Volume 18, Issue 1

Tobacco taxes in Canada varied markedly across time and across regions in the early 1990s. We exploit this variation to estimate the long reach of prices faced in adolescence on smoking behavior roughly a decade later in early to mid-adulthood. Results from a variety of econometric approaches suggest that there is a small but detectable long-run effect of price faced during adolescence. A 10% increase in prices faced during adolescence, holding contemporaneous prices constant, leads to roughly a 1% reduction in adult smoking propensity and intensity. The results are somewhat sensitive to specification and to how price during adolescence is measured.

Alzheimer’s disease (AD) extracts a heavy societal toll. The value of medical advances that delay onset of AD could be significant. Using data from nationally representative samples from the Health and Retirement Study (1998–2008) and Aging Demographics and Memory Study (2001–2009), we estimate the prevalence and incidence of AD and the formal and informal health care costs associated with it. We use microsimulation to project future prevalence and costs of AD under different treatment scenarios. We find from 2010 to 2050, the number of individuals ages 70+ with AD increases 153%, from 3.6 to 9.1 million, and annual costs increase from $307 billion ($181B formal, $126B informal costs) to $1.5 trillion. 2010 annual per person costs were $71,303 and double by 2050. Medicare and Medicaid are paying 75% of formal costs. Medical advances that delay onset of AD for 5 years result in 41% lower prevalence and 40% lower cost of AD in 2050. For one cohort of older individuals, who would go on to acquire AD, a 5-year delay leads to 2.7 additional life years (about 5 AD-free), slightly higher formal care costs due to longer life but lower informal care costs for a total value of $511,208 per person. We find Medical advances delaying onset of AD generate significant economic and longevity benefits. The findings inform clinicians, policymakers, businesses and the public about the value of prevention, diagnosis, and treatment of AD.

Legal prohibitions on sex-selective abortions are proliferating in the United States. Eight state legislatures have banned abortions sought on the basis of the sex of the fetus, 21 states have considered such laws since 2009, and a similar bill is pending in U.S. Congress. These laws have been introduced and enacted without any empirical data about their impact or effectiveness. Prior studies of U.S. Census data found sex ratios among foreign-born Chinese, Korean and Indian immigrants were skewed in favor of boys, but only in families where there were already one or two girls. Using the variation in the timing of bans in Illinois and Pennsylvania as natural experiments, we compare the pre-ban and post-ban sex ratios of certain Asian newborn children in these states over 12-year periods. We then compare these ratios with the sex ratios of Asian newborn children in neighboring states during the same period. We find that the bans in Illinois and Pennsylvania are not associated with any changes in sex ratios at birth among Asians. In Illinois and its neighboring states, the sex ratio at birth of Asian children was not male-biased during our study period. On the other hand, the sex ratio at birth among Asians in Pennsylvania and its neighboring states was skewed slightly in favor of boys, but the enactment of the ban did not normalize the sex ratio. This strongly suggests that sex-selective abortion bans have had no impact on the practice of sex selection, to the extent that it occurs, in these states. This finding is highly relevant to legislative and policy debates in the U.S. Congress and state legislatures where sex-selective abortion laws are being considered.

The BRICS countries (Brazil, Russia, India, China, and South Africa) have experienced tremendous economic and health gains in recent decades. Two of the major health challenges faced by the BRICS and other low and middle income countries are decreasing inequity in health outcomes and increasing affordability of health insurance. One fiscally sustainable option for the BRICS governments is a public subsidy system for private health insurance plans. This essay lays out the potential applicability and impacts of public subsidies for private health insurance plans, as well as opportunities and challenges for implementation, in the BRICS countries. Overall, providing public subsidies rather than health insurance would enable the BRICS governments to avoid the open-ended financial liabilities that have plagued advanced economies, while still expanding access to health insurance and encouraging the develoment of a robust private health insurance market. We conclude by suggesting an array of pilot programs that could serve as the seeds for publicly subsidized health insurance schemes within the BRICS markets.