International differences in interspousal health correlations.

Using objective measures of lung function, we document strong positive associations in health within couples in all European countries but large and significant differences in this correlation within broad European regions, with Southern Europe having by far stronger correlations than elsewhere. We analyze potential explanations for such differences, investigating the role of measures capturing current and past health behaviors, early life circumstances of each spouse, and measures capturing assortative mating in multiple dimensions. We show that marital sorting patterns by dimensions of early life health and socioeconomic position, as well as by geographical subregion within countries, are key to understanding the empirical patterns observed.

Unbalanced sex ratios in Germany caused by World War II and their effect on fertility: A life cycle perspective.

This paper analyzes the effects of permanently unbalanced sex ratios in Germany caused by World War II on fertility outcomes over the life cycle. Using Census records linked with individual biography data, our analysis confirms the commonly found short-term pattern of decreased fertility rates due to a stark imbalance of the sex ratio. Yet, the long-term effects of such an imbalance crucially depend on when in the life cycle fertility is evaluated. We find that female cohorts with low sex ratios have fewer children at younger ages and a larger fraction remains childless. While childlessness remains higher throughout their life cycle, mothers from affected cohorts catch up and even overcompensate at later ages with respect to the number of children. Our preferred reading of this result is that with low sex ratios women select themselves into late motherhood according to their fertility preferences. This interpretation is consistent with the finding that women from affected cohorts expand their childbearing period and accept lower quality matches in the marriage market. Our findings have important implications for understanding the long-term consequences of large population shocks.

Student characteristics, professional preferences, and admission to medical school.

Objectives: A potential new avenue to address the shortage of country doctors is to change the rules for admission to medical school. We therefore study the link between high-school grade point average and prospective physicians' choice to work in rural areas. To further inform the discussion about rules for admission, we also study the effects of other predictors: a measure of students' attitudes towards risk; whether they waited for their place of study (Wartesemester); whether their parents worked as medical doctors; and whether they have some practical experience in the medical sector. Methods: We conducted two internet surveys in 2012 and 2014. In the first survey, the sample comprised 701 students and in the second, 474 students. In both surveys, we asked students for their regional preferences; in the 2014 survey, we additionally asked students for their first, second, and third preferences among a comprehensive set of specializations, including becoming a general practitioner. In both surveys, we asked students for basic demographic information (age and gender), their parents' occupation, a measure of subjective income expectations, a measure of risk attitudes, and their high-school grade point average (Abiturnote), and First National Boards Examination grade (Physikum). In 2014, we additionally asked for waiting periods (Wartesemester) as well as for prior professional experience in the health-care sector. Results: We find that three factors increase the probability of having a preference for working in a rural area significantly, holding constant all other influences: having a medical doctor among the parents, having worse grades in the high-school grade point average, and being more risk averse. Moreover, we find that those willing to work in the countryside have significantly more experience in the medical sector before admission to medical school. Discussion: Our results suggest that a change in the selection process for medical school may increase the supply of country doctors. Instead of focusing on the high-school grade point average, universities could even more intensely screen for study motivation through interviews or by taking into account students' background, extracurricular activities, or waiting periods.

The Role of Outcome Forecasts in Patients' Treatment Decisions--Evidence from a Survey Experiment on Knee Replacement Surgery.

OBJECTIVE: To analyze the effect of personalized outcome probabilities on treatment decisions. DATA SOURCE: American Life Panel. STUDY DESIGN: We designed an experimental survey that respondents answered by recommending replacement surgery for hypothetical patients diagnosed with knee osteoarthritis. The primary manipulation was whether respondents were given personalized outcome probabilities for the patients. PRINCIPAL FINDINGS: Patient-specific outcome forecasts significantly influenced decisions, with effect sizes comparable to those of physicians' opinions and patient testimonials. The presentation format also affected the probabilities' influence on choices. We did not find evidence that the educational level of subjects affected the weight that they give to outcome probabilities in making recommendations. CONCLUSION: Our study points to a need for more research on the use of patient-specific outcome forecasts.

The Effects of World War II on Economic and Health Outcomes across Europe.

We investigate long-run effects of World War II on socio-economic status and health of older individuals in Europe. We analyze data from SHARELIFE, a retrospective survey conducted as part of SHARE in Europe in 2009. SHARELIFE provides detailed data on events in childhood during and after the war for over 20,000 individuals in 13 European countries. We construct several measures of war exposure-experience of dispossession, persecution, combat in local areas, and hunger periods. Exposure to war and more importantly to individual-level shocks caused by the war significantly predicts economic and health outcomes at older ages.

Contributions of Second Opinions, Outcome Forecasts, and Testimonials to Patient Decisions about Knee Replacement Surgery.

BACKGROUND: Decision aids are now a well-established means of supporting patients in their medical decision making. The widespread use of decision aids invites questions about how their components contribute to patient decisions. OBJECTIVE: The objective of this study was to measure the importance of second opinions, patient-specific outcome forecasts, and patient testimonials relative to patient clinical and socioeconomic factors and the primary physician recommendation on the decision to undergo full knee replacement surgery to treat knee osteoarthritis. METHODS: Middle-aged and older members of the RAND American Life Panel (N = 1616) chose whether to recommend surgery as a treatment for each of 3 hypothetical patients (vignettes) presented in a video-enhanced internet survey. Vignettes randomly sampled levels of scenario attributes. RESULTS: Second opinions, person-specific outcome forecasts, and 2 consistent patient testimonials strongly affected respondents' decision making; a single testimonial, however, did not significantly affect decisions. CONCLUSIONS: Information provided in a decision aid, including person-specific outcome forecasts and testimonials, can affect patient choices. The strong effect of testimonials and respondents' interest in reviewing them reinforces concerns about unwanted influence when testimonials are biased.

Suit the action to the word, the word to the action: Hypothetical choices and real decisions in Medicare Part D.

In recent years, consumer choice has become an important element of public policy. One reason is that consumers differ in their tastes and needs, which they can express most easily through their own choices. Elements that strengthen consumer choice feature prominently in the design of public insurance markets, for instance in the United States in the recent introduction of prescription drug coverage for older individuals via Medicare Part D. For policy makers who design such a market, an important practical question in the design phase of such a new program is how to deduce enrollment and plan selection preferences prior to its introduction. In this paper, we investigate whether hypothetical choice experiments can serve as a tool in this process. We combine data from hypothetical and real plan choices, elicited around the time of the introduction of Medicare Part D. We first analyze how well the hypothetical choice data predict willingness to pay and market shares at the aggregate level. We then analyze predictions at the individual level, in particular how insurance demand varies with observable characteristics. We also explore whether the extent of adverse selection can be predicted using hypothetical choice data alone.