GARROUSTE Clementine

We evaluate the impact of a French vaccination campaign against Hepatitis B (HB) in 1994. Usinga regression discontinuity design, we show that this campaign created an exogenous shock on vaccinationbehavior, increasing the vaccination rate for children aged 11 and above. We also show that this vaccinationscheme led to a decline in the knowledge about HB transmission modes, as well as public confusion aboutthe target population. But our most important result is a drop in measles, mumps, and rubella (MMR)vaccination rate and an increase in the belief that measles is a benign disease. We interpret these results asa salience effect: the focus on HB vaccination may lead to a decrease in the beliefs that other vaccines are asimportant. We find that the decrease in MMR vaccination is mostly due to high-educated parents who aremore likely to substitute MMR with HB for their children, and could have been influenced by their familydoctor. The effect on MMR vaccination was relatively unexpected and may imply a negative externality.Measles is an extremely contagious disease. If the vaccination rate falls, the disease will spread further,raising the question of the net effect of the HB vaccination campaign on the well-being of the population.Overall, it shows the necessity - but also the difficulty- to evaluate the effects of a public policy as a whole,taking into account all potential side effects but also unexpected adverse effects.

This paper investigates the impact of delaying retirement on mortality amongthe French population. We take advantage of the 1993 pension reform in the private sector to identify the causal effect of an increase in claiming age on mortality. We use administrative data which provide detailed information on career characteristics, dates of birth and death. Our results, precisely estimated, show that an exogenous increase of one year in the claiming age has no significant impact on the probability to die, measured between age 61 and 79. To test the power of our sample to detect statistically significant effects for rare events like death, we compute minimum detectable effects (MDE). Our MDE estimates suggest that, if an impact of later retirement on mortality would be detectable, it would remain very small in magnitude.

Using a simple theoretical decision model and an original database, we were able to elicit thedistribution of the utility value of having a child with Down syndrome for a large sample of Frenchpregnant women (n = 28, 341) between 2003 and 2007. We found that, on a scale where the value ofa fetal death is 0 and the value of a healthy child is 1, the mean value for a child with Down syndromeis about −0.6. Assuming that the policymaker used the same decision model as the women, we inferfrom the French amniocentesis reimbursement regulation an implicit social value for a child withDown syndrome of −2.5. We conclude from our study that the policymaker is more likely to preventthe birth of children with Down syndrome than French women themselves.

We investigate the causal effect of retirement on health through literature. We explore the potential mechanisms which explain three effects: the switch from employment to retirement, later retirement, and earlier retirement. The empirical strategies used to identify the causal effects are mainly based on the observation of changes in health status at the legal age for retirement entitlement or on reforms that have led to changes in retirement incentives. Literature renders possible to make several observations on the average effect estimation. Retirement leads to better self-reported health, less depression, a decrease in healthcare consumption, a decline in cognition and an ambiguous effect on physical health. Later retirement has no effect on mortality, decreases healthcare consumption, and has a negative or non-significant impact on self-reported health. Studies on the impact of earlier retirement are scarce due to few natural experiments exploiting such a variation. Lastly, some studies find evidence of heterogeneous effects by gender and occupational status. As there are relatively few studies on this aspect, the question should be seriously explored in future research.

This paper investigates the impact of delaying retirement on mortality among the French population. We take advantage of the 1993 pension reform in the private sector to identify the causal effect of an increase in claiming age on mortality. We use administrative data which provide detailed information on career characteristics, dates of birth and death. Our results, precisely estimated, show that an exogenous increase of one year in the claiming age has no significant impact on the probability to die, measured between age 61 and 79, even when we allow for nonlinear effects of treatment intensity. To test the power of our sample to detect statistically significant effects for rare events like death, we compute minimum detectable effects (MDEs). Our MDE estimates suggest that, if an impact of later retirement on mortality would be detectable, it would remain very small in magnitude.

A pay-as-you-go pension system requires a balance between the population that contributes to benefits and the population that receives them. In most Western countries, the number of elderly people (beneficiaries) is increasing faster than the number of working people (contributors). This observation has prompted various governments to implement reforms aimed at increasing the retirement age in order to reverse this trend. The study of the effects of these reforms on health is of twofold interest from a public policy point of view. Indeed, the arduousness or the risks taken in certain professions may be the source of costs in terms of health, which may be accentuated by an extension of the length of the career. It therefore seems essential to measure the social repercussions of such reforms and to have a precise idea of their effects on health inequalities. These reforms, which increase the length of working life, could also have an impact on health care expenditure, with the transfer of costs from the pension branch to the health branch of the social security system, which would consequently attenuate the expected benefits of these reforms. Epidemiological studies reveal a negative correlation between retirement and health (being retired is associated with poorer health). However, it is difficult to deduce that retirement worsens health. Indeed, some individuals remain in employment longer precisely because their health status allows them to do so. In this review, we present a comparative analysis of the results obtained in the literature, focusing on the causal effect of retirement on health, and not the reverse1 (→). We thus distinguish three elements: retirement, i.e., the transition from employment to retirement . the increase in the retirement age . and the reduction in the retirement age2. We will thus examine the mechanisms that can explain the link between retirement and health and will detail the tools for identifying the causal effect. We will then present empirical (or observational) results from studies examining this causal link.(→) See T. Barnay Forum, m/s No. 10, October 2016, page 889.

How does the retirement age affect the physical and mental health of seniors? We identify this effect based on the 1993 reform of the French pension system, which was heterogeneously introduced among the population. With each cohort, the French government gradually increased the incentive to work using two tools: the contribution period required for entitlement to a full pension and the number of reference earning years taken to calculate pensions. We use a unique database on health and employment in France in 1999 and 2005, when the cohorts affected by the reform started to retire. A difference-in-differences approach, with the control group comprising public sector employees (not concerned by the 1993 reform), finds that the people more affected by the reform, and hence with a stronger incentive to work, were those posting less of an improvement and even a deterioration in their health between 1999 and 2005. Subsequently, taking the reform as a tool to filter out the potential influence of health on employment choices, we show that retirement improves physical and social health. The more physically impacted are the low-educated individuals.

This paper investigates the impact of delaying retirement on mortality among the French population. We take advantage of the 1993 pension reform in the private sector to identify the causal effect of an increase in claiming age on mortality. We use administrative data which provide detailed information on career characteristics, dates of birth and death. Our results, precisely estimated, show that an exogenous increase of the claiming age has no significant impact on the probability to die between age 65 and 72, conversely we find that an increase of the retirement age of one year leads to an increase of 0.004 in the death rate between age 72 and 77. This effect is qualitatively small, and we discuss more generally the ability to estimate small effects in rare event data using minimal detectable effect procedure.

How does the retirement age affect the physical and mental health of seniors? We identify this effect based on the 1993 reform of the French pension system, which was heterogeneously introduced among the population. With each cohort, the French government gradually increased the incentive to work using two tools: the contribution period required for entitlement to a full pension and the number of reference earning years taken to calculate pensions. We use a unique database on health and employment in France in 1999 and 2005, when the cohorts affected by the reform started to retire. A difference-in-differences approach, with the control group comprising public sector employees (not concerned by the 1993 reform), finds that the people more affected by the reform, and hence with a stronger incentive to work, were those posting less of an improvement and even a deterioration in their health between 1999 and 2005. Subsequently, taking the reform as a tool to filter out the potential influence of health on employment choices, we show that retirement improves physical and social health. The more physically impacted are the low-educated individuals.

We measure the effects of the 1993 French pension reform on health, especially the reform has gradually increased the length of the contribution period required to benefit from a full pension, as well as the number of earnings years taken into account to calculate pension benefits. Most importantly, the reform heterogeneously has affected different cohorts of individuals, creating a quasi-experimental framework. Given that this reform concerned only private sector workers, we use the results of a survey on health ran in 2005 and a difference-in-differences analysis to compare health outcomes between two population samples, one composed of private sector workers and another of public sector workers. The results show significant differences between these two samples in two health measures – perceived health and physical health – but concentrated on less-educated individuals exclusively.

This study investigated the relationship between women's disadvantage in mental health and physical functioning and gender differences in career backgrounds. Sexual division of labor persists and key career characteristics are overrepresented in women: low-skilled first job, downward occupational trajectory, interruptions. These interrelated characteristics are usually linked to poor health. Their overrepresentation in women may be related to the female-male health gap. however, it may not if overrepresentation transposed into substantially weaker associations with poor health outcomes. To address this question, we used the French population survey “Health and Occupational Trajectories” (2006) and focused on 45–74 year-old individuals who ever worked (n=7537). Past career characteristics were qualified by retrospective information. Logistic regressions identified past characteristics related to current depressive symptoms and physical limitations. Non-linear decomposition showed whether these characteristics contributed to the gender health gap, through their different distribution and/or association with health. The overrepresentation of unskilled first jobs, current and past inactivity and unemployment in women contributed to their excess depressive symptoms. These contributions were only slightly reduced by the weaker mental health-relatedness of current inactivity in women and increased by the stronger relatedness of low-skilled and self-employed first jobs. Overrepresentation of current inactivity, past interruptions and downward trajectories also contributed positively to women's excess physical limitations. Gender-specific career backgrounds were significantly linked to women's disadvantage in mental health and physical functioning. We need to further explore whether equalization of opportunities, especially at the early stages and in terms of career continuity, could help to reduce women’s mental and physical health disadvantage.

Using a simple theoretical decision model and an original database, we were able to elicit the distribution of the utility value of having a child with Down syndrome for a large sample of French pregnant women (n = 28,341) between 2003 and 2007. We found that, on a scale where the value of a fetal death is 0 and the value of a healthy child is 1, the mean value for a child with Down syndrome is about −0.6. Assuming that the policymaker used the same decision model as the women, we infer from the French amniocentesis reimbursement regulation an implicit social value for a child with Down syndrome of −2.5. We conclude from our study that the policymaker is more likely to prevent the birth of children with Down syndrome than French women themselves.

This paper investigates whether leaving school in a bad economy deteriorates health in the long run. It focuses on low-educated individuals in England and Wales – specifically, individuals who left full-time education in their last year of compulsory schooling – who entered the labour market immediately after the 1973 oil crisis. Unemployment rates sharply increased in the wake of this crisis, such that between 1974 and 1976, each school cohort faced worse economic conditions at labour-market entry than did the previous cohort. Our identification strategy relies on the comparison of very similar pupils – born in the same year and having a similar quantity of education – whose school-leaving behaviour in different economic conditions was exogenously implied by compulsory schooling laws. We provide evidence that, unlike school-leavers who did postpone their entry into the labour market during the recessions of the 1980s and 1990s, pupils’ decisions to leave school at compulsory age immediately after the 1973 oil crisis were not endogenous to the contemporaneous economic conditions at labour-market entry. We use a repeated cross section of individuals over the period 1983-2001 from the General Household Survey (GHS) and adopt a lifecourse perspective, from 7 to 26 years after school-leaving. Our results show that poor economic conditions at labourmarket entry are particularly damaging to women’s health. Women who left school in a bad economy are more likely to report poorer health and to consult a general practitioner over the whole period under study (1983-2001). Additional evidence suggests that they are also more likely to suffer from a longstanding illness/disability over the whole period. For men, the health impact of poor economic conditions at labour-market entry is less obvious and not robust to all specifications.

Women live longer than men on average, but spend more of their lives in poor health. This study looks at how much of the difference in health is related to career paths. Previous work shows that women's careers are more interrupted than men's. Women have fewer opportunities for promotion, qualification and experience in their career trajectory, which is notably accompanied by lower pay. The purpose of this study is to find out whether interruptions, lower promotions and downgrading, which are more frequent among women, are equally linked to poor health for men and women. If so, do differences in career paths contribute to differences in health status between women and men?

Critical bibliography of the following work: Armelle Testenoire, Danièle Trancart, Parcours professionnels, ruptures et transitions. Inégalités face aux événements de santé, Noisy-Le-Grand, Centre d'études de l'emploi, Rapport de recherche du CEE, 2011, 89 p.

This thesis consists of four essays related to health economics. On the one hand, we try to estimate the effects of activity on health and longevity, by analyzing the impact of recent pension reforms. On the other hand, we analyze the choice of pregnant women regarding the prenatal diagnosis of trisomy 21 (amniocentesis). The first essay shows that retirement has positive effects on the physical and social health of older people. The recently implemented reforms have the effect of degrading the physical health of seniors, mainly for individuals who do not have the baccalaureate, while the most qualified are affected in terms of social health. The second essay completes the first one by evaluating the effects of retirement not on health, but on mortality. We show that the 1993 pension reform has a negative effect on longevity. The third test shows that the terms of reimbursement for amniocentesis have a significant and important impact on women's decision to undergo amniocentesis or not. We also measure the impact of the amniocentesis procedure on fetal health outcomes using the discontinuity generated by the reimbursement scheme in France. The last essay complements the third one by developing a model of pregnant women's behavior regarding the decision to undergo amniocentesis or not.