nep-hea New Economics Papers
on Health Economics
Issue of 2019‒08‒19
thirty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. A Unified Welfare Analysis of Government Policies By Nathaniel Hendren; Benjamin D. Sprung-Keyser
  2. Losing Insurance and Behavioral Health Hospitalizations: Evidence from a Large-Scale Medicaid Disenrollment By Maclean, J. Catherine; Tello-Trillo, Sebastian; Webber, Douglas A.
  3. Multiple Births, Birth Quality and Maternal Labor Supply: Analysis of IVF Reform in Sweden By Bhalotra, Sonia R.; Clarke, Damian; Mühlrad, Hanna; Palme, Mårten
  4. The Introduction of Abuse-Deterrent Opioids and Rates of Viral Infection By Mark McInerney
  5. Does long-term care subsidization reduce hospital admissions and utilization? By Costa-Font, Joan; Jiménez-Martínez, Sergi; Vilaplana, Cristina
  6. Long-run consequences of informal elderly care and implications of public long-term care insurance By Korfhage, T.;
  7. Uninsured by Choice? A Choice Experiment on Long Term Care Insurance By Akaichi, Faical; Costa-Font, Joan; Frank, Richard
  8. Fair Long-Term Care Insurance By Marie-Louise Leroux; Pierre Pestieau; Gregory Ponthiere
  9. Credit, Default, and Optimal Health Insurance By Jang, Youngsoo
  10. Government Regulation and Lifecycle Wages: Evidence from Continuing Coverage Mandates By Maclean, J. Catherine; Webber, Douglas A.
  11. Frequency and Time of Day That Americans Eat: A Comparison of Data From the American Time Use Survey and the National Health and Nutrition Examination Survey By Zeballos, Eliana; Todd, Jessica E.; Restrepo, Brandon
  12. Adult Eating and Health Patterns: Evidence From the 2014-16 Eating & Health Module of the American Time Use Survey By Zeballos, Eliana; Restrepo, Brandon
  13. Improving Children Health and Cognition: Evidence from School-Based Nutrition Intervention in India By Marion Krämer; Santosh Kumar; Sebastian Vollmer
  14. Obesity, Income and Gender: The Changing Global Relationship By Hannah Ameye and Johan Swinnen
  15. Parental Beliefs, Investments, and Child Development: Evidence from a Large-Scale Experiment By Carneiro, Pedro; Galasso, Emanuela; Lopez Garcia, Italo; Bedregal, Paula; Cordero, Miguel
  16. Labor Demand Shocks at Birth and Cognitive Achievement during Childhood By Regmi, Krishna; Henderson, Daniel J.
  17. Air Pollution during Pregnancy and Birth Outcomes in Italy By Palma, Alessandro; Petrunyk, Inna; Vuri, Daniela
  18. Mental Health around Pregnancy and Child Development from Early Childhood to Adolescence By Stephanie von Hinke; Nigel Rice; Emma Tominey
  19. The long-term consequences of the global 1918 influenza pandemic: A systematic analysis of 117 IPUMS international census data sets By Sebastian Vollmer; Juditha Wójcik
  20. Natural Disasters and Mental Health: A Quantile approach By Nadezhda V. Baryshnikova; Ngoc T. A. Pham
  21. Widening the high school curriculum to include soft skill training: impacts on health, behaviour, emotional wellbeing and occupational aspirations By Lordan, Grace; Mcguire, Alistair
  22. Military Training Exercises, Pollution, and their Consequences for Health By Gustavo J. Bobonis; Mark Stabile; Leonardo Tovar
  23. The Impact of Paid Family Leave on the Timing of Infant Vaccinations By Choudhury, Agnitra Roy; Polachek, Solomon
  24. Climbing up Ladders and Sliding down Snakes: An Empirical Assessment of the Effect of Social Mobility on Subjective Wellbeing By Dolan, Paul; Lordan, Grace
  25. Measuring the activity of mental health services in England: variation in categorising activity for payment purposes By Jacobs, Rowena; Chalkley, Martin; Böhnke, Jan R.; Clark, Michael; Moran, Valerie; Aragón, M. J.
  26. Smokers’ Rational Lexicographic Preferences for Cigarette Package Warnings: A Discrete Choice Experiment with Eye Tracking By Jeffrey E. Harris; Mariana Gerstenblüth; Patricia Triunfo
  27. Scamming and the Reputation of Drug Dealers on Darknet Markets By Romain Espinosa
  28. Immigration and Work-Related Injuries: Evidence from Italian Administrative Data By Alacevich, Caterina; Nicodemo, Catia
  29. Does the Healthcare Educational Market Respond to Short-Run Local Demand? By Marcus Dillender; Andrew I. Friedson; Cong T. Gian; Kosali I. Simon
  30. Why so many significant Phase 3 results in clinical trials? By Adda, Jerome; Decker, Christian; Ottaviani, Marco
  31. A Flow Measure of Missing Women by Age and Disease By Stephan Klasen; Sebastian Vollmer

  1. By: Nathaniel Hendren; Benjamin D. Sprung-Keyser
    Abstract: We conduct a comparative welfare analysis of 133 historical policy changes over the past half-century in the United States, focusing on policies in social insurance, education and job training, taxes and cash transfers, and in-kind transfers. For each policy, we use existing causal estimates to calculate both the benefit that each policy provides its recipients (measured as their willingness to pay) and the policy’s net cost, inclusive of long-term impacts on the government's budget. We divide the willingness to pay by the net cost to the government to form each policy’s Marginal Value of Public Funds, or its “MVPF”. Comparing MVPFs across policies provides a unified method of assessing their impact on social welfare. Our results suggest that direct investments in low-income children's health and education have historically had the highest MVPFs, on average exceeding 5. Many such policies have paid for themselves as governments recouped the cost of their initial expenditures through additional taxes collected and reduced transfers. We find large MVPFs for education and health policies amongst children of all ages, rather than observing diminishing marginal returns throughout childhood. We find smaller MVPFs for policies targeting adults, generally between 0.5 and 2. Expenditures on adults have exceeded this MVPF range in particular if they induced large spillovers on children. We relate our estimates to existing theories of optimal government policy and we discuss how the MVPF provides lessons for the design of future research.
    JEL: H0
    Date: 2019–08
  2. By: Maclean, J. Catherine (Temple University); Tello-Trillo, Sebastian (University of Virginia); Webber, Douglas A. (Temple University)
    Abstract: We study the effects of losing insurance on behavioral health – mental health and substance use disorder (SUD) – community hospitalizations. We leverage variation in public insurance eligibility offered by a large-scale Medicaid disenrollment. Losing insurance decreased SUD-related hospitalizations but mental illness hospitalizations were unchanged. Use of Medicaid to pay for behavioral health hospitalizations declined post-disenrollment. Mental illness hospitalization financing shifted to private insurance, Medicare, and patients, while SUD treatment financing shifted entirely to patients. We investigate implications of reliance on data that is not representative at the level of the treatment variable and propose a possible solution.
    Keywords: healthcare, community hospitalizations, insurance, mental illness, substance use disorders, data quality
    JEL: I1 I11 I18
    Date: 2019–07
  3. By: Bhalotra, Sonia R. (University of Essex); Clarke, Damian (Universidad de Santiago de Chile); Mühlrad, Hanna (IFN - Research Institute of Industrial Economics); Palme, Mårten (Stockholm University)
    Abstract: In this study we examine the passage of a reform to in-vitro fertilization (IVF) procedures in Sweden in 2003. Following publication of medical evidence showing that pregnancy success rates could be maintained using single rather than multiple embryo transfers, the single embryo transfer (SET) was mandated as the default IVF procedure. Using linked registry data for the period 1998-2007, we find that the SET reform was associated with a precipitous drop in the share of multiple births of 63%. This narrowed differences in health between IVF and non- IVF births by 53%, and differences in the labor market outcomes of mothers three years after birth by 85%. For first time mothers it also narrowed the gap in maternal health between IVF and non-IVF births by 36%. Our findings imply that more widespread adoption of SET could lead to massive gains, reducing hospitalization costs and the foregone income of mothers and improving the long-run socioeconomic outcomes of children. This is important given that the share of IVF facilitated births exceeds 3% in several industrialized countries and is on the rise.
    Keywords: IVF, fertility, maternal health, neonatal health, career penalty, human capital formation
    JEL: J13 I11 I12 I38 J24
    Date: 2019–07
  4. By: Mark McInerney (University of Connecticut)
    Abstract: Along with the many deaths that have been attributed to opioid overdose and the substantial economic impact of the epidemic, the increasing prevalence of opioid use disorder has been associated with new viral infections. Powell et al. (2019) find that states with higher prevalence of OxyContin misuse prior to the introduction of abuse-deterrent OxyContin experienced substantially higher growth in the hepatitis C infection rate since 2010. In this study, I find that increases in hepatitis C infections have coincided with increases in hepatitis B infections in states with higher rates of OxyContin misuse prior to the introduction of abuse-deterrent OxyContin in 2010. I apply this analytical framework to HIV infections but face data limitations.
    JEL: I18 I12
    Date: 2019–08
  5. By: Costa-Font, Joan; Jiménez-Martínez, Sergi; Vilaplana, Cristina
    Abstract: We use quasi-experimental evidence on the expansion of the public subsidization of long-term care to examine the causal effect of a change in caregiving affordability on the delivery of hospital care. More specifically, we examine a reform that both introduced a new caregiving allowance and expanded the availability of publicly funded home care services, on both hospital admissions (both on the internal and external margin) and length of stay. We find robust evidence of a reduction in both hospital admissions and utilization among both those receiving a caregiving allowance and, albeit less intensely, among beneficiaries of publicly funded home care, which amounts to 11% of total healthcare costs. These effects were stronger when regions had an operative regional health and social care coordination plan in place. Consistently, a subsequent reduction in the subsidy, five years after its implementation, is found to significantly attenuate such effects. We investigate a number of potential mechanisms, and show a number of falsification and robustness checks
    Keywords: Hospital admissions; Hospital utilization; Long-term care reform; Bed-blocking; Poisson hurdle model; Spain
    JEL: H53 I18 J14
    Date: 2018–01–31
  6. By: Korfhage, T.;
    Abstract: In this paper, I estimate a dynamic structural model of labor supply, retirement, and informal care supply, incorporating labor market frictions and the German tax and benefit system. I find that informal elderly care has adverse and persistent effects on labor market outcomes and therefore negatively affects lifetime earnings, future pension benefits, and individuals'well-being. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that, even though fiscally costly, public long-term care insurance can offset the personal costs of caregiving to a large extent - in particular for low-income individuals.
    Keywords: long-term care; informal care; long-term care insurance; labor supply; retirement; pension benefits; structural model;
    JEL: I18 I38 J14 J22 J26
    Date: 2019–08
  7. By: Akaichi, Faical (SRUC Edinburgh); Costa-Font, Joan (London School of Economics); Frank, Richard (Harvard University)
    Abstract: We examine evidence from two unique discrete choice experiments (DCE) on long term care insurance and several of its relevant attributes, and more specifically, choices made by 15,298 individuals in the United States with and without insurance. We study the valuation of the following insurance attributes, namely daily insurance benefit, insurance coverage, the compulsory and voluntary nature of the insurance policy design, alongside the costs (insurance premium) and health requirements This paper investigates respondents' preferences and willingness to pay (WTP) for these care insurance's attributes using a random parameter logit model, and assess the heterogeneity of choice responses using demographic, socioeconomic and attitudinal motivations to segment response to insurance choices. We find that an increase in the insurance premium by an additional 100US$ would reduce insurance uptake by 1pp. Insurance policy uptake is higher when it provides benefits for the lifetime (the monthly marginal WTP being $178.64), and voluntary (the monthly marginal WTP increases by an extra $74.71) as opposed to universal, and when it forgoes health checks (the monthly marginal WTP increases by an extra 28US$).
    Keywords: long term care insurance, constrained choices, self-insurance, behavioural constraints, insurance design
    JEL: I18
    Date: 2019–07
  8. By: Marie-Louise Leroux; Pierre Pestieau; Gregory Ponthiere
    Abstract: The study of optimal long-term care (LTC) social insurance is generally carried out under the utilitarian social criterion, which penalizes individuals who have a lower capacity to convert resources into well-being, such as dependent elderly individuals or prematurely dead individuals. This paper revisits the design of optimal LTC insurance while adopting the ex post egalitarian social criterion, which gives priority to the worst-off in realized terms (i.e. once the state of nature has been revealed). Using a lifecycle model with risk about the duration of life and risk about old-age dependence, it is shown that the optimal LTC social insurance is quite sensitive to the postulated social criterion. The optimal second-best social insurance under the ex post egalitarian criterion involves, in comparison to utilitarianism, higher LTC benefits, lower pension benefits, a higher tax rate on savings, as well as a lower tax rate on labor earnings.
    Keywords: long-term care, social insurance, fairness, mortality, compensation, egalitarianism.
    JEL: J14 I31 H55
    Date: 2019
  9. By: Jang, Youngsoo
    Abstract: How do defaults and bankruptcies affect optimal health insurance policy? I answer this question using a life-cycle model of health investment with the option to default on emergency room (ER) bills and financial debts. I calibrate the model for the U.S. economy and compare the optimal health insurance in the baseline economy with that in an economy with no option to default. With no option to default, the optimal health insurance is similar to the health insurance system in the baseline economy. In contrast, with the option to default, the optimal health insurance system (i) expands the eligibility of Medicaid to 22 percent of the working-age population, (ii) replaces 72 percent of employer-based health insurance with a private individual health insurance plus a progressive subsidy, and (iii) reforms the private individual health insurance market by improving coverage rates and preventing price discrimination against people with pre-existing conditions. This result implies that with the option to default, households rely on bankruptcies and defaults on ER bills as implicit health insurance. More redistributive healthcare reforms can improve welfare by reducing the dependence on this implicit health insurance and changing households’ medical spending behavior to be more preventative.
    Keywords: Credit, Default, Bankruptcy, Optimal Health Insurance
    JEL: E21 H51 I13 K35
    Date: 2019–07
  10. By: Maclean, J. Catherine (Temple University); Webber, Douglas A. (Temple University)
    Abstract: We examine the lifecycle wage effects of health insurance market regulation that compels private insurers to offer continuing coverage to beneficiaries. Using a panel of male workers drawn from the National Longitudinal Survey of Youth 1979, we model wages across the lifecycle as a function of the mandated number of months of continuing coverage at labor market entrance. Access to continuing coverage is plausibly valuable to young workers as this benefit facilities job mobility, which is important for early career wage growth and lifecycle wages, but is costly to firms. We show that more generous mandated continuing coverage at labor market entrance causes an initial wage decline of roughly 1% that reverses after five years in the labor market leading to higher wages later in the career. Wage increases are observable up to 30 years after labor market entrance. We provide suggestive evidence that increased job mobility early in the career is a mechanism for the observed wage effects.
    Keywords: regulation, job lock, continuing coverage, wage determination, persistence
    JEL: J3 H2 I13
    Date: 2019–07
  11. By: Zeballos, Eliana; Todd, Jessica E.; Restrepo, Brandon
    Abstract: Since 2003, the American Time Use Survey (ATUS) has collected detailed information about how Americans spend their time by asking respondents to identify primary or main activities they were engaged in over a full 24-hour period, including eating. This means that the ATUS misses “secondary” eating occasions that occur while an individual is otherwise occupied doing something else that is considered to be primary, such as working or watching TV. The Eating & Health Module (EHM) was designed to collect these secondary eating occasions and was included as a supplement to the ATUS during 2006-08 and again in 2014-16. This report compares the number and timing of eating occasions reported in the 2014-16 ATUS-EHM to those reported in the dietary intake component of the 2013-16 National Health and Nutrition Examination Survey (NHANES), which is considered to contain the best available data for estimating average daily dietary intake among the U.S. population. Findings show that the EHM reduces the gap between the ATUS and NHANES with respect to the total number of eating occasions during the day, as well as the share of people reporting eating during each hour of the day, but overall the ATUS-EHM does not capture as many eating occasions as NHANES. When the analysis excludes more easily forgotten eating occasions—that is, drinks and snacks—from the NHANES data, the ATUS-EHM data capture 93.1 percent of all eating occasions reported in NHANES.
    Keywords: Agricultural and Food Policy, Food Consumption/Nutrition/Food Safety, Health Economics and Policy
    Date: 2019–07
  12. By: Zeballos, Eliana; Restrepo, Brandon
    Abstract: This report uses data from the 2014-16 Eating & Health Module (EHM) of the American Time Use Survey to present national statistics on eating and health patterns for the adult population as a whole and a wide variety of demographic subgroups. It also examines whether and how select behaviors have changed over time using data from the 2006-08 EHM. On an average day over 2014-16, Americans age 18 and older spent about 65 minutes eating and drinking as a primary activity, down 5 percent relative to an average day over 2006-08. The report finds significant differences across demographic subgroups in eating and health patterns, such as in prepared food purchases and physical activity, which may contribute to variation in nutrition and dietrelated health outcomes across different segments of the U.S. population.
    Keywords: Food Consumption/Nutrition/Food Safety, Health Economics and Policy
    Date: 2018–10
  13. By: Marion Krämer; Santosh Kumar; Sebastian Vollmer
    Abstract: We present experimental evidence on the impact of delivering double-fortified salt (DFS), salt fortified with iron and iodine, through the Indian school-feeding program called “midday meal” on anemia, cognition and math and reading outcomes of primary school children. We conducted a field experiment that randomly provided one-year supply of DFS at a subsidized price to public primary schools in one of the poorest regions of India. The DFS treatment had significantly positive impacts on hemoglobin levels and reduced the prevalence of any form of anemia by 9.3 percentage points (or about 20 percent) but these health gains did not translate into statistically significant impacts on cognition and test scores. While exploring the heterogeneity in effects, we find that treatment had statistically significant gains in anemia and test scores among children with higher treatment compliance. We further estimate that the intervention was very cost effective and can potentially be scaled up rather easily.
    Keywords: Double-fortified salt; education; anemia; school feeding; India and randomized controlled trial
    Date: 2018–03–12
  14. By: Hannah Ameye and Johan Swinnen
    Abstract: Obesity is considered one of the major health concerns of the 21st century and is frequently associated with economic development. This paper reviews evidence on internal (within countries) and external (across countries) relationships between obesity, income and gender. Obesity changes with income, but in a non-linear way. On average, obesity increases with income in poor countries, has no relationship with income in middle-income countries and decreases with income for rich countries. Within countries, obesity is concentrated among richer groups in low-income countries and evenly distributed in middle-income countries. In high-income countries, the poor are the most obese. The relationship differs for men and women. Women are more obese in low-income countries and much more obese in middleincome countries. The gender obesity gap disappears in high-income economies. The geographic concentration of obesity also changes with income growth: from urban areas in poor countries to rural areas in rich countries. Despite these patterns, total obesity rates continue to increase in all countries, and for the world as a whole.
    Keywords: Obesity, Income, Gender, Urbanization
    Date: 2019
  15. By: Carneiro, Pedro (University College London); Galasso, Emanuela (World Bank); Lopez Garcia, Italo (RAND); Bedregal, Paula (Pontificia Universidad Catolica de Chile); Cordero, Miguel (University of Bristol)
    Abstract: This paper experimentally estimates medium term impacts of a large-scale and low-cost parenting program targeting poor families in Chile. Households in 162 public health centers were randomly assigned to three groups: a control group, a second group that was offered eight weekly group parenting sessions, and a third group that was offered the same eight group sessions plus two sessions of guided interactions between parents and children focused on responsive play and dialogic reading. In spite of its short duration and intensity, three years after the end of the intervention, the receptive vocabulary and the socio-emotional development of children of families participating in either of the treatment arms improved (by 0.43 and 0.54 standard deviation, respectively) relative to children of nonparticipating families. The treatments also led to improvements in home environments and parenting behaviors of comparable magnitudes, which far outlasted the short duration of the intervention.
    Keywords: parenting, early childhood development
    JEL: H43 I10 I20 I38
    Date: 2019–07
  16. By: Regmi, Krishna (Montana State University); Henderson, Daniel J. (University of Alabama)
    Abstract: As epidemiological studies have shown that conditions during gestation and early childhood affect adult health outcomes, we examine the effect of local labor market conditions in the year of birth on cognitive development in childhood. To address the endogeneity of labor market conditions, we construct gender-specific predicted employment growth rates at the state level by interacting an industry's share in a state's employment with the industry's national growth rate. We find that an increase in employment opportunities for men leads to an improvement in children's cognitive achievement as measured by reading and math test scores. Additionally, our estimates show a positive and significant effect of male-specific employment growth on children's Peabody Picture Vocabulary Test scores and in home environment in the year of birth. We find an insignificant positive effect of buoyancy in females' employment opportunities on said test scores.
    Keywords: labor market conditions, cognitive ability, child's well-being
    JEL: J20 J21 I20 I30
    Date: 2019–07
  17. By: Palma, Alessandro (University of Rome Tor Vergata); Petrunyk, Inna (Leuphana University Lüneburg); Vuri, Daniela (University of Rome Tor Vergata)
    Abstract: We investigate the impact of fetal exposure to air pollution on health outcomes at birth in Italy in the 2000s combining information on mother’s residential location from birth certificates with information on PM10 concentrations from air quality monitors. The potential endogeneity deriving from differential pollution exposure is addressed by exploiting as-good-as-random variation in rainfall shocks as an instrumental variable for air pollution concentrations. Our results show that both average levels of PM10 and days above the hazard limit have detrimental effects on birth weight, duration of gestation as well as overall health status at birth. These effects are mainly driven by pollution exposure during the third trimester of pregnancy and further differ in size with respect to the maternal socio-economic status, suggesting that babies born to socially disadvantaged mothers are more vulnerable. Given the non negligible effects of pollution on birth outcomes, further policy efforts are needed to fully protect fetuses from the adverse effects of air pollution and to mitigate the environmental inequality of health at birth.
    Keywords: air pollution, particulate matter, birth weight, pre-term birth, environmental policies
    JEL: I18 J13 Q53 Q58
    Date: 2019–07
  18. By: Stephanie von Hinke (University of Bristol); Nigel Rice (University of York); Emma Tominey (University of York)
    Abstract: We identify the causal effect of mothers' mental health during early - and soon after pregnancy on a range of child psychological, socio-emotional and cognitive outcomes measured between ages 4-16. Results suggest a negative effect on children's psychological and socio-emotional skills in early childhood, but these effects fade-out between the ages of 11-13. We find no significant effect on cognitive outcomes. The fade-out of effects may be partly explained by compensatory behaviour of parents, as we find that mental health during or soon after pregnancy raises breastfeeding and improves measures of interaction between mother and child.
    Keywords: Prenatal psychological health, child psychological outcomes, child socio-emotional outcomes, child cognitive outcomes
    JEL: I12 I14
    Date: 2019–08
  19. By: Sebastian Vollmer; Juditha Wójcik
    Abstract: Several country-level studies, including a prominent one for the United States, have identified long-term effects of in-utero exposure to the 1918 influenza pandemic (also known as the Spanish Flu) on economic outcomes in adulthood. In-utero conditions are theoretically linked to adult health and socioeconomic status through the fetal origins or Barker hypothesis. Historical exposure to the Spanish Flu provides a natural experiment to test this hypothesis. Although the Spanish Flu was a global phenomenon, with around 500 million people infected worldwide, there exists no comprehensive global study on its long-term economic effects. We attempt to close this gap by systematically analyzing 117 Census data sets provided by IPUMS International. We do not find consistent global long-term effects of influenza exposure on education, employment and disability outcomes. A series of robustness checks does not alter this conclusion. Our findings indicate that the existing evidence on long-term economic effects of the Spanish Flu is likely a consequence of publication bias.
    Date: 2017–12–06
  20. By: Nadezhda V. Baryshnikova (School of Economics, University of Adelaide); Ngoc T. A. Pham (School of Economics, University of Adelaide)
    Abstract: Mental health has been recently declared a global priority by the World Bank and World Health Organization. This article investigates heterogeneity in the effect of experiencing natural disasters on mental health. Using population representative longitudinal data from Australia, we find that home owners generally show a reduction in mental health score after a disaster. While the average effect for those that do not own a house is zero, the quantile approach reveals that there is a strong negative effect in the lowest two quantiles of the distribution for the non-owners. The results suggest that policies targeted at home owners and the lowest mental health non-owners (rather than only at the economically poorest) would help mitigate mental health consequences attributable to natural disaster exposure.
    Keywords: quantile treatment effects, mental health, disasters, home owners, panel data
    JEL: C21 C23 I31 Q54 R2
    Date: 2019–03
  21. By: Lordan, Grace; Mcguire, Alistair
    Abstract: From 2020 Personal, Social, Health and Economic Education will be compulsory in UK schools for adolescents, however less is known about how it can be taught in a an effective manner. We examine, through a randomised trial, the impact of an evidenced based health related quality of life (HRQoL) curriculum called Healthy Minds that ran in 34 high schools in England over a four-year period. We find robust evidence that Healthy Minds positively augments many physical health domains of treated adolescents. We also find some evidence that Healthy Minds positively affects behaviour, but has no impact on emotional wellbeing. We find notable gender effects, strongly favouring boys. We also present evidence that Healthy Minds changes career aspirations, with those exposed to treatment being less likely to choose competitive work and more likely to choose work that involves "people-skills". Overall our work illustrates the potential for later childhood interventions to promote HRQoL and develop the career aspirations of adolescents.
    Keywords: soft skills; health related quality of life; character; high school curriculum; personal; social; health and economic education
    JEL: I18 I20
    Date: 2019–06
  22. By: Gustavo J. Bobonis; Mark Stabile; Leonardo Tovar
    Abstract: Militaries around the world perform training exercises in preparation for war. We study the relationship between in utero exposure to military exercises (bombing) and early-life health outcomes, combining data on naval bombing exercises in Vieques, Puerto Rico, and the universe of births from 1990-2003. Using a differences-in-differences design, we find that the sudden end of bombing practices is associated with a 56-79 percent decrease in the incidence of congenital anomalies. The evidence is generally consistent with the channel of environmental pollution; increases in arsenic levels in waters surrounding the live impact area.
    Keywords: infant health; military activity; environmental pollution; maternal stress
    JEL: I15 I14 O1
    Date: 2019–08–14
  23. By: Choudhury, Agnitra Roy (Auburn University); Polachek, Solomon (Binghamton University, New York)
    Abstract: Raising a new-born child involves not only financial resources, but also time investment from the parents. A time constraint can affect important decisions made by parents at the early stages of an infant's life. One form of investment that is particularly important is vaccinating an infant. We analyze the impact of time constraints on immunization of infants on time. To establish a causal relationship, we exploit California's implementation of Paid Parental Leave Program as a natural experiment. Using a nationally representative dataset from the National Immunization Survey, we find evidence that the policy reduced late vaccinations for children born to parents in California after the policy was implemented. We test for heterogeneous effects of the policy on different subgroups in the population. We find the policy had a stronger impact on families that are below the poverty line. We conduct a series of falsification tests and robustness checks to test the validity of the results. In addition, our results are robust to several placebo tests.
    Keywords: vaccination, paid parental leave, difference-in-difference, synthetic control method
    JEL: D04 I12 I18 J18
    Date: 2019–07
  24. By: Dolan, Paul (London School of Economics); Lordan, Grace (London School of Economics)
    Abstract: We examine how intergenerational mobility affects subjective wellbeing (SWB) using data from the British Cohort Study. Our SWB measures encapsulates both life satisfaction and mental health, and we consider both relative and absolute movements in income. We find that relative income mobility is a significant predictor of life satisfaction and mental health, whether people move upward or downward. For absolute income, mobility is only a consistent predictor of SWB and mental health outcomes if the person moves downwards, and in this case the impact is far larger than relative mobility. For both relative and income mobility downward movements affect SWB to a greater extent than upward movements, consistent with notions of loss aversion. Notably, we find that social class mobility does not affect SWB. We present evidence that the significant relative and absolute mobility effects we find operate partially through financial perceptions and consumption changes which can occur because of income mobility.
    Keywords: income mobility, relative income, social class mobility, loss aversion, intergenerational mobility, life satisfaction, SWB, subjective wellbeing, mental health
    JEL: D31 D63 I1 J60
    Date: 2019–07
  25. By: Jacobs, Rowena; Chalkley, Martin; Böhnke, Jan R.; Clark, Michael; Moran, Valerie; Aragón, M. J.
    Abstract: In the context of international interest in reforming mental health payment systems, national policy in England has sought to move towards an episodic funding approach. Patients are categorised into care clusters, and providers will be paid for episodes of care for patients within each cluster. For the payment system to work, clusters need to be appropriately homogenous in terms of financial resource use. We examine variation in costs and activity within clusters and across health care providers. We find that the large variation between providers with respect to costs within clusters mean that a cluster-based episodic payment system would have substantially different financial impacts across providers.
    Keywords: mental health funding; provider payment; episodic payment; variation; costs
    JEL: J50
    Date: 2019–07–27
  26. By: Jeffrey E. Harris (Department of Economics, Massachusetts Institute of Technology); Mariana Gerstenblüth (Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la República); Patricia Triunfo (Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la República)
    Abstract: We asked 97 cigarette smokers to make a series of 12 binary choices between experimental cigarette packages with varying warnings and background colors. Each smoker had to decide which of the two packages contained cigarettes less risky for his health. We tested whether the smokers, confronted with warnings that were repugnant and threatening to many of them, could still make choices that adhered to the standard axioms of rational choice. We supplemented our observations on smokers’ choices with data on their eye movements. We find that participants universally made choices consistent with a complete, transitive preference ordering. We find little evidence of inconsistent choices violating the weak axiom of revealed preference. In a majority of smokers, we find strong evidence of the use of a lexicographic decision rule to assess the riskiness of a cigarette package. These smokers first ranked the two packages solely on the basis of their warnings. Only when the two packages had the same warning did they rankthe packages on the basis of their color. The data on eye tracking strongly confirmed the lexicographic nature of the underlying decision rule. Our studyrepresentsan entirely different angle of inquiry into thequestion of rational addiction.
    Keywords: addiction, cigarettes, smoking, health warnings, rationality, discrete choice experiment, eye tracking, transitivity, additive utility, lexicographic preferences, context-dependent preferences, response time, drift diffusion model, Schelling-Thaler-Shefrin dual-self model
    JEL: D12 D83 D87 D91 I12 M31
    Date: 2018–09
  27. By: Romain Espinosa (CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR1 - Université de Rennes 1 - UNIV-RENNES - Université de Rennes - CNRS - Centre National de la Recherche Scientifique)
    Abstract: In this paper I investigate the role of e-reputation mechanisms on illegal platforms that specialize in drug sales. I ask whether online reputation systems can limit the risk of scamming (i.e. fraud) by dishonest sellers, and thus prevent Akerlof-like market destruction. I do so by analyzing all published offers on the second-largest platform operating on March 18th 2017 (Hansa). Three types of drugs show relatively low scamming risks, with the average probability that a random seller effectively send the ordered good of over 83%. The recent shutdowns of the two leading platforms are likely to increase this probability by 2.7 to 9.7%. Endogeneity may either lead us to overestimate the effect of e-reputation mechanisms (e.g., unobserved heterogeneity in sellers) or underestimate it (e.g., better-functioning markets may attract more scammers).
    Keywords: Darknet markets,Hansa,e-reputation,scamming,drug price,honesty
    Date: 2019
  28. By: Alacevich, Caterina (Pompeu Fabra University); Nicodemo, Catia (University of Oxford)
    Abstract: There is growing evidence that foreign-born workers are over represented in physically demanding and dangerous jobs with relatively higher injury hazard rates. Given this pattern, do increasing inflows of foreign-born workers alleviate native workers' exposure to injuries? This paper provides evidence of the effects of immigration on the incidence and severity of workrelated accidents. We combine administrative data on work-place accidents in Italy with the Labour Force Survey from 2009 to 2017. Our approach exploits spatial and temporal variation in the distribution of foreign-born residents across provinces. Using province fixed-effects and an instrumental variable specification based on historical settlements of immigrants, we show that inflows of foreign-born residents drive reductions in the injury rate, paid sick leave, and severity of impairment for natives. Next, we investigate potential underlying mechanisms that could drive this effect, such as increased unemployment and selection of the workforce, and the sorting of native workers into less physically demanding jobs. Our results rule out that decreased injuries are driven by higher native unemployment. We find that employment rates are positively associated with immigration, in particular for workers with higher education. While not statistically significant at conventional levels, we also find that average occupational physical intensity for natives is lower in provinces that receive larger foreign-born inflows.
    Keywords: immigration, labour-market flexibility, work-related injuries, health
    JEL: J61 J28 I1
    Date: 2019–07
  29. By: Marcus Dillender; Andrew I. Friedson; Cong T. Gian; Kosali I. Simon
    Abstract: The Patient Protection and Affordable Care Act (ACA) increased demand for healthcare across the U.S., but it is unclear if or how the supply side has responded to meet this demand. In this paper, we take advantage of plausibly exogenous geographical heterogeneity in the ACA to examine the healthcare education sector’s response to increased demand for healthcare services. We look across educational fields, types of degrees, and types of institutions, paying particular attention to settings where our conceptual model predicts heightened responses. We find no statistically significant evidence of increases in graduates and can rule out fairly modest effects. This implies that healthcare production may have adjusted to increased demand from insurance expansion in other ways rather than primarily through new graduates of local healthcare educational markets.
    JEL: I11 I23 I25
    Date: 2019–07
  30. By: Adda, Jerome; Decker, Christian; Ottaviani, Marco
    Abstract: Planning and execution of clinical research and publication of results should conform to the highest ethical standards, given that human lives are at stake. However, economic incentives can generate conflicts of interest for investigators, who may be inclined to withhold unfavorable results or even tamper with the data. Analyzing p-values reported to the registry with two different methodologies, we find suspicious patterns only for results from trials conducted by smaller industry sponsors, with presumably less reputation at stake. First, a density discontinuity test reveals an upward jump at the classical threshold for statistical significance for Phase 3 results by small industry sponsors, suggesting some selective reporting. Second, we find an excess mass of significant results in Phase 3 compared to Phase 2. However, we can explain almost completely this excess mass for large industry sponsors, once we account for the incentives to selectively continue research through a novel technique linking trials across phases. In contrast, for trials sponsored by small pharmaceutical companies, selective continuation of trials economizing on research costs only explains one third of the increase in the number of significant results from Phase 2 to Phase 3. The different pattern depending on the type of sponsor suggests that reputational concerns can mitigate the short-run economic incentives that undermine integrity in reporting results of clinical research.
    Keywords: Clinical trials; Drug development; Economic incentives in research; p-Hacking; Selective reporting
    JEL: D8 O3
    Date: 2019–07
  31. By: Stephan Klasen; Sebastian Vollmer
    Abstract: The existing literature on 'missing women' has suggested that the problem is mostly concentrated in India and China, and mostly related to sex-selective abortions and post-birth neglect of female children. In a recent paper in the Review of Economic Studies, Anderson and Ray (AR) develop a new ‘flow’ measure of missing women in developing countries by comparing actual age-sex-specific mortality rates with 'expected' ones. Contrary to the existing literature on missing women, they, and the World Bank which subsequently followed this method, find that gender bias in mortality is much larger than previously found (4-5 million excess female deaths per year), is as severe among adults as it is among children in India, is larger in Sub-Saharan Africa than in China and India, and existed on a large scale in the US around 1900. We first show that the data for Sub-Saharan Africa used by AR are generated by simulations in ways that deliver the findings on Africa (and the US in 1900) essentially by construction. We also show that the findings are entirely dependent on a highly implausible reference standard for sex-specific mortality from rich countries that is inappropriately applied to settings in developing countries; the attempt to control for differences in the disease environment does not correct for this problem and leads to implausible results. When a more appropriate reference standard is used, most of the new findings of AR regarding the regional and age composition of missing women disappear.
    Keywords: Missing women; gender bias; mortality; disease; age; Sub-Saharan Africa; China; India
    JEL: J16 D63 I10
    Date: 2018–08–21

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