Economy and health: essays on early-life conditions, health, and health insurance


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This thesis focuses on two aspects of the interactions between economy and health. First, based on the fetal programming hypothesis that suggests a relationship between the economic circumstances before birth and health later in life, I analyze the impact of macroeconomic conditions around birth on infant health and on adult cardiovascular disease risk. The results in chapters 2 and 3 show that high provincial unemployment rates decrease fertility, improve the socio-economic cohort composition of mothers and lead to a lower birthweight in boys. Moreover, girls exposed to unfavorable business-cycle conditions at birth are at an increased risk for fatal CVD events in adult life. Chapter 4 focuses on one of the potential mechanisms linking the economic conditions and health – ambient stress. There, I show that stress caused by high unemployment levels can increase the probability of Cesarean delivery for male babies.
The second part of this thesis takes a different look at the interactions of economy and health by investigating incentives for moral hazard and selection in health insurance. Chapter 5 investigates whether the voluntary deductible in the Dutch health insurance system reduces excessive use of healthcare services or acts only as a cost reduction tool for low-risk individuals. The results show that even though healthier people are more likely to opt for a higher deductible, overall, the voluntary deductible reduces moral hazard in healthcare utilization in the Netherlands.
Originele taal-2English
KwalificatieDoctor of Philosophy
Toekennende instantie
  • Rijksuniversiteit Groningen
  • Alessie, Rob, Supervisor
  • Mierau, Jochen, Co-supervisor
  • Angelini, Viola, Co-supervisor
Datum van toekenning8-apr.-2019
Plaats van publicatie[Groningen]
Gedrukte ISBN's978-94-034-1435-5
Elektronische ISBN's978-94-034-1434-8
StatusPublished - 2019

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