13 results found
Marti J, Richards MR, 2016, Smoking Response to Health and Medical Spending Changes and the Role of Insurance, Health Economics, ISSN: 1057-9230
Severe health shocks provide new information about one's personal health and have been shown to influence smoking behaviors. In this paper, we suggest that they may also convey information about the hard to predict financial consequences of illnesses. Relevant financial risk information is idiosyncratic and unavailable to the consumer preceding illness, and the information search costs are high. However, new and salient information about the health as well as financial consequences of smoking after a health shock may impact smoking responses. Using variation in the timing of health shocks and two features of the US health care system (uninsured spells and aging into the Medicare program at 65), we test for heterogeneity in the post-shock smoking decision according to plausibly exogenous changes in financial risk exposure to medical spending. We also explore the relationship between smoking and the evolution of out-of-pocket costs. Individuals experiencing a cardiovascular health shock during an uninsured spell have more than twice the cessation effect of those receiving the illness while insured. For those uninsured prior to age 65 years, experiencing a cardiovascular shock post Medicare eligibility completely offsets the cessation effect. We also find that older adults' medical spending changes separate from health shocks influence their smoking behavior.
Marti J, Hall PS, Hamilton P, et al., 2016, The economic burden of cancer in the UK: a study of survivors treated with curative intent, Psycho-Oncology, Vol: 25, Pages: 77-83, ISSN: 1057-9249
ObjectiveWe aim to describe the economic burden of UK cancer survivorship for breast, colorectal and prostate cancer patients treated with curative intent, 1 year post-diagnosis.MethodsPatient-level data were collected over a 3-month period 12–15 months post-diagnosis to estimate the monthly societal costs incurred by cancer survivors. Self-reported resource utilisation data were obtained via the electronic Patient-reported Outcomes from Cancer Survivors system and included community-based health and social care, medications, travel costs and informal care. Hospital costs were retrieved through data linkage. Multivariate regression analysis was used to examine cost predictors.ResultsOverall, 298 patients were included in the analysis, including 136 breast cancer, 83 colorectal cancer and 79 prostate cancer patients. The average monthly societal cost was $US409 (95%CI: $US316–$US502) [mean: £260, 95%CI: £198–£322] and was incurred by 92% of patients. This was divided into costs to the National Health Service (mean: $US279, 95%CI: $US207–$US351) [mean: £177, 95%CI: £131–£224], patients' out-of-pocket (OOP) expenses (mean: $US40, 95%CI: $US15–$US65) [mean: £25, 95%CI: £9–£42] and the cost of informal care (mean: $US110, 95%CI: $US57–$US162) [mean: £70, 95%CI: £38–£102]. The distribution of costs was skewed with a small number of patients incurring very high costs. Multivariate analyses showed higher societal costs for breast cancer patients. Significant predictors of OOP costs included age and socioeconomic deprivation.ConclusionsThis study found the economic burden of cancer survivorship is unevenly distributed in the population and that cancer survivors may still incur substantial costs over 1 year post-diagnosis. In addition, this study illustrates the feasibility of using an innovative online data collection platform to collect patient-repor
Boes S, Marti J, Maclean JC, 2015, The Impact of Smoking Bans on Smoking and Consumer Behavior: Quasi-Experimental Evidence from Switzerland., Health Econ, Vol: 24, Pages: 1502-1516
In this paper, we exploit the progressive implementation of smoking bans in public venues at the state level in Switzerland to evaluate both the direct effects on smoking and the potential unintended consequences of these legislations on consumer behaviors as measured by visiting restaurants/bars and discos ('going out'). Our results indicate that public venue smoking bans in Switzerland reduce smoking rates, but the findings do not emerge until 1 year following the ban. This pattern of results is consistent with delays in ban enforcement on the part of business owners, difficulties in changing addictive behaviors such as smoking, and/or learning on the part of smokers. We find evidence that smoking bans influence going-out behavior and there is substantial heterogeneity across venue and consumer characteristics.
Ashley L, Marti J, Jones H, et al., 2015, Illness perceptions within 6 months of cancer diagnosis are an independent prospective predictor of health-related quality of life 15 months post-diagnosis., Psychooncology, Vol: 24, Pages: 1463-1470
OBJECTIVE: Studies have found that illness perceptions explain significant variance in health outcomes in numerous diseases. However, most of the research is cross-sectional and non-oncological. We examined, for the first time in breast, colorectal and prostate cancer patients, if cognitive and emotional illness perceptions near diagnosis predict future multidimensional health-related quality of life (HRQoL). METHODS: UK-based patients (N = 334) completed the illness perception questionnaire-revised within 6 months post-diagnosis and the quality of life in adult cancer survivors scale 15 months post-diagnosis. Sociodemographic and clinical data were obtained from medical records. Hierarchical multiple regression analyses were conducted. RESULTS: The sociodemographic and clinical factors collectively significantly predicted 8/12 HRQoL domains, although for 5/8 accounted for <10% of the variance. For all 12 HRQoL domains, illness perceptions collectively explained significant substantial additional variance (∆R(2) range: 5.6-27.9%), and a single illness perception questionnaire-revised dimension was the best individual predictor of 9/12 HRQoL domains. The consequences dimension independently predicted 7/12 HRQoL domains; patients who believed their cancer would have a more serious negative impact on their life reported poorer future HRQoL. The emotional representations and identity dimensions also predicted multiple HRQoL domains. CONCLUSIONS: Future research should focus on realising the potential of illness perceptions as a modifiable target for and mediating mechanism of interventions to improve patients' HRQoL.
Marti JEF, 2015, Cost of care for economic evaluation in cancer: A UK analysis of patient-level routine health system data, British Journal of Cancer, ISSN: 1532-1827
Marti J, Sindelar J, 2015, Smaller Cigarette Pack as a Commitment to Smoke Less? Insights from Behavioral Economics, PLOS ONE, Vol: 10, Pages: e0137520-e0137520
Marti J, 2014, The impact of tobacco control expenditures on smoking initiation and cessation., Health Econ, Vol: 23, Pages: 1397-1410
Between 1997 and 2007, smoking prevalence declined from 33% to 28% in Switzerland. Over the same period, funding for tobacco control activities significantly increased, resulting in the implementation of a large variety of national and regional interventions. In this paper, I exploit variation over time and across cantons of tobacco control expenditures to examine the impact of these policies on smoking decisions. I use retrospective smoking information from the Swiss Health Survey (2007) and find that tobacco control expenditures decreased the probability of smoking initiation among adolescents and young adults and increased cessation rates in the general population of smokers. I estimate that if funding had been kept at the 1997 level, there would have been 107,000 additional smokers in 2007.
Richards MR, Marti J, 2014, Heterogeneity in the smoking response to health shocks by out-of-pocket spending risk., Health Econ Policy Law, Vol: 9, Pages: 343-357
An existing literature demonstrates that adverse changes to health can lead to improvements in health behaviors. Although the exact explanations for these empirical findings are debated, some posit that individuals learn about their true health risks through health shocks. Updated health risk information can then induce changes in health behaviors. While we follow a learning framework, we argue that past work has neglected the role of health insurance and medically related financial risk within this decision making context. Using longitudinal data from 11 European countries, we investigate the impact of a new cardiovascular (CV) health shock on smoking decisions among older adults and examine whether personal exposure to medical spending risk influences the smoking response. We then explore two potential mechanisms for this link: larger updates to health risk beliefs and higher medical expenditures to incentivize behavior change. We find that CV shocks impact the propensity to smoke, with relatively more impact among individuals with high financial risk exposure to medical spending. We also see larger increases in out-of-pocket expenditures following a shock for this group--consistent with the latter mechanism for behavior change.
Marti J, Schläpfer J, 2014, The economic impact of Swiss smoking bans on the hospitality sector, Economics Letters, Vol: 124, Pages: 136-139, ISSN: 0165-1765
Maclean JC, Webber DA, Marti J, 2013, An Application of Unconditional Quantile Regression to Cigarette Taxes, Journal of Policy Analysis and Management, Vol: 33, Pages: 188-210, ISSN: 0276-8739
Marti J, 2012, Assessing preferences for improved smoking cessation medications: a discrete choice experiment, The European Journal of Health Economics, Vol: 13, Pages: 533-548, ISSN: 1618-7598
Marti J, 2012, A best–worst scaling survey of adolescents' level of concern for health and non-health consequences of smoking, Social Science & Medicine, Vol: 75, Pages: 87-97, ISSN: 0277-9536
Marti J, 2010, Successful Smoking Cessation and Duration of Abstinence—An Analysis of Socioeconomic Determinants, International Journal of Environmental Research and Public Health, Vol: 7, Pages: 2789-2799
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