Research

The Health Economics group is part of the Department of Applied Economics at Erasmus University. It is one of the larger groups of health economists at a School of Economics in Europe, with about 10 senior scientific staff members and about 10 PhD students. They have research collaborations with other economists in the Tinbergen Institute in the Empirical Microeconomics Group, and with other health economists at Erasmus University through EsCHER. Core research topics include the following:

• Health Inequality

• Health Behavior
• Health, Work and Care
• Global Health

Health Inequality 

Health differs dramatically across socioeconomic groups. Even in the Netherlands, a country that celebrates its egalitarian principles, the higher educated can expect to live 6-7 years longer than their lower educated compatriots. Our research aims to document the extent of such disparities and to advance understanding of their causes. We derive inequality measures and survey methods that allow health to be compared across population sub-groups. We also develop methods for the measurement and evaluation of inequity in the distribution of healthcare. Finally, we explain health inequalities through decompositions and estimate causal impacts of measures of socioeconomic status on health. In recent years, we pay particular attention to the genetic and early-life (in utero, early childhood) drivers of health inequalities.  

Key publications

• Coveney, Max, Pilar García-Gómez, Eddy van Doorslaer, and Tom Van Ourti. “Thank Goodness for Stickiness: Unravelling the Evolution of Income-Related Health Inequalities before and after the Great Recession in Europe.” Journal of Health Economics 70 (2020): 102259.
• Galama, Titus J., and Hans Van Kippersluis. “A Theory of Socio-Economic Disparities in Health over the Life Cycle.” The Economic Journal 129, no. 617 (2019): 338–374.
• Rossouw, Laura, Teresa Bago d’Uva, and Eddy van Doorslaer. “Poor Health Reporting? Using Anchoring Vignettes to Uncover Health Disparities by Wealth and Race.” Demography 55, no. 5 (October 1, 2018): 1935–56.
• Bijwaard, G.E., H. van Kippersluis, and J. Veenman (2015). Education and Health: The Role of Cognitive Ability. Journal of Health Economics, 42: 29-43.
• Garcia Gomez P., Schokkaert E., Van Ourti T., Bago d’Uva T. (2015). Inequity in the face of death. Health Economics, 24(10): 1348-1367
• Bago d’Uva, T., Lindeboom, M., O’Donnell, O., and E. Van Doorslaer (2011). Slipping Anchor? Testing the Vignettes Approach to Identification and Correction of Reporting Heterogeneity. Journal of Human Resources, 46(4): 872-903
• Van Kippersluis, H., O. O'Donnell, and E. Van Doorslaer (2011). Long Run Returns to Education: Does Schooling Lead to an Extended Old Age? Journal of Human Resources, 46(4): 695-721.
• Erreygers G., Van Ourti T. (2011). Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: a recipe for good practice. Journal of Health Economics, 30(4): 685-694

Health Behavior

About half of premature deaths in high-income countries are attributable to behavioral and other preventable causes. Encouraging people to take better care of their health is therefore critical to improving population health and restraining the escalation of medical spending. Eliminating the strong socioeconomic gradient in health behavior is central to reducing health inequalities. Our research involves development and testing of models of health behaviors, with particular focus on understanding fundamental economic, psychological, environmental and genetic mechanisms responsible for smoking, heavy drinking, diet, exercise and uptake of preventive care. We also conduct empirical analyses of the demand for illicit drugs and consider appropriate regulation of the use of recreational drugs.  

Key publications

• Griffith, Rachel, Stephanie von Hinke, and Sarah Smith. “Getting a Healthy Start: The Effectiveness of Targeted Benefits for Improving Dietary Choices.” Journal of Health Economics 58 (2018): 176–187.
• Hsieh, C.S. and H. van Kippersluis (2017). Smoking Initiation: Peers and Personality. Quantitative Economics, forthcoming.
• Hinke, Stephanie von, George Davey Smith, Debbie A. Lawlor, Carol Propper, and Frank Windmeijer. “Genetic Markers as Instrumental Variables.” Journal of Health Economics 45 (2016): 131–148.
• Williams, J., J.C. van Ours and M. Grossman (2016). Attitudes to legalizing cannabis use. Health Economics, 25: 1201-1216.
• Van Kippersluis, H., and T.J. Galama (2014), “Wealth and Health Behavior: Testing the Concept of a Health Cost”, European Economic Review, 72: 197-220.
• Van Ours, J.C. and J. Williams (2012). The effect of cannabis use on physical and mental health. Journal of Health Economics, 31: 564-577.

Health, Work and Care 

As governments raise retirement ages in response to population aging, it becomes increasingly important to understand the extent to which ill-health constrains work both directly, through impaired functioning at older ages, and indirectly, through the provision of informal care for relatives. At the same time, compensation for reduced earnings capacity needs to be balanced against work disincentives of disability insurance. And many high-income countries are struggling with the challenge of financing the long-term care needs of rapidly increasing numbers of the oldest old. Our research makes use of linked administrative data sets on the Dutch population to address all of these major issues of public policy related to aging. We are also examining the formation of longevity expectations and their influence on retirement behavior.  

Key publications

• Roos, Anne-Fleur, Owen O’Donnell, Frederik T. Schut, Eddy Van Doorslaer, Raf Van Gestel, and Marco Varkevisser. “Does Price Deregulation in a Competitive Hospital Market Damage Quality?” Journal of Health Economics 72 (July 1, 2020): 102328.
• Van Ourti, Tom, Owen O’Donnell, Hale Koç, Jacques Fracheboud, and Harry J. de Koning. “Effect of Screening Mammography on Breast Cancer Mortality: Quasi-Experimental Evidence from Rollout of the Dutch Population-Based Program with 17-Year Follow-up of a Cohort.” International Journal of Cancer 146, no. 8 (2020): 2201–2208.
• Garcia-Mandicó, Sílvia, Pilar García-Gómez, Anne C. Gielen, and Owen O’Donnell. “Earnings Responses to Disability Insurance Stringency.” Labour Economics 66 (2020): 101880.
• Galama, Titus J., Adriana Lleras-Muney, and Hans van Kippersluis. “The Effect of Education on Health and Mortality: A Review of Experimental and Quasi-Experimental Evidence.” In The Oxford Encyclopedia of Health Economics: 3-Volume Set, edited by Andrew M. Jones. Oxford, New York: Oxford University Press, 2020.
• Rellstab, Sara, Pieter Bakx, Pilar García-Gómez, and Eddy van Doorslaer. “The Kids Are Alright - Labour Market Effects of Unexpected Parental Hospitalisations in the Netherlands.” Journal of Health Economics 69 (January 1, 2020): 102275.
• Garcia Gomez, P., Hernandez Quevedo, C., Jimenez Rubio, D. & Oliva, J. (2015). Inequity in long-term care use and unmet need: two sides of the same coin. Journal of Health Economics, 39, 147-158.
• Bakx, P.L.H., De Meijer, C.A.M., Schut, F.T. & Van Doorslaer, E.K.A. (2015). Going formal or informal, who cares? The influence of public long-term care insurance. Health Economics, 24(6): 631-43.
• Garcia-Gomez, P., H. van Kippersluis, O. O'Donnell, E.K.A. van Doorslaer (2013). Long term and spillover effects of health shocks on employment and income, Journal of Human Resources, 2013, 48 (4): 873-906.
• De Meijer, C., M. Koopmanschap, T. Bago d’Uva and E.K.A Van Doorslaer, Determinants of long-term care spending: ageing, time-to-death or disability? Journal of Health Economics, 2011, 30, 425–438.

Global Health 

Governments in the developing world face the unenviable task of stretching severely constrained health budgets to ensure that needed healthcare can be accessed without further straining the finances of already desperately poor households. Our research aims to help find ways of meeting this challenge by providing evidence on the effectiveness of health financing policies in extending healthcare access and improving financial protection from the risk of medical expenses. We are also developing measures of medical expenditure risk and exploring behavioral explanations for low enrollment in health insurance. An ongoing study examines the role of health risk perceptions in the demand for primary prevention of cardiovascular disease, which is the leading cause of death worldwide.  

Key publications

• Hessel, Philipp, P. Sayer, and Carlos Riumallo-Herl. “Educational Inequalities in Disability Linked to Social Security Coverage among Older Individuals in Five Latin American Countries.” Social Science & Medicine, July 3, 2019.
• Buisman, Leander, Ellen Van de Poel, Owen O’Donnell, and Eddy van Doorslaer. “What Explains the Fall in Child Stunting in Sub-Saharan Africa?” SSM - Population Health 8 (May 13, 2018).
• Riumallo-Herl, Carlos, and E. Aguila. “The Effect of Old-Age Pensions on Health Care Utilization Patterns and Insurance Uptake in Mexico.” Bmj Global Health 4, no. 6 (November 13, 2019).
• Neelsen, S. and O’Donnell, O. (2017). Progressive Universalism? The Impact of Targeted Coverage on Healthcare Access and Expenditures in Peru. Health Economics, DOI: 10.1002/hec.3492.
• Flores, G. and O’Donnell, O. (2016). Catastrophic Medical Expenditure Risk. Journal of Health Economics, 2016, 46:1-15.
• Van de Poel, E., G. Flores, P. Ir and O. O’Donnell (2016). Impact of Performance-Based Financing in a Low-Resource Setting: A Decade of Experience in Cambodia. Health Economics, 2016, 25(6): 688-706
• Limwattananon S., Neelsen S., O'Donnell O., Prakongsai P., Tangcharoensathien V., van Doorslaer E., V Vongmogkol (2015). Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand, Journal of Public Economics, 121, 79-94.
• G. Flores, P. Ir, C.R. Men, O. O’Donnell and E. Van Doorslaer (2013). Financial Protection of Patients through Compensation of Providers: The Impact of Health Equity Funds in Cambodia. Journal of Health Economics, 32(6): 1180-93.