nep-hea New Economics Papers
on Health Economics
Issue of 2020‒07‒13
fifty-two papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Application and Award Responses to Stricter Screening in Disability Insurance By Mathilde Godard; Pierre Koning; Maarten Lindeboom
  2. If Sick-Leave becomes More Costly, Will I go back to Work? Could it be too soon? By Olivier Marie; Judit Vall Castello
  3. Workplace presenteeism, job substitutability and gender inequality By Azmat, Ghazala; Hensvik, Lena; Rosenqvist, Olof
  4. In Sickness and in Health: Job Displacement and Health Spillovers in Couples By Gathmann, Christina; Huttunen, Kristiina; Jernström, Laura; Sääksvuori, Lauri; Stitzing, Robin
  5. Mental health and employment: a bounding approach using panel data By Mark L. Bryan; Nigel Rice; Jennifer Roberts; Cristina Sechel
  6. Dying to Work: Effects of Unemployment Insurance on Health By Alexander Ahammer; Analisa Packham
  7. Measuring the Spatial Distribution of Health Rankings in the United States By Will Davis; Alexander D. Gordan; Rusty Tchernis
  8. The effect of changes in alcohol tax differentials on alcohol consumption By Markus Gehrsitz; Henry Saffer; Michael Grossman
  9. Cities and Smoking By Michael Darden
  10. The Interaction Between Personality and Health Policy: Empirical Evidence from the UK Smoking Bans By Josten, Cecily; Lordan, Grace
  11. Effects of Passive Smoking on Prenatal and Infant Development: Lessons from the Past By Ciccarelli, Carlo; De Fraja, Gianni; Vuri, Daniela
  12. Coordination and Contagion: Individual Connections and Peer Mechanisms in a Randomized Field Experiment By Philip Babcock; Kelly Bedard; Stefanie Fischer; John Hartman
  13. Temperature, Disease, and Death in London: Analyzing Weekly Data for the Century from 1866-1965 By W. Walker Hanlon; Casper Worm Hansen; Jake W. Kantor
  14. Does Access to Health Care Mitigate Environmental Damages? By Jamie Mullins; Corey White
  15. 'More than One Red Herring'? Heterogeneous Effects of Ageing on Healthcare Utilisation By Joan Costa-i-Font; Cristina Vilaplana-Prieto
  16. Impact of Quality-based Procedures on orthopedic care quantity and quality in Ontario Hospitals By Alex Proshin; Lise Rochaix; Adrian Rohit Dass; Audrey Laporte
  17. Can inequalities in political participation explain health inequalities? By Reeves, Aaron; Mackenbach, Johan P.
  18. Preferences of a new health care profession. A pilot study with anaesthesia technologist trainees in Germany By Katharina Saunders; Christian Hagist; Alistair McGuire; Christian Schlereth
  19. Stress Test: Examining the Evolution of Teachers' Mental Health Over Time By Holt, Stephen B.; Wang, Rui; Gershenson, Seth
  20. Impact of Child Subsidies on Child Health, Well-being and Parental Investment in Human Capital: Evidence from Russian Longitudinal Monitoring Survey 2011-2017 By Alex Proshin
  21. The Long-Term Cognitive and Schooling Effects of Childhood Vaccinations in China By Hamid R. Oskorouchi; Alfonso Sousa-Poza; David E. Bloom
  22. Macroeconomic Conditions and Health in Britain: Aggregation, Dynamics and Local Area Heterogeneity By Janke, Katharina; Lee, Kevin; Propper, Carol; Shields, Kalvinder K; Shields, Michael
  23. Genetic Risks, Adolescent Health and Schooling Attainment By Vikesh Amin; Jere R. Behrman; Jason M. Fletcher; Carlos A. Flores; Alfonso Flores-Lagunes; Hans-Peter Kohler
  24. Parental Beliefs about Returns to Child Health Investments By Biroli, P.; Boneva, T.; Raja A.; Rauh, C.
  25. Partial Lockdown and the Spread of COVID-19: Lessons from the Italian Case By di Porto, Edoardo; Naticchioni, Paolo; Scrutinio, Vincenzo
  26. What Does and Does Not Correlate with COVID-19 Death Rates By Christopher R. Knittel; Bora Ozaltun
  27. The Political Scar of Epidemics By Aksoy, Cevat Giray; Eichengreen, Barry; Saka, Orkun
  28. The Short-Run Macro Implications of School and Child-Care Closures By Fuchs-Schündeln, Nicola; Kuhn, Moritz; Tertilt, Michèle
  29. COVID-19, Lockdowns and Well-Being: Evidence from Google Trends By Brodeur, Abel; Clark, Andrew E.; Fleche, Sarah; Powdthavee, Nattavudh
  30. The COVID-19 epidemic in rural U.S. counties By Cohen, Philip N.
  31. Trading Off Consumption and COVID-19 Deaths By Robert E. Hall; Charles I. Jones; Peter J. Klenow
  32. Trust in the Healthcare System and COVID-19 Treatment in the Developing World. Survey and Experimental Evidence from Armenia By Armenak Antinyan; Thomas Bassetti; Luca Corazzini; Filippo Pavesi
  33. Can privatisation of primary care contribute to the spread of antibiotic resistance? By Granlund, David; Zykova, Yana
  34. Impact of Covid 19 on Mental Health: Whether India is prepared to handle the crisis? By Sahoo, Harihar; Biswal, R.K.
  35. Risk Attitudes and Human Mobility during the COVID-19 Pandemic By Ho Fai Chan; Ahmed Skali; David Savage; David Stadelmann; Benno Torgler
  36. Can the World’s Poor Protect Themselves from the New Coronavirus? By Caitlin S. Brown; Martin Ravallion; Dominique van de Walle
  37. COVID-19 Employment Status Impacts on Food Sector Workers By Cho, Seung Jin; Lee, Jun Yeong; Winters, John V.
  38. Covid-19 Pandemic and Politics: The Cases of Florida and Ohio By YANO Makoto
  39. Does Policy Communication during COVID-19 Work? By Coibion, Olivier; Gorodnichenko, Yuriy; Weber, Michael
  40. On the Optimal "Lockdown" During an Epidemic By Gonzalez-Eiras, Martin; Niepelt, Dirk
  41. Infection Rates from Covid-19 in Great Britain by Geographical Units: A Model-based Estimation from Mortality Data By Kulu, Hill; Dorey, Peter
  42. Genetic diversity, disease prevalence and the coronavirus pandemic By Phiri, Andrew
  43. The Usual Suspects: Does Risk Tolerance, Altruism, and Health Predict the Response to COVID-19? By Ketki Sheth; Greg C. Wright
  44. Epidemics and Policy: The Dismal Trade-off By Francesco Flaviano Russo
  45. Optimal Epidemic Suppression under an ICU Constraint By Laurent Miclo; Daniel Spiro; Jörgen Weibull
  46. Estimating and Forecasting Disease Scenarios for COVID-19 with an SIR Model By Andrew Atkeson; Karen Kopecky; Tao Zha
  47. The Role of Institutional Trust in Medical Care Seeking during the COVID-19 Pandemic By Wong, Li Ping; Wu, Qunhong; Hao, Yanhua; Chen, Xi; Chen, Zhuo; Alias, Haridah; Shen, Mingwang; Hu, Jingcen; Duan, Shiwei; Zhang, Jinjie; Han, Liyuan
  48. Impact of virus testing on COVID-19 case fatality rate: estimate using a fixed-effects model By Anthony Terriau; Arthur Poirier; Julien Albertini; Quentin Le Bastard
  49. A systematic review on the suicide’s consequences of social isolation/and loneliness: a first approach to measure indirect effects of COVID-19 By Blázquez-Fernández, Carla; Lanza-León, Paloma; Cantarero-Prieto, David
  50. "The effect of health and economic costs on governments' policy responses to COVID-19 crisis, under incomplete information" By Germà Bel; Óscar Gasulla; Ferran A. Mazaira-Font
  51. Impact of COVID-19 in India: An Analysis of the Adversely Affected States and Districts By Kumar, Vijay
  52. Privatization and Pandemic: A Cross-Country Analysis of COVID-19 Rates and Health-Care Financing Structures By Jacob Assa; Cecilia Calderon

  1. By: Mathilde Godard (University of Lyon, CNRS, GATE UMR 5824, F-69130 Ecully, France); Pierre Koning (Leiden University, Vrije Universiteit, Amsterdam, IZA and Tinbergen Institute); Maarten Lindeboom (Vrije Universiteit, Amsterdam, Tinbergen Institute, Centre for Health Economics, Monash University, IZA)
    Abstract: We examine the targeting effects of stricter screening in the Dutch Disability Insurance (DI) program induced by a major nationwide reform. The drastic 2003 “Gatekeeper Protocol” raised DI application costs and revealed more information about individual true ability to work. Discontinuity-in-Time regressions on administrative data show substantial declines in DI application rates (a 40% decrease in one year), with the largest decline occurring in difficult-todiagnose impairments and less severe health disorders. This resulted in a more deserving pool of applicants. At the same time, those who stopped applying had worse health, worked less, and were more likely to be on UI and social assistance than workers who did not apply in the old system. There are no additional targeting gains at the point of the award decision, implying that changes in average health conditions of awardees were fully driven by self-screening and work resumption in the DI waiting period.
    Keywords: Disability Insurance, Screening, Targeting efficiency
    JEL: H2 I3
    Date: 2020
  2. By: Olivier Marie (Erasmus University Rotterdam); Judit Vall Castello (University of Barcelona)
    Abstract: We investigate the impact on work absence of a massive reduction in paid sick leave benefits. We exploit a policy change that only affected public sector workers in Spain and compare changes in the number and length of spells they take relative to unaffected private sector workers. Our results highlight a large drop in frequency mostly offset by increases in average duration. Overall, the policy did reduce number of days lost to sick leave. For some, however, return to work may have been premature as we document huge increases in both the proportion of relapses and working accidents rates.
    Keywords: Sickness Insurance, Paid Sick Leave, Absenteeism, Presenteeism, Relapses Contagious Diseases, Benefit Displacement, Working Accidents, Negative Externalities, Spain
    JEL: J32 I12 I13 I18 J22 J28
    Date: 2020–06–20
  3. By: Azmat, Ghazala (Sciences Po); Hensvik, Lena (Uppsala University, Department of Economics); Rosenqvist, Olof (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: Following the arrival of the first child, women’s absence rates soar and become less predictable due to the greater frequency of their own sickness and the need to care for sick children. In this paper, we argue that this fall in presenteeism in the workplace hurts women’s wages, not only indirectly and gradually, through a slower accumulation of human capital, but also immediately, through a direct negative effect on productivity in unique jobs (i.e., jobs with low substitutability). Although both presenteeism and uniqueness are highly rewarded, we document that women’s likelihood of holding jobs with low substitutability decreases substantially relative to men’s after the arrival of the first child. This gap persists over time, with important long-run wage implications. We highlight that the parenthood wage penalty for women could be reduced by organizing work in such a way that more employees have tasks that, at least in the short run, can be performed satisfactorily by other employees in the workplace.
    Keywords: first child; presenteeism; couples; job substitutability; gender wage gap
    JEL: J16 J22
    Date: 2020–06–23
  4. By: Gathmann, Christina (Heidelberg University); Huttunen, Kristiina (VATT, Helsinki); Jernström, Laura (University of Helsinki); Sääksvuori, Lauri (University of Turku); Stitzing, Robin (Aalto University)
    Abstract: We study how a negative labor market shock like job loss generates health spillovers in couples. Using administrative data of all workers and firms matched to mortality and patient records, we document that male job displacement increases the mortality risk for both the man and his partner. For every 10,000 displaced men, there are 27 additional deaths over a 5-year period rising to 115 additional deaths over two decades. Of those, 60% accrue to the displaced worker but 40% are due to excess spousal mortality. Deaths from cardiovascular diseases jump up and hospitalization records show more treatments for alcohol-related disorders and mental health issues. We also find a stunning gender asymmetry: while male job displacement generates large and persistent health effects, no such dire health consequences are observed after a woman loses her job. We explore three explanations for the observed health spillovers: risk sharing through spousal labor supply; earnings losses and the role of public insurance; and the influence of gender roles and family structure.
    Keywords: job displacement, mortality, spillovers, added worker, public insurance, gender roles
    JEL: I14 J21 J63 J12 D13
    Date: 2020–06
  5. By: Mark L. Bryan (Department of Economics, University of Sheffield, UK); Nigel Rice (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK); Jennifer Roberts (Department of Economics, University of Sheffield, UK); Cristina Sechel (Department of Economics, University of Sheffield, UK)
    Abstract: The disability employment gap is an issue of concern in most Western developed economies. This paper provides important empirical evidence on the influence of mental health on the probability of being in employment for prime age workers. We use longitudinal data and recently developed techniques, which use selection on observable characteristics to provide information on selection along unobservable factors, to estimate an unbiased effect of changes in mental health. Our results suggest that selection into mental health is almost entirely based on time-invariant characteristics, and hence fixed effects estimates are unbiased in this context. Our results indicate that transitioning into poor mental health leads to a reduction of 1.6 percentage points in the probability of employment. This is approximately 10 per cent of the raw employment gap. This effect is substantially smaller than the typical instrumental variable estimates, which dominate the literature, and often provide very specific estimates of a local average treatment effect based on an arbitrary exogenous shock. These findings should provide some reassurance to practitioners using fixed effects methods to investigate the impacts of health on work. They should also be useful to policy makers as the average effect of mental health on employment for those whose mental health changes is a highly relevant policy parameter.
    Keywords: Mental health, employment, fixed effects, Oster bounds, UKHLS
    JEL: I12 J14 J24
    Date: 2020–06
  6. By: Alexander Ahammer; Analisa Packham
    Abstract: Using administrative data for Upper Austrian workers from 2003--2013, we show that an extension in unemployment insurance (UI) duration increases unemployment length and impacts worker physical and mental health. These effects vary by gender. Specifically, we find that women eligible for an additional 9 weeks of UI benefits fill fewer opioid and antidepressant prescriptions and experience a lower likelihood of filing a disability claim, as compared to non-eligible unemployed women. Moreover, estimates indicate within-household spillovers for young children. For men, we find that extending UI benefit duration increases the likelihood of a cardiac event and eventual disability retirement filing.
    JEL: I18 I38 J18 J65
    Date: 2020–05
  7. By: Will Davis; Alexander D. Gordan; Rusty Tchernis
    Abstract: We rank counties in the United States of America with respect to population health. We utilize the five observable county health variables used to construct the University of Wisconsin Population Health Institute’s County Health Rankings (CHRs). Our method relies on a factor analysis model to directly compute weights for our rankings, incorporate county population sizes into the variances, and allow for spillovers of health stock across county lines. We find that demographic and economic variation explain a large portion of the variation in health rankings. We address the importance of uncertainty caused by imputation of missing data and show that the use of rankings leads to inherently greater uncertainty. Analyzing the health of counties both within and across state lines shows substantial degrees of disparity. We find some disagreement between our ranks and the CHRs, but we show that much can be learned by combining results from both methods.
    JEL: I1 I14
    Date: 2020–05
  8. By: Markus Gehrsitz (Department of Economics, University of Strathclyde & IZA); Henry Saffer (NBER); Michael Grossman (NBER, CUNY Graduate Center & IZA)
    Abstract: We show that tax-induced increases in alcohol prices can lead to substantial substitution and avoidance behavior that limits reductions in alcohol consumption. Causal estimates are derived from a natural experiment in Illinois where spirits and wine taxes were raised sharply and unexpectedly in 2009. Beer taxes were increased by only a trivial amount. We construct representative and consistent measures of alcohol prices and sales from scanner data collected for hundreds of products in several thousand stores across the US. Using several difference-in-differences models, we show that alcohol excise taxes are instantly over-shifted by a factor of up to 1.5. Consumers react by switching to less expensive products and increase purchases of low-tax alcoholic beverages, thus all but offsetting any moderate, tax-induced reductions in total ethanol consumption. Our study highlights the importance of tax-induced substitution, the implications of differential tax increases by beverage group and the impacts on public health of alternative types of tax hikes whose main aims are to increase revenue.
    Keywords: Health; Alcohol; Excise Taxes; Sin Taxes; Externalities; Difference-in-Differences
    JEL: I12 H21 D12 D62
    Date: 2020–06
  9. By: Michael Darden
    Abstract: In 1956, 52% of urban men and 42% of rural men smoked cigarettes. By 2010, the disparity had flipped: 24.7% of urban men and 30.6% of rural men smoked. Smoking remains the greatest preventable cause of mortality in the United States, and understanding the underlying causes of place-specific differences in behavior is crucial for policy aimed at reducing regional inequality. Using geocoded data from the National Longitudinal Survey of Youth, I estimate a dynamic model that captures smoking behavior, location decisions, and education over thirty years. Simulation of the estimated model demonstrates that selection on permanent unobserved variables that are correlated with smoking cessation, both in native populations and in those who migrate between rural and urban areas, explains 62.8$\%$ of the urban/rural smoking disparity. Alternatively, differential tobacco control policies explain only 7.3% of the urban/rural smoking disparity, which suggests that equalizing cigarette taxes across regions may fail to bridge gaps in behavior and health. This paper emphasizes that rural smoking disparities are largely driven by who selects into rural communities.
    JEL: H2 I12
    Date: 2020–06
  10. By: Josten, Cecily (London School of Economics); Lordan, Grace (London School of Economics)
    Abstract: We investigate whether responses to the UK public places smoking ban depend on personality. Drawing on individual level panel data from the British Household Panel Survey (BHPS) we exploit variation in the timing and location of these bans to establish their overall effect on smoking outcomes, and how this differs by personality. We measure personality using the Big Five personality traits. We are particularly interested in conscientiousness, given the evidence that it is a good proxy for self-control. Overall, we find that a one standard deviation increase in conscientiousness leads to a 1.4 percentage point reduction in the probability of smoking after the ban. Notably, this is the only Big Five personality trait that interacts with the smoking ban. This finding is very robust to different specifications.
    Keywords: smoking ban, personality, Five Factor Model, conscientiousness
    JEL: C23 D04 I10 I12 I18 H75
    Date: 2020–06
  11. By: Ciccarelli, Carlo; De Fraja, Gianni; Vuri, Daniela
    Abstract: This paper studies the effect of passive smoking on child development. We use data from a time when the adverse effects of smoking on health were not known, and when tobacco was not an inferior good. This allows us to disentangle the effect on foetuses and infants of smoking from that of other indicators of social and economic conditions. We exploit a set of unique longitudinal historical datasets defined at a detailed level of geographical disaggregation, namely the 69 Italian provinces. The datasets record precise information on the per capita consumption of tobacco products, the heights of twenty-year old conscripts in the second half of the 19th century Italy, and other relevant controls. We find a strong negative effect of smoking in the period before and after birth on the height at age 20. Results are robust to changes in specification and consistent across the height distribution.
    Keywords: Infant Development; Nineteenth Century Italy; Passive Smoking; Stature
    JEL: I12 J13 N33
    Date: 2020–03
  12. By: Philip Babcock (Department of Economics, University of California, Santa Barbara); Kelly Bedard (Department of Economics, University of California, Santa Barbara); Stefanie Fischer (Department of Economics, California Polytechnic State University); John Hartman (Department of Economics, University of California, Santa Barbara)
    Abstract: This paper investigates peer effects at the level of individual connections, leveraging the approach to shed light on peer mechanisms. In a field experiment using college freshmen, we elicited best friends and offered monetary incentives for gym visits to a treated subset. We find large spillovers from treated subjects to treated best friends but none from treated subjects to control best friends. We also find evidence of a mechanism: Subjects coordinate by visiting the gym with best friends, indicating that the intervention harnesses complementarities in utility or commitment mechanisms. Results highlight subtle peer effects and mechanisms that often go undetected.
    Date: 2019
  13. By: W. Walker Hanlon; Casper Worm Hansen; Jake W. Kantor
    Abstract: Using weekly mortality data for London spanning 1866-1965, we analyze the changing relationship between temperature and mortality as the city developed. Our results show that both warm and cold weeks were associated with elevated mortality in the late 19th-century, but heat effects, due mainly to infant deaths from digestive diseases, largely disappeared after WWI. The resulting change in the temperature-mortality relationship meant that thousands of heat-related deaths–equal to 0.8-1.3 percent of all deaths–were averted. Our findings also indicate that a series of hot years in the 1890s substantially changed the timing of the infant mortality decline in London.
    JEL: I15 N3 Q54
    Date: 2020–06
  14. By: Jamie Mullins (Department of Economics, University of Massachusetts, Amherst); Corey White (Department of Economics, California Polytechnic State University)
    Abstract: Differential access to health care is commonly cited as a source of heterogeneity in environmental health damages, yet little causal evidence exists to support such claims. We address this deficit in two settings by testing whether the negative impacts of ambient temperature exposure on mortality were mitigated by (1) access to primary care through the Community Health Center program, and (2) access to hospital care through the desegregation of Southern hospitals. The results demonstrate that increased access to health care can drive heterogeneity in environmental damages when the mode of care is sufficiently relevant to the damages suffered.
    Keywords: Health Care, Access, Climate, Temperature, Environment
    JEL: I10 I14 I18 Q50 Q52 Q54 Q58
    Date: 2019
  15. By: Joan Costa-i-Font; Cristina Vilaplana-Prieto
    Abstract: We study the effect of ageing, defined an extra year of life, on health care utilisation. We disentangle the direct effect of ageing, from other alternative explanations such as the presence of comorbidities and endogenous time to death (TTD) that are argued to absorb the effect of ageing (so-called ‘red herring’ hypothesis). We exploit individual level end of life data from several European countries that record the use of medicine, outpatient and inpatient care as well as long-term care. Consistently with a ‘red herring hypothesis’, we find that corrected TTD estimates are significantly different from uncorrected ones, and its effect size exceeds that of an extra year of life, which in turn is moderated by individual comorbidities. Corrected estimates suggest an overall attenuated effect of ageing, which does not influence outpatient care utilisation. These results suggest the presence of ‘more than one red herring’ depending on the type of health care examined.
    Keywords: time to death, ageing, health care utilization, hospital care, medicines use, home help use and comorbidity, endogeneous time to death (TTD), comorbidities
    JEL: I18
    Date: 2020
  16. By: Alex Proshin (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Hospinomics - PSE - Paris School of Economics); Lise Rochaix (Hospinomics - PSE - Paris School of Economics, PSE - Paris School of Economics); Adrian Rohit Dass (University of Toronto); Audrey Laporte (University of Toronto)
    Abstract: In 2012 the Ontario Ministry of Health introduced Quality-Based Procedures (QBPs), whereby for a selected set of medical interventions hospitals started to be reimbursed based on the price by volume formula, with the expectation that payments would be subsequently adjusted with respect to hospital performance on quality indicators. From the onset, unilateral hip and knee replacements were included in QBPs, whereas bilateral hip and knee replacements were added in 2014. In complement to QBPs, in 2012 the Health-Based Allocation Model (HBAM) was phased in allowing part of hospital funding to be tied to municipality-level patient and hospital characteristics. Using patient-level data from Canadian Discharge Abstract Database (DAD), we evaluate through a difference-in-difference approach the impact of QBPs/HBAM on the volume and quality of targeted procedures and other types of joint replacements plausibly competing for hospital resources. After controlling for patient, hospital and regional characteristics, we found a signi_cant decrease in acute length of stay associated to QBPs, as well as a marked shift towards patients being discharged home with/without post-operative supporting services. However, evidence with regards to spillover effects and quality improve ment across all joint replacement types is weak. Results are robust to various model specifications, and different estimation techniques, including matching methods and synthetic control groups.
    Date: 2020–06
  17. By: Reeves, Aaron; Mackenbach, Johan P.
    Abstract: Inequalities in health are pervasive and durable, but they are not uniform. To date, however, the drivers of these between-country patters in health inequalities remain largely unknown. In this analysis, we draw on data from 17 European countries to explore whether inequalities in political participation, that is, inequalities in voting by educational attainment, are correlated with health inequalities. Over and above a range of relevant confounders, such as GDP, income inequality, health spending, social protection spending, poverty rates, and smoking, greater inequalities in political participation remain correlated with higher health inequalities. If ‘politicians and officials are under no compulsion to pay much heed to classes and groups of citizens that do not vote’ then political inequalities could indirectly affect health through its impact on policy choices that determine who has access to the resources necessary for a healthy life. Inequalities in political participation, then, may well be one of the ‘causes of the causes’ of ill-health.
    Keywords: Health inequality; Mortality; Political economy; Political participation; Voting
    JEL: N0
    Date: 2019–08–01
  18. By: Katharina Saunders; Christian Hagist; Alistair McGuire; Christian Schlereth
    Abstract: The profession of anaesthesia technologist is a relatively new profession in Germany. The German hospital Association published the first training guideline in 2011. Likewise the surgical technologist profession, the profession of anaesthesia technologists are not officially certified. Hence, similar disadvantages such as further career restrictions and uncertainties in case of unemployment exist. Even the hospitals need to cover the full training expenses. The training of an anaesthesia technologist lasts three years, containing of practical work experience within the anaesthesia units such as the post-anaesthesia caring unit and a theoretical education. The action site is limited to the anaesthesia units only. An anaesthesia technologist is an assistant to the doctor and takes care of the patient before, during and after the anaesthesia. Since the anaesthesia technologist profession is a very young profession group, little is known about the preferences of this group. However, hospital manager need to understand the individual preferences to be able to provide a target group tailored recruitment. The motivation was to provide results to inform the human resource management of hospitals about the preferences of the very young profession group of anaesthesia technologist with respect to contribute to a successful development of this professi on in order to cope with the current labour shortage crisis.
    Keywords: DCE, labour shortage, specialised health care profession, job preferences
    JEL: I18 J08 J30 C93 C90
    Date: 2020–01–24
  19. By: Holt, Stephen B. (University at Albany, SUNY); Wang, Rui (Tulane University); Gershenson, Seth (American University)
    Abstract: Teaching is often assumed to be a relatively stressful occupation and occupational stress among teachers has been linked to poor mental health, attrition from the profession, and decreased effectiveness in the classroom. Despite widespread concern about teachers' mental health, however, little empirical evidence exists on long-run trends in teachers' mental health or the prevalence of mental health problems in teaching relative to other professions. We address this gap in the literature using nationally representative data from the 1979 and 1997 cohorts of the National Longitudinal Survey of Youth (NLSY). In the 1979 cohort, women who become teachers have similar mental health to non-teachers prior to teaching but enjoy better mental health than their non-teaching peers, on average, while working as teachers. However, in the 1997 cohort teachers self-report worse mental health, on average, than the 1979 cohort and fare no better than their non-teaching professional peers while teaching. Overall, teachers seem to enjoy mental health outcomes that are as good or better than their peers in other professions.
    Keywords: mental health, accountability, teacher quality, teacher retention
    JEL: I2
    Date: 2020–06
  20. By: Alex Proshin (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)
    Abstract: This study evaluates the impact of introducing Maternity Capital (MC) program child subsidy of 250,000 Rub (7,150 euros or 10,000 USD, in 2007) for giving birth to /adopting 2nd and subsequent children since January 2007. The reform made it possible for eligible Russian families to allocate these funds to improve family housing conditions, to sponsor children education, or to invest them in mother's retirement fund. The objective of this study is to evaluate the impact of the MC claim eligibility on various child outcomes and household-level consumption patterns. Using data from representative Russian Longitudinal Monitoring Survey 2011-2017, I test regression discontinuity models and find no significant difference in health, educational and well-being outcomes between children raised in MC claim eligible and ineligible families. In addition, no such differences were found in terms of household-level dietary habits and preferences. The results are robust to different and functional, semi- and non-parametric RDD specifications.
    Keywords: child subsidy,child outcomes,Maternity Capital,regression discontinuity
    Date: 2020–05
  21. By: Hamid R. Oskorouchi; Alfonso Sousa-Poza; David E. Bloom
    Abstract: By exploiting rich retrospective data on childhood immunization, socioeconomics, and health status in China (the China Health and Retirement Longitudinal Study), we assess the long-term effects of childhood vaccination on cognitive and educational outcomes in that country. To do so, we apply various techniques (e.g., propensity score and coarsened exact matching and correlated random effects) to different sets of conditioning variables and subsamples to estimate the average treatment on the treated effect of childhood vaccination. Our results confirm that vaccinations before the age of 15 have long-term positive and economically meaningful effects on nonhealth outcomes such as education and cognitive skills. These effects are relatively strong, with vaccinated individuals enjoying about one more year of schooling and performing substantially better later in life on several cognitive tests.
    JEL: I12 I18 I21
    Date: 2020–05
  22. By: Janke, Katharina; Lee, Kevin; Propper, Carol; Shields, Kalvinder K; Shields, Michael
    Abstract: We estimate a model that allows for dynamic and interdependent responses of morbidity in different local areas to economic conditions at the local and national level, with statistical selection of optimal local area. We apply this approach to quarterly British data on chronic health conditions for those of working age over the period 2002-2016. We find strong and robust counter-cyclical relationships for overall chronic health, and for five broad types of health conditions. Chronic health conditions therefore increase in poor economic times. There is considerable spatial heterogeneity across local areas, with the counter-cyclical relationship being strongest in poorer local areas with more traditional industrial structures. We find that feedback effects are quantitatively important across local areas, and dynamic effects that differ by health condition. Consequently, the standard panel data model commonly used in the literature considerably under-estimates the extent of the counter-cyclical relationship in our context.
    Keywords: aggregation; dynamics; health; Heterogeneity; macroeconomic conditions; Morbidity
    JEL: C33 E32 J10 J21
    Date: 2020–03
  23. By: Vikesh Amin (Central Michigan University); Jere R. Behrman (University of Pennsylvania); Jason M. Fletcher (University of Wisconsin-Madison, NBER, and IZA); Carlos A. Flores (California Polytechnic State University); Alfonso Flores-Lagunes (Syracuse University, IZA, and GLO); Hans-Peter Kohler (University of Pennsylvania)
    Abstract: We provide new evidence on the effect of adolescent health behaviors/outcomes (obesity, depression, smoking, and attention deficit hyperactivity disorder (ADHD)) on schooling attainment using the National Longitudinal Study of Adolescent to Adult Health. We take two different approaches to deal with omitted variable bias and reverse causality. Our first approach attends to the issue of reverse causality by using health polygenic scores (PGSs) as proxies for actual adolescent health. Second, we estimate the effect of adolescent health using sibling fixed-effects models that control for unmeasured genetic and family factors shared by siblings. We use the PGSs as additional controls in the sibling fixed-effects models to reduce concerns about residual confounding from sibling-specific genetic differences. We find consistent evidence across both approaches that being genetically predisposed to smoking and smoking regularly in adolescence reduces schooling attainment. We find mixed evidence for ADHD. Our estimates suggest that having a high genetic risk for ADHD reduces grades of schooling, but we do not find any statistically significant negative effects of ADHD on grades of schooling. Finally, results from both approaches show no consistent evidence for a detrimental effect of obesity or depression on schooling attainment.
    Keywords: adolescent health; polygenic scores; education
    JEL: I21 I10
    Date: 2020–06–28
  24. By: Biroli, P.; Boneva, T.; Raja A.; Rauh, C.
    Abstract: Childhood obesity has adverse health and productivity consequences and it poses negative externalities to health services. To shed light on the role of parents, we elicit parental beliefs about the returns and the persistence of a healthy diet and exercise routine in childhood. Parents believe both types of investments to improve child and adult health outcomes. Consistent with a model of taste formation, parents believe that childhood health behaviors persist into adulthood. We show that perceived returns are predictive of health investments and outcomes, and that less educated parents view the returns to health investments to be lower. Our descriptive evidence suggests that beliefs contribute to the socioeconomic inequality in health outcomes and the intergenerational transmission of obesity.
    Keywords: Parental Investments, Health, Beliefs, Inequality, Equality of Opportunity, Obesity
    JEL: D19 I10 I12 I14
    Date: 2020–03–11
  25. By: di Porto, Edoardo (University of Naples Federico II); Naticchioni, Paolo (University of Rome 3); Scrutinio, Vincenzo (University of Bologna)
    Abstract: This paper investigates the effect of the lockdown on COVID-19 infections. After the 22nd of March 2020, the Italian government shut down many economic activities to limit the contagion. Sectors deemed essentials for the economy were, however, allowed to remain active. We exploit the distribution of the density of essential workers across provinces and rich administrative data in a difference in difference framework. We find that a standard deviation increase in essential workers per square kilometre leads to an additional daily registered case per 100,000 inhabitants. This is a sizeable impact, and it represents about 18% of the daily increase in COVID-19 cases after the 22nd of March. Back of envelope computations suggest that the about one third of the cases considered could be attributed to the less stringent lockdown for essential sectors, with an additional 107 million Euros in direct expenditure. Although this assessment should be taken with caution, this suggests that the less stringent lockdown came at moderate public health related economic costs. In addition, we find that these effects are heterogeneous across sectors, with services having a much larger impact than Manufacturing, while there are only small differences across geographic areas. These results are stable across a wide range of specifications and robustness check.
    Keywords: COVID-19, lockdown, essential sectors
    JEL: J18 I18
    Date: 2020–06
  26. By: Christopher R. Knittel; Bora Ozaltun
    Abstract: We correlate county-level COVID-19 death rates with key variables using both linear regression and negative binomial mixed models, although we focus on linear regression models. We include four sets of variables: socio-economic variables, county-level health variables, modes of commuting, and climate and pollution patterns. Our analysis studies daily death rates from April 4, 2020 to May 27, 2020. We estimate correlation patterns both across states, as well as within states. For both models, we find higher shares of African American residents in the county are correlated with higher death rates. However, when we restrict ourselves to correlation patterns within a given state, the statistical significance of the correlation of death rates with the share of African Americans, while remaining positive, wanes. We find similar results for the share of elderly in the county. We find that higher amounts of commuting via public transportation, relative to telecommuting, is correlated with higher death rates. The correlation between driving into work, relative to telecommuting, and death rates is also positive across both models, but statistically significant only when we look across states and counties. We also find that a higher share of people not working, and thus not commuting either because they are elderly, children or unemployed, is correlated with higher death rates. Counties with higher home values, higher summer temperatures, and lower winter temperatures have higher death rates. Contrary to past work, we do not find a correlation between pollution and death rates. Also importantly, we do not find that death rates are correlated with obesity rates, ICU beds per capita, or poverty rates. Finally, our model that looks within states yields estimates of how a given state's death rate compares to other states after controlling for the variables included in our model; this may be interpreted as a measure of how states are doing relative to others. We find that death rates in the Northeast are substantially higher compared to other states, even when we control for the four sets of variables above. Death rates are also statistically significantly higher in Michigan, Louisiana, Iowa, Indiana, and Colorado. California's death rate is the lowest across all states.
    JEL: I1 Q5 R4
    Date: 2020–06
  27. By: Aksoy, Cevat Giray (European Bank for Reconstruction and Development); Eichengreen, Barry; Saka, Orkun (University of Essex)
    Abstract: What will be political legacy of the Coronavirus pandemic? We find that epidemic exposure in an individual's "impressionable years" (ages 18 to 25) has a persistent negative effect on confidence in political institutions and leaders. We find similar negative effects on confidence in public health systems, suggesting that the loss of confidence in political leadership and institutions is associated with healthcare-related policies at the time of the epidemic. In line with this argument, our results are mostly driven by individuals who experienced epidemics under weak governments with less capacity to act against the epidemic, disappointing their citizens. We provide evidence of this mechanism by showing that weak governments took longer to introduce policy interventions in response to the COVID-19 outbreak. These results imply that the Coronavirus may leave behind a long-lasting political scar on the current young generation ("Generation Z").
    Keywords: epidemics, trust, democracy, political approval, COVID-19
    JEL: D72 F50 I19
    Date: 2020–06
  28. By: Fuchs-Schündeln, Nicola (Goethe University Frankfurt); Kuhn, Moritz (University of Bonn); Tertilt, Michèle (University of Mannheim)
    Abstract: The COVID19 crisis has hit labor markets. School and child-care closures have put families with children in challenging situations. We look at Germany and quantify the macroeconomic importance of working parents. We document that 26 percent of the German workforce have children aged 14 or younger and estimate that 11 percent of workers and 8 percent of all working hours are affected if schools and child-care centers remain closed. In most European countries, the share of affected working hours is even higher. Policies to restart the economy have to accommodate the concerns of these families.
    Keywords: COVID-19, labor market, children, child-care, parents, workforce
    JEL: E24 E32 J22
    Date: 2020–06
  29. By: Brodeur, Abel; Clark, Andrew E.; Fleche, Sarah; Powdthavee, Nattavudh
    Abstract: The COVID-19 pandemic has led many governments to implement lockdowns. While lockdowns may help to contain the spread of the virus, they may result in substantial damage to population well-being. We use Google Trends data to test whether the lockdowns implemented in Europe and America led to changes in well-being related topic search terms. Using differences-in-differences and a regression discontinuity design to evaluate the causal effects of lockdown, we find a substantial increase in the search intensity for boredom in Europe and the US. We also found a significant increase in searches for loneliness, worry and sadness, while searches for stress, suicide and divorce on the contrary fell. Our results suggest that people's mental health may have been severely affected by the lockdown.
    Keywords: Boredom,COVID-19,Loneliness,Well-being
    JEL: I12 I31 J22
    Date: 2020
  30. By: Cohen, Philip N. (University of Maryland, College Park)
    Abstract: Having first reached epidemic proportions in coastal metropolitan areas, COVID-19 has spread around the country. Reported case rates vary across counties from zero to 125 per thousand population (around a state prison in the rural county of Trousdale, Tennessee). Overall, rural counties are underrepresented relative to their share of the population, but a growing proportion of all daily cases and deaths have been reported in rural counties. This analysis uses daily reports for all counties to present the trends and distribution of COVID-19 cases and deaths in rural counties, from late March to May 16, 2020. I describe the relationship between population density and case rates in rural and non-rural counties. Then I focus on noteworthy outbreaks linked to prisons, meat and poultry plants, and nursing homes, many of which are linked to high concentrations of Hispanic, American Indian, and Black populations. The growing epidemic in rural counties is apparently driven by outbreaks concentrated in these institutional settings, which are conducive to transmission. The impact of the epidemic in rural areas may be heightened due to their weaker health infrastructure and more vulnerable populations, especially due to age, socioeconomic status, and health conditions. As a result, the epidemic may contribute to the ongoing decline of health, economic, and social conditions in rural areas.
    Date: 2020–05–17
  31. By: Robert E. Hall; Charles I. Jones; Peter J. Klenow
    Abstract: This note develops a framework for thinking about the following question: What is the maximum amount of consumption that a utilitarian welfare function would be willing to trade off to avoid the deaths associated with the pandemic? The answer depends crucially on the mortality rate associated with the coronavirus. If the mortality rate averages 0.81%, taken from the Imperial College London study, our answer is 41% of one year's consumption. If the mortality rate instead averages 0.44% across age groups, our answer is 28%.
    JEL: E0 I10
    Date: 2020–06
  32. By: Armenak Antinyan (Wenlan School of Business, Zhongnan University of Economics and Law; National Research University Higher School of Economics, Moscow); Thomas Bassetti (Department of Economics ‘Marco Fanno’, University of Padua); Luca Corazzini (Department of Economics, University Of Venice Cà Foscari; Center for Experimental Research in Management and Economics (CERME)); Filippo Pavesi (School of Economics and Management, LIUC (Carlo Cattaneo University); Stevens Institute of Technology)
    Abstract: Concerns are looming that the healthcare systems in low- and middle-income countries (LMICs) are mostly unprepared to combat COVID-19 because of limited resources. The problems in LMICs are exacerbated by the fact that citizens in these countries generally exhibit low trust in the healthcare system, which could trigger a number of uncooperative behaviors. In this paper, we focus on one such behavior and investigate the relationship between trust in the healthcare system and the likelihood of potential treatment-seeking behavior upon the appearance of the first symptoms of COVID-19. First, we provide motivating evidence from a unique national on-line survey administered in Armenia — a post-Soviet LMIC country. We then present results from a large-scale survey experiment in Armenia that provides causal evidence in support of the investigated relationship. Our main finding is that a more trustworthy healthcare system enhances the likelihood of potential treatment-seeking behavior when observing the initial symptoms.
    Keywords: COVID-19, Epidemic, Healthcare system, Trust, Survey experiment
    JEL: C9 I12 I15
    Date: 2020
  33. By: Granlund, David (Department of Economics, Umeå University); Zykova, Yana (The Arctic University of Norway)
    Abstract: Growing rates of antibiotic resistance, caused by increasing antibiotic use, pose a threat by making antibiotics less effective in treating infections. In this paper, we studied whether physicians working at privately and publicly owned health centres differed in the likelihood of prescribing antibiotics and choosing broad-spectrum over arrow-spectrum antibiotics. To estimate the effect of ownership on the probability of a prescribed drug being an antibiotic, we analysed all 4.5 million prescriptions issued from 2011 to 2015 at primary health-centres in Västerbotten, Sweden. We then analysed how ownership affected the likelihood of a prescribed antibiotic being broad spectrum. We also used aggregated data to estimate the impact of the number of private health centres on the number of antibiotic prescriptions per inhabitant and the proportion of broad-spectrum antibiotics. The results show that, holding other factors constant, private physicians were 6% more likely to prescribe antibiotics and 9% more likely to choose broad-spectrum antibiotics. An increase by one additional private health centre was positively associated with an increase in the number of antibiotic prescriptions per inhabitant and a higher proportion, although not significant, of broad-spectrum antibiotic prescriptions.
    Keywords: Antibiotic resistance; prescription; ownership structure; salary; fee-for-service; capitation
    JEL: I11 I18 L33
    Date: 2020–06–25
  34. By: Sahoo, Harihar; Biswal, R.K.
    Abstract: The COVID-19 is clearly having a major impact on mental health by affecting our day to day functioning with increasing unemployment, separating families and various other changes. There is a worldwide fear, depression and panic because of this pandemic. The frequently updating of the worst case scenarios by the media can fuel fear and worry. The uncertainty and Isolation can lead to difficulty in sleeping or concentrating. Therefore, the objective of this study is to address the several issues related to mental health because of COVID-19 pandemic. Besides, it also identifies high risk populations of adverse mental health outcomes. Finally, we discuss whether India, the second-largest populous country in the world and enormous cultural diversity, is prepared to face the challenges that may arise in future. The study concludes by stating that, there is a need for real-time monitoring of mental health issues, across the population at-risk groups and also the frontline workers including healthcare professionals. Marginalized sections of the society including the elderly, undocumented migrants, homeless persons and those with mental illness should be given priority and extra effort should be made to obstruct from their deteriorated mental health conditions due to this pandemic.
    Keywords: Covid 19; Mental Health; Depression; Anxiety; India.
    JEL: I18
    Date: 2020–05–24
  35. By: Ho Fai Chan; Ahmed Skali; David Savage; David Stadelmann; Benno Torgler
    Abstract: Behavioral responses to pandemics are less shaped by actual mortality or hospitalization risks than they are by risk attitudes. We explore human mobility patterns as a measure of behavioral responses during the COVID-19 pandemic. Our results indicate that risk-taking attitude is a critical factor in predicting reduction in human mobility and increase social confinement around the globe. We find that the sharp decline in movement after the WHO (World Health Organization) declared COVID-19 to be a pandemic can be attributed to risk attitudes. Our results suggest that regions with risk-averse attitudes are more likely to adjust their behavioral activity in response to the declaration of a pandemic even before most official government lockdowns. Further understanding of the basis of responses to epidemics, e.g., precautionary behavior, will help improve the containment of the spread of the virus.
    Date: 2020–06
  36. By: Caitlin S. Brown; Martin Ravallion; Dominique van de Walle
    Abstract: We propose an index of the adequacy of home environments for protection (HEP) from COVID-19, and we compare our index across developing countries using data for one million sampled households from the latest Demographic and Health Surveys. We find that prevailing WHO recommendations for protection posit unrealistic home environments. 90% of households have inadequate HEP by one or more dimensions considered. 40% do not have a formal health-care facility within 5km. A strong wealth effect is indicated within and between countries. Only 6% of the poorest 40% have an adequate HEP, and the proportion is virtually zero in sub-Saharan Africa.
    JEL: I14 I15 O15
    Date: 2020–05
  37. By: Cho, Seung Jin (Iowa State University); Lee, Jun Yeong (Iowa State University); Winters, John V. (Iowa State University)
    Abstract: Food production and distribution is essential for human well-being, but the food sector has experienced a number of difficulties maintaining worker health and productivity during the COVID-19 pandemic. We examine employment status changes of persons recently employed in the U.S. food sector with a focus on food manufacturing and grocery stores. We find that the pandemic significantly reduced the probability of continued active employment for previous workers in both food manufacturing and grocery stores. Individual-level analysis confirms that the COVID-19 infection rate in an individual's local labor market is a strong and significant factor. The employment changes are not just due to unemployment during facility closures. Previous workers increasingly exit the labor force as the severity of the COVID-19 infection rate in their local area worsens. The considerable risk of infection drives many previous food sector workers to stop working altogether. Maintaining worker health and safety is essential for a stable food supply.
    Keywords: COVID-19, coronavirus, pandemic, food sector, employment, worker safety
    JEL: J2 Q1
    Date: 2020–06
  38. By: YANO Makoto
    Abstract: This study provides empirical evidence supporting that the coronavirus may spread in a natural manner, or the spread accelerates with community population, if both local and national leaders downplay the danger of the epidemic. People may compensate inadequate information and take self-protective actions to slow the spread, although it is not enough to stop the natural spread. The larger the number of core voters for the national leader, the larger community cases. These results are derived by comparing the coronavirus outbreaks in Florida, in which the governor follows President Trump's approach, and in Ohio, in which the governor has taken a much more cautious approach.
    Date: 2020–04
  39. By: Coibion, Olivier (University of Texas at Austin); Gorodnichenko, Yuriy (University of California, Berkeley); Weber, Michael (World Bank)
    Abstract: Using a large-scale survey of U.S. households during the Covid-19 pandemic, we study how new information about fiscal and monetary policy responses to the crisis affects households' expectations. We provide random subsets of participants in the Nielsen Homescan panel with different combinations of information about the severity of the pandemic, recent actions by the Federal Reserve, stimulus measures, as well as recommendations from health officials. This experiment allows us to assess to what extent these policy announcements alter the beliefs and spending plans of households. In short, they do not, contrary to the powerful effects they have in standard macroeconomic models.
    Keywords: subjective expectations, fiscal policy, monetary policy, COVID-19, surveys
    JEL: E31 C83 D84 J26
    Date: 2020–06
  40. By: Gonzalez-Eiras, Martin; Niepelt, Dirk
    Abstract: We embed a lockdown choice in a simplified epidemiological model and derive formulas for the optimal lockdown intensity and duration. The optimal policy reflects the rate of time preference, epidemiological factors, the hazard rate of vaccine discovery, learning effects in the health care sector, and the severity of output losses due to a lockdown. In our baseline specification a Covid-19 shock as currently experienced by the US optimally triggers a reduction in economic activity by two thirds, for about 50 days, or approximately 9.5 percent of annual GDP.
    Keywords: COVID-19; Epidemic; Health care system; lockdown; logistic model; Pandemic; Production shortfall; SIR model; social distancing
    JEL: I18
    Date: 2020–04
  41. By: Kulu, Hill; Dorey, Peter
    Abstract: This study estimates cumulative infection rates from Covid-19 in Great Britain by geographical units and investigates spatial patterns in infection rates. We propose a model-based approach to calculate cumulative infection rates from data on observed and expected deaths from Covid-19. Our analysis of mortality data shows that between 5 and 6% of people in Great Britain were infected by Covid-19 by the last third of April 2020. It is unlikely that the infection rate was lower than 3% or higher than 12%. Secondly, England had higher infection rates than Scotland and Wales, although the differences between countries were not large. Thirdly, we observed a substantial variation in virus infection rates in Great Britain by geographical units. Estimated infection rates were highest in the capital city of London where more than 10% of the population might have been infected and also in other major urban regions, while the lowest were in small towns and rural areas. Finally, spatial regression analysis showed that the virus infection rates increased with the increasing population density of the area and the level of deprivation. The results suggest that people from lower socioeconomic groups in urban areas (including those with minority backgrounds) were most affected by the spread of coronavirus in March and April.
    Date: 2020–05–21
  42. By: Phiri, Andrew
    Abstract: The COVID-19 disease outbreak is the deadliest viral pandemic our generation has experienced, and much uncertainty exists over the vulnerability of different populations to the virus since a clinically-approved vaccination does not exist. Our study investigates whether evolutionary processes such as genetic diversity and cultural behaviour norms can explain the differences in COVID-19 virus infections and mortalities observed in different countries. Using a sample of 133 countries we find that populations with higher expected genetic heterozygosity and more historical exposure to infectious diseases are associated with lower COVID-19 infections and mortalities. Further investigations reveal two ‘channels’ of transmission. Firstly, a longer migratory distance from the origins of homo sapiens adversely influences expected heterozygosity, which then increases the populations susceptibility to the COVID_19 virus. Secondly, higher disease prevalence leads to higher collectivism (lower individualism) behaviour, which then reduces the populations susceptibility to COVID_19 infections. Our analysis is robust to the inclusion of additional controls and dummies. Policy implications of our findings are discussed.
    Keywords: COVID-19; Expected heterozygosity; Disease prevalence; Collectivism; Individualism; Deep roots.
    JEL: C33 C36 C52 I18 Z1 Z13
    Date: 2020–06–17
  43. By: Ketki Sheth; Greg C. Wright
    Abstract: Using a registered pre-analysis plan, we survey college students during California’s Stay-at-Home order to test whether compliance with social distancing requirements depends on key parameters that affect their marginal benefit from doing so. We find a quarter of students violated the order. Yet, neither risk preference, altruism, nor preexisting health conditions were predictive of compliance. Our findings raise doubt about the efficiency of minimally enforced social distancing policies, as well as commonly assumed motivations for compliance. Our results also imply that that those with pre-existing health conditions may not voluntarily comply, resulting in higher health care congestion than otherwise expected.
    Keywords: COVID-19, risk, altruism, health
    JEL: I10 D80
    Date: 2020
  44. By: Francesco Flaviano Russo (Università di Napoli Federico II and CSEF)
    Abstract: I propose a stochastic SIR-Macro model to study the effects of alternative policies to cope with an epidemic. Lockdowns that order firms to close and that discontinues social activities slow down the epidemic progression at the cost of reducing GDP and increasing debt and, on average, decrease mortality. Testing strategies that identify and isolate a large number of infected but asymptomatics decrease mortality at a lower cost, but they are effective only if thorough. The more aggressive the pathogen, and the smaller the capacity of the health system, the bigger the gains from both policies. I also find that lockdowns work best in case of bigger average family size, diffused participation to the job market and bigger average workplace size.
    Keywords: Lockdown, Testing, Pathogen, Pandemic
    JEL: E1 I1 H12
    Date: 2020–06–23
  45. By: Laurent Miclo; Daniel Spiro; Jörgen Weibull
    Abstract: How much and when should we limit economic and social activity to ensure that the health-care system is not overwhelmed during an epidemic? We study a setting where ICU resources are constrained while suppression is costly (e.g., limiting economic interaction). Providing a fully analytical solution we show that the common wisdom of “flattening the curve”, where suppression measures are continuously taken to hold down the spread throughout the epidemic, is suboptimal. Instead, the optimal suppression is discountinuous. The epidemic should be left unregulated in a first phase and when the ICU constraint is approaching society should quickly lock down (a discontinuity). After the lockdown regulation should gradually be lifted, holding the rate of infected constant thus respecting the ICU resources while not unnecessarily limiting economic activity. In a final phase, regulation is lifted. We call this strategy “filling the box”.
    Keywords: Covid-19, corona, epidemic, pandemic, suppression, control optimality, health, infection.
    JEL: C61 D60 I18
    Date: 2020
  46. By: Andrew Atkeson; Karen Kopecky; Tao Zha
    Abstract: This paper presents a procedure for estimating and forecasting disease scenarios for COVID-19 using a structural SIR model of the pandemic. Our procedure combines the flexibility of noteworthy reduced-form approaches for estimating the progression of the COVID-19 pandemic to date with the benefits of a simple SIR structural model for interpreting these estimates and constructing forecast and counterfactual scenarios. We present forecast scenarios for a devastating second wave of the pandemic as well as for a long and slow continuation of current levels of infections and daily deaths. In our counterfactual scenarios, we find that there is no clear answer to the question of whether earlier mitigation measures would have reduced the long run cumulative death toll from this disease. In some cases, we find that it would have, but in other cases, we find the opposite — earlier mitigation would have led to a higher long-run death toll.
    JEL: C01 C02 C11
    Date: 2020–06
  47. By: Wong, Li Ping; Wu, Qunhong; Hao, Yanhua; Chen, Xi; Chen, Zhuo; Alias, Haridah; Shen, Mingwang; Hu, Jingcen; Duan, Shiwei; Zhang, Jinjie; Han, Liyuan
    Abstract: This paper investigates the associations between institution trust and public response to the COVID-19 outbreak. An Internet-based, cross-sectional survey was administered on January 29, 2020 to the epicenter Hubei province, China. A total of 4,393 adults who ≥18 years of age and residing or working in the province of Hubei were included in the study. The majority of the participants expressed a higher level of trust in the information and preventive instructions provided by the central government than by the local government. Being under quarantine (adjusted odds ratio (OR) = 2.35, 95% confidence interval (CI) 1.80–3.08) and having a high institutional trust score (OR = 2.23, 95% CI 1.96–2.53) were both strong and significant determinants of higher preventive behavior scores. The majority of study participants (85.7%, n = 3,640) reported that they would seek hospital treatment if they suspected themselves to have been infected with COVID-19. Few of the participants from Wuhan (16.6%, n = 475) and those participants who were under quarantine (13.8%, n = 550) expressed an unwillingness to seek hospital treatment. Institutional trust is an important factor influencing adequate preventive behavior and seeking formal medical care during an outbreak.
    Date: 2020
  48. By: Anthony Terriau (GAINS, University of Le Mans); Arthur Poirier (GAINS, University of Le Mans); Julien Albertini (Univ Lyon, Université Lumière Lyon 2, GATE UMR 5824, F-69130 Ecully, France); Quentin Le Bastard (MiHAR, University of Nantes)
    Abstract: In response to the coronavirus disease (COVID-19) pandemic, governments have adopted a variety of public health measures. In this study, we aimed to evaluate the impact of testing on the fatality rate. We use data on inpatients across French geographic areas and propose a novel methodology that exploits policy discontinuities at region borders to estimate the effect of testing symptomatic individuals on the case-fatality rate in France. Our identi?cation strategy is based on the fact that, in France, testing policies are determined regionally by the Regional Public Health Agencies. We compare all contiguous department pairs located on the opposite sides of a region border. Department pairs have different testing rates but share similar health trends. The heterogeneity in testing rate between department pairs together with the similarities in other dimensions allow us to mimic the existence of treatment and control groups and to identify the impact of testing on the mortality rate. We find that in France, the increase of one percentage point in the test rate is associated with a decrease of 0.001 percentage point in the death rate. Putting this number into perspective involves that for each additional 1000 tests, one person would have remained alive.
    Keywords: Tests, Covid-19, Case-fatality rate, fixed-effects model
    JEL: I10 C21
    Date: 2020
  49. By: Blázquez-Fernández, Carla; Lanza-León, Paloma; Cantarero-Prieto, David
    Abstract: Background: The present COVID-19 pandemic will negatively affect population public health. A huge economic and emotional impact can be expected because of this situation, contributing to mental health disorders or less healthy lifestyles, among others. The aim of this paper was to identify the relationship between “isolation” and suicides. Methods: In this regard, we had made a systematic review of the most recent papers, published from January 2016 to April 2020, thought the most acknowledged databases. This issue is very important due to the indirect relationship between COVID-19 and suicides. Results: Our analysis demonstrates that suicide and -social isolation and loneliness- have a positive and direct relationship although these findings varied slightly by region or areas. Moreover, the attention is focus on the youth during the most recent period and this is a real problem because economies cannot afford losing (young) population. Conclusions: In order to prevent suicides, public policies should prevent suicidal thoughts that it could induce to terminate the lives of individuals in their most productive years and harmful outcomes to their families and friends.
    Keywords: Suicides, social isolation, loneliness, systematic review
    JEL: I31
    Date: 2020–06
  50. By: Germà Bel (Departament d’Econometria, Estadística I Economia Aplicada- Universitat de Barcelona.); Óscar Gasulla (Hospital Universitari de Bellvitge – Universitat de Barcelona.); Ferran A. Mazaira-Font (Departament d’Econometria, Estadística I Economia Aplicada- Universitat de Barcelona.)
    Abstract: COVID-19 outbreak has become an unprecedented health, economic and social crisis. We build a theoretical model, based on which we develop an empirical strategy to analyze the drivers of the agility of policy response to the outbreak. Our empirical results show that government overconfidence in its own country capacity of health services and the intensity of expected economic costs from hard measures to manage the crisis delayed policy response. Contrarily, being a game against nature with incomplete information, increased knowledge and reduced uncertainty on other countries’ policy responses and on the epidemic development increased the agility of the country’s policy response.
    Keywords: COVID-19, Crisis management, Public policy, Policy response. JEL classification: D81, H12, I18.
    Date: 2020–06
  51. By: Kumar, Vijay
    Abstract: The progressive spread of the COVID-19 pandemic has created havoc with a high mortality rate worldwide. Countries took measures like the lockdown/shutdown of the economies, including India, which in turn badly hit the lower-income groups and daily wage earners especially the internal migrants. This study focuses specifically on the impact of different sectors in four states and six districts with a large number of COVID-19 cases in India. To emerge from this crisis, the paper would be analysing the situation and providing policy recommendations as well.
    Keywords: COVID-19; Impact on Different sectors; Current Scenario; Severely Infected Districts and States
    JEL: I11 I28 I31
    Date: 2020–06–14
  52. By: Jacob Assa (UNDP/HDRO); Cecilia Calderon (UNDP/HDRO)
    Abstract: The outbreak of coronavirus and the infectious disease it causes (COVID-19) have taken different paths around the world, with countries experiencing different rates of infection, case prevalence and mortality. This simultaneous yet heterogenous process presents a natural experiment for understanding some of the reasons for such different experiences of the same shock. This paper looks at the privatization of healthcare as one key determinant of this pattern. We use a cross-section dataset covering 147 countries with the latest available data. Controlling for per capita income, health inequality and several other control variables, we find that a 10% increase in private health expenditure relates to a 4.3% increase in COVID-19 cases and a 4.9% increase in COVID-19 related mortality. Globalization also has a small positive effect on COVID-19 prevalence, while higher hospital capacity (in beds per 1,000 people) is significant in lowering COVID-19 mortality. The findings suggest caution regarding policies which privatize healthcare systems in order to boost efficiency or growth in the short-run, as these reduce countries' long-term preparedness for dealing with pandemics.
    Date: 2020–06

This nep-hea issue is ©2020 by Nicolas R. Ziebarth. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.