Race/Ethnicity and Age Group, http://ca.rand.org/stats/popdemo/popraceage.html [30 January 2014].Google Scholar
Roodman, D. (2009), ‘How to do xtabond2: an introduction to difference and system GMM in Stata’, Stata Journal, 9: 86–136.Google Scholar
Rosenbaum, P. R. and Rubin, D. B. (1984), ‘Difficulties with regression analyses of age-adjusted rates’, Biometrics 40: 437–443.CrossRefGoogle ScholarPubMed
Rutledge, T., Linke, S. E., Johnson, B. D., Bittner, V., Krantz, D. S., Whittaker, K. S., Eastwood, J. A., Eteiba, W., Cornell, C. E., Pepine, C. J., Vido, D. A., Olson, M. B., Shaw, L. J., Vaccarino, V. and Bairey Merz, C. N. (2010), ‘Self-rated versus objective health indicators as predictors of major cardiovascular events: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation’, Psychosomatic Medicine, 72: 549–555.CrossRefGoogle ScholarPubMed
Sabia, J. J. (2007a), The effect of body weight on adolescent academic performance’, Southern Economic Journal, 73: 871–900.CrossRefGoogle Scholar
Sabia, J. J. (2007b), Reading, writing, and sex: the effect of losing virginity on academic performance’, Economic Inquiry, 45: 647–670.CrossRefGoogle Scholar
Sabia, J. J. (2007c), Early adolescent sex and diminished school attachment: selection or spillovers?’, Southern Economic Journal, 74: 239–268.Google Scholar
Schroeter, C., Anders, S. and Carlson, A. (2013), ‘The economics of health and vitamin consumption’, Applied Economic Perspectives and Policy, 35: 125–149.Google Scholar
Shankar, A., Charumathi, S. and Kalidindi, S. (2011), ‘Sleep duration and self-rated health: the national health interview survey, 2008’, Sleep, 34: 1173–1177.Google Scholar
Stifel, D. and Alderman, H. (2006), ‘The “glass of milk” subsidy program and malnutrition in Peru’, World Bank Economic Review, 20: 421–448.CrossRefGoogle Scholar
Stock, J. and Yogo, M. (2005), ‘Testing for weak instruments in linear IV regression’, in D. W. K. Andrews and J. H. Stock (eds), Identification and Inference for Econometric Models: A Festschrift in Honor of Thomas J. Rothenberg, Cambridge: Cambridge University Press, 80–108.CrossRefGoogle Scholar
Thacker, S. B., Stroup, D. F., Carande-Kulis, V., Marks, J. S., Roy, K. and Gerberding, J. L. (2006), ‘Measuring the public’s health’, Public Health Reports, 121: 14–22.Google Scholar
U.S. Department of Health and Human Services (2011), General Health Status – Health People 2020, http://www.healthypeople.gov/2020/about/GenHealthAbout.aspx#self [30 January 2014].Google Scholar
Wooldridge, J. M. (2003), Introductory Econometrics: A Modern Approach, Mason: Thomson South-Western.Google Scholar
Zhang, W. and Ta, V. M. (2009), ‘Social connections, immigration-related factors, and self-rated physical and mental health among Asian Americans’, Social Science & Medicine, 68: 2104–2112.CrossRefGoogle ScholarPubMed
Zweifel, P. and Breyer, F. (1997), Health Economics, New York: Oxford University Press.Google Scholar