EuHEA Seminar: Jannis Stöckel (Erasmus University Rotterdam)

Jannis Stöckel

Abstract

Objective: Severe health shocks may affect one’s objective health and subjective health perceptions, but potentially in different ways. Specifically, self-perceived health might revert back to pre-shock levels as individuals adapt to their new health state over time, even when the effects on objective health remain persistent. This difference is important given that individuals make decisions based on these biased subjective health perceptions. We explore how health perceptions, lifestyle behavior, and medication use change after experiencing a negative health shock that persistently affects objective health: an ischemic stroke or an acute myocardial infarction. We shed new light on post-health shock recovery and on the role of health perceptions and choices using a novel combination of detailed administrative and survey data.

 Methods

We combined two large Dutch health surveys from 2012 and 2016 with administrative data on hospital admissions, healthcare demand and death records from 1995 to 2018. We identified a sample of 13,000 heart attack and 9,000 stroke patients providing survey responses on subjective outcome measures at different relative time points to their respective health shocks. The resulting repeated cross-section of heart attack/stroke patients is interviewed between 6 years prior and 7 years after their event. We use a doubly robust event-study approach that exploits the exogenous timing of the occurrence of these shocks to explore the causal effects of heart attacks and strokes on subjective outcome measures, risky health behaviors, and medication use over time.

Results

A heart attack or stroke has large immediate negative effects on subjective health perceptions as self-assessed health decreases substantially by one-third of a standard deviation in the year after a heart attack or stroke occurs. Despite these substantial initial differences, the effects attenuate quickly. While individuals experience an increased objective burden of disease over time, reflected in an increasing prevalence of long-term physical disability, their self-assessed health reverses towards pre-shock levels. Further we observe heterogenous impacts on a range of (risky) health behaviors with both health shocks leading to long-term decreased smoking prevalence of around 10-15 percentage points but only temporary decreases in alcohol consumption and no change in overweight rates or physical activity.

Discussion

Our findings suggest that even after a severe health shock like a heart attack or a stroke, individuals health perceptions return to pre-shock levels within a short period of time, despite an increasing burden of disease observed. Our results on health behaviors confirm previous studies that find smoking behavior to be consistently affected by a health shock. In line with the temporary effect on subjective health, we find that most effects on lifestyle behaviors are short-lasting. Only for smoking we observe a permanent decrease. In ongoing work, we aim to extend our analyses to the health perceptions and behaviors of cohabiting family members and to explore whether the observed pattern of adapted health perceptions also influence economic behaviors such as the decision to retire or rejoin the labor force, individuals’ choice of health insurance deductibles or adherence to prescription medicine.

Discussant: Torben Heien Nielsen, University of Copenaghen

Chair: Davide Dragone, University of Bologna