Efficiency of Health Investment: Education or Intelligence?

Govert Bijwaard, Hans van Kippersluis

Research output: Contribution to journalArticleAcademicpeer-review


In this paper, we hypothesize that education is associated with a higher efficiency of health investment, yet that this efficiency advantage is solely driven by intelligence. We operationalize efficiency of health investment as the probability of dying conditional on a certain hospital diagnosis and estimate a multistate structural equation model with three states: (i) healthy, (ii) hospitalized, and (iii) death. We use data from a Dutch cohort born around 1940 that links intelligence tests at age 12 years to later-life hospitalization and mortality records. The results indicate that intelligent individuals have a clear survival advantage for most hospital diagnoses, while the remaining disparities across education groups are small and not statistically significant.
Original languageEnglish
Pages (from-to)1056-1072
Number of pages17
JournalHealth Economics
Issue number9
Publication statusPublished - 2016


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