nep-hea New Economics Papers
on Health Economics
Issue of 2020‒08‒31
fifty-five papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Dynamics of the Smoking Wage Penalty By Michael Darden; Julie L. Hotchkiss; M. Melinda Pitts
  2. The Intergenerational Transmission of Opioid Dependence: Evidence from Administrative Data By Ahammer, Alexander; Halla, Martin
  3. How Do Prescription Drug Monitoring Programs Reduce Opioid Prescribing? The Role of Hassle Costs versus Information By Abby E. Alpert; Sarah E. Dykstra; Mireille Jacobson
  4. Immigration Policy and Immigrants’ Sleep. Evidence from DACA By Giuntella, Osea; Lonsky, Jakub; Mazzona, Fabrizio; Stella, Luca
  5. Mortality Effects and Choice Across Private Health Insurance Plans By Jason Abaluck; Mauricio M. Caceres Bravo; Peter Hull; Amanda Starc
  6. Does economic recession impact newborn health? Evidence from Greece By Kyriopoulos, I.; Nikoloski, Zlatko; Mossialos, E.
  7. Parental Unemployment During the Great Recession and Childhood Adiposity By Jonathan Briody
  8. Conflict, Rockets, and Birth Outcomes: Evidence from Israel's Operation Protective Edge By Lichtman-Sadot, Shirlee; Benshalom-Tirosh, Neta; Sheiner, Eyal
  9. Genetic Risks, Adolescent Health and Schooling Attainment By Amin, Vikesh; Behrman, Jere R.; Fletcher, Jason M.; Flores, Carlos A.; Flores-Lagunes, Alfonso; Kohler, Hans-Peter
  10. Present Bias for Monetary and Dietary Rewards: Evidence from Chinese Teenagers By Cheung, Stephen L.; Tymula, Agnieszka; Wang, Xueting
  11. Health Economics of Genetic Distance By Jelnov, Pavel
  12. The impacts of alcohol taxes: A replication review By David Roodman
  13. Does tobacco spending crowd-out the household budget? Preliminary results using nationwide survey data By Kostakis, Ioannis
  14. NICE 'Optimised' Decisions: What is the Recommended Level of Patient Access? By Bulut, M.; O'Neill, P.; Cole, A.
  15. The Broader Value of Vaccines: The Return on Investment From a Governmental Perspective By Brassel, S.; Steuten, L.
  16. Realising the Broader Value of Vaccines in the UK By Brassel, S.; Neri, M.; O'Neill, P.; Steuten, L.
  17. A Bargaining Approach: A Theory on ICER Pricing and Optimal Level of Cost-Effectiveness Threshold By Berdud. M.; Ferraro. J.; Towse. A.
  18. Addressing Private Practice in Public Hospitals By Xidong Guo; Sarah Parlane
  19. Epidemics, inequality and poverty in preindustrial and early industrial times By Guido Alfani
  20. Does the Rise of Robotic Technology Make People Healthier? By Gunadi, Christian; Ryu, Hanbyul
  21. Health-policyholder clustering using health consumption By Romain Gauchon; Stéphane Loisel; Jean-Louis Rullière
  22. Benchmarked Risk Minimizing Hedging Strategies for Life Insurance Policies By Jin Sun; Eckhard Platen
  23. Retirement, Social Support and Mental Wellbeing: A Couple-level Analysis By Kettlewell, Nathan; Lam, Jack
  24. The Effect of Medical Marijuana Legalization on Pharmaceutical Payments to Physicians By Lebesmuehlbacher, Thomas; Smith, Rhet A.
  25. Investing in Ex Ante Regulation: Evidence from Pharmaceutical Patent Examination By Michael D. Frakes; Melissa F. Wasserman
  26. Stochastic Modelling of the COVID-19 Epidemic By Eckhard Platen
  27. Impact of (SARS-CoV-2) COVID 19 on the five main indigenous language-speaking areas in Veracruz Mexico: The case of the Huasteco from the Tantoyuca area By Medel-Ramírez, Carlos; Medel-López, Hilario
  28. Lifestyle and Mental Health Disruptions During COVID-19 By Giuntella, Giovanni; Hyde, Kelly; Saccardo, Silvia; Sadoff, Sally
  29. Nursing Home Staff Networks and COVID-19 By M. Keith Chen; Judith A. Chevalier; Elisa F. Long
  30. Pandemic Meets Pollution: Poor Air Quality Increases Deaths by COVID-19 By Isphording, Ingo E.; Pestel, Nico
  31. How Effective Are Social Distancing Policies? Evidence on the Fight against COVID-19 from Germany By Ulrich Glogowsky; Emanuel Hansen; Simeon Schächtele
  32. The social underpinnings of mental distress in the time of COVID-19-time for urgent action By Rose, Nikolas; Manning, Nick; Bentall, Richard; Bhui, Kamaldeep; Burgess, Rochelle; Carr, Sarah; Cornish, Flora; Devakumar, Delan; Dowd, Jennifer B.; Ecks, Stefan; Faulkner, Alison; Keene, Alex Ruck; Kirkbride, James; Knapp, Martin; Lovell, Anne M.; Martin, Paul; Moncrieff, Joanna; Parr, Hester; Pickersgill, Martyn; Richardson, Genevra; Sheard, Sally
  33. Population density index and its use for distribution of covid-19: A case study using Turkish data By Baser, Onur
  34. Measuring the Economic Risk of COVID-19 By Ilan Noy; Nguyen Doan; Benno Ferrarini; Donghyun Park
  35. Epidemic response to physical distancing policies and their impact on the outbreak risk By Fabio Vanni; David Lambert; Luigi Palatella
  36. Indirect consequences of COVID-19 on people’s lives. Findings from an on-line survey in France, Italy and Spain By Arpino, Bruno; Pasqualini, Marta; Bordone, Valeria; Solé-Auró, Aïda
  37. Racial and Ethnic Disparities in COVID-19: Evidence from Six Large Cities By Joseph A. Benitez; Charles J. Courtemanche; Aaron Yelowitz
  38. Are Less Developed Countries More Likely to Manipulate Data During Pandemics? Evidence from Newcomb-Benford Law By Vadim S. Balashov; Yuxing Yan; Xiaodi Zhu
  39. A note on pollution and infectious disease. By Guillaume MOREL
  40. Excess Mortality as a Predictor of Mortality Crises: The Case of COVID-19 in Italy By Ceriani, Lidia; Verme, Paolo
  41. COVID-19 Crisis Monitor: Assessing the Effectiveness of Exit Strategies in the State of São Paulo, Brazil By Haddad, Eduardo; Vieira, Renato; Araújo, Inácio; Ichihara, Silvio; Perobelli, Fernando; Bugarin, Karina
  42. Infectious diseases and meat production By Romain Espinosa; Damian Tago; Nicolas Treich
  43. Understanding the Relationship between Social Distancing Policies, Traffic Volume, Air Quality, and the Prevalence of COVID-19 Outcomes in Urban Neighborhoods By Daniel L. Mendoza; Tabitha M. Benney; Rajive Ganguli; Rambabu Pothina; Benjamin Krick; Cheryl S. Pirozzi; Erik T. Crosman; Yue Zhang
  44. The Impact of the COVID-19 Pandemic on the Demand for Density: Evidence from the U.S. Housing Market By Sitian Liu; Yichen Su
  45. The Short-Run Macro Implications of School and Child-Care Closures By Nicola Fuchs-Schündeln; Moritz Kuhn; Michèle Tertilt
  46. COVID-19 and external shock: economic impacts and policy options By Jaramillo, Miguel; Ñopo, Hugo
  47. Aggression in the workplace makes social distance difficult By Keisuke Kokubun
  48. Who Values Human Capitalists' Human Capital? Healthcare Spending and Physician Earnings By Joshua D. Gottlieb; Maria Polyakova; Kevin Rinz; Hugh Shiplett; Victoria Udalova
  49. Medical Worker Migration and Origin-Country Human Capital: Evidence from U.S. Visa Policy By Abarcar, Paolo; Theoharides, Caroline
  50. If the objective is herd immunity, on whom should it be built? By Christian Gollier
  51. Getting out while staying in: Park use decreased during the COVID-19 pandemic, especially where park availability was low By Curtis, David Stuart; Rigolon, Alessandro; Schmalz, Dorothy L; Brown, Barbara
  52. Short-term forecasting of the COVID-19 pandemic using Google Trends data: Evidence from 158 countries By Fantazzini, Dean
  53. The Cost of Being Unprepared or the Benefit of the Precautionary Principle? Comparing Cost-Benefit COVID-19 Policies and Outcomes in Scandinavia By Brooks A. Kaiser; Henning P. Joergensen; Lucas Porto Echave-Sustaeta; Maarten J. Punt; Simon Soelvsten; Chris Horbel; Eva Roth
  54. Does Policy Communication During COVID Work? By Olivier Coibion; Yuriy Gorodnichenko; Michael Weber; Michael Weber
  55. More than Words: Leaders' Speech and Risky Behavior During a Pandemic By Ajzenman, N.; Cavalcanti, T.; Da Mata, D.

  1. By: Michael Darden; Julie L. Hotchkiss; M. Melinda Pitts
    Abstract: Cigarette smokers earn significantly less than nonsmokers, but the magnitude of the smoking wage gap and the pathways by which it originates are unclear. Proposed mechanisms often focus on spot differences in employee productivity or employer preferences, neglecting the dynamic nature of human capital development and addiction. In this paper, we formulate a dynamic model of young workers as they transition from schooling to the labor market, a period in which the lifetime trajectory of wages is being developed. We estimate the model with data from the National Longitudinal Survey of Youth, 1997 Cohort, and we simulate the model under counterfactual scenarios that isolate the contemporaneous effects of smoking from dynamic differences in human capital accumulation and occupational selection. Results from our preferred model, which accounts for unobserved heterogeneity in the joint determination of smoking, human capital, labor supply, and wages, suggest that continued heavy smoking in young adulthood results in a wage penalty at age 30 of 14.8 percent and 9.3 percent for women and men, respectively. These differences are less than half of the raw mean difference in wages at age 30. We show that the contemporaneous effect of heavy smoking net of any life-cycle effects explains roughly 67 percent of the female smoking wage gap but only 11 percent of the male smoking wage gap.
    Keywords: wages; smoking; dynamic system of equations
    JEL: I10 I12
    Date: 2020–07–28
  2. By: Ahammer, Alexander (University of Linz); Halla, Martin (University of Linz)
    Abstract: To address the opioid crisis, it is crucial to understand its origins. We provide evidence for the intergenerational transmission of opioid dependence. Our analysis is based on administrative data covering the universe of Austrian births from 1984 to 1990. We consider prescription opioids and have a close proxy for addiction to illicit opioids. We find that, if at least one parent is using illicit opioids, the likelihood of the child using increases from 1.1 to 6.1%. For prescription opioids, we observe an increase from 4.6 to 7.7%. Both associations are stable and do not change when controlling for environmental variables.
    Keywords: opioids, prescription opioids, illicit opioids, heroin, addiction, drug abuse, intergenerational transmission, intergenerational correlation
    JEL: I12 I14 I18 J62
    Date: 2020–06
  3. By: Abby E. Alpert; Sarah E. Dykstra; Mireille Jacobson
    Abstract: Past work demonstrates that mandated prescription drug monitoring programs (PDMPs) decrease opioid prescribing, but provides limited evidence on mechanisms. We analyze Kentucky’s landmark PDMP mandate to disentangle the role of information versus hassle costs. PDMP mandates are meant to affect prescribing through information provision but may also unintentionally affect prescribing through the hassle cost of required record checks. On net, we find that although information clearly affected prescribing, hassle costs explain the majority of the decline in prescribing from this program. Hassle costs, however, did not deter physicians from prescribing opioids to the patients who would benefit the most
    JEL: I1 I18
    Date: 2020–07
  4. By: Giuntella, Osea; Lonsky, Jakub; Mazzona, Fabrizio; Stella, Luca
    Abstract: Stress is associated with sleep problems. And poor sleep is linked with mental health and depression symptoms. The stress associated with immigrant status and immigration policy can directly affect mental health. While previous studies have documented a significant relationship between immigration policy and the physical and mental health of immigrants, we know little about the effects that immigration policy may have on immigrants’ sleep patterns. Exploiting the approval of the Deferred Action for Childhood Arrivals (DACA) in 2012, we study how immigrants’ sleep behavior responds to a change in immigration policy. Consistent with previous research documenting positive effects of DACA on mental health, we find evidence of a significant improvement in immigrants’ sleep in response to this policy change. However, the estimated effects of the policy quickly disappear since 2016. While temporary authorization programs, such as DACA, may have beneficial impacts on immigrants’ sleep in the short-term, the effects of temporary programs can be rapidly undermined by the uncertainty on their future. Thus, permanent legalization programs may be more effective in achieving long-term effects, eliminating any uncertainty related to the undocumented immigrant legal status.
    Keywords: Immigration,Sleep,Mental health,DACA
    JEL: J15 I10
    Date: 2020
  5. By: Jason Abaluck; Mauricio M. Caceres Bravo; Peter Hull; Amanda Starc
    Abstract: Competition in health insurance markets may fail to improve health outcomes if consumers are not willing to pay for high quality plans. We document large differences in the mortality rates of Medicare Advantage (MA) plans within local markets. We then show that when high (low) mortality plans exit these markets, enrollees tend to switch to more typical plans and subsequently experience lower (higher) mortality. We develop a framework that uses this variation to estimate the relationship between observed mortality rates and causal mortality effects; we find a tight link. We then extend the framework to study other predictors of mortality effects and estimate consumer willingness to pay. Higher spending plans tend to reduce enrollee mortality, but existing quality ratings are uncorrelated with plan mortality effects. Consumers place little weight on mortality effects when choosing plans. Moving beneficiaries out of the bottom 5% of plans could save tens of thousands of elderly lives each year.
    JEL: C26 I11 J14
    Date: 2020–07
  6. By: Kyriopoulos, I.; Nikoloski, Zlatko; Mossialos, E.
    Abstract: This study examines the impact of the Greek recession on newborn health. Using a large administrative dataset of 838,700 births from 2008 to 2015, our analysis shows that birth weight (BW) and pregnancy length are generally procyclical with respect to prenatal economic climate, while the risk of low birth weight and preterm birth are both countercyclical. We report heterogeneity in the relationship between business cycle fluctuations during pregnancy and newborn health across socioeconomic groups. Birth outcomes of children born to low socioeconomic status (SES) families are sensitive to economic fluctuations during the first and third trimesters of the pregnancy, whereas those of high-SES newborns respond to economic volatility only in the first trimester. These results are robust, even after using different measures of economic climate and uncertainty. After accounting for potential selection into pregnancy, we find that in utero exposure to economic crisis is linked with a BW loss, which is driven by the low-SES children. Our findings have social policy implications. The impact of economic crisis on birth indicators is more detrimental for the low-SES children, resulting in a widening of the BW gap between children of low- and high-SES families. This could, in turn, exacerbate long-term socioeconomic and health inequalities and hinder social mobility.
    Keywords: Birth outcomes; Birth weight; Business cycle fluctuations; Economic crisis; Greece; Newborn health; Recession
    JEL: N0
    Date: 2019–09–01
  7. By: Jonathan Briody
    Abstract: The incidence of adiposity in the early years of life has outgrown the prevalence rate in older children and adolescents globally; however, the relationships between unemployment and weight are predominantly studied in adults. This study examines the relationship between changing economic conditions during the Irish recession and child weight. Fixed effect logistic regression is used to examine the effects of parental unemployment on weight using the Growing up in Ireland infant cohort from 2008 to 2013. This study is the first to use longitudinal anthropometric measurements to estimate the impact of parental unemployment on children’s weight before, during and after a recession. Child growth charts are used to quantify children according to overweight for BMI, weight for age, and weight for height measures. For BMI, the probability of a child being overweight is 6 percentage points higher if either parent has experienced unemployment. For weight for age the probability is of similar magnitude across several alternative growth charts and definitions of adiposity. The analysis is repeated, cross-sectionally, for physical activity and diet to clarify mechanisms of effect. The probability of a child consuming healthy food and physical activity with an implied cost is lower if either parent becomes unemployed. A focus on excess adiposity in the early years is of crucial importance as if current trends are not addressed a generation of children may grow up with a higher level of chronic disease.
    Keywords: Health; Panel data; Unemployment; The Great Recession; Children
    JEL: I12 I18 C33 J10 J13
    Date: 2020–05
  8. By: Lichtman-Sadot, Shirlee (Ben Gurion University); Benshalom-Tirosh, Neta (Ben Gurion University); Sheiner, Eyal (Ben Gurion University)
    Abstract: In summer 2014, southern Israel experienced rocket attacks from the Hamas-ruled Gaza strip on a nearly daily basis for over 50 consecutive days. We exploit this unexpected escalation in the Israeli-Palestinian conflict and variation across localities in Israel in the amount of sirens that warned of rocket attacks to measure the effect of conflict intensity on birth weight and gestation length among mothers who were pregnant during this period. In addition to the common notion that conflict intensity induces stress and anxiety, we also show that conflict intensity is correlated with absences from work and lack of prenatal care. Results on changes in birth outcomes are consistent with a detrimental effect of stress and reduced prenatal care and a beneficial effect of reduced work attendance during pregnancy. Our results demonstrate that multiple factors can impact birth outcomes when evaluating the effect of armed conflict and that the effects can also be qualitatively different.
    Keywords: birth outcomes, prenatal stress, prenatal care, Israeli-Palestinian conflict
    JEL: I10 I12
    Date: 2020–06
  9. By: Amin, Vikesh; Behrman, Jere R.; Fletcher, Jason M.; Flores, Carlos A.; Flores-Lagunes, Alfonso; Kohler, Hans-Peter
    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
  10. By: Cheung, Stephen L. (University of Sydney); Tymula, Agnieszka (University of Sydney); Wang, Xueting (University of Sydney)
    Abstract: Economists model self-control problems through time-inconsistent preferences. Empirical tests of these preferences largely rely on experimental elicitation methods using monetary rewards, with several recent studies failing to find present bias for money. In this paper, we compare estimates of present bias for money with estimates for healthy and unhealthy foods. In a within-subjects longitudinal experiment with 697 low-income Chinese high school students we find strong present bias for both money and food, and that individual measures of present bias are moderately correlated across reward types. Our experimental measures of time preferences over money predict field behaviours better than preferences elicited over foods.
    Keywords: self-control, quasi-hyperbolic discounting, present bias, adolescents, food rewards
    JEL: C91 D12 D80 D91
    Date: 2020–06
  11. By: Jelnov, Pavel
    Abstract: In this note, I address the trade-off between children’s health and parental preference toward similarity with children. In my model, better-off individuals mate genetically close partners and then use wealth to treat their children’s health problems, caused by inbreeding depression. As a result, the relationship between parental wealth and children’s health includes decreasing portions. Siblings health inequality is also nonmonotonically related to parental wealth, if parents discriminate in favor of more similar children.
    Keywords: inbreeding,genetic distance,health inequality
    JEL: J12 J13 N30
    Date: 2020
  12. By: David Roodman
    Abstract: This paper reviews the research on the impacts of alcohol taxation outcomes such as heavy drinking and mortality. Where data availability permits, reviewed studies are replicated and reanalyzed. Despite weaknesses in the majority of studies, and despite seeming disagreements among the more credible one--ones based on natural experiments--we can be reasonably confident that taxing alcohol reduces drinking in general and problem drinking in particular. The larger and cleaner the underlying natural experiment, the more apt a study is to detect impacts on drinking. Estimates from the highest-powered study settings, such as in Alaska in 2002 and Finland in 2004, suggest an elasticity of mortality with respect to price of -1 to -3. A 10% price increase in the US would, according to this estimate, save 2,000-6,000 lives and 48,000-130,000 years of life each year.
    Date: 2020–07
  13. By: Kostakis, Ioannis
    Abstract: The aim of this paper is to examine the crowding out effect of tobacco spending on other household commodity groups. It uses a national representative household sample survey retrieved from Hellenic Statistical Authority for the year 2017. A system of conditional Engel curve formula was estimated for a set of 12 commodity groups based on Eurostat categorization. Results reveal that spending on tobacco leads to a household budget allocation having a negative effect on certain commodity groups such as food, clothes, health and durables and positive on communication, education and spending on hotels and restaurants. Policy implications suggest that a regressive policy recommendation that result a cut tobacco effect could lead to a better wellbeing and household health status with a more sustainable consuming behavior.
    Keywords: Tobacco; Crowd out; Greece; Expenditure
    JEL: D1 D10
    Date: 2020–08
  14. By: Bulut, M.; O'Neill, P.; Cole, A.
    Abstract: The National Institute of Health and Care Excellence (NICE) makes recommendations for the use of interventions including medicines in the National Health Service in England based on their clinical and cost-effectiveness. Over the last 20 years 82% of technology appraisal recommendations have been 'positive'. However, around one third of these are 'optimised' recommendations. In this report we quantify the patient access associated with NICE 'optimised' recommendations. We evaluated optimised recommendations published between 2015 and 2019; 40 contained sufficient information to estimate recommended patient access levels. In about two-thirds (65%) of optimised recommendations evaluated, NICE recommended use for less than half of eligible patients. While the justification for these restrictions may be well-founded, more granular reporting of recommendations would help paint a more accurate picture of recommended levels of patient access associated with NICE decision outcomes.
    Keywords: Value, Affordability, and Decision Making
    JEL: I1
    Date: 2020–07–01
  15. By: Brassel, S.; Steuten, L.
    Abstract: Most value assessments of vaccination programs are carried out by taking the perspective of the health system. To stimulate the debate concerning the broader value of vaccination beyond this perspective, this report quantifies the related return on investment to the UK government. A sample of three vaccination programs from the UK vaccination schedule was selected for a form of fiscal health modelling. The model is intended to complement the regular cost-effectiveness assessment of vaccines from a health-system perspective. The results demonstrate that a significant part of the value generated by vaccination programs accrues outside the healthcare system's perspective.
    Keywords: Economics of Health Technology Assessment; Value, Affordability, and Decision Making
    JEL: I1
    Date: 2020–08–01
  16. By: Brassel, S.; Neri, M.; O'Neill, P.; Steuten, L.
    Abstract: Many health technology assessment (HTA) agencies limit their assessment of vaccines to individual health benefits and the costs associated with vaccine administration and the disease avoided. However, compared to other health technologies, the standard evaluation approaches have often been criticised as inadequate to accurately estimate the value of vaccines. This study uses a newly designed framework to capture the broader value of 10 selected vaccines with a high likelihood of entering the UK within the next decade. The findings qualify the critical gaps between value generation through vaccination and value recognition by relevant regulators. Recommendations are given to prevent the systematic undervaluation of future vaccines.
    JEL: I1
    Date: 2020–08–01
  17. By: Berdud. M.; Ferraro. J.; Towse. A.
    Abstract: This paper presents a supply and demand model of pharmaceutical markets to analyse the relationship between the value of the Cost-Effectiveness Threshold (CET) and the distribution of the health and economic value of new medicines between consumers (payers) and developers (life science industry). As a novelty, the model incorporates a bargaining process and bargaining power distributed between the payer and the developers, which has an impact on the distribution of the health and economic value of new medicines between the two parties. One of the key findings of the paper is that, with sufficiently large payer's bargaining power, an efficient CET value, which distributes health and economic value evenly between the payer and developers, could be higher than the supply-side CET. The paper includes a user-friendly executive summary summarising key results of the paper and discussing its policy implications.
    Keywords: Economics of Innovation; Value, Affordability, and Decision Making
    JEL: I1
    Date: 2020–07–01
  18. By: Xidong Guo; Sarah Parlane
    Abstract: This paper proposes a theoretical analysis of the private provision of care within public hospitals and assesses its impact on the quality and cost of healthcare. We also capture this policy’s impact on the number of outpatients that are seen and the number that are cured. We show that the private income gathered by consultants engaged in dual practice has a negative impact on the level of care being provided as it incentivises consultants to focus on the number of patients seen. However, the private fees generate lower healthcare costs. Hence the removal of private practice in public hospitals is only optimal when the benefit associated with curing patients is large enough. The impact on waiting lists is ambiguous. Considering that consultants may differ in their ability, we show that the optimal contracts enable senior doctors (with more experience) to get a greater private income than junior doctors when discrimination between senior and junior physicians is allowed. When discrimination is not allowed, it is optimal to offer a uniform contract. Proposing distinct contracts, as currently done in Ireland, increases healthcare costs due to incentive compatibility issues.
    Keywords: Healthcare; Public hospital; Dual practice; Optimal contracts; Consultant incentives
    JEL: D86 I11 I18 L32
    Date: 2020–05
  19. By: Guido Alfani (Bocconi University, Department of Social and Political Science, Dondena Centre and IGIER)
    Abstract: Recent research has explored the distributive consequences of major historical epidemics, and the current crisis triggered by Covid-19 induces to look at the past for insights about how pandemics can affect inequalities in income, wealth, and health. The fourteenth-century Black Death, which is usually credited to have led to a significant reduction in economic inequality, has attracted the greatest attention. However, the picture becomes much more complex if other epidemics are considered. This article covers the worst epidemics of preindustrial times, from Justinian’s Plague of 540-41 to the last great European plagues of the seventeenth century, as well as the cholera waves of the nineteenth. It shows how the distributive outcomes of lethal epidemics do not only depend upon mortality rates, but are mediated by a range of factors, chief among them the institutional framework in place at the onset of each crisis. It then explores how past epidemics affected poverty, arguing that highly lethal epidemics could reduce its prevalence through two deeply different mechanisms: redistribution towards the poor, or extermination of the poor. It concludes by recalling the historical connection between the progressive weakening and spacing in time of lethal epidemics and improvements in life expectancy, and by discussing how epidemics affected inequality in health and living standards.
    Keywords: epidemic, pandemics, inequality, poverty, plague, Black Death, cholera, preindustrial times, wealth concentration, middle ages, early modern period
    JEL: D31 D63 I14 I30 J11 N30 N33
    Date: 2020–08
  20. By: Gunadi, Christian; Ryu, Hanbyul
    Abstract: Technological advancements bring changes to our life, altering our behaviors as well as our role in the economy. In this paper, we examine the potential effect of the rise of robotic technology on health. The results of the analysis suggest that higher penetration of industrial robots in the local labor market is positively related to the health of the low-skilled population. A ten percent increase in robots per 1,000 workers is associated with an approximately 10% reduction in the fraction of low-skilled individuals reporting poor health. Further analysis suggests that reallocation of tasks and reduction in unhealthy behavior partly explain this finding.
    Keywords: Automation,Robots,Health
    JEL: I10 I13 J24 O33
    Date: 2020
  21. By: Romain Gauchon (SAF - Laboratoire de Sciences Actuarielle et Financière - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon); Stéphane Loisel (SAF - Laboratoire de Sciences Actuarielle et Financière - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon); Jean-Louis Rullière (SAF - Laboratoire de Sciences Actuarielle et Financière - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon)
    Abstract: On paper, prevention appears to be a good complement to health insurance. However, its implementation is often costly. To maximize the impact and efficiency of prevention plans these should target particular groups of policyholders. In this article, we propose a way of clustering policyholders that could be a starting point for the targeting of prevention plans. This two-step method mainly classifies using policyholder health consumption. This dimension is first reduced using a Nonnegative matrix factorization algorithm, producing intermediate health-product clusters. We then cluster using Kohonen's map algorithm. This leads to a natural visualization of the results, allowing the simple comparison of results from different databases. We apply our method to two real health-insurer datasets. We carry out a number of tests (including tests on a text-mining database) of method stability and clustering ability. The method is shown to be stable, easily-understandable, and able to cluster most policyholders efficiently.
    Keywords: Kohonen self-organizing map,Prevention,Non negative Matrix Factorization NMF,Health insurance claims databases,Clustering Algorithm
    Date: 2020
  22. By: Jin Sun; Eckhard Platen (Finance Discipline Group, UTS Business School, University of Technology Sydney)
    Abstract: Traditional life insurance policies offer no equity investment opportunities for the premium paid, and suffer from low returns over the long insurance terms. Modern equity-linked insurance policies offer equity investment opportunities exposed to equity market risk. To combine the low-risk of traditional policies with the high returns offered by equity-linked policies, we consider insurance policies under the benchmark approach (BA), where the policyholders’ funds are invested in the growth-optimal portfolio and the locally risk-free savings account. Under the BA, life insurance policies can be delivered at their minimal costs, lower than the classical actuarial theory predicts. Due to unhedgeable mortality risk, life insurance policies cannot be fully hedged. In this case benchmarked risk-minimization can be applied to obtain hedging strategies with minimally fluctuating profit and loss processes, where the fluctuations can further be reduced through diversification.
    Keywords: benchmark approach; benchmarked risk minimization; life insurance; mortality model
    JEL: G13 G22
    Date: 2019–03–01
  23. By: Kettlewell, Nathan (University of Technology, Sydney); Lam, Jack (University of Queensland)
    Abstract: Social support is increasingly acknowledged as an important resource for promoting wellbeing. We test whether social support changes around retirement. We also examine whether social support moderates dynamics in mental wellbeing around retirement and consider both own and spouse's retirement. Using longitudinal data from Australia, we find little effect of own or spouse's retirement on social support. However, in fixed-effects models, dynamics in mental wellbeing are significantly different between those with low/high social support. Using pension eligibility as an instrument, we find that own retirement causally improves mental wellbeing for women (weaker evidence for men) and by a similar degree for those with low/high social support. We also estimate responses to life satisfaction and find evidence that spill-over benefits from spousal retirement are much larger for individuals with low social support.
    Keywords: retirement, social support, Australia, couples, mental wellbeing
    JEL: I10 H55 J14 J26
    Date: 2020–06
  24. By: Lebesmuehlbacher, Thomas; Smith, Rhet A.
    Abstract: Although cannabis is federally prohibited, a majority of U.S. states have implemented medical cannabis laws (MCLs). As more individuals consider the drug for medical treatment, they potentially substitute away from prescription drugs. Therefore, an MCL signals competitor entry. This paper exploits geographic and temporal variation in MCLs to examine the strategic response in direct-to-physician marketing by pharmaceutical firms as cannabis enters the market. We use office detailing records from 2014-2018 aggregated to the county level and find detailing increases by 7% in the quarter an MCL is proposed. The increase is temporary, however, and attenuates after MCL approval. We then incorporate physician-level cannabis recommendation data from Florida and find opioid detailing to cannabis-friendly doctors declines following MCL enactment. Although we find weak evidence of a similar decline in our primary analysis, the effects are muted at the aggregate level by the small percent of doctors that recommend cannabis.
    Keywords: Cannabis, Medical Marijuana, Prescription Drugs, Competitor Entry, Detailing
    JEL: D22 D78 I11 L21
    Date: 2020–08
  25. By: Michael D. Frakes; Melissa F. Wasserman
    Abstract: The debate surrounding escalating prescription drug prices has increasingly focused on the legitimacy of the practice of brand-name manufacturers receiving patent protection on peripheral features of the drug such as the route of administration, as opposed to just the active-ingredient itself. The key question is whether these later-obtained, secondary patents protect novel features and represent true innovation or, instead, provide little to no innovative benefit and improperly delay generic entry. In this paper, we explore how the Patent Office may improve the quality of the secondary patents issued—thereby reducing the degree of unnecessary and harmful delays of generic entry—by giving examiners more time to review patent applications. Our findings suggest that current examiner time allocations are causing patent examiners to issue low quality secondary patents on the margin. We further set forth evidence suggesting that the costs to investing in greater ex ante scrutiny of secondary pharmaceutical patent applications by the Patent Office are greatly outweighed by the benefits, which include the avoidance of downstream litigation expenses and gains to consumer and total surplus from reduced drug prices.
    JEL: I18 O34
    Date: 2020–07
  26. By: Eckhard Platen (Finance Discipline Group, UTS Business School, University of Technology Sydney)
    Abstract: The need for the management of risks related to the COVID-19 epidemic in health, economics, finance and insurance became obvious after its outbreak. As a basis for respective quantitative methods, the paper models in a novel manner the dynamics of an epidemic via a four-dimensional stochastic differential equation. Crucial time dependent input parameters include the reproduction number, the average number of externally new infected and the average number of new vaccinations. The proposed model is driven by a single Brownian motion. When fitted to COVID-19 data it generates the typically observed features. In particular, it captures widely noticed fluctuations in the number of newly infected. Fundamental probabilistic properties of the dynamics of an epidemic can be deduced from the proposed model. These form a basis for managing successfully an epidemic and related economic and financial risks. As a general tool for quantitative studies a simulation algorithm is provided. A case study illustrates the model and discusses strategies for reopening the Australian economy during the COVID-19 epidemic.
    Keywords: stochastic epidemic model; stochastic differential equations; squared Bessel process, COVID-19 epidemic; simulation
    Date: 2020–04–01
  27. By: Medel-Ramírez, Carlos; Medel-López, Hilario
    Abstract: The importance of the working document is that it allows the analysis of the information and the status of cases associated with (SARS-CoV-2) COVID-19 as open data at the municipal, state and national level, with a daily record of patients, according to a age, sex, comorbidities, for the condition of (SARS-CoV-2) COVID-19 according to the following characteristics: a) Positive, b) Negative, c) Suspicious. Likewise, it presents information related to the identification of an outpatient and / or hospitalized patient, attending to their medical development, identifying: a) Recovered, b) Deaths and c) Active, in Phase 3 and Phase 4, in the five main population areas speaker of indigenous language in the State of Veracruz - Mexico. The data analysis is carried out through the application of a data mining algorithm, which provides the information, fast and timely, required for the estimation of Medical Care Scenarios of (SARS-CoV-2) COVID-19, as well as for know the impact on the indigenous language speaking population in Veracruz. For this purpose, the following study zones are presented: a) Totonacapan Zone, b) Huasteco from the Tantoyuca Zone, c) Otomi from the Inxhuatlan de Madero Zone, d) Nahuatl from the Zongolica Zone, e) Nahuatl from the Chicontepec Zone, f) Nahualt from the Pajapan Zone and g) Popoluca from the Soteapan Zone. This data article presents the information as of August 1, 2020 corresponding to the Huasteco Area.
    Keywords: (SARS-CoV-2) COVID-19, Algorithm (SARS-CoV-2) COVID-19, Mexico, identification of patients, Huasteco Area
    JEL: C80 C88 I10 I15 Z00
    Date: 2020–08–11
  28. By: Giuntella, Giovanni; Hyde, Kelly; Saccardo, Silvia; Sadoff, Sally
    Abstract: COVID-19 has affected daily life in unprecedented ways. Using a longitudinal dataset linking biometric and survey data from several cohorts of young adults before and during the pandemic (N=685), we document large disruptions to physical activity, sleep, time use, and mental health. At the onset of the pandemic, average steps decline from 9,400 to 4,600 steps per day, sleep increases by about 25-30 minutes per night, time spent socializing declines by over half to less than 30 minutes, and screen time more than doubles to over 5 hours per day. The proportion of participants at risk of clinical depression increases to 65%, over twice the rate in the same population prior to the pandemic. Our analyses suggest that disruption to physical activity is a leading risk factor for depression during the pandemic. However, restoration of those habits--either naturally or through policy intervention--has limited impact on restoring mental well-being.
    Date: 2020–08–04
  29. By: M. Keith Chen; Judith A. Chevalier; Elisa F. Long
    Abstract: Nursing homes and other long term-care facilities account for a disproportionate share of COVID-19 cases and fatalities worldwide. Outbreaks in U.S. nursing homes have persisted despite nationwide visitor restrictions beginning in mid-March. An early report issued by the Centers for Disease Control and Prevention identified staff members working in multiple nursing homes as a likely source of spread from the Life Care Center in Kirkland, Washington to other skilled nursing facilities. The full extent of staff connections between nursing homes---and the crucial role these connections serve in spreading a highly contagious respiratory infection---is currently unknown given the lack of centralized data on cross-facility nursing home employment. In this paper, we perform the first large-scale analysis of nursing home connections via shared staff using device-level geolocation data from 30 million smartphones, and find that 7 percent of smartphones appearing in a nursing home also appeared in at least one other facility---even after visitor restrictions were imposed. We construct network measures of nursing home connectedness and estimate that nursing homes have, on average, connections with 15 other facilities. Controlling for demographic and other factors, a home's staff-network connections and its centrality within the greater network strongly predict COVID-19 cases. Traditional federal regulatory metrics of nursing home quality are unimportant in predicting outbreaks, consistent with recent research. Results suggest that eliminating staff linkages between nursing homes could reduce COVID-19 infections in nursing homes by 44 percent.
    JEL: I10 I12 I18
    Date: 2020–07
  30. By: Isphording, Ingo E. (IZA); Pestel, Nico (IZA)
    Abstract: We study the impact of short-term exposure to ambient air pollution on the spread and severity of COVID-19 in Germany. We combine data on county-by-day level on confirmed cases and deaths with information on local air quality and weather conditions and exploit short-term variation in the concentration of particulate matter (PM10) and ozone (O3). We apply fixed effects regressions controlling for global time-varying confounding factors and regional time-invariant confounding factors on the county level, as well as potentially confounding weather conditions and the regional stage of the pandemic. We find significant positive effects of PM10 concentration after the onset of the illness on COVID-19 deaths specifically for elderly patients (80+ years): higher levels of air pollution by one standard deviation 3 to 12 days after developing symptoms increase deaths by 30 percent (males) and 35 percent (females) of the mean. In addition, air pollution raises the number of confirmed cases of COVID-19. The timing of results supports mechanisms of air pollution affecting the severity of already realized infections. Air pollution appears not to affect the probability of infection itself.
    Keywords: COVID-19, health, air pollution, Germany
    JEL: I12 I18 Q53
    Date: 2020–06
  31. By: Ulrich Glogowsky; Emanuel Hansen; Simeon Schächtele
    Abstract: To fight the spread of COVID-19, many countries implemented unprecedented social distancing policies. This is the first paper that uses an event-study approach to examine the effects of the German social distancing policies on (a) individual behavior and (b) the spread of the epidemic. Combining administrative health data and cell phone data, we find that the policies, first, heavily reduced citizens’ mobility and, second, strongly contained the epidemic. In comparison to a benchmark without social distancing, within three weeks, the policies avoided 84% of the potential COVID-19 cases (point estimate: 499.3K) and 66% of the potential fatalities (5.4K).
    Keywords: COVID-19, social distancing policies, policy evaluation, mobility behavior
    JEL: I18 H12 I12
    Date: 2020
  32. By: Rose, Nikolas; Manning, Nick; Bentall, Richard; Bhui, Kamaldeep; Burgess, Rochelle; Carr, Sarah; Cornish, Flora; Devakumar, Delan; Dowd, Jennifer B.; Ecks, Stefan; Faulkner, Alison; Keene, Alex Ruck; Kirkbride, James; Knapp, Martin; Lovell, Anne M.; Martin, Paul; Moncrieff, Joanna; Parr, Hester; Pickersgill, Martyn; Richardson, Genevra; Sheard, Sally
    Abstract: We argue that predictions of a 'tsunami' of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health. Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services. However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations. Health care organisations must tackle racism and discrimination to ensure genuine equal access to universal health care. Government must replace highly conditional benefit systems by something like a universal basic income. All economic and social policies must be subjected to a legally binding mental health audit. This may sound unfeasibly expensive, but the social and economic costs, not to mention the costs in personal and community suffering, though often invisible, are far greater.
    Keywords: BAME; benefit system reform; mental distress; social disadvantage; universal basic income; Covid-19; coronavirus; 207922; 104845; 106612; 209519; 209534; 203376; ES/S004440/1; ES/S013873/1; ES/S012567/1; C969/CM/UBCN-P137; PR-PRU-0916-22003; MR/S035818/1
    JEL: E6
    Date: 2020–07–13
  33. By: Baser, Onur
    Abstract: Since March 2020, Turkey has been experiencing a large outbreak of a novel coronavirus (2019-nCoV). We estimated the population weighted density for each of the 81 cities in Turkey as well as the districts of its three densest cities. Istanbul, a city of 16 million, has a district with a population weighted density more than 5 times higher than New York City, the epicenter of Covid-19 pandemic. By using weighted least squares, we calculated the elasticity of the Covid-19 spread with respect to population weighted density as 0.67. In addition to the density, the proportion of people over 65, the per capita GDP, and the number of total health care workers in each city positively contributed to the case numbers, while education level and temperature had a negative effect. We suggested a policy measure on how to transfer health care workers from different areas to the areas with a possibility of wide spread and rank some of the cities according to their success at minimizing death given their population weighted density.
    Keywords: Density index, covid-19, turkish data, distribution
    JEL: C0 I1
    Date: 2020–04–22
  34. By: Ilan Noy; Nguyen Doan; Benno Ferrarini; Donghyun Park
    Abstract: We measure the economic risk of COVID-19 at a geo-spatially detailed resolution. In addition to data about the current prevalence of confirmed cases, we use data from 2014-2018 and a conceptual disaster risk model to compute measures for exposure, vulnerability, and resilience of the local economy to the shock of the epidemic. Using a battery of proxies for these four concepts, we calculate the hazard, the principal components of exposure and vulnerability to it, and of the economy’s resilience (i.e., its ability of the recover rapidly from the shock). We find that the economic risk of this pandemic is particularly high in most of Sub-Saharan Africa, South Asia, and Southeast Asia. These results are consistent when comparing an ad-hoc equal weighting algorithm for the four components of the index, an algorithm that assumes equal hazard for all countries, and one based on estimated weights using previous aggregated Disability-Adjusted Life Years losses associated with communicable diseases.
    Keywords: epidemic, COVID-19, risk measurement, economic impact
    JEL: I10
    Date: 2020
  35. By: Fabio Vanni; David Lambert; Luigi Palatella
    Abstract: We introduce a theoretical framework that highlights the impact of physical distancing variables such as human mobility and physical proximity on the evolution of epidemics and, crucially, on the reproduction number. In particular, in response to the coronavirus disease (CoViD-19) pandemic, countries have introduced various levels of 'lockdown' to reduce the number of new infections. Specifically we use a collisional approach to an infection-age structured model described by a renewal equation for the time homogeneous evolution of epidemics. As a result, we show how various contributions of the lockdown policies, namely physical proximity and human mobility, reduce the impact of SARS-CoV-2 and mitigate the risk of disease resurgence. We check our theoretical framework using real-world data on physical distancing with two different data repositories, obtaining consistent results. Finally, we propose an equation for the effective reproduction number which takes into account types of interactions among people, which may help policy makers to improve remote-working organizational structure.
    Date: 2020–07
  36. By: Arpino, Bruno; Pasqualini, Marta; Bordone, Valeria; Solé-Auró, Aïda
    Abstract: The COVID-19 pandemic has limited individuals’ possibility to meet and socialize with others due to the state of emergency restrictions to movements, events and relations imposed in different countries. Most shops and restaurants have been closed and some economic activities have been seriously damaged. This significant disruption may have contributed to a deterioration of people’s mental health on top of other negative consequences of the pandemic. To better understand the indirect consequences of the COVID-19 outbreak on people’s lives we have designed the intergen-COVID online survey (, carried out in France, Italy and Spain between the 14th to the 24th of April 2020. Quota sampling on the population 18-plus and post-stratification weights were used to achieve the alignment between the sample (N = 9,056) and the total population on important socio-demographic characteristics. We collected information on four key domains of individuals’ lives: intergenerational (and other type of) relationships (physical and non-physical; means of communication; frequency, etc.); living arrangements; mental health; events experienced during the lockdown (e.g., income loss, death of relative/friend due to COVID-19, worsened partner relationships, time spent with family); intentions for the future 3 years (e.g., fertility, living parental home, marriage, cohabitation, divorce/separation, retirement). In this paper we provide the main results from this survey, focusing on the first three domains abovementioned. The fourth domain consists of questions applicable to different sub-groups of the population and will be analyzed in separate papers. We show that, despite the general reduction of physical contacts, with low educated people reporting a lower reduction in all kinds of physical contacts, non-physical contacts have significantly increased, especially among women. About 50% of respondents felt sad or depressed more often than usual during the lockdown, but mental health deterioration was found to be heterogeneous and vary with respondents’ age, gender and country. Job and income loss, and worsening of relationships quality were other negative consequences often experienced during the lockdown, especially by younger individuals. Finally, although maintaining physical distance, during the lockdown people have experienced a high level of social connection, emotional support and practical help.
    Date: 2020–07–07
  37. By: Joseph A. Benitez; Charles J. Courtemanche; Aaron Yelowitz
    Abstract: As of June 2020, the coronavirus pandemic has led to more than 2.3 million confirmed infections and 121 thousand fatalities in the United States, with starkly different incidence by race and ethnicity. Our study examines racial and ethnic disparities in confirmed COVID-19 cases across six diverse cities – Atlanta, Baltimore, Chicago, New York City, San Diego, and St. Louis – at the ZIP code level (covering 436 “neighborhoods” with a population of 17.7 million). Our analysis links these outcomes to six separate data sources to control for demographics; housing; socioeconomic status; occupation; transportation modes; health care access; long-run opportunity, as measured by income mobility and incarceration rates; human mobility; and underlying population health. We find that the proportions of black and Hispanic residents in a ZIP code are both positively and statistically significantly associated with COVID-19 cases per capita. The magnitudes are sizeable for both black and Hispanic, but even larger for Hispanic. Although some of these disparities can be explained by differences in long-run opportunity, human mobility, and demographics, most of the disparities remain unexplained even after including an extensive list of covariates related to possible mechanisms. For two cities – Chicago and New York – we also examine COVID-19 fatalities, finding that differences in confirmed COVID-19 cases explain the majority of the observed disparities in fatalities. In other words, the higher death toll of COVID-19 in predominantly black and Hispanic communities mostly reflects higher case rates, rather than higher fatality rates for confirmed cases.
    JEL: I14
    Date: 2020–07
  38. By: Vadim S. Balashov; Yuxing Yan; Xiaodi Zhu
    Abstract: We use the Newcomb-Benford law to test if countries manipulate reported data during the COVID-19 pandemic. We find that democratic countries, countries with the higher Gross Domestic Product (GDP) per capita, higher healthcare expenditures, and better universal healthcare coverage are less likely to deviate from the Newcomb-Benford law. The relationship holds for the cumulative number of deaths and for the cumulative number of total cases but is more pronounced for the death toll. The findings are robust for the second digit tests, for a sub-sample of countries with regional data, and during the previous swine flu (H1N1) 2009-2010 pandemic.
    Date: 2020–07
  39. By: Guillaume MOREL
    Abstract: Within the present paper, we build a model from epidemiology and economics to study the impact of infectious diseases on the steady states and dynamic of an economy. More precisely, we embed a SIS model within a Ramsey growth model in a close framework with a tax where pollution comes from consumption. Firstly, we show that a consumption tax allocated to a depollution policy possesses an ambiguous effect on consumption and welfare, depending on the disease infectivity factor. Secondly, we point out that an increase in the spread of an infectious disease can’t make a limit cycle (Hopf bifurcation) emerge near the endemic steady state.
    Keywords: Hopf bifurcation, Pollution, Ramsey model, SIS model.
    JEL: C62 O44 Q5 I1
    Date: 2020
  40. By: Ceriani, Lidia; Verme, Paolo
    Abstract: The paper provides initial evidence that excess mortality rates by locality can be used as a statistically reliable predictor of looming mortality crises. Using recently published daily deaths figures for 7,357 Italian municipalities, we estimate the growth in daily mortality rates between the period 2015-2019 and 2020 by province. All provinces that experienced a major mortality shock in mid-March 2020 had increases in mortality rates of 100% or above already in mid-February 2020. This increase was particularly strong for males and older people, two recognizable features of COVID-19. Using panel data models, we find a strong positive and significant association between overall deaths and COVID-19 related deaths, and between early increases in mortality rates in February 2020 for any cause and the March 2020 outbreak in COVID-19 deaths. We conclude that the growth in mortality rates can potentially be used as a statistically reliable predictor of mortality crises, including COVID- 19 crises.
    Date: 2020
  41. By: Haddad, Eduardo (Departamento de Economia, Universidade de São Paulo); Vieira, Renato (Universidade Católica de Brasília); Araújo, Inácio (Departamento de Economia, Universidade de São Paulo); Ichihara, Silvio (DERSA, Secretariat of Logistics and Transportation, São Paulo, Brazil); Perobelli, Fernando (Department of Economics, Federal University of Juiz de Fora); Bugarin, Karina (Economics and Politics Research Group)
    Abstract: As COVID-19-related health indicators improve after restrictive measures were set in place in different parts of the world, governments are expected to provide guidance on how to ease interventions while minimizing the risk of resurgent outbreaks. Whereas epidemiologists track the progress of the disease using daily indicators to better understand the pandemic, economic activity indicators are usually available at a lower frequency, and with considerable time lags. We propose and implement a timely trade-based regional economic activity indicator (EAI) that uses high-frequency traffic data to monitor daily sectoral economic activity in different sectors for the Brazilian State of São Paulo, a highly impacted region, overcoming the challenge of real-time assessment of the economy amid the COVID-19 outbreak. We then use this novel set of information combined with hospitalization rates to provide a first assessment of the São Paulo Plan, the COVID-19 exit strategy designed to gradually lifting interventions introduced to control the outbreak in the State. Available data show that, in its first 60 days, the phased strategy pursued in São Paulo has been effective in gradually reactivating economic activity while maintaining the adequate responsiveness of the healthcare system.
    Keywords: COVID-19; Impact analysis; Input-output analysis; Regional economic activity indicator
    JEL: C43 C67 I18 R11 R40
    Date: 2020–08–17
  42. By: Romain Espinosa (CNRS - Centre National de la Recherche Scientifique, CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR1 - Université de Rennes 1 - UNIV-RENNES - Université de Rennes - CNRS - Centre National de la Recherche Scientifique); Damian Tago (Emergency Centre for Transboundary Animal Diseases, Food and Agriculture Organization of the UN); Nicolas Treich (TSE - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)
    Abstract: Most infectious diseases in humans originate from animals. In this paper, we explore the role of animal farming and meat consumption in the emergence and amplification of infectious diseases. First, we discuss how meat production increases epidemic risks, either directly through increased contact with wild and farmed animals or indirectly through its impact on the environment (e.g., biodiversity loss, water use, climate change). Traditional food systems such as bushmeat and backyard farming increase the risks of disease transmission from wild animals, while intensive farming amplifies the impact of the disease due to the high density, genetic proximity, increased immunodeficiency, and live transport of farmed animals. Second, we describe the various direct and indirect costs of animal-based infectious diseases, and in particular, how these diseases can negatively impact the economy and the environment. Last, we discuss policies to reduce the social costs of infectious diseases. While existing regulatory frameworks such as the "One Health" approach focus on increasing farms' biosecurity and emergency preparedness, we emphasize the need to better align stakeholders' incentives and to reduce meat consumption. We discuss in particular the implementation of a "zoonotic" Pigouvian tax, and innovations such as insect-based food or cultured meat.
    Keywords: Infectious diseases,meat production,meat consumption,biodiversity,prevention,intensive farming,regulation,taxation
    Date: 2020
  43. By: Daniel L. Mendoza (Department of Atmospheric Sciences, University of Utah, Salt Lake City, Utah USA; Department of City & Metropolitan Planning, University of Utah, Salt Lake City, Utah USA); Tabitha M. Benney (Department of Political Science, University of Utah, Salt Lake City, Utah USA); Rajive Ganguli (Department of Mining Engineering, University of Utah, Salt Lake City, Utah USA); Rambabu Pothina (Department of Mining Engineering, University of Utah, Salt Lake City, Utah USA); Benjamin Krick (Department of Political Science, University of Utah, Salt Lake City, Utah USA); Cheryl S. Pirozzi (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah USA); Erik T. Crosman (Department of Life, Earth, and Environmental Sciences, West Texas A&M University, Canyon, Texas USA); Yue Zhang (Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah USA)
    Abstract: In response to the COVID-19 pandemic, governments have implemented policies to curb the spread of the novel virus. Little is known about how these policies impact various groups in society. This paper explores the relationship between social distancing policies, traffic volumes and air quality and how they impact various socioeconomic groups. This study aims to understand how disparate communities respond to Stay-at-Home Orders and other social distancing policies to understand how human behavior in response to policy may play a part in the prevalence of COVID-19 positive cases. We collected data on traffic density, air quality, socio-economic status, and positive cases rates of COVID-19 for each zip code of Salt Lake County, Utah (USA) between February 17 and June 12, 2020. We studied the impact of social distancing policies across three periods of policy implementation. We found that wealthier and whiter zip codes experienced a greater reduction in traffic and air pollution during the Stay-at-Home period. However, air quality did not necessarily follow traffic volumes in every case due to the complexity of interactions between emissions and meteorology. We also found a strong relationship between lower socioeconomic status and positive COVID-19 rates. This study provides initial evidence for social distancing's effectiveness in limiting the spread of COVID-19, while providing insight into how socioeconomic status has compounded vulnerability during this crisis. Behavior restrictions disproportionately benefit whiter and wealthier communities both through protection from spread of COVID-19 and reduction in air pollution. Such findings may be further compounded by the impacts of air pollution, which likely exacerbate COVID-19 transmission and mortality rates. Policy makers need to consider adapting social distancing policies to maximize equity in health protection.
    Date: 2020–07
  44. By: Sitian Liu; Yichen Su
    Abstract: Cities are shaped by the strength of agglomeration and dispersion forces. We show that the COVID-19 pandemic has re-introduced disease transmission as a dispersion force in modern cities. We use detailed housing data to study the impact of the COVID-19 pandemic on the location demand for housing. We find that the pandemic has led to a greater decline in the demand for housing in neighborhoods with high population density. We further show that the reduced demand for density is partially driven by the diminished need of living close to jobs that are telework-compatible and the declining value of access to consumption amenities. Neighborhoods with high pre-COVID-19 home prices also see a greater drop in housing demand. While the national housing market partially recovered in June, we show that the negative effect of the pandemic on the demand for density persists, indicating that the change in the demand for density may last beyond an aggregate recovery of housing demand.
    Keywords: COVID-19; Housing; Density; Amenity; Location; City; Telework; Neighborhood; Pandemic
    JEL: I1 R2 R3
    Date: 2020–08–14
  45. By: Nicola Fuchs-Schündeln; Moritz Kuhn; Michèle Tertilt
    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
  46. By: Jaramillo, Miguel; Ñopo, Hugo (Grupo de Análisis para el Desarrollo (GRADE))
    Abstract: Latin America is currently suffering from two independent but related shocks: the impact of COVID-19 and the shock of commodity prices. Peru, we argue, is a case in which the strongest impact comes from the pandemic. Peru was the first country in Latin America to react and implement sanitary and economic measures against the coronavirus. The country has been in mandatory quarantine since Monday, March 16. This carries very important challenges for all economic actors. Global and national activity has suffered a sudden stop with direct implications for: (i) the income generating capacity of independent workers, (ii) the jobs of formal and informal and informal workers, and (iii) the survival of small, medium and large companies. In this note we consider the situation of Peruvian households in the face of the pandemic, exploring their vulnerabilities through an analysis of their main source of income generation: work. We also consider the situation of the companies that employ the workers under analysis. We present an overview of what the government’s main action have been so far and offer some recommendations.
    Keywords: COVID 19, Impactos económicos, Políticas públicas, Economic impacts, Public policies, Perú, Peru
    JEL: I18 F6
    Date: 2020
  47. By: Keisuke Kokubun
    Abstract: The spread of new coronavirus (COVID-19) infections continues to increase. The practice of social distance attracts attention as a measure to prevent the spread of infection, but it is difficult for some occupations. Therefore, in previous studies, the scale of factors that determine social distance has been developed. However, it was not clear how to select the items among them, and it seemed to be somewhat arbitrary. In response to this trend, this paper extracted eight scales by performing exploratory factor analysis based on certain rules while eliminating arbitrariness as much as possible. They were Adverse Conditions, Leadership, Information Processing, Response to Aggression, Mechanical Movement, Autonomy, Communication with the Outside, and Horizontal Teamwork. Of these, Adverse Conditions, Response to Aggression, and Horizontal Teamwork had a positive correlation with Physical Proximity, and Information Processing, Mechanical Movement, Autonomy, and Communication with the Outside had a negative correlation with Physical Proximity. Furthermore, as a result of multiple regression analysis, it was shown that Response to Aggression, not the mere teamwork assumed in previous studies, had the greatest influence on Physical Proximity.
    Date: 2020–08
  48. By: Joshua D. Gottlieb; Maria Polyakova; Kevin Rinz; Hugh Shiplett; Victoria Udalova
    Abstract: Is government guiding the invisible hand at the top of the labor market? We study this question among physicians, the most common occupation among the top one percent of income earners, and whose billings comprise one-fifth of healthcare spending. We use a novel linkage of population-wide tax records with the administrative registry of all physicians in the U.S. to study the characteristics of these high earnings, and the influence of government payments in particular. We find a major role for government on the margin, with half of direct changes to government reimbursement rates flowing directly into physicians' incomes. These policies move physicians' relative and absolute incomes more than any reasonable changes to marginal tax rates. At the same time, the overall level of physician earnings can largely be explained by labor market fundamentals of long work and training hours. Competing occupations also pay well and provide a natural lower bound for physician earnings. We conclude that government plays a major role in determining the value of physicians' human capital, but it is unrealistic to use this power to reduce healthcare spending substantially.
    Date: 2020–07
  49. By: Abarcar, Paolo; Theoharides, Caroline
    Abstract: We exploit changes in U.S. visa policies for nurses to measure brain drain versus gain. Combining data on all migrant departures and postsecondary institutions in the Philippines, we show that nursing enrollment and graduation increased substantially in response to greater U.S. demand for nurses. The supply of nursing programs expanded to accommodate this increase. Nurse quality, measured by licensure exam pass rates, declined. Despite this, for each nurse migrant, 10 additional nurses were licensed. New nurses switched from other degree types, but graduated at higher rates than they would have otherwise, thus increasing the human capital stock in the Philippines.
    Date: 2020–07–31
  50. By: Christian Gollier (TSE - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)
    Abstract: Assuming that there is no other solution than herd immunity in front of the current pandemic, on which categories of citizens should we build this herd immunity? Given the fact that young people face a mortality rate which is at least a thousand times smaller than people aged 70 years and more, there is a simple rational to build it on these younger generations. The transfer of some mortality risk to younger people raises difficult ethical issues. However, none of the familiar moral or operational guidelines (equality of rights, VSL, QALY, ...) that have been used in the Western world over the last century weights the value of young lives 1000 times or more than the lives of the elders. This suggests that Society could offer covid protection to the elders by confining them as long as this herd immunity has not been attained by the younger generations. This would be a potent demonstration of intergenerational solidarity towards the most vulnerable people in our community. The welfare gain of this age-specific deconfinement strategy is huge, as it can reduce the global death toll by more than 80%.
    Date: 2020–05–11
  51. By: Curtis, David Stuart (University of Utah); Rigolon, Alessandro; Schmalz, Dorothy L; Brown, Barbara
    Abstract: The spread of COVID-19 altered use of public spaces, such as parks, with potential effects on human health and well-being. Little is known about park use during the pandemic, how local features (e.g, park availability) influence use, and whether park visits accelerate COVID-19 spread. Using weekly panel data for 620 U.S. counties, we show park visits decreased by 10% beginning March 15, and by 17-35% through May 9, 2020. Net of weekly sample trends, park visits decreased by 2.3% when stay-at-home orders were in effect, yet increased by 8.3% after school closures and 4.1% after business closures. Park visits decreased less during the pandemic in metropolitan counties or where park availability was high. Higher park visits were weakly associated with COVID-19 case growth rate but not incidence. Thus, parks may serve as alternatives for recreation when schools and businesses close, especially where parks are available, with no-to-little influence on COVID-19 spread.
    Date: 2020–07–06
  52. By: Fantazzini, Dean
    Abstract: The ability of Google Trends data to forecast the number of new daily cases and deaths of COVID-19 is examined using a dataset of 158 countries. The analysis includes the computations of lag correlations between confirmed cases and Google data, Granger causality tests, and an out-of-sample forecasting exercise with 18 competing models with a forecast horizon of 14 days ahead. This evidence shows that Google-augmented models outperform the competing models for most of the countries. This is significant because Google data can complement epidemiological models during difficult times like the ongoing COVID-19 pandemic, when official statistics maybe not fully reliable and/or published with a delay. Moreover, real-time tracking with online-data is one of the instruments that can be used to keep the situation under control when national lockdowns are lifted and economies gradually reopen.
    Keywords: Covid-19; Google Trends; VAR; ARIMA; ARIMA-X; ETS; LASSO; SIR model
    JEL: C22 C32 C51 C53 G17 I18 I19
    Date: 2020–08
  53. By: Brooks A. Kaiser (Department of Sociology, Environmental and Business Economics, University of Southern Denmark); Henning P. Joergensen (Department of Sociology, Environmental and Business Economics, University of Southern Denmark); Lucas Porto Echave-Sustaeta (Department of Sociology, Environmental and Business Economics, University of Southern Denmark); Maarten J. Punt (Windesheim Honours College and Lectorate Networks in a circular economy, Windesheim University of Applied Science); Simon Soelvsten (Department of Sociology, Environmental and Business Economics, University of Southern Denmark); Chris Horbel (Norwegian School of Sport Sciences and Department of Sociology, Environmental and Business Economics, University of Southern Denmark); Eva Roth (Department of Sociology, Environmental and Business Economics, University of Southern Denmark)
    Abstract: The Scandinavian countries of Denmark, Iceland, Norway and Sweden have approached the first months of the 2020 novel coronavirus pandemic with a range of economic and health policies that have resulted in disparate outcomes. Though similar in behavioral norms and institutions, Denmark, Iceland and Norway chose a precautionary approach that formally shut down schools and businesses to protect human health, while Sweden took a Business-As-Usual (BAU) approach aimed at maintaining normal economic and social activities. Iceland and Denmark have further invested in testing, tracking and containing the disease. Economic costs of the pandemic and government fiscal and monetary interventions to reduce their impacts have been dramatic and similar across countries, while Sweden has had the most severe loss of life. Using a panel from the four countries since the beginning of the pandemic, we calculate lives saved from stricter interventions by estimating cases and deaths as functions of behavior and government interventions with a bioeconomic model, then estimating the additional lives lost if these interventions did not occur. Comparison of the countries reveals three important lessons for both policies aimed at the pandemic and broader goals with high uncertainty levels: (1) the precautionary approach can be lowest cost, while still expensive; (2) detection and monitoring (e.g. testing and tracking) are integral to a successful precautionary approach; and (3) expecting tradeoffs between economic activity and health creates a false dichotomy – they are complements not substitutes. Pandemic policy should focus on minimizing expected costs and damages rather than attempting to exchange health and safety for economic well-being.
    Keywords: COVID-19 Pandemic; precautionary approach; Scandinavian policy responses to COVID-19 pandemic; Denmark; Iceland; Norway; Sweden; impacts of COVID-19 testing
    Date: 2020–08
  54. By: Olivier Coibion; Yuriy Gorodnichenko; Michael Weber; Michael Weber
    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
  55. By: Ajzenman, N.; Cavalcanti, T.; Da Mata, D.
    Abstract: How do political leader's words and actions affect people's behavior? We address this question in the context of Brazil by combining electoral information and geo-localized mobile phone data for more than 60 million devices throughout the entire country. We find that after Brazil's president publicly and emphatically dismissed the risks associated with the COVID-19 pandemic and advised against isolation, the social distancing measures taken by citizens in pro-government localities weakened compared to places where political support of the president is less strong, while pre-event effects are insignificant. The impact is large and robust to different empirical model specifications, and definitions of political support and events. Moreover, we find suggestive evidence that this impact is driven by localities with relatively higher levels of media penetration, municipalities with presence of active Twitter accounts, and municipalities with a larger proportion of Evangelic parishioners, a key group in terms of support for the president.
    Keywords: Health, Coronavirus, Leadership, Persuasion, Risky Behavior
    JEL: D10 I31 Z13
    Date: 2020–04–29

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