nep-hea New Economics Papers
on Health Economics
Issue of 2020‒04‒06
27 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Policy response, social media and science journalism for the sustainability of the public health system amid COVID-19 outbreak: The Vietnam lessons By Viet-Phuong La; Thanh-Hang Pham; Manh Toan Ho; Minh Hoang Nguyen; Nguyen Phuc Khanh Linh; Thu-Trang Vuong; Hong Kong To Nguyen; Manh-Tung Ho; Quan-Hoang Vuong
  2. The Covid-19/SARS CoV-2 pandemic outbreak and the risk of institutional failures By Marcello Basili; Antonio Nicita
  3. Certified Corona-Immunity as a Resource and Strategy to Cope with Pandemic Costs By Reiner Eichenberger; Rainer Hegselmann; David Savage; David Stadelmann; Benno Torgler
  4. Ex ante knowledge for infectious disease outbreaks : Introducing the organizational network governance approach By Raab, Jörg; Kenis, Patrick; Kraaij – Dirkzwager, Marleen; Timen, Aura
  5. Using Mobile Phone Data to Reduce Spread of Disease By Milusheva,Sveta
  6. The Second Worldwide Wave of Interest in Coronavirus since the COVID-19 Outbreaks in South Korea, Italy and Iran: A Google Trends Study By Artur Strzelecki
  7. The Responses of Consumption and Prices in Japan to the COVID-19 Crisis and the Tohoku Earthquake By Tsutomu Watanabe
  8. Exploring the Effect of 2019-nCoV Containment Policies on Crime: The Case of Los Angeles By Gian Maria Campedelli; Alberto Aziani; Serena Favarin
  9. Strategies for controlling the medical and socio-economic costs of the Corona pandemic By Claudius Gros; Roser Valenti; Kilian Valenti; Daniel Gros
  10. Options on infectious diseases By Andrew Lesniewski; Nicholas Lesniewski
  11. Covid-19 Coronavirus and Macroeconomic Policy By Luca Fornaro; Martin Wolf
  12. Feverish Stock Price Reactions to COVID-19 By Stefano Ramelli; Alexander F. Wagner
  13. The CoRisk-Index: A data-mining approach to identify industry-specific risk assessments related to COVID-19 in real-time By Fabian Stephany; Niklas Stoehr; Philipp Darius; Leonie Neuh\"auser; Ole Teutloff; Fabian Braesemann
  14. Infections, Accidents and Nursing Overtime in a Neonatal Intensive Care Unit: A Bayesian Semiparametric Panel Data Logit Model By Beltempo, Marc; Bresson, Georges; Etienne, Jean-Michel; Lacroix, Guy
  15. The Timing of Early Interventions and Child and Maternal Health By Jonas Lau-Jensen Hirani; Hans Henrik Sievertsen; Miriam Wust
  16. Psychological Resilience to Major Socioeconomic Life Events By Etilé, Fabrice; Frijters, Paul; Johnston, David W.; Shields, Michael A.
  17. Income Volatility, Health and Well-Being By Amélie Adeline; Ismaël Choinière Crèvecoeur; Raquel Fonseca; Pierre-Carl Michaud
  18. Maternal Investments in Children: The Role of Expected Effort and Returns By Bhalotra, Sonia; Delavande, Adeline; Font-Gilabert, Paulino; Maselko, Joanna
  19. Climate shocks, coping responses and gender gap in human development By Haile, Kaleab; Tirivayi, Nyasha; Nillesen, Eleonora
  20. Who’s declining the “free lunch”? New evidence from the uptake of public child dental benefits By Nguyen, Ha Trong; Le, Huong Thu; Connelly, Luke B.
  21. Fiscal Federalism and the Budget Impacts of the Affordable Care Act's Medicaid Expansion By Jonathan Gruber; Benjamin D. Sommers
  22. Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S. By Pragya Kakani; Michael Chernew; Amitabh Chandra
  23. Efficiency of Universities and Research-Focused Institutions Worldwide: An Empirical DEA Investigation Based on Institutional Publication Numbers and Estimated Academic Staff Numbers By Lutz Bornmann; Sabine Gralka; Félix de Moya Anegón; Klaus Wohlrabe
  24. Estimating the extra costs of disability in European countries: Implications for poverty measurement and disability-related decommodification By Morris, Zachary A.; Zaidi, Asghar
  25. Understanding Cross-country Differences in Health Status and Expenditures By Raquel Fonseca Benito; François Langot; Pierre-Carl Michaud; Thepthida Sopraseuth
  26. Demand for Information on Environmental Health Risk, Mode of Delivery, and Behavioral Change : Evidence from Sonargaon, Bangladesh By Tarozzi,Alessandro; Maertens,Ricardo; Ahmed,Kazi Matin Uddin; van Geen,Alexander
  27. Richer, wiser and in better health? The socioeconomic gradient in hypertension prevalence, unawareness and control in South Africa By Thomas, Ranjeeta; Burger, Ronelle; Hauck, Katharina

  1. By: Viet-Phuong La; Thanh-Hang Pham; Manh Toan Ho; Minh Hoang Nguyen; Nguyen Phuc Khanh Linh; Thu-Trang Vuong; Hong Kong To Nguyen; Manh-Tung Ho; Quan-Hoang Vuong
    Abstract: With the geographic proximity and high volume of trade with China, Vietnam was expected to have a high risk of the new Coronavirus (COVID-19) outbreak. However, to date [mid-March 2020], in comparison to attempts to containing the disease around the world, responses from Vietnam are seen as prompt and effective in protecting the interests of its citizens. This study analyzes the situation in terms of Vietnam’s policy response, social media, and science journalism. It contributes valuable lessons for other nations in the concurrent fight against the COVID-19 pandemic via fostering genuine cooperation between government, civil society, and private individuals.
    Keywords: Coronavirus; COVID-19; Pandemic; Policy Response; Social Media; Science Journalism; Public Health System; Vietnam
    JEL: I12 I18 Q54
    Date: 2020–03–24
  2. By: Marcello Basili; Antonio Nicita
    Abstract: The new coronavirus CoVid-19 (SARS Cov-2) pandemic outbreak all around theWorld puts in evidence how institutional failures may end up in a catastrophic event. The precautionary principle (PP) has been proposed as the proper guide for the decision-making criteria to be adopted in the face of the new catastrophic risks that have arisen in the decades of this century. Unfortunately the political institutions at the national and supranational level, such as the European Union Commission, seem having neglected it opening the scenario of a lethal global pandemic that could cause millions of deaths, principally elderlies with chronic diseases, based on early evidence in China and Italy. According to scientists and health authorities human beings are facing the high probable nightmare of a very aggressive and mortal pandemy, worst than the Spanish flu (1918-1919) the most famous reconbined avian flu killed millions, without targeted therapeutics for treatment and vaccines.
    JEL: D81
    Date: 2020–03
  3. By: Reiner Eichenberger; Rainer Hegselmann; David Savage; David Stadelmann; Benno Torgler
    Abstract: A pandemic is not only a biological event and a public health disaster, but it also generates impacts that are worth understan ding from a societal, historical, and cultural perspective. In this contribution, we argue that as the disease spreads, we are able to harness a valuable key resource, namely people who have immunity to Corona. This vital resource must be employed effectively, it must be certified, it must be searched for, it must be found, and it may even be actively produced. We discuss why this needs to be done and how this can be achieved. Our arguments not only apply to the current pandemic, but also to any future rapidly spreading, infectious disease epidemics. In addition, we argue for awareness of a secondary non-biological crisis arising from the side effects of pandemic reactions. There is a risk that the impacts of the secondary crisis could outweigh that of the biological event from a health and societal perspective.
    Date: 2020–03
  4. By: Raab, Jörg (Tilburg University, School of Economics and Management); Kenis, Patrick (Tilburg University, School of Economics and Management); Kraaij – Dirkzwager, Marleen; Timen, Aura
    Abstract: The core question addressed is to what extent ex ante knowledge can be made available from a network governance perspective to deal with a crisis such as an infectious disease outbreak. Such outbreaks are often characterized by a lack of information and knowledge, changing and unforeseen conditions as well as a myriad of organizations becoming involved on the one hand but also organizations which do not become adequately involved. We introduce the organizational network governance approach as an exploratory approach to produce useful ex ante information for limiting the transmission of a virus and its impact. We illustrate the usefulness of our approach introducing two fictitious but realistic outbreak scenarios: the West Nile Virus (WNV), which is transmitted via mosquitos and the outbreak of a New Asian Coronavirus (NAC) which is characterized by human to human transmission. Both viruses can lead to serious illnesses or even death as well as large health care and economic costs. Our organizational network governance approach turns out to be effective in generating information to produce recommendations for strengthening the organizational context in order to limit the transmission of a virus and its impact. We also suggest how the organizational network governance approach could be further developed
    Date: 2020
  5. By: Milusheva,Sveta
    Abstract: While human mobility has important benefits for economic growth, it can generate negative externalities. This paper studies the effect of mobility on the spread of disease in a low-incidence setting when people do not internalize their risks to others. Using malaria as a case study and 15 billion mobile phone records across nine million SIM cards, this paper causally quantifies the relationship between travel and the spread of disease. The estimates indicate that an infected traveler contributes to 1.7 additional cases reported in the health facility at the traveler's destination. This paper develops a simulation-based policy tool that uses mobile phone data to inform strategic targeting of travelers based on their origins and destinations. The simulations suggest that targeting informed by mobile phone data could reduce the caseload by 50 percent more than current strategies that rely only on previous incidence.
    Date: 2020–03–30
  6. By: Artur Strzelecki
    Abstract: The recent emergence of a new coronavirus, COVID-19, has gained extensive coverage in public media and global news. As of 24 March 2020, the virus has caused viral pneumonia in tens of thousands of people in Wuhan, China, and thousands of cases in 184 other countries and territories. This study explores the potential use of Google Trends (GT) to monitor worldwide interest in this COVID-19 epidemic. GT was chosen as a source of reverse engineering data, given the interest in the topic. Current data on COVID-19 is retrieved from (GT) using one main search topic: Coronavirus. Geographical settings for GT are worldwide, China, South Korea, Italy and Iran. The reported period is 15 January 2020 to 24 March 2020. The results show that the highest worldwide peak in the first wave of demand for information was on 31 January 2020. After the first peak, the number of new cases reported daily rose for 6 days. A second wave started on 21 February 2020 after the outbreaks were reported in Italy, with the highest peak on 16 March 2020. The second wave is six times as big as the first wave. The number of new cases reported daily is rising day by day. This short communication gives a brief introduction to how the demand for information on coronavirus epidemic is reported through GT.
    Date: 2020–03
  7. By: Tsutomu Watanabe (Graduate School of Economics, University of Tokyo. Founder and Technical Advisor, Nowcast Inc.)
    Abstract: This note compares the responses of consumption and prices to the COVID-19 shock and another large-scale natural disaster that hit Japan, the Tohoku earthquake in March 2011. The comparison shows that the responses of supermarket sales and prices at a daily frequency during the two crises are quite similar: (1) the year-on-year rate of sales growth increased quickly and reached a peak of 20 percent two weeks after the outbreak of COVID-19 in Japan, which is quite similar to the response immediately after the earthquake; (2) the items consumers purchased at supermarkets in these two crisis are almost identical; (3) the year-on-year rate of consumer price inflation for goods rose by 0.6 percentage points in response to the coronavirus shock, compared to 2.2 percentage points in the wake of the earthquake. However, evidence suggests that whereas people expected higher inflation for goods and services in the wake of the earthquake, they expect lower inflation in response to the coronavirus shock. This difference in inflation expectations suggests that the economic deterioration due to COVID-19 should be viewed as driven mainly by an adverse aggregate demand shock to face-to-face service industries such as hotels and leisure, transportation, and retail, rather than as driven by an aggregate supply shock.
    Date: 2020–03
  8. By: Gian Maria Campedelli; Alberto Aziani; Serena Favarin
    Abstract: The global spread of 2019-nCoV, a new virus belonging to the coronavirus family, forced national and local governments to apply different sets of measures aimed at containing the outbreak. Los Angeles has been one of the first cities in the United States to declare the state of emergency on March 4th, progressively issuing stronger policies involving (among the others) social distancing, the prohibition of crowded private and public gatherings and closure of leisure premises. These interventions highly disrupt and modify daily activities and habits, urban mobility and micro-level interactions between citizens. One of the many social phenomena that could be influenced by such measures is crime. Exploiting public data on crime in Los Angeles, and relying on routine activity and pattern theories of crime, this work investigates whether and how new coronavirus containment policies have an impact on crime trends in a metropolis. The article specifically focuses on eight urban crime categories, daily monitored from January 1st 2017 to March 16th 2020. The analyses will be updated bi-weekly to dynamically assess the short- and medium-term effects of these interventions to shed light on how crime adapts to such structural modification of the environment. Finally, policy implications are also discussed.
    Date: 2020–03
  9. By: Claudius Gros; Roser Valenti; Kilian Valenti; Daniel Gros
    Abstract: In response to the rapid spread of the Coronavirus (COVID-19), with ten thousands of deaths and intensive-care hospitalizations, a large number of regions and countries have been put under lockdown by their respective governments. Policy makers are confronted in this situation with the problem of balancing public health considerations, with the economic costs of a persistent lockdown. We introduce a modified epidemic model, the controlled-SIR model, in which the disease reproduction rates evolve dynamically in response to political and societal reactions. Social distancing measures are triggered by the number of infections, providing a dynamic feedback-loop which slows the spread of the virus. We estimate the total cost of several distinct containment policies incurring over the entire path of the endemic. Costs comprise direct medical cost for intensive care, the economic cost of social distancing, as well as the economic value of lives saved. Under plausible parameters, the total costs are highest at a medium level of reactivity when value of life costs are omitted. Very strict measures fare best, with a hands-off policy coming second. Our key findings are independent of the specific parameter estimates, which are to be adjusted with the COVID-19 research status. In addition to numerical simulations, an explicit analytical solution for the controlled continuous-time SIR model is presented. For an uncontrolled outbreak and a reproduction factor of three, an additional 28% of the population is infected beyond the herd immunity point, reached at an infection level of 66%, which adds up to a total of 94%.
    Date: 2020–04
  10. By: Andrew Lesniewski; Nicholas Lesniewski
    Abstract: We present a parsimonious stochastic model for valuation of options on the fraction of infected individuals during an epidemic. The underlying stochastic dynamical system is a stochastic differential version of the SIR model of mathematical epidemiology.
    Date: 2020–03
  11. By: Luca Fornaro; Martin Wolf
    Abstract: As we write, the Covid-19 coronavirus is spreading throughout the globe. Besides its impact on public health, this coronavirus outbreak is likely to have significant economic consequences. The consensus is that the virus will cause a negative supply shock to the world economy, by forcing factories to shut down and disrupting global supply chains (OECD, 2020). But how deep and persistent is this supply disruption going to be? Will aggregate demand be affected? What is the appropriate monetary policy response? What about fiscal policy? These questions are currently at the center of a heated debate.
    Date: 2020–03
  12. By: Stefano Ramelli (University of Zurich - Department of Banking and Finance); Alexander F. Wagner (University of Zurich - Department of Banking and Finance; Centre for Economic Policy Research (CEPR); European Corporate Governance Institute (ECGI); Swiss Finance Institute)
    Abstract: This paper studies how markets adjust to the sudden emergence of previously neglected risks. It does so by analyzing the stock price effects of the 2019 novel Coronavirus disease (COVID-19) pandemic. The telecom and health care industries did relatively well, while transportation and energy plummeted. Within industries, US firms reliant on Chinese inputs and those with a strong export orientation towards China suffered. Sophisticated investors appear to have started pricing in the effects of the virus already in the first part of January (the "Incubation" phase), that is, before managers or analysts started paying attention; the first earnings conference call that contained a discussion of "Coronavirus" took place on January 22. The "Outbreak" phase followed, during which China-oriented stocks and internationally oriented stocks more generally strongly underperformed. In the last week of February and early March (the "Fever" phase), the aggregate market first fell strongly and then entered a whipsaw pattern. But behind these feverish and seemingly behaviorally-driven price moves, some patterns emerge. In particular, investors became increasingly worried about corporate debt and liquidity, indicating widespread concerns that the health crisis may evolve into a financial crisis.
    Keywords: Behavioral finance, Corporate debt, Coronavirus, COVID-19, Earnings conference calls, Event study, Global Value Chains, Neglected risks, Pandemic, SARS-CoV-2, Supply Chains
    JEL: G01 G02 G14 G15 F15 F23 F36
    Date: 2020–03
  13. By: Fabian Stephany; Niklas Stoehr; Philipp Darius; Leonie Neuh\"auser; Ole Teutloff; Fabian Braesemann
    Abstract: While the coronavirus spreads around the world, governments are attempting to reduce contagion rates at the expense of negative economic effects. Market expectations have plummeted, foreshadowing the risk of a global economic crisis and mass unemployment. Governments provide huge financial aid programmes to mitigate the expected economic shocks. To achieve higher effectiveness with cyclical and fiscal policy measures, it is key to identify the industries that are most in need of support. In this study, we introduce a data-mining approach to measure the industry-specific risks related to COVID-19. We examine company risk reports filed to the U.S. Securities and Exchange Commission (SEC). This data set allows for a real-time analysis of risk assessments. Preliminary findings suggest that the companies' awareness towards corona-related business risks is ahead of the overall stock market developments by weeks. The risk reports differ substantially between industries, both in magnitude and in nature. Based on natural language processing techniques, we can identify corona-related risk topics and their perceived relevance for different industries. Our approach allows to distinguish the industries by their reported risk awareness towards COVID-19. The preliminary findings are summarised an online index. The CoRisk-Index tracks the industry-specific risk assessments related to the crisis, as it spreads through the economy. The tracking tool could provide relevant empirical data to inform models on the immediate economic effects of the crisis. Such complementary empirical information could help policy-makers to effectively target financial support and to mitigate the economic shocks of the current crisis.
    Date: 2020–03
  14. By: Beltempo, Marc (McGill University); Bresson, Georges (University of Paris 2); Etienne, Jean-Michel (Université Paris-Sud); Lacroix, Guy (Université Laval)
    Abstract: The paper investigates the effects of nursing overtime on nosocomial infections and medical accidents in a neonatal intensive care unit (NICU). The literature lacks clear evidence on this issue and we conjecture that this may be due to empirical and methodological factors. We thus focus on a single NICU, thereby removing much variation in specialty mixes such neonatologists, fellows, residents, nurse practitioners that are observed across units. We model the occurrences of both outcomes using a sample of 3,979 neonates which represents over 84,846 observations (infant/days). We use a semiparametric panel data Logit model with random coefficients. The non-parametric components of the model allow to unearth potentially highly non-linear relationships between the outcomes and various policy-relevant covariates. We use the mean field variational Bayes approximation method to estimate the models. Our results show unequivocally that both health outcomes are affected by nursing overtime. Furthermore, they are both highly sensitive to infant and NICU-related characteristics.
    Keywords: neonatal health outcomes, nursing overtime, semi-parametric panel data logit model, mean field variational Bayes, random coefficients
    JEL: I1 J2 C11 C14 C23
    Date: 2020–03
  15. By: Jonas Lau-Jensen Hirani; Hans Henrik Sievertsen; Miriam Wust
    Abstract: What is the impact of timing of early-life investment policies on child and maternal health? Exploiting variation from a 2008 Danish nurse strike, we study this question in the context of universal nurse home visiting. We show that early but not later strike exposure increases child (and mother) general practitioner contacts in the first four years after childbirth. Mothers, who forgo an early nurse visit (rather than a later one), have a higher probability of mental health specialist contacts in the first two years after childbirth. We highlight two channels for these results, screening and information provision: We show that nurses perform well in identifying maternal mental health risks during early home visits in control years (likely preventing longer-term problems). Finally, we show that first-born children and children of parents without a health-related education drive our results. A stylized calculation confirms that short- run health benefits from early universal home visiting outweigh costs.
    Date: 2020–03–30
  16. By: Etilé, Fabrice (INRA-CORELA); Frijters, Paul (London School of Economics); Johnston, David W. (Monash University); Shields, Michael A. (Monash University)
    Abstract: Understanding who in the population is psychologically resilient in the face of major life events, and who is not, is important for policies that target reductions in disadvantage. In this paper we construct a measure of adult resilience, document its distribution, and test its predictability by childhood socioeconomic circumstances. We use a dynamic finite mixture model applied to 17 years of panel data, and focus on the psychological reaction to ten major adverse life events. These include serious illness, major financial events, redundancy and crime victimisation. Our model accounts for nonrandom selection into events, anticipation of events, and differences between individuals in the immediate response and the speed of adaptation. We find considerable heterogeneity in the response to adverse events, and that resilience is strongly correlated with clinical measures of mental health. Resilience in adulthood is predictable by childhood socioeconomic circumstances; the strongest predictor is good childhood health.
    Keywords: psychological resilience, major life events, non-cognitive skills, childhood, panel data, mixture model
    JEL: I10 C2 C5
    Date: 2020–03
  17. By: Amélie Adeline; Ismaël Choinière Crèvecoeur; Raquel Fonseca; Pierre-Carl Michaud
    Abstract: While there is mounting evidence that large income shocks, e.g. in the form of a job loss, may impact health and mortality, little evidence exist on the potential relationship between sustained income volatility, keeping average lifetime income constant, and health. This paper exploits rich survey data on the near-elderly in Canada paired with their administrative tax records to investigate whether a relationship exists between health and well-being on the one hand, and individual-specific volatility of income on the other, decomposing volatility into a permanent and transitory component. Controlling for average lifetime income, we find that a one unit increase in the standard deviation of the permanent component of (log) income experienced over the working life is associated with a lower probability of being in excellent (-23.9%) and very good health (-13.3%), to be satisfied with life (-34.9%), and implies the onset of 1.1 additional mental health issues. Similar results, albeit smaller in size, are found for the transitory component of income. These results have potentially important implications for public policy, as well as, understanding the relationship between the labor market and population health.
    Keywords: Income volatility, health, well-being, Canada.
    JEL: C22 D31 I10 I14 I31
    Date: 2019
  18. By: Bhalotra, Sonia; Delavande, Adeline; Font-Gilabert, Paulino; Maselko, Joanna
    Abstract: We investigate the importance of subjective expectations of returns to and effort costs of the two main investments that mothers make in newborns: breastfeeding and stimulation. We find heterogeneity across mothers in expected effort costs and expected returns for outcomes in the cognitive, socio-emotional and health domains, and we show that this contributes to explaining heterogeneity in investments. We find no significant heterogeneity in preferences for child developmental outcomes. We simulate the impact of various policies on investments. Our findings highlight the relevance of interventions designed to reduce perinatal fatigue alongside interventions that increase perceived returns to investments.
    Date: 2020–03–25
  19. By: Haile, Kaleab (UNU-MERIT); Tirivayi, Nyasha (UNU-MERIT); Nillesen, Eleonora (UNU-MERIT, and SBE, Maastricht University)
    Abstract: This study examines the impact of drought on child health and schooling outcomes and investigates the contemporaneous relationship between these two main building blocks of human capital. We merge childlevel longitudinal data from the Ethiopia Rural Socioeconomic Survey (ERSS) with geo-referenced climate data. Our findings from within-child variation estimators reveal that drought has a detrimental impact on the highest grade completed of female children. We show that the negative effect of drought on a female child's completed years of formal schooling is channelled, albeit not entirely, through ill health. Our result is robust to using recursive bivariate estimation with exclusion restriction to correct for biases associated with the endogeneity of child health due to time-varying heterogeneities. Gender bias in the household explains why the direct and mediated schooling e ects of drought are concentrated only on female children. We find that households respond to drought-induced income shocks by decreasing the allocation of resources for the medical treatment of an ill female child. Moreover, households also increase the use of female child labour for non-agricultural activities, which is consistent with a disproportionate increase in school absenteeism of older girls during drought. We discuss how gender-responsive policy design and implementation may help alleviate gender inequality in human development in the face of climate change.
    Keywords: Drought, coping capacity, human capital, human development, gender bias, sub-Saharan Africa, Ethiopia
    JEL: D13 I31 J16 O15 Q54
    Date: 2019–12–31
  20. By: Nguyen, Ha Trong; Le, Huong Thu; Connelly, Luke B.
    Abstract: Recent economic literature has advanced the notion that cognitive biases and behavioural barriers may be important influencers of uptake decisions in respect of public programs that are designed to help disadvantaged people. This paper provides the first evidence on the determinants of uptake of two recent public dental benefit programs for Australian children and adolescents from disadvantaged families. Using longitudinal data from a nationally representative survey linked to administrative data with accurate information on eligibility and uptake, we find that only a third of all eligible families actually claim their benefits. These actual uptake rates are about half of the targeted access rates that were announced for them. We provide new and robust evidence consistent with the idea that cognitive biases and behavioural factors are barriers to uptake. For instance, mothers with worse mental health or riskier lifestyles are much less likely to claim the available benefits for their children. These barriers to uptake are particularly large in magnitude: together they reduce the uptake rate by up to 10 percentage points (or 36%). We also find some indicative evidence about the presence of the lack of information barrier to uptake. The results are robust to a wide range of sensitivity checks, including controlling for possible endogenous sample selection.
    Keywords: Government Programs,Impact Evaluation,Dental Health,Provision and Effects of Welfare Programs,Australia,Uptake,Take-up
    JEL: D91 H51 I12 I18 I38
    Date: 2020
  21. By: Jonathan Gruber; Benjamin D. Sommers
    Abstract: Medicaid’s federal-state matching system of financing is the nation’s largest example of fiscal federalism. Using generous federal subsidies, the Affordable Care Act incentivized states to expand Medicaid, which became a state option in the aftermath of a 2012 Supreme Court ruling. As of early 2020, 14 states had not yet expanded, with concerns over state budgetary effects described as a key barrier. We use an event-study approach to analyze state budget data from 2010-2018 and assess the effects of state Medicaid expansion decisions. We find that Medicaid expansion increased total spending in expansion states by 6% to 9%, compared to non-expansion states. By source of funds, federal spending via the states increased by 10% in the first year of Medicaid expansion, rising to 27% in 2018. Changes in spending from state funding were modest and non-significant, with less than a 1% change from baseline annually in the most recent years, 2017 and 2018. Meanwhile, we find no evidence that increased Medicaid spending from expansion produced any reductions in spending on education, corrections, transportation, or public assistance. Changes in Medicaid spending tracked closely with the baseline pre-ACA (2013) uninsured rate in each states, with expansion leading to roughly $2680 in added annual spending per uninsured adult. As a result, we estimate states that didn’t expand Medicaid passed up $43 billion in federally-subsidized program funds in 2018. Finally, state projections in the aggregate were reasonably accurate, with expansion states projecting average Medicaid spending from 2014-2018 within 2 percent of the actual amounts, and in fact overestimating Medicaid spending in most years.
    JEL: H77 I18
    Date: 2020–03
  22. By: Pragya Kakani; Michael Chernew; Amitabh Chandra
    Abstract: Rising list prices are often used to illustrate the burden of prescription drug spending, but payers routinely negotiate rebates from manufacturers that generate differences between list and net prices. List prices are easily available and affect patient cost-sharing, but net prices are confidential and affect innovation incentives. We use novel data on medicines sold in a retail setting to quantify rebate growth, the sensitivity of pharmaceutical price indices to list versus net prices, and contribution of net price growth to revenue growth. From 2012 to 2017, we find average rebates increased from 32% to 48%, owing entirely to growth in rebate-levels over a product lifetime rather than shifts towards high rebate products. Annual inflation of list prices was 12% while that of net prices was 3%, implying that financial rewards to manufacturers per unit sold have not grown proportionally to list prices. This pattern is mirrored in 19 of the 20 top drug classes by revenue including insulins, where list and net price inflation were 16% and 2% annually respectively. Finally, we find price growth explains 76% of revenue growth when measured by list prices but 31% of revenue growth when measured by net prices. Moreover, new product entry is the most important factor affecting pharmaceutical revenue growth. These findings provide a cautionary note on using list prices for policy analysis.
    JEL: I11
    Date: 2020–03
  23. By: Lutz Bornmann; Sabine Gralka; Félix de Moya Anegón; Klaus Wohlrabe
    Abstract: One of the core indicators in the field of scientometrics is the number of papers published by a unit within a given period. However, such indicators can only be assessed properly by considering the unit’s available resources. When evaluating the efficiency of institutions worldwide, the problem concerning the availability of internationally standardized data arises. While on the output side consistent publication indicators are available, these data are frequently not available on the input side. We therefore introduce a new input indicator based on the authors’ mentions in the institutions’ papers. We calculate efficiency scores for more than 4,800 universities and other research-focused institutions worldwide. “Harvard University” is the best performing institution (in all years) followed by many other institutions from Northern America or Europe. The results of the study show that institutions in the Pacific region have the highest average efficiency scores, followed by Northern America and Western Europe. While many results of this study are scarcely surprising, it is the first time that an efficiency analysis is being performed for a multitude of institutions worldwide using a standardized input indicator. It seems that the new proxy indicator based on co-authors is suitable for reflecting institutional staff numbers.
    Keywords: bibliometrics, efficiency, data envelopment analysis, universities, research-focused institutions, world
    JEL: I21 I23 D61 H52
    Date: 2020
  24. By: Morris, Zachary A.; Zaidi, Asghar
    Abstract: It is widely accepted that people with disabilities incur additional expenditures on transport, heating, equipment and other items. In this article, we estimate the magnitude of these extra costs of living for adults with disabilities aged 50–65 across 15 countries of Europe using the Survey of Health, Aging, and Retirement in Europe (SHARE) data. Drawing on the standard of living approach of Zaidi and Burchardt, we compare the incomes required by households with and without adults with disabilities to obtain an equivalent standard of living. We advance upon this research by drawing on the cross-nationally harmonized data of adults aged 50+ from the SHARE. The results suggest that there are substantial extra costs of disability in these countries: around 44 percent of income for a household with an adult reporting a work-related disability and somewhat less than 30 percent of income for a household with an adult who receives disability benefits. Applying an equivalization scale based on these figures increases the overall poverty incidence rate, especially for households with disabled adult members. These findings thus have implications for analysing the entitlement and benefit levels for disability support programmes and for devising accurate poverty estimates concerning persons with disabilities.
    Keywords: costs of disability; disability insurance; poverty measurement; standard of living; work-disability
    JEL: N0
    Date: 2020–01–20
  25. By: Raquel Fonseca Benito; François Langot; Pierre-Carl Michaud; Thepthida Sopraseuth
    Abstract: Using a general equilibrium heterogeneous agent model featuring health production, we quantify the relative contribution of price distortions in the health market, TFP and other health risks in explaining cross-country differences in health expenditure (as a share of GDP) and health status. Estimated parameters reveal a substantial price wedge that explains at most 20% of the difference in health spending (as a share of GDP) and 30% of the difference in health status between Europe and the U.S. We estimate a one percentage point negative impact on the life-time cost-of-living of Americans from higher prices due to inefficiencies.
    Keywords: Health Production,Health Status,Heterogeneous Agent Model,Price Indices,
    JEL: C51 D61 E21 I10 I32
    Date: 2020–03–30
  26. By: Tarozzi,Alessandro; Maertens,Ricardo; Ahmed,Kazi Matin Uddin; van Geen,Alexander
    Abstract: Millions of villagers in Bangladesh are exposed to arsenic by drinking contaminated water from private wells. Testing for arsenic can encourage switching from unsafe wells to safer sources. This study describes results from a cluster randomized controlled trial conducted in 112 villages in Bangladesh to evaluate the effectiveness of different test selling schemes at inducing switching from unsafe wells. At a price of about USD0.60, only one in four households purchased a test. Sales were not increased by informal inter-household agreements to share water from wells found to be safe, or by visual reminders of well status in the form of metal placards mounted on the well pump. However, switching away from unsafe wells almost doubled in response to agreements or placards relative to the one in three proportion of households who switched away from an unsafe well with simple individual sales.
    Date: 2020–03–24
  27. By: Thomas, Ranjeeta; Burger, Ronelle; Hauck, Katharina
    Abstract: The socioeconomic gradient in chronic conditions is clear in the poorest and wealthiest of countries, but extant evidence on this relationship in low- and middle-income countries is inconclusive. We use data gathered between 2008 and 2012 from a nationally representative sample of over 10,000 South African adults, and objective health measures to analyse the differential effects of education, income and other factors on the prevalence of hypertension, individuals' awareness and control of hypertensive status. Prevalence of hypertension is high at 38% among women and 34% among men. 59% of hypertensive individuals are unaware of their status. We find prevalence and unawareness of hypertension are a public health concern across all income groups in South Africa. Higher income is however associated with effective control amongst men. Completing secondary education is associated with 7 mmHg lower blood pressure only in a small sub-group of women but is associated with 22 percentage point higher likelihood of effective hypertension control amongst women. We conclude that poorer and less educated individuals are particularly at high risk of cardiovascular disease in South Africa.
    Keywords: South Africa; hypertension; socioeconomic gradient; unawareness; control
    JEL: N0
    Date: 2018–11–01

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