nep-hea New Economics Papers
on Health Economics
Issue of 2019‒12‒02
28 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Why Don't We Sleep Enough? A Field Experiment among College Students By Avery, Mallory; Giuntella, Osea; Jiao, Peiran
  2. Water Purification Efforts and the Black-White Infant Mortality Gap, 1906-1938 By Anderson, D. Mark; Charles, Kerwin Kofi; Rees, Daniel I.; Wang, Tianyi
  3. The Mental Health Effects of Retirement By Picchio, Matteo; van Ours, Jan C.
  4. Selection with Variation in Diagnostic Skill: Evidence from Radiologists By David C. Chan Jr; Matthew Gentzkow; Chuan Yu
  5. The Contributions of Socioeconomic and Opioid Supply Factors to Geographic Variation in U.S. Drug Mortality Rates By Shannon M. Monnat
  6. The Impact of Medicaid on Medical Utilization in a Vulnerable Population: Evidence from COFA Migrants By Halliday, Timothy J.; Akee, Randall K. Q.; Sentell, Tetine; Inada, Megan; Miyamura, Jill
  7. Age takes hold of us by surprise: Conceptualising Vulnerabilities in Ageing as the Timing of Adverse Events By Vanhoutte, Bram
  8. Does One Medicare Fit All? The Economics of Uniform Health Insurance Benefits By Mark Shepard; Katherine Baicker; Jonathan S. Skinner
  9. Subsidizing Inequality: Performance Pay and Risk Selection in Medicare By Michele Fioretti; Hongming Wang
  10. How do Hospitals Respond to Payment Incentives? By Gautam Gowrisankaran; Keith A. Joiner; Jianjing Lin
  11. Impacts of hospital wait time on patient health and labor supply By Anna Godøy; Venke Furre Haaland; Ingrid Huitfeldt; Mark Votruba
  12. Convenient primary care and emergency hospital utilisation By Pinchbeck, Ted
  13. Prenatal Exposure to Marijuana and Infant Health in the US By Fernando Fernandez
  14. The Impact of BMI on Mental Health: Further Evidence from Genetic Markers By Amin, Vikesh; Flores, Carlos A; Flores-Lagunes, Alfonso
  15. Not Only in My Genes: The Effects of Peers' Genotype on Obesity By Brunello, Giorgio; Sanz-de-Galdeano, Anna; Terskaya, Anastasia
  16. Mental Health, Schooling Attainment and Polygenic Scores: Are There Significant Gene-Environment Associations? By Amin, Vikesh; Fletcher, Jason; Behrman, Jere; Flores, Carlos A; Flores, Carlos A; Flores-Lagunes, Alfonso; Kohler, Hans Peter
  17. Does Pollution Drive Achievement? The Effect of Traffic Pollution on Academic Performance By Heissel, Jennifer; Persico, Claudia; Simon, David
  18. Self-reported wellbeing indicators are a valuable complement to traditional economic indicators but aren’t yet ready to compete with them By Dan Benjamin; Kristen Cooper; Ori Heffetz; Miles Kimball
  19. How Do Early-Life Shocks Interact with Subsequent Human Capital Investments? Evidence from Administrative Data By Duque, Valentina; Rosales-Rueda, Maria; Sanchez, Fabio
  20. Impacts of industrial and entrepreneurial jobs on youth: 5-year experimental evidence on factory job offers and cash grants in Ethiopia By Blattman, Chris; Franklin, Simon; Dercon, Stefan
  21. Brazil's Missing Infants: Zika Risk Changes Reproductive Behavior By Rangel, Marcos; Nobles, Jenna; Hamoudi, Amar
  22. The Effect of Stressors and Resilience Factors on Mental Health of Recent Refugees in Austria By Isabella Buber-Ennser; Judith Kohlenberger; Michael Landesmann; Sebastian Leitner; Bernhard Rengs
  23. Early childhood health during conflict: The legacy of the Lord’s Resistance Army in Northern Uganda By Sarah Bridges; Douglas Scott
  24. Social Interventions, Health and Wellbeing: The Long-Term and Intergenerational Effects of a School Construction Program By Mazumder, Bhashkar; Rosales, Maria Fernanda; Triyana, Margaret
  25. The long term impacts of grants on poverty: 9-year evidence from Uganda’s Youth Opportunities Program By Blattman, Chris; Fiala, Nathan; Martinez, Sebastian
  26. Does The Market Reward Quality?: Evidence from India By Zachary Wagner; Somalee Banerjee; Manoj Mohanan; Neeraj Sood
  27. Where there is smoke: Solid fuel externalities, gender, and adult respiratory health in India By Gupta, Aashish
  28. Early Life Environments and Frailty in Old Age among Chinese Older Adults By Li, Yaxi; Xue, Qian-Li; Odden, Michelle C.; Chen, Xi; Wu, Chenkai

  1. By: Avery, Mallory (University of Pittsburgh); Giuntella, Osea (University of Pittsburgh); Jiao, Peiran (Maastricht University)
    Abstract: Sleep deprivation is a risky behavior prevalent in modern societies, leading to negative health and economic consequences. However, we know little about why people decide to sleep less than the recommended number of hours. This study investigates the mechanisms affecting sleep choice and explores whether commitment devices and monetary incentives can be used to promote healthier sleep habits. Toward this end, we conducted a field experiment with college students, providing them incentives to sleep, and collected data from wearable activity trackers, surveys, and time-use diaries. Our results are consistent with sophisticated time-inconsistent preferences and overconfidence. The subjects in the treatment group responded to the monetary incentives by significantly increasing the likelihood of sleeping between 7 and 9 hours (+19%). We uncover evidence of demand for commitment. Overall, 63% of our subjects were sophisticated enough to take up commitment, and commitment improved sleep for the less overconfident among them. Using time-use diaries, we show that during the intervention, there was a reduction in screen time near bedtime (-48%). Subjects in the treatment group were less likely to report insufficient sleep than at baseline even after removal of the incentive (-16%), which is consistent with habit formation. Finally, our treatment also had positive (albeit small) effects on health and academic outcomes.
    Keywords: sleep, health behaviors, sophistication, present bias, habit formation, incentives
    JEL: B49 C93 I1
    Date: 2019–11
  2. By: Anderson, D. Mark (Montana State University); Charles, Kerwin Kofi (Harris School, University of Chicago); Rees, Daniel I. (University of Colorado Denver); Wang, Tianyi (University of Pittsburgh)
    Abstract: According to Troesken (2004), efforts to purify municipal water supplies at the turn of the 20th century dramatically improved the relative health of blacks. There is, however, little empirical evidence to support the Troesken hypothesis. Using city-level data published by the U.S. Bureau of the Census for the period 1906-1938, we explore the relationship between water purification efforts and the black-white infant mortality gap. Our results suggest that, while water filtration was effective across the board, adding chlorine to the water supply reduced mortality only among black infants. Specifically, chlorination is associated with an 11 percent reduction in black infant mortality and a 13 percent reduction in the black-white infant mortality gap. We also find that chlorination led to a substantial reduction in the black-white diarrhea mortality gap among children under the age of 2, although this estimate is measured with less precision.
    Keywords: infant mortality, public health, black-white infant mortality gap
    JEL: I18 J11 J15 N3
    Date: 2019–11
  3. By: Picchio, Matteo; van Ours, Jan C.
    Abstract: We study the retirement effects on mental health using a fuzzy regression discontinuity design based on the eligibility age to the state pension in the Netherlands. We find that the mental effects are heterogeneous by gender and marital status. Retirement of partnered men positively affects mental health of both themselves and their partners. Single men retiring experience a drop in mental health. Female retirement has hardly any effect on their own mental health or the mental health of their partners. Part of the effects seem to be driven by loneliness after retirement.
    Keywords: Retirement,health,well-being,happiness,regression discontinuity design
    JEL: H55 J14 J26
    Date: 2019
  4. By: David C. Chan Jr; Matthew Gentzkow; Chuan Yu
    Abstract: Physicians, judges, teachers, and agents in many other settings differ systematically in the decisions they make when faced with similar cases. Standard approaches to interpreting and exploiting such differences assume they arise solely from variation in preferences. We develop an alternative framework that allows variation in both preferences and diagnostic skill, and show that both dimensions are identified in standard settings under quasi-random assignment. We apply this framework to study pneumonia diagnoses by radiologists. Diagnosis rates vary widely among radiologists, and descriptive evidence suggests that a large component of this variation is due to differences in diagnostic skill. Our estimated model suggests that radiologists view failing to diagnose a patient with pneumonia as more costly than incorrectly diagnosing one without, and that this leads less-skilled radiologists to optimally choose lower diagnosis thresholds. Variation in skill can explain 44 percent of the variation in diagnostic decisions, and policies that improve skill perform better than uniform decision guidelines. Failing to account for skill variation can lead to highly misleading results in research designs that use agent assignments as instruments.
    JEL: C26 D81 I1 J24
    Date: 2019–11
  5. By: Shannon M. Monnat (Maxwell School of Citizenship and Public Affairs at Syracuse University)
    Abstract: Over the past two decades deaths from opioids and other drugs have grown to be a major U.S. population health problem, but the magnitude of the crisis varies across the U.S., and explanations for widespread geographic variation in the severity of the drug crisis are limited. An emerging debate is whether geographic differences in drug mortality rates are driven mostly by opioid supply factors or socioeconomic distress. To explore this topic, I examined relationships between county-level non-Hispanic white drug mortality rates for 2000-02 and 2014-16 and several socioeconomic and opioid supply measures across the urban-rural continuum and within different rural labor markets. Net of county demographic composition, average non-Hispanic white drug mortality rates are highest and increased the most in large metro counties. In 2014-16, the most rural counties had an average of 6.2 fewer deaths per 100,000 population than large metro counties. Economic distress, family distress, persistent population loss, and opioid supply factors (exposure to prescription opioids and fentanyl) are all associated with significantly higher drug mortality rates. However, the magnitude of associations varies across the urban-rural continuum and across different types of rural labor markets. In rural counties, economic distress appears to be a stronger predictor than opioid supply measures of drug mortality rates, but in urban counties, opioid supply factors are more strongly associated with drug mortality rates than is economic distress. Ultimately, the highest drug mortality rates are disproportionately concentrated in economically distressed mining and service sector dependent counties with high exposure to prescription opioids and fentanyl.
    Keywords: health, mortality, urban-rural continuum, inequality, economic disadvantage, opioids
    JEL: I1 I3 J21 K32 R1
    Date: 2019–01
  6. By: Halliday, Timothy J. (University of Hawaii at Manoa); Akee, Randall K. Q. (Brookings Institution); Sentell, Tetine (University of Hawaii at Manoa); Inada, Megan (Kokua Kalihi Valley Comprehensive Family Services); Miyamura, Jill (Hawaii Health Information Corporation)
    Abstract: In March 2015, the State of Hawaii stopped covering the majority of migrants from countries belonging to the Compact of Free Association (COFA) in its Medicaid program. COFA migrants were required to obtain private insurance in the exchanges established under the Affordable Care Act. Using statewide hospital discharge data, we show that Medicaid-funded hospitalizations and emergency room visits declined in this population by 31% and 19%. Utilization funded by private insurance did increase, but not enough to offset the declines in Medicaid-funded utilization. Finally, the expiration of benefits increased uninsured ER visits.
    Keywords: immigration, health insurance, cost sharing, Medicaid, insurance exchange
    JEL: I10 I14 J61
    Date: 2019–11
  7. By: Vanhoutte, Bram
    Abstract: Objectives Ageing in the public eye can be distilled to a limited number of adverse events, such as loss of health, partnership and wealth. While these events are a constitutive part of “normal ageing”, they do not occur uniformly at the same time point in the life course. This study investigates to what extent bereavement, functional health loss and onset of poverty are adequate markers of ageing, and illustrates inequalities in their timing according to cohort, gender, class and ethnicity. Methods Data of the English Longitudinal Study of Ageing (ELSA), collected over 7 waves (2002-2016) (n=7913) are examined using survival analysis. Results Persistent associations of manual or routine occupational class and belonging to an ethnic minorities are found with increased hazards of health loss, bereavement and wealth loss. Later born cohorts have higher health loss hazards as well as lower hazards for wealth loss, while earlier born cohorts have lower hazards for bereavement. Gender effects are pronounced in terms of bereavement, limited in terms of health loss and absent in terms of wealth loss. Discussion The timing of adverse events is a crucial gateway through which existing social inequalities are transferred into unequal ageing pathways.
    Date: 2019–02–06
  8. By: Mark Shepard; Katherine Baicker; Jonathan S. Skinner
    Abstract: There is increasing interest in expanding Medicare health insurance coverage in the U.S., but it is not clear whether the current program is the right foundation on which to build. Traditional Medicare covers a uniform set of benefits for all income groups and provides more generous access to providers and new treatments than public programs in other developed countries. We develop an economic framework to assess the efficiency and equity tradeoffs involved with reforming this generous, uniform structure. We argue that three major shifts make a uniform design less efficient today than when Medicare began in 1965. First, rising income inequality makes it more difficult to design a single plan that serves the needs of both higher- and lower-income people. Second, the dramatic expansion of expensive medical technology means that a generous program increasingly crowds out other public programs valued by the poor and middle class. Finally, as medical spending rises, the tax-financing of the system creates mounting economic costs and increasingly untenable policy constraints. These forces motivate reforms that shift towards a more basic public benefit that individuals can “top-up” with private spending. If combined with an increase in other progressive transfers, such a reform could improve efficiency and reduce public spending while benefiting low income populations.
    JEL: H4 H51 I13
    Date: 2019–11
  9. By: Michele Fioretti (Département d'économie); Hongming Wang (Hitotsubashi University (HIT-U))
    Abstract: Pay-for-performance is commonly employed to improve the quality of social services contracted out to firms. We show that insurer responses to pay-for-performance can widen the inequality in accessing social services. Focusing on the U.S. Medicare Advantage market, we find that high-quality insurance contracts responded to quality-linked payments by selecting healthier enrollees with premium differences across counties. The selection is profitable because the quality rating fails to adjust for pre-existing health differences of enrollees. As a result, quality improved mostly due to selection, and the supply of high-quality insurance shifted to the healthiest counties. Revising the quality rating could prevent these unintended consequences.
    Keywords: Pay-for-Performance; Quality Bonus Payment Demonstration; Medicare Advantage; Risk Selection; Supply-Side Selection; Quality Ratings; Health Inequality
    JEL: I13 I14 L15
    Date: 2019–11
  10. By: Gautam Gowrisankaran; Keith A. Joiner; Jianjing Lin
    Abstract: A literature has found that medical providers inflate bills and report more conditions given financial incentives. We evaluate whether Medicare reimbursement incentives are driven more by bill inflation or coding costs. Medicare reformed its payment mechanism for inpatient hospitalizations in 2007, increasing coding costs. We first examine whether increased extra reimbursements from reporting more diagnoses lead hospitals to report more high bill codes. We find that increases in reimbursements within narrow patient groups led to more high bill codes before 2007 but not after. Using the payment reform, we then test for costly coding by comparing hospitals that adopted electronic medical records (EMRs) to others. Adopters reported relatively more top bill codes from secondary diagnoses after the reform, exclusively for medical patients, with a negative effect for surgical patients. This is consistent with EMRs lowering coding costs for medical discharges but increasing them for surgical ones. We further use a 2008 policy where Medicare implemented financial penalties for certain hospital-acquired conditions. EMR hospitals coded relatively more of these conditions following the penalization, lowering revenues. Together, this evidence is contrary to bill inflation but consistent with costly coding. Reducing coding costs may increase inpatient Medicare costs by $1.04 billion annually.
    JEL: H51 I11 I13 O33
    Date: 2019–11
  11. By: Anna Godøy; Venke Furre Haaland; Ingrid Huitfeldt (Statistics Norway); Mark Votruba
    Abstract: We estimate the effects of wait time for orthopedic surgery on health and labor market outcomes of Norwegian workers. Our identification strategy exploits variation in wait times for surgery generated by the idiosyncratic variation in system congestion at the time of referral. While we find no significant evidence of lasting health effects, longer wait times have persistent negative effects on subsequent labor supply. For every 10 days spent waiting for surgery, we estimate health-related workplace absences increase 8.7 days over the five years following referral, and the likelihood of permanent disability insurance increases by 0.4 percentage point. Cost benefit calculations point to sizable fiscal savings from shorter wait times.
    Keywords: Wait time; queues; hospital treatment; health outcomes; labor market attachment; sickness absence
    JEL: I12 J32
    Date: 2019–11
  12. By: Pinchbeck, Ted
    Abstract: Participation and utilisation decisions lie at the heart of many public policy questions. I contribute new evidence by using hospital records to examine how access to primary care services affects utilisation of hospital Emergency Departments in England. Using a natural experiment in the roll out of services, I first show that access to primary care reduces Emergency Department visits. Additional strategies then allow me to separate descriptively four aspects of primary care access: proximity, opening hours, need to make an appointment, and eligibility. Convenience-oriented services divert three times as many patients from emergency visits, largely because patients can attend without appointments.
    Keywords: Primary care; Emergency care; Access; Utilisation decisions; RES-591-28-0001
    JEL: I11 I12 I18 D12
    Date: 2019–10–09
  13. By: Fernando Fernandez (Universidad de Piura)
    Abstract: This study evaluates the consequences of increased marijuana exposure during pregnancy on infant health in the US. Unlike previous studies on the impacts of marijuana, which rely on state-level variation to identify their effects of interest, I exploit county-specific measures of cannabis prenatal exposure using data on the precise location and opening date of every cannabis dispensary (legal point of sale for marijuana) in the country. Estimations based on state-level measures of increased marijuana access suggest no adverse impact on infant health. In addition, the estimated effects exploiting county-level variation in the opening dates of cannabis dispensaries, suggest that higher prenatal exposure to cannabis is unrelated to changes in infant health, once I control for county fixed effects and state-specific trends. Additional evidence from an event-study analysis with similar controls, corroborates that increased availability of marijuana during pregnancy is not linked to changes in infant health.
    Keywords: marijuana, cannabis dispensaries, infant health
    JEL: I10 I12 I18
    Date: 2019–11
  14. By: Amin, Vikesh; Flores, Carlos A; Flores-Lagunes, Alfonso
    Abstract: We examine the relationship between BMI and mental health for young adults and elderly individuals using data from the National Longitudinal Study of Adolescent Health and the Health & Retirement Study. While OLS estimates show that BMI is significantly associated with worse mental health in both young adulthood and old age, they are likely to be confounded by (i) unobserved factors that affect both BMI and mental health and (ii) reverse causality. To tackle confounding, we take two complementary approaches. First, we use a polygenic score for BMI as an IV and adjust for polygenic scores for other factors that may invalidate this IV. The IV estimates indicate that there is no statistically significant relationship between BMI and mental health for young adults, whereas there is a positive and statistically significant relationship for the elderly. Moreover, we show that IV estimates likely have to be interpreted as identifying a weighted average of effects of BMI on mental health mostly for individuals on the upper quantiles of the BMI distribution. Given potential remaining concerns about the validity of the IV, our second approach is to consider it an “imperfect” IV and estimate an upper bound on the average treatment effect for the corresponding population following Nevo & Rosen (2012). The estimated upper bounds reinforce the conclusions from the IV estimates: they show little evidence of a detrimental effect of BMI on mental health for young adults while being consistent with an economically meaningful effect for elderly individuals. Lastly, we explore some of the potential channels through which BMI may affect mental health for the elderly.
    Date: 2019–08–22
  15. By: Brunello, Giorgio (University of Padova); Sanz-de-Galdeano, Anna (Universidad de Alicante); Terskaya, Anastasia (Universidad de Alicante)
    Abstract: We use data from three waves of Add Health to study the short- and long-run effects of high school peers' genetic predisposition to high BMI – measured by grade-mates' average BMI polygenic scores – on adolescent and adult obesity in the U.S. We find that, in the short-run, a one standard deviation increase in peers' average BMI polygenic scores raises the probability of obesity for females by 2.8 percentage points, about half the size of the effect induced by a one standard deviation increase in one's own polygenic score. No significant effect is found for males. In the long-run, however, the social-genetic effect fades away, while the effect of one's own genetic risk for BMI increases substantially. We suggest that mechanisms explaining the short-run effect for females include changes in nutrition habits and a distorted perception of body size.
    Keywords: obesity, peer effect, BMI polygenic scores, Add Health
    JEL: D62 I1 I12
    Date: 2019–11
  16. By: Amin, Vikesh; Fletcher, Jason; Behrman, Jere; Flores, Carlos A; Flores, Carlos A; Flores-Lagunes, Alfonso; Kohler, Hans Peter
    Abstract: It is well-established that (1) there is a large genetic component to mental health, and (2) higher schooling attainment is associated with better mental health. Given these two observations, we test the hypothesis that schooling may attenuate the genetic predisposition to poor mental health. Specifically, we estimate associations between a polygenic score (PGS) for depressive symptoms, schooling attainment and gene-environment (GxE) interactions with mental health (depressive symptoms and depression), in two distinct United States datasets at different adult ages- 29 years old in the National Longitudinal Study of Adolescent Health (Add Health) and 54 years old in the Wisconsin Longitudinal Study (WLS). OLS results indicate that the association of the PGS with mental health is similar in Add Health and the WLS, but the association of schooling attainment is much larger in Add Health than in the WLS. There is some suggestive evidence that the association of the PGS with mental health is lower for more-schooled older individuals in the WLS, but there is no evidence of any significant GxE associations in Add Health. Quantile regression estimates also show that in the WLS the GxE associations are statistically significant only in the upper parts of the conditional depressive symptoms score distribution. We assess the robustness of the OLS results to omitted variable bias by using the siblings samples in both datasets to estimate sibling fixed-effect regressions. The sibling fixed-effect results must be qualified, in part due to low statistical power. However, the sibling fixed-effect estimates show that college education is associated with fewer depressive symptoms in both datasets.
    Date: 2019–06–26
  17. By: Heissel, Jennifer (Naval Postgraduate School); Persico, Claudia (American University); Simon, David (University of Connecticut)
    Abstract: We examine the effect of school traffic pollution on student outcomes by leveraging variation in wind patterns for schools the same distance from major highways. We compare within-student achievement for students transitioning between schools near highways, where one school has had greater levels of pollution because it is downwind of a highway. Students who move from an elementary/middle school that feeds into a "downwind" middle/high school in the same zip code experience decreases in test scores, more behavioral incidents, and more absences, relative to when they transition to an upwind school. Even within zip codes, microclimates can contribute to inequality.
    Keywords: air pollution, academic achievement, child health
    JEL: Q53 I24 I14
    Date: 2019–11
  18. By: Dan Benjamin (University of Southern California and NBER); Kristen Cooper (Gordon College); Ori Heffetz (Cornell University); Miles Kimball (University of Colorado Boulder and NBER)
    Abstract: We join the call for governments to routinely collect survey-based measures of self-reported wellbeing and for researchers to study them. We list a number of challenges that have to be overcome in order for these measures to eventually achieve a status competitive with traditional economic indicators. We discuss in more detail one of the challenges, comprehensiveness: single-question wellbeing measures do not seem to fully capture what people care about. We briefly review the existing evidence, suggesting that survey respondents, when asked to make real or hypothetical tradeoffs, would not always choose to maximize their predicted response to single-question wellbeing measures. The deviations appear systematic, and persist under conditions where alternative explanations are less plausible. We also review an approach for combining single-question measures into a more comprehensive wellbeing index—an approach that itself is not free of ongoing theoretical and implementational challenges, but that we view as a promising direction.
    Date: 2019–10–02
  19. By: Duque, Valentina; Rosales-Rueda, Maria; Sanchez, Fabio
    Abstract: We explore how early-life shocks interact with subsequent human capital investments to influence children’s long-term outcomes. Using large-scale administrative data from Colombia, we combine a difference-in-difference framework with a regression discontinuity design to exploit two sources of exogenous variation: i) early-life exposure to adverse weather shocks that affect children’s initial skills and ii), the introduction of conditional cash transfers (CCT) that promote investments in children’s health and education. We show that the timing and type of CCT-induced investments matter for both the effects of CCTs and their interactive effects with weather shocks. When the CCT-induced investments occur in sensitive periods of human capital formation (e.g., early childhood), the effects are large and their interactive effects with weather conditions suggest that the returns of the program are even larger for children exposed to “normal” weather conditions. In contrast, CCT-induced investments that come relatively late in childhood (e.g., adolescence), have a smaller “main” effect and a smaller or zero interactive effect with weather shocks. We also find that initial CCT-induced health investments tend to have larger returns than initial CCT-induced educational investments. These findings shed new light on the developmental production function for human capital and the role of social policies in closing gaps generated by early-life adversities.
    Keywords: Early-life influences, Human development, Social programs
    Date: 2019–11
  20. By: Blattman, Chris; Franklin, Simon; Dercon, Stefan
    Abstract: We study two interventions for underemployed youth across five Ethiopian sites: a $300 grant to spur self-employment, and a job offer to an industrial firm. Despite significant impacts on occupational choice, income, and health in the first year, after five years we see nearly complete convergence across all groups and outcomes. Short run increases in productivity and earnings from the grant dissipate as recipients exit their micro-enterprises. Adverse effects of factory work on health found after one year also appear to be temporary. These results suggest that one-time and one-dimensional interventions may struggle to overcome barriers to wage- or self-employment.
    Date: 2019–04–19
  21. By: Rangel, Marcos; Nobles, Jenna; Hamoudi, Amar
    Abstract: Zika virus epidemics have potential large-scale population effects. Controlled studies of mice and non-human primates indicate Zika effects on fecundity, raising concerns about miscarriage in human populations. In regions of Brazil, Zika risk peaked months before residents learned about the epidemic. This spatio-temporal variation supports differentiation between the biological effects of Zika infection on fertility and the effects of learning about Zika risk on reproductive behavior. Causal inference techniques used with vital statistics indicate that the epidemic caused 20% reductions in birth cohort size 18 months after Zika infection risk peaked, but 10 months after public health messages advocated childbearing delay. The evidence is not consistent with biological reductions in fecundity; it indicates strategic changes in reproductive behavior to temporally align childbearing with reduced risk to infant health. The effects are larger for the more educated, older and wealthier women, which may reflect facilitated access to information and family planning services within high-risk/mosquito-infested urban locations.
    Date: 2019–04–10
  22. By: Isabella Buber-Ennser; Judith Kohlenberger; Michael Landesmann (The Vienna Institute for International Economic Studies, wiiw); Sebastian Leitner (The Vienna Institute for International Economic Studies, wiiw); Bernhard Rengs
    Abstract: Given the exposure to stressors in their home countries, during their migration and in the phase after arrival, refugees are particularly vulnerable to mental health problems. At the same time, their access to adequate healthcare and other social infrastructure might be hampered by factors such as lack of knowledge as well as cultural and language barriers. In addition to other factors, this reduces their ability to take part in social activities as well as their integration into the labour market of the host societies. We examine the prevalence of mental disorders in the refugee population from Afghanistan, Iraq and Syria who arrived in Austria recently, drawing on data from a refugee survey conducted between December 2017 and April 2018 in Austria with a specific focus on Vienna, Salzburg, Graz, Linz and Innsbruck (FIMAS+INTEGRATION). We found a high share of refugees (32%) to have moderate or severe mental health problems. In particular, young refugees (15-34 years) show higher risk levels. When investigating the effects of stressors on the mental health situation, we found a positive association with e.g. experienced discrimination in Austria and the fear for partners and children left behind. In contrast, the results show a negative correlation for a couple of mitigating factors that foster resilience, i.e. proficiency in the German language, being employed (including volunteer work), having more supportive relationships and satisfaction with the housing situation. Disclaimer Research for this paper was financed by the Anniversary Fund of the Oesterreichische Nationalbank (Project No. 17166). Support provided by Oesterreichische Nationalbank for this research is gratefully acknowledged.
    Keywords: refugees, mental health, social integration, labour market integration
    JEL: I10 J15 F22
    Date: 2019–11
  23. By: Sarah Bridges; Douglas Scott
    Abstract: This study finds evidence of irreversible health deficits amongst young children who were exposed to the Lord’s Resistance Army insurgency in Northern Uganda (1987- 2007). The causal effect of the conflict is found to be a 0.65 standard deviation fall in height-for-age z-scores amongst children exposed for a period of more than six months. In contrast, the health impacts of shorter periods of exposure are found to be relatively minimal. These findings highlight the need for a swift resolution to conflict, in particular where it impacts heavily upon civilian populations, without which, the health consequences of protracted wars may extend far beyond the current generation.
    Keywords: conflict, Uganda, child health
    Date: 2019
  24. By: Mazumder, Bhashkar (Federal Reserve Bank of Chicago); Rosales, Maria Fernanda (Rutgers University); Triyana, Margaret (Federal Reserve Bank of Chicago)
    Abstract: We analyze the long-run and intergenerational effects of a large-scale school building project (INPRES) that took place in Indonesia between 1974 and 1979. Specifically, we link the geographic rollout of INPRES to longitudinal data from the Indonesian Family Life Survey covering two generations. We find that individuals exposed to the program have better health later in life along multiple measures. We also find that the children of those exposed also experience improved health and educational outcomes and that these effects are generally stronger for maternal exposure than paternal exposure. We find some evidence that household resources, neighborhood quality, and assortative mating may explain a portion of our results. Our findings highlight the importance of considering the long-run and multigenerational benefits when evaluating the costs and benefits of social interventions in a middle-income country.
    Keywords: Intergenerational transmission of human capital; education; adult wellbeing; income
    JEL: I38 J13 O15
    Date: 2019–10–28
  25. By: Blattman, Chris; Fiala, Nathan; Martinez, Sebastian
    Abstract: There is growing enthusiasm for cash grants as a tool to tackle poverty globally, but we have little sense whether the promising short-run impacts persist in the long term. In 2008, Uganda gave $400/person to thousands of young people, to help them start skilled trades. Four years on, an experimental evaluation found grants raised earnings by 38% (Blattman, Fiala, Martinez 2014). We return after 9 years to find these start-up grants raised earnings and consumption temporarily only. Grantees’ investment leveled off; controls eventually increased their incomes through business and casual labor; and so both groups converged in employment, earnings, and consumption. Grants had lasting impacts on assets, skilled work, and possibly child health, but had little effect on mortality, fertility, health or education.
    Date: 2019–04–16
  26. By: Zachary Wagner; Somalee Banerjee; Manoj Mohanan; Neeraj Sood
    Abstract: There are two salient facts about health care in low and middle-income countries; 1) the private sector plays an important role and 2) the care provided is often of poor quality. Despite these facts we know little about what drives quality of care in the private sector and why patients continue to seek care from poor quality providers. We use two field studies in India that provide unique insight into this issue. First, we use a discrete choice experiment to show that patients are willing to pay higher prices for better technical quality (defined by correct treatment and correct diagnosis). Second, we use standardized patients to show that private providers who provide better technical quality are not able to charge higher prices. Instead providers are able to charge higher prices for elements of quality that the patient can observe (good patient interactions and more effort), which are less important for health outcomes. Taken together, this research highlights a market inefficiency and suggests that engaging patients with accessible information on technical quality of the providers in their community could shift demand to providers that provide better care and thus improve health outcomes.
    JEL: D12 D22 D52 I1 I11 I12
    Date: 2019–11
  27. By: Gupta, Aashish
    Abstract: Chronic respiratory conditions are a leading cause of death in the world. Using data on lung obstruction from the WHO Survey of Global AGEing and Adult Health (WHO-SAGE 2007-08), this paper studies the determinants of respiratory health in India, home to a third of all deaths from Chronic Obstructive Pulmonary Disease. First, we find that smokers and members of households that use solid fuels (wood, biomass, coal or dung) for cooking have higher lung obstruction. Second, even if a respondent's household uses clean fuels, their lung obstruction is higher if their neighbors use solid fuels. In neighborhoods with high solid fuel use, the lungs of members of households that use clean fuels can be as obstructed as lungs of members of households that use solid fuels. These negative externalities of solid fuel use are robust to additional controls for neighborhood socioeconomic status, falsification tests, tests with placebo measures, and tests using alternative measures of respiratory health as outcomes. Third, the influence of the determinants is patterned by gender. Smoking tobacco is an important influence on lung obstruction among men. Confirming non-linear dose-response relationships, we find that women from households that use solid fuels are the only group not further harmed by neighborhood solid fuel smoke, possibly because of high exposure to pollutants while cooking. The study improves our understanding of behavioral, social, and environmental determinants of respiratory health in India. Importantly, it makes a case for greater public investments to promote the adoption and use of cleaner fuels.
    Date: 2019–06–04
  28. By: Li, Yaxi (Duke Kunshan University); Xue, Qian-Li (John Hopkins University, Baltimore); Odden, Michelle C. (Stanford University); Chen, Xi (Yale University); Wu, Chenkai (Duke Kunshan University)
    Abstract: Exposures in childhood and adolescence may impact the development of diseases and symptoms in late life. However, evidence from low- and middle- income countries is scarce. In this study, we examined the association of early life risk factors with frailty among older adults using a large, nationally representative cohort of community-dwelling Chinese sample. 6,806 participants aged ≥60 years from the China Health and Retirement Longitudinal Study were included. We measured 13 risk factors in childhood or adolescence through self-reports, encompassing six dimensions (education, family economic status, nutritional status, domestic violence, neighborhood, and health). We used multinomial regression models to examine the association between risk factors and frailty and further calculated the absolute risk difference for the statistically significant factors. Results show that worse health condition in childhood and unfavorable childhood and adolescent socioeconomic status as measured by educational attainment and neighborhood quality may increase the risk of late-life frailty among Chinese older adults. Severe starvation in childhood was associated with higher risk of prefrailty. The risk differences of being frail were 5.7% lower for persons with a high school or above education, 1.5% lower for those whose fathers were literate, 4.8% lower for the highest neighborhood quality, and 2.9% higher for worse childhood health status compared to their counterparts.
    Keywords: early life environments, life course health, physical health, frailty, aging, China
    JEL: I10 I14 I18
    Date: 2019–11

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