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CINCH - Health Economics Research Center

Virtual Essen Health Economics Seminar


On Monday, June 15 2020, 16:00 - 17:30, George MacKerron (University of Sussex) will present:

Mappiness: dynamics and loss aversion in the wellbeing of football supporters

By joining Mappiness, which is a large panel of momentary happiness data, to detailed information on British football matches between 2010 and 2017, we are able to identify football supporters and the teams they support. After conditioning on expected results for each match using bookmakers’ odds, match events and match results represent exogenous shocks to these supporters. We show how these events and results affect supporters’ reported momentary happiness, and provide some preliminary, novel evidence of loss aversion.

Room: Due to the current situation regarding the COVID-19 pandemic, the talk will be held in a virtual seminar room. For more information click here.

Virtual Essen Health Economics Seminar


On Monday, June 8 2020, 16:00 - 17:30, Lucia Fiestas Navarrete (Bocconi University) will present:

The Speculum of marital age: How early marriage impacts women’s use of opportunistic cervical and breast screening in India


The consequences of women’s social status on health are widely discussed in the literature, yet partly owing to the difficulty in measuring the complex phenomenon of disempowerment, few have offered insight into how the conditions of social life affect women’s health utilization. Our main objective is to investigate the effect of female empowerment, in the form of marital age, on women’s use of cervical and breast screening in India, while exploring the channels that mediate and moderate the relationship.


We linked data from a sample of 15,903 ever-married women (15-49 years) who participated in the National Family Health Survey in 2015-16 with district-level data from the Indian Ministry of Health on per capita health facility supply. Drawing on Lauver’s theory of care-seeking behaviour, we incorporate women’s health insurance status into the analysis as a critical factor facilitating the external conditions that enable women to seek care. Our empirical strategy relies on a twofold instrumental variable approach seeking to generate quasi-random sources of variation in marital age and insurance participation. Specifically, we instrument age of first union by age of first menstruation and insurance status by cluster insurance rate in order to isolate their causal influence on women’s health utilization. Using structural equation modelling, we test (i) whether financial self-efficacy mediates the relationship between marital age and opportunistic screening and (ii) to what extent the district-level per capita supply of community health centres (CHCs) moderates the strength of the mediating channel.


The prevalence of ever having cervical and breast screening is 23 and 9 percent, respectively. We show that with every additional year that marriage is postponed, the probability of a woman ever having a cervical exam significantly increases by 7.9 percentage points and that of having a breast exam by 5.1. We find that higher marital age is associated with improvements in financial self-efficacy, which in turn, positively influence women’s use of cervical and breast screening. This is an important finding as it reveals financial self-efficacy to be consistent with a ‘second-stage’ form of empowerment resulting from marriage postponement. We also show that the indirect effect of marital age on cervical screening mediated through financial self-efficacy is positive and significant for any value of district supply greater than 3.6 CHCs per million inhabitants. This points to the critical burden that a poor supply context may have on women’s health utilization despite the relative improvements in autonomy associated with marital age.


Our findings suggest that losses in female empowerment attributed to early marriage partly explain Indian women’s low cervical and breast screening participation. Interventions aiming to address the uniquely high prevalence of women’s cancers in India would be wise to reflect on the health utilization consequences that can be attributed to socio-cultural practices exacerbating female disempowerment. Enforcing legal protections against underaged marriage is an actionable arena where both social and health agendas may converge in the interest of women – and good public policy.

Room: Due to the current situation regarding the COVID-19 pandemic, the talk will be held in a virtual seminar room. For more information click here.

Virtual Essen Health Economics Seminar


On Monday, May 25 2020, 16:00 - 17:30, Katharina Blankart (CINCH/University of Duisburg-Essen) will present:

What does it need to alter physician treatment style? Cost-control measures in Statin prescribing in Germany

Due to rapidly increasing health expenditures, many countries have implemented guidelines and cost-control strategies in the health care sector to regulate physician treatment discretion. Such strategies typically are intended to reduce unwarranted inefficiencies in health care across providers. Yet the treatment style literature suggests that physicians do not easily alter their behaviors and treatment styles are known to be highly heterogeneous. Policy makers typically do not aim to attach strong financial consequences when designing cost-control strategies to maintain treatment autonomy and may also aim to alter behaviors of physicians that do not show cost-reducing efforts. We study how regional, time and implementation variation in preferred drug policies within the German statutory health insurance affects physicians’ prescribing decisions for the high volume drug class of HMG-CoA-reductase inhibitors (Statins). We use a nationally representative panel of ambulatory care physicians between 2011 and 2014 to identify the treatment effects of changes in the preferred drug policy. Especially, we aim to identify whether the preferred drug policies are capable to alter the behaviors of physicians not compliant with the policy in place. Preliminary findings show that physicians appear to not adhere strongly to "soft" recommendations but instead use other non-preferred drugs (Atorvastatin) despite small differences in evidence -based efficacy. Future analyses will concentrate on studying other dimensions of compliance.

Room: Due to the current situation regarding the COVID-19 pandemic, the talk will be held in a virtual seminar room. For more information click here.