nep-hea New Economics Papers
on Health Economics
Issue of 2020‒03‒23
fifteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Effects of Income on Children’s Health: Evidence from Supplemental Security Income Eligibility under New York State Medicaid By Hansoo Ko; Renata E. Howland; Sherry A. Glied
  2. Mandated Sick Pay: Coverage, Utilization, and Welfare Effects By Johanna Catherine Maclean; Stefan Pichler; Nicolas R. Ziebarth
  3. The Economic Lives of Young Women in the Time of Ebola : Lessons from an Empowerment Program By Bandiera,Oriana; Buehren,Niklas; Goldstein,Markus P.; Rasul,Imran; Smurra,Andrea
  4. Epidemics and Trust: The Case of the Spanish Flu By Arnstein Aassve; Guido Alfani; Francesco Gandolfi; Marco Le Moglie
  5. Personal Belief Exemptions for School-Entry Vaccinations, Vaccination Rates, and Academic Achievement By Hair, Nicole L.; Gruber, Anja; Urban, Carly
  6. Prices and Federal Policies in Opioid Markets By Casey B. Mulligan
  7. Early Childhood Care and Cognitive Development By Juan Chaparro; Aaron Sojourner; Matthew J. Wiswall
  8. The Dependent Coverage Mandate Took a Bite Out of Crime By Fone, Zachary S.; Friedson, Andrew I.; Lipton, Brandy; Sabia, Joseph J.
  9. Intended and Unintended Effects of Banning Menthol Cigarettes By Christopher Carpenter; Hai V. Nguyen
  10. Got Milk? Using Nudges to Reduce Consumption of Added Sugar By Chien-Yu Lai; John List; Anya Samek
  11. Education and Health Over the Life Cycle By Robert Kaestner; Cuiping Schiman; Jason M. Ward
  12. Going Beyond GDP with a Parsimonious Indicator: Inequality-Adjusted Healthy Lifetime Income By Bloom, David E.; Fan, Victoria Y.; Kufenko, Vadim; Ogbuoji, Osondu; Prettner, Klaus; Yamey, Gavin
  13. Multilayer Network Analysis of the Drug Pipeline in the Global Pharmaceutical Industry By Hiromitsu Goto; Wataru Souma; Mari Jibu; Yuichi Ikeda
  14. The Effect of Open-Air Waste Burning on Infant Health: Evidence from Government Failure in Lebanon By Pierre Mouganie; Ruba Ajeeb; Mark Hoekstra
  15. Access to iodized salt in four areas of rural Papua New Guinea By Schmidt, Emily; Namusoke, Hanifa; Temple, Victor J.; Codling, Karen; Rudert, Christiane; Holtemeyer, Brian; Benson, Todd

  1. By: Hansoo Ko; Renata E. Howland; Sherry A. Glied
    Abstract: There is a well-established association between income and child health. We examine the Supplemental Security Income (SSI) program, which provides cash assistance to low-income children with disabilities, to assess how this relationship arises. We use a large database of Medicaid administrative records to estimate the causal effects of SSI receipt on children’s health, using a regression discontinuity design that exploits the rule that low-income children born below a birthweight threshold are automatically eligible for SSI. We find that children whose birthweights fall below the threshold are significantly more likely to be awarded SSI. Over the first 8 years of their lives, children with birthweights just below the threshold incur Medicaid expenditures 30% lower than do those born just above the threshold. They are less likely to be admitted to hospital, have shorter hospital stays when admitted, and use fewer specialist services. Eligible children experience reduced rates of diagnosis across a range of conditions, with significantly lower rates of both acute (infection, injury) and chronic (malnutrition, developmental delay) conditions in early life. SSI receipt delays the incidence of new chronic conditions by 1.7 months and reduces the number of new chronic conditions recorded through age 3 by 15%. Past health shocks significantly increase current healthcare utilization, but an interaction term between the SSI eligibility and past health shocks is not statistically significant, a pattern that suggests that increased income derived from SSI reduces the incidence of early health shocks but does not change how families respond to these shocks. Children receiving SSI are more likely to live in higher income neighborhoods mainly because their families are less likely to move out of better neighborhoods. However, we do not find evidence that children’s receipt of SSI affects their mother’s health or fertility. Reductions in Medicaid spending associated with SSI eligibility offset increased cash transfer payments by a ratio of 3.3:1.
    JEL: H55 I10 I38
    Date: 2020–01
  2. By: Johanna Catherine Maclean; Stefan Pichler; Nicolas R. Ziebarth
    Abstract: This paper evaluates the labor market effects of sick pay mandates in the United States. Using the National Compensation Survey and difference-in-differences models, we estimate their impact on coverage rates, sick leave use, labor costs, and non-mandated fringe benefits. Sick pay mandates increase coverage significantly by 13 percentage points from a baseline level of 66%. Newly covered employees take two additional sick days per year. We find little evidence that mandating sick pay crowds-out other non-mandated fringe benefits. We then develop a model of optimal sick pay provision along with a welfare analysis. Mandating sick pay likely increases welfare.
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2020–03
  3. By: Bandiera,Oriana; Buehren,Niklas; Goldstein,Markus P.; Rasul,Imran; Smurra,Andrea
    Abstract: This paper evaluates an intervention to raise young women's economic empowerment in Sierra Leone, where women frequently experience sexual violence and face multiple economic disadvantages. The intervention provides them with a protective space (a club) where they can find support, receive information on health and reproductive issues, and vocational training. Unexpectedly, the post-baseline period coincided with the 2014 Ebola outbreak. The analysis leverages quasi-random across-village variation in the severity of Ebola-related disruption, and random assignment of villages to the intervention to document the impact of the Ebola outbreak on the economic lives of 4,700 women tracked over the crisis, and any ameliorating role played by the intervention. In highly disrupted control villages, the crisis leads younger girls to spend significantly more time with men, out-of-wedlock pregnancies rise, and as a result, they experience a persistent 16 percentage points drop in school enrolment post-crisis. These adverse effects are almost entirely reversed in treated villages because the intervention enables young girls to allocate time away from men, preventing out-of-wedlock pregnancies and enabling them to re-enrol in school post-crisis. In treated villages, the unavailability of young women leads some older girls to use transactional sex as a coping strategy. The intervention causes them to increase contraceptive use so this does not translate into higher fertility. The analysis pinpoints the mechanisms through which the severity of the aggregate shock impacts the economic lives of young women and shows how interventions in times of crisis can interlink outcomes across younger and older cohorts.
    Date: 2019–02–28
  4. By: Arnstein Aassve; Guido Alfani; Francesco Gandolfi; Marco Le Moglie
    Abstract: Recent studies argue that major crises can have long lasting effects on individual behavior. While most studies focused on natural disasters, we explore the consequences of the global pandemic caused by a lethal influenza virus in 1918-19: the so-called “Spanish Flu”. This was by far the worst pandemic of modern history, causing up to 100 million deaths worldwide. Using information about attitudes of respondents to the General Social Survey (GSS), we find evidence that experiencing the pandemic likely had permanent consequences in terms of individuals’ social trust. Our findings suggest that lower social trust was passed on to the descendants of the survivors of the Spanish Flu who migrated to the US. As trust is a crucial factor for long-term economic development, our research offers a new angle from which to assess current health threats. JEL Classification: I15, N3, Z1 Keywords: Epidemic, Generalized trust, Spanish flu, Pandemic, Mortality crisis
    Date: 2020
  5. By: Hair, Nicole L. (University of South Carolina); Gruber, Anja (University of Colorado, Boulder); Urban, Carly (Montana State University)
    Abstract: Nonmedical exemptions from school-entry vaccine mandates are receiving increased policy and public health scrutiny. This paper examines how expanding the availability of exemptions influences vaccination rates in early childhood and academic achievement in middle school. We leverage 2003 legislation that granted personal belief exemptions (PBE) in Texas and Arkansas, two states the previously allowed exemptions only for medical or religious regions. We find that PBE decreased vaccination coverage among black and low-income preschoolers by 16.1% and 8.3%, respectively. Furthermore, we find that those cohorts affected by the policy change in early childhood performed less well on standardized tests of academic achievement in middle school. Estimated effects on mathematics and English Language Arts test scores were largest for black students, especially those residing in economically disadvantaged counties.
    Keywords: vaccination, state mandates, nonmedical exemptions, test scores
    JEL: H75 I12 I18 I21 I24 I28
    Date: 2020–02
  6. By: Casey B. Mulligan
    Abstract: More than a dozen Federal policy changes since the year 2000 have affected incentives to prescribe, manufacture, and purchase both prescription and illicitly-manufactured opioids. To the extent that one of the policies, the 2013 “Holder memo,” had a meaningful effect on the cost structure of suppliers of heroin and illicit fentanyl, standard consumer theory predicts that the trend for opioid-involved fatalities would proceed in distinct phases. Prior to 2013, subsidies to, and conveniences for, prescribers and consumers would increase total opioid consumption by reducing the full price of Rx. More surprising is that, with heroin relatively cheap of late, any Rx opioid policy could – and likely does – have the opposite total-consumption effect after 2013 than it would before, especially when the more expensive Rx opioid products are most affected. Subsidies to benzodiazepines (an opioid complement) increase opioid consumption in both phases. While policy changes at first reduced the full price of Rx, and then later increased it, technological change in illicit markets is also a relevant factor over the longer term.
    JEL: H22 I18 K42 L51
    Date: 2020–02
  7. By: Juan Chaparro; Aaron Sojourner; Matthew J. Wiswall
    Abstract: This paper combines multiple sources of information on early childhood development in a unified model for analysis of a wide range of early childhood policy interventions. We develop a model of child care in which households decide both the quantities and qualities of maternal and non-maternal care along with maternal labor supply. The model introduces a novel parenting-effort channel, whereby child care subsidies that permit less parenting may enable better parenting. To estimate the model, we combine observational data with experimental data from the Infant Health and Development Program (IHDP) which randomly assigned free child care when the child was 1 and 2 years old. We estimate a cognitive skill production function and household preferences, giving insight into mechanisms driving the ex post heterogeneous effects of the IHDP intervention, accounting for alternative care substitutes available to the control group and spillovers of the child care offer across the household's decisions. We also estimate ex ante effects of counterfactual policies such as an offer of lower-quality care, requiring a co-pay for subsidized care, raising the maternal wage offer, or a cash transfer. Finally, we use the model to rationalize existing evidence from outside the US on the effects of universal child care programs.
    JEL: J13
    Date: 2020–02
  8. By: Fone, Zachary S. (University of New Hampshire); Friedson, Andrew I. (University of Colorado Denver); Lipton, Brandy (San Diego State University); Sabia, Joseph J. (San Diego State University)
    Abstract: The Affordable Care Act's Dependent Coverage Mandate (DCM) induced approximately two million young adults to join parental employer-sponsored health insurance (ESI) plans. This study is the first to explore the impact of the DCM on criminal arrests, a potentially important externality. Using data from the National Incident-Based Reporting System, we find that the DCM induced an 11 percent reduction in criminal incidents involving arrestees ages 19 to 25, driven by property crime declines. An examination of the underlying mechanisms suggests that declines in large out-of-pocket expenditures for health care, increased educational attainment, and increases in parent-adult child cohabitation may explain these crime declines. Back-of-the-envelope calculations suggest that the DCM generated approximately $3.1 billion in annual social benefits from crime reduction.
    Keywords: Affordable Care Act, Dependent Coverage Mandate, crime, arrests
    JEL: I13 I18 K14
    Date: 2020–02
  9. By: Christopher Carpenter; Hai V. Nguyen
    Abstract: Bans on menthol cigarettes have been recommended by the World Health Organization, adopted throughout the European Union, and proposed by the United States Food and Drug Administration (FDA), primarily due to concerns that menthol cigarettes enable youth smoking. Yet there is almost no direct evidence on their effects using real-world policy variation. We provide the first comprehensive evaluation of this policy by studying Canada where seven provinces banned menthol cigarettes prior to a nationwide menthol ban in 2018. Using provincial sales data, we show that menthol cigarette sales fell to zero immediately after menthol bans, with no meaningful effect on non-menthol sales. Survey data confirm that provincial menthol bans significantly reduced menthol cigarette smoking among both youths and adults. We also find strong evidence of substitution, however: provincial menthol bans significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates. We also document evidence of evasion: provincial menthol bans shifted smokers’ cigarette purchases away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not bind). Our results demonstrate the importance of accounting for substitution and evasion responses in the design of stricter tobacco regulations.
    JEL: I1
    Date: 2020–02
  10. By: Chien-Yu Lai; John List; Anya Samek
    Abstract: The National School Lunch Program (NSLP) is a federal food assistance program that serves over 30 million children in the United States annually. Yet the impact of NSLP on nutritional intake may be limited because children frequently do not choose the healthier offerings or waste large portions of their meal. In this article, we study whether we can improve the impact of the NSLP on child food choice through low-cost nudges. We conduct a field experiment in a school lunchroom with 2500 children, evaluating the impact of informational prompts on milk choice and consumption over two weeks. We find that the prompts alone increase the proportion of children choosing and consuming the healthier white milk relative to sugar-sweetened chocolate milk from 20% in the control group to 30% in the treatment groups. Adding health or taste messaging to the prompt does not seem to make a difference. We survey students and find that most prompts affect perceived healthfulness of the milk, but not perceived taste. Finally, we find that the prompts are nearly as effective as a small nonmonetary incentive.
    Date: 2020
  11. By: Robert Kaestner; Cuiping Schiman; Jason M. Ward
    Abstract: There is little theoretical and empirical research on the effects of education on health over the life cycle. In this article, we extend the Grossman (1972) model of the demand for health and use the extended model to analyze the effect of education on health at different ages. The main conclusion from our model is that it is unlikely that the relationship between education and health will be constant over the life cycle and that education is likely to have little effect on health at younger ages when there is little depreciation of the health stock. We also present an extensive empirical analysis documenting the association between education and health over the life cycle. Results of our analysis suggest that in terms of mortality, education has little effect until age 60, but then lowers the hazard rate of death. For measures of morbidity, education has an effect at most ages between 45 to 60, but after age 60 has apparently little effect most likely due to selective mortality. In addition, most of the apparent beneficial effect of education stems from obtaining a high school degree or more. It is the health and mortality of lowest education group—those with less than a high school degree—that diverges from the health and mortality of other education groups. Finally, we find that the educational differences in health have become larger for more recent birth cohorts.
    JEL: I12 I14 I26
    Date: 2020–03
  12. By: Bloom, David E. (Harvard University); Fan, Victoria Y. (University of Hawaii at Manoa); Kufenko, Vadim (University of Hohenheim); Ogbuoji, Osondu (Duke University); Prettner, Klaus (University of Hohenheim); Yamey, Gavin (Duke University)
    Abstract: Per capita GDP has limited use as a well-being indicator because it does not capture many dimensions that imply a "good life," such as health and equality of opportunity. However, per capita GDP has the virtues of easy interpretation and can be calculated with manageable data requirements. Against this backdrop, a need exists for a measure of well-being that preserves the advantages of per capita GDP, but also includes health and equality. We propose a new parsimonious indicator to fill this gap and calculate it for 149 countries.
    Keywords: beyond GDP, well-being, health, inequality, human development, lifetime income
    JEL: I31 I15 D63 O10 E01
    Date: 2020–02
  13. By: Hiromitsu Goto; Wataru Souma; Mari Jibu; Yuichi Ikeda
    Abstract: Generally, open innovation is a lucrative research topic within industries relying on innovation, such as the pharmaceutical industry, which are also known as knowledge-intensive industries. However, the dynamics of drug pipelines within a small-medium enterprise level in the global economy remains concerning. To reveal the actual situation of pharmaceutical innovation, we investigate the feature of knowledge flows between the licensor and licensee in the drug pipeline based on a multilayer network constructed with the drug pipeline, global supply chain, and ownership data. Thus, our results demonstrate proven similarities between the knowledge flows in the drug pipeline among the supply chains, which generally agrees with the situation of pharmaceutical innovation collaborated with other industries, such as the artificial intelligence industry.
    Date: 2020–03
  14. By: Pierre Mouganie; Ruba Ajeeb; Mark Hoekstra
    Abstract: An estimated 40 percent of the world's garbage is burned in open-air fires, which are responsible for as much as half of the global emissions of some pollutants. However, there is little evidence on the health consequences of open-air waste burning. In this paper, we estimate the effect of in utero exposure to open-air waste burning on birth outcomes. We do so by examining the consequences of the Lebanese garbage crisis of 2015, which led to an abrupt, unanticipated increase in waste burning in residential neighborhoods in Beirut and Mount Lebanon. To identify effects, we exploit variation in exposure across neighborhoods before and after the crisis. Results indicate exposure had large impacts on birth outcomes; in utero exposure to at least one open-air waste burn increased premature births by 4 percentage points (50%) and low birth weight by 5 to 8 percentage points (80 - 120%). Given previous research documenting the long-run effects of prenatal shocks on adult health, human capital, and labor market outcomes, this suggests open-air waste burning imposes significant costs on populations worldwide.
    JEL: H41 I18
    Date: 2020–03
  15. By: Schmidt, Emily; Namusoke, Hanifa; Temple, Victor J.; Codling, Karen; Rudert, Christiane; Holtemeyer, Brian; Benson, Todd
    Abstract: Dietary iodine deficiency results in stunted physical and mental growth in children. Fortifying commercial household salt with a small but adequate amount of iodine is the principal strategy used globally to prevent iodine deficiency. However, there may be barriers to consuming adequately iodized salt for many rural households in Papua New Guinea (PNG). Using results from a rural household survey conducted in four areas of the country in 2018 that was administered to just over 1,000 households, two issues related to salt iodization in PNG are examined. First, only about 9 percent of survey households reported that they did not consume iodized table salt in the seven days prior to being interviewed for the survey. However, specific characteristics are associated with such households. They tend to be located in remote communities, are in the poorest 20 percent of survey households, have no members who received any formal education, and have experienced recent food insecurity. Particularly for remote households, ensuring that their members consume sufficient iodine will require going beyond salt iodization to use other approaches to iodine supplementation. Second, of the samples of salt obtained from the survey households, the iodine content of two-thirds fell within the PNG regulations, a reasonably encouraging finding. Only about 17 percent of the almost 800 samples obtained had inadequate iodine. However, when the salt samples were examined by brand, it was found that the brand most commonly consumed had the highest share of samples with inadequate iodine levels. Closer monitoring of the iodine content in table salt produced or imported into PNG and enforcement of salt iodization regulations is required.
    Keywords: PAPUA NEW GUINEA, OCEANIA, iodized salt, rural areas, iodine deficiency, health, diet, common salt, micronutrient deficiencies,
    Date: 2019

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