健康经济学讲义2 - 经济发展与健康人力资本

3/18/201011经济发展与健康人力资本刘国恩北京大学光华管理学院Email:[e-mail]北大光华《宏观经济与健康》讲座，2010年3月18日2健康与经济的关系经济增长理论：基本框架经济学理论:生产函数Y=Y(L,K,T)生产投入要素物质资本人力资本科学技术人力资本理论：L=L(H,E)教育人力资本：Welldocumented健康人力资本：Tobedocumented33/18/20102Age-earningsProfilesEarnings($)DirectCosts($)Age(years)0182265SecondaryschoolgraduateDirectcostsIndirectcosts(foregoneearnings)UniversitygraduateBenefitsofcompletinguniversityaftersecondary(incrementalearnings)Source:WangR(2008)EuropeanestimatesReturnstoschoolinginEurope,menandwomen(yearclosestto1995)0.020.040.060.080.10.120.14Sweden(91)Denmark(95)NorwayNetherlands(96)Austria(95)Italy(95)France(95)Spain(94)Greece(94)Finland(93)Switzerland(95)Portugal(94)(95)Germany(West)(95)UK(94-96)Ireland(94)RateofReturnWomenMenSource:WangR(2008)2010-3-186RatesofReturnstoEducationinChina0.00%2.00%4.00%6.00%8.00%10.00%12.00%14.00%199119952000初中高中大专大本Source:WangR(2008)3/18/201037健康人力资本的作用机制ProductivityEffect:DirectLaborSupply-QuantityLaborSupply–QualityandEfficiencyIncentiveEffect:IndirectIndividualinvestmentBusinessinvestmentProductivityEffect工作时间疾病误工生命早逝度量指标：LostWorkingDaysQALY,DALY工作效率物理效率学习效率8L365days生产力H1H2IncentiveEffectIndividualInvestmentEducationalbehavior(keydriverforgrowth)SavingbehaviorSocialbehaviorBusinessinvestmentEmploymentOn-jobtrainingLesscostlymedicalinsurance93/18/2010410实证：ProductivityEffect020000400006000080000100000120000140000198419891994MeadianWealthby1984HealthStatusExcellentVerygoodGoodPoorSource:JSmith,HealthyBodiesandThickWallets,JEP,1999J.Smith11新发疾病的经济影响-18,000-13,000-8,000-3,0002,0007,00012,00017,00022,00027,000WealthOOPExpTotalHCMildOnsetSevereOnset12健康对财富的影响途径-3,000-2,500-2,000-1,500-1,000-50005001,0001,5002,000OOP(W2-1)OOP(W3-2)Earnings(W3-1)SevereMild3/18/2010513未解之谜：剩余财富下降？APuzzleAddingtogethertheeffectsofhealtheventsonOOPexpenditureandearnings,itaccountsforabout¼ofthetotalwealthreduction,leaving¾ofitunexplained;PossiblefactorsRisingcurrentconsumption(LillardandWeiss1993),inducedbyahighermarginalutilityofcurrentconsumptionduetosickness;Highermotivationtotargetfuturelowincomeeligibilityofgovernmentsupportforlong-termcare；19健康问题对劳动产出与就业影响Female,-7.5Female,-3.9Male,-6.64Male,-6.5-8-7-6-5-4-3-2WagesHoursSource:PelkowskiandBerger(2004),„Theimpactofhealthonemployment,wages,andhoursworkedoverthelifecycle‟,QuarterlyReviewofEconomicsandFinance,44:102–121.-0.7-0.6-0.5-0.4-0.3-0.2-0.10FemaleMaleWageandHoursEquationsEmploymentEquationsHealthdummy:1withpermanenthealthproblemand0otherwise20健康问题对提前退休的影响0%50%100%150%200%250%300%350%400%MenWomen欧洲人群配偶退休配偶工作Source:Jiménez-Martínetal.(1999)3/18/2010621中国研究证据：CHNS22IncomebyHealthStatus1100120013001400150016001700180019002000VeryGoodGoodFairPoor1991199323IncomebyEducation11001300150017001900210023002500270029003100NoSchoolEschoolMschoolHschoolCollege199119933/18/2010724OLSvs.FEModelFindings2070120170220270FairGoodExcellentMarginalIncomeProductivityofHealth(OLSvs.FEModel)Familybackgroundaccountsforasubstantialportionoftheincomevariationthroughindividualhealtheffect25FEModel:U-RDifferentialsRuralRuralRuralUrbanUrbanUrban050100150200250FairGoodExcellentSource:Liuetal.,JHE,200826FEModel:GenderDifferentialsWomenWomenWomenMenMenMen2070120170220270320FairGoodExcellentRuralSample3/18/2010827实证：健康的教育产出影响Incentiveeffect(StraussandThomas1998)NationalHealthandNutritionExaminationSurvey(1976–80)Menaged25and34years,a10cminheightgapwasassociatedwith1additionalyearofschoolingintheUSA(a8%increase)and1.5yearsinBrazil(a25%increase);Efficiencyeffect(EdwardsandGrossman1980)TheCycleIIoftheHealthExaminationSurvey(HES)Significantcorrelationsbetweencognitivedevelopment(IQ,andschoolachievement)and13healthindicators.近期研究：健康的激励影响BackgroundHypothesis:healthhasbothdirectproductivityeffectandindirectincentiveeffectArgument:healtheffectonincomewouldbeunderestimatedifmodeledthroughsingleequation;thussystemequationmodelwasappliedAnalyticalFramework–systemapproachGrowth=g(GDP,Schooling,Fertility,AdultMortality,X;E)Schooling=s(GDP,AdultMortality,Z;E)Fertility=f(GDP,Schooling,ChildMortality,M;E)28JocelynFinlay,“TheRoleofHealthinEconomicDevelopment,”WorkingPaper,HSPH,March27,2007Finlay系统模型的主要结果Data：CountrylevelpaneldataResultsIfmodeledindividually,healthwouldhavenodirectproductivityeffectongrowth,consistentwithsomepreviousstudy;Oncemodeledsimultaneouslyforbothdirectandindirecteffect,shefindssignificanthealtheffectongrowth;ConclusionBothproductivityandincentiveeffectsshouldbeaccountedforwhenmeasuringhealtheffect293/18/2010930HealthandEconomicGrowthFogel(1994)Improvedhealthandnutritionaccountedforabout30%ofincomegrowthintheUnitedKingdom,orabout1.15%percapitaperannuminthe200-yearperiodfrom1780to1980;Arora(2001)Data:Australia(1881–1994),Denmark(1870–1992),Finland(1881–1992),France(1870–1994),Italy(1875–1992),Japan(1891–1994),Netherlands(1880–1992),Norway(1870–1992),Sweden(1870–1994)andtheUnitedKingdom(1871–1992)Findings:improvedhealthincreasedtherateofgrowthinthesecountriesby30to40%,alteringpermanentlytheslopeoftheirgrowthpaths.Sources:Fogel(1