nep-hea New Economics Papers
on Health Economics
Issue of 2020‒09‒21
39 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Are All Managed Care Plans Created Equal? Evidence from Random Plan Assignment in Medicaid By Michael Geruso; Timothy J. Layton; Jacob Wallace
  2. Comparative Effects of Recreational and Medical Marijuana Laws On Drug Use Among Adults and Adolescents By Hollingsworth, Alex; Wing, Coady; Bradford, Ashley
  3. Economic Crises and Mortality Among the Elderly: Evidence from Two Russian Crises By Khvan, Margarita; Smorodenkova, Elizaveta; Yakovlev, Evgeny
  4. What Can Economics Say About Alzheimer's Disease? By Amitabh Chandra; Courtney Coile; Corina Mommaerts
  5. Dismissal protection and long-term sickness absence: First evidence from Germany By Gürtzgen, Nicole; Hiesinger, Karolin
  6. Disclosing physician ratings: performance effects and the difficulty of altering rating consensus By Eyring, Henry
  7. The Patent Buyout Price for Human Papilloma Virus (HPV) Vaccine and the Ratio of R&D Costs to the Patent Value By Mario Songane; Volker Grossmann
  8. Fee Equalization and Appropriate Health Care By Emilia Barili; Paola Bertoli; Veronica Grembi
  9. The economics of patient safety Part III: Long-term care: Valuing safety for the long haul By Katherine de Bienassis; Ana Llena-Nozal; Nicolaas S. Klazinga
  10. Variations in external reference pricing implementation: does it matter for public policy? By Gill, Jennifer; Fontrier, Anna-Maria; Kyriopoulos, Dionysis; Kanavos, Panos
  11. Working and disability expectancies at older ages: the role of childhood circumstances and education By Lorenti, Angelo; Dudel, Christian; Hale, Jo Mhairi; Myrskylä, Mikko
  12. Exploring Genetic Influences on Birth Weight By Trejo, Sam
  13. The impact of working memory training on children’s cognitive and noncognitive skills By Eva M. Berger; Ernst Fehr; Henning Hermes; Daniel Schunk; Kirsten Winkel
  14. As if it weren’t hard enough already: Breaking down hiring discrimination following burnout A causal machine learning evaluation of training in Belgium By Philippe Sterkens; Stijn Baert; Claudia Rooman; Eva Derous
  15. Subsidizing Domestic Services as a Tool to Fight Unemployment: Effectiveness and Hidden Costs By Leduc, Elisabeth; Tojerow, Ilan
  16. Mental Model Based Repeated Multifaceted (MRM) Intervention Design: A Conceptual Framework for Improving Preventive Health Behaviors and Outcomes By Ahamad, Mazbahul G; Tanin, Fahian
  17. Bismarck to no Effect: Fertility Decline and the Introduction of Social Insurance in Prussia By Guinnane, Timothy; Streb, Jochen
  18. Social media for health promotion: A visual analysis of “TB Proof” South Africa’s Facebook page By Asongu Acha-Anyi; Paul N. Acha-Anyi; Simplice A. Asongu; Vanessa Tchamyou
  19. Short-term subsidies and seller type: a health products experiment in Uganda By Fischer, Greg; Karlan, Dean; McConnell, Margaret; Raffler, Pia
  20. Behavioral Change Promotion, Cash Transfers and Early Childhood Development : Experimental Evidence from a Government Program in a Low-Income Setting By Premand,Patrick; Barry,Oumar
  21. Unintended Consequences of Welfare Reform: Evidence from Birth Outcomes of Aboriginal Australians By Doyle, Mary-Alice; Schurer, Stefanie; Silburn, Sven
  22. Modeling optimal quarantines under infectious disease related mortality By Goenka, Aditya; Liu, Lin; Nguyen, Manh-Hung
  23. Is the Cure Worse than the Disease? County-Level Evidence from the COVID-19 Pandemic in the United States By Catalina Amuedo-Dorantes; Neeraj Kaushal; Ashley N. Muchow
  24. The scale of COVID-19 graphs affects understanding, attitudes, and policy preferences By Romano, Alessandro; Sotis, Chiara; Dominioni, Goran; Guidi, Sebastián
  25. Infodemics: Do healthcare professionals detect corona-related false news stories better than students? By Gruener, Sven; Krüger, Felix
  26. Gig Workers During the COVID-19 Crisis in France: Financial Precarity and Mental Well-Being By Bénédicte H. Apouey; Alexandra Roulet; Isabelle Solal; Mark Stabile
  27. The Distributional Effects of COVID-19 and Mitigation Policies By Sewon Hur
  28. State capacity in responding to COVID-19 By Serikbayeva, Balzhan; Abdulla, Kanat; Oskenbayev, Yessengali
  29. Supply-Side Effects of Pandemic Mortality: Insights from an Overlapping-Generations Model By Etienne Gagnon; Benjamin K. Johannsen; J. David Lopez-Salido
  30. Pandemic Control in ECON-EPI Networks By Marina Azzimonti; Alessandra Fogli; Fabrizio Perri; Mark Ponder
  31. Firm Behavior during an Epidemic By Luiz Brotherhood; Vahagn Jerbashian
  32. Compliance with Social Distancing: Theory and Empirical Evidence from Ontario during COVID-19 By Anastasios Papanastasiou; Bradley J. Ruffle; Angela L. Zheng
  33. Face Masks Considerably Reduce Covid-19 Cases in Germany - A Synthetic Control Method Approach By Timo Mitze; Reinhold Kosfeld; Johannes Rode; Klaus Wälde
  34. Covid-19 lockdowns, income distribution, and food security: an analysis for South Africa By Arndt, Channing; Davies, Rob; Gabriel, Sherwin; Harris, Laurence; Makrelov, Konstantin; Robinson, Sherman; Levy, Stephanie; Simbanegavi, Witness; van Seventer, Dirk; Anderson, Lillian
  35. Can a COVID-19 Vaccine Live up to Americans’ Expectations? A Conjoint Analysis of how Vaccine Characteristics Influence Vaccination Intentions By Motta, Matthew
  36. Socioeconomic Factors influencing the Spatial Spread of COVID-19 in the United States By Christopher F Baum; Miguel Henry
  37. Wind of Change? Experimental Survey Evidence on the COVID-19 Shock and Socio-Political Attitudes in Europe By Gianmarco Daniele; Andrea F.M. Martinangeli; Francesco Passarelli; Willem Sas; Lisa Windsteiger
  38. Transatlantic excess mortality comparisons in the pandemic By ARON, JANINE; Muellbauer, John
  39. Identifying policy challenges of COVID-19 in hardly reliable data and judging the success of lockdown measures By Bonacini, Luca; Gallo, Giovanni; Patriarca, Fabrizio

  1. By: Michael Geruso; Timothy J. Layton; Jacob Wallace
    Abstract: Exploiting random assignment of Medicaid beneficiaries to managed care plans, we identify plan-specific effects on healthcare utilization. Auto-assignment to the lowest-spending plan generates 30% lower spending than if the same enrollee were assigned to the highest-spending plan, despite identical cost-sharing. Effects via quantities, rather than differences in negotiated prices, explain these patterns. Rather than reducing “wasteful” spending, low-spending plans cause broad reductions in the use of medical services—including low-cost, high-value care—and worsen beneficiary satisfaction and health. Supply side tools circumvent the classic trade-off between financial risk protection and moral hazard, but give rise instead to a cost/quality trade-off.
    JEL: H75 I11 I13
    Date: 2020–08
  2. By: Hollingsworth, Alex; Wing, Coady; Bradford, Ashley
    Abstract: Thirty-four states have adopted medical marijuana laws and ten states have adopted recreational marijuana laws. There is little research comparing how these two types of laws affect drug consumption of the general US population. Using a difference in difference strategy, we find that recreational laws increase past-year marijuana use by 25% among adults and by 10% among adolescents. In contrast, medical laws increase adult use by only 5% and have a negligible effect on adolescent use. We also find that recreational marijuana dispensaries are an important driver of the increase in marijuana use for adults 26 and over. Taken together, our results suggest that medical laws are not de facto recreational laws in that they succeed in mitigating recreational use, that recreational laws have broad effects on overall levels of marijuana use, and that underage marijuana use may be an important problem with existing implementations of recreational marijuana laws.
    Date: 2020–08–19
  3. By: Khvan, Margarita (New Economic School, Moscow); Smorodenkova, Elizaveta (New Economic School, Moscow); Yakovlev, Evgeny (New Economic School, Moscow)
    Abstract: We assess the short-term effects of the two recent economic crises, the Great Recession and the collapse of the USSR, on the elderly mortality in Russia. According to our study, crises have led to an increase in mortality with quantitatively similar elasticities of death with respect to GDP fall for both events. Further analysis of the Great Recession suggests that income depreciation, limited access to medical services, and an increase in alcohol consumption are responsible for the rise in mortality. While increases at a higher rate compared to overall mortality, alcohol-related mortality explains a relatively small part of total mortality rise.
    Keywords: mortality, crises
    JEL: J1 H1 I1
    Date: 2020–07
  4. By: Amitabh Chandra; Courtney Coile; Corina Mommaerts
    Abstract: Alzheimer’s Disease (AD) affects one in ten people aged 65 or older and is the most expensive disease in the United States. We describe the central economic questions raised by AD. While there is overlap with the economics of aging, the defining features of the ‘economics of Alzheimer’s Disease’ is an emphasis on cognitive decline, choice by cognitively impaired patients, and a host of issues where dynamic contracts between patients and caregivers are hard to enforce. There is enormous scope for economists to contribute to our understanding of AD-related issues, including drug development, efficient care delivery, dynamic contracting within the family and with care providers, long-term care risk, financial decision-making, and public programs for AD. These topics overlap with many areas of economics -- labor economics, health economics, public finance, behavioral economics, experimental economics, family economics, mechanism design, and the economics of innovation -- suggesting the presence of a rich research program that should attract many economists.
    JEL: I11 I13 J14 J22 O31
    Date: 2020–08
  5. By: Gürtzgen, Nicole; Hiesinger, Karolin
    Abstract: This paper analyses the causal effects of weaker dismissal protection on the incidence of long-term sickness (> six weeks). We exploit a German policy change, which shifted the threshold exempting small establishments from dismissal protection from five to ten workers. Using administrative data, we find a significantly negative reform effect on transitions into long-term sickness in the second year after a worker has entered an establishment. This response is due to a behavioural, rather than a compositional effect and is particularly pronounced among medium-skilled males. Our results further indicate that the reform did not alter the probability of involuntary unemployment after sickness.
    Keywords: dismissal protection,long-term sickness,involuntary unemployment,difference-in-differences,administrative data,small establishments
    JEL: D02 I12 J28 J38 J88 J63 K31
    Date: 2020
  6. By: Eyring, Henry
    Abstract: I examine effects of a health care system's policy to publicly disclose patient ratings of its physicians. I find evidence that this policy leads to performance improvement by the disclosed, subjective ratings and also by undisclosed, objective measures of quality. These effects are consistent with multitasking theory, in that physicians respond to the disclosure by providing more of a shared input—time with patients—that benefits performance by ratings and underlying quality. I also find, as predicted by information cascade theory, that the ratings become jammed to some degree near initially disclosed values. Specifically, raters observe the pattern of initial ratings and follow suit by providing similar ratings. Finally, I find evidence that physicians anticipate rating jamming and so concentrate their effort on earlier performance in order to set a pattern of high ratings that later ratings follow. These results demonstrate that the disclosure of subjective ratings can benefit performance broadly but can also shift effort toward earlier performance.
    Keywords: disclosure; real effects; information cascades; multitasking; Wiley
    JEL: D83 I10 I11 L15
    Date: 2020–07–19
  7. By: Mario Songane; Volker Grossmann
    Abstract: Human papillomavirus (HPV) is responsible for almost all of the 570,000 new cases of cervical cancer and approximately 311,000 deaths per year. HPV vaccination is an integral component of the World Health Organization’s (WHO) global strategy to fight the disease. However, high vaccine prices enforced through patent protection are limiting vaccine expansion, particularly in low- and middle-income countries. By limiting market power, patent buyouts could reduce vaccine prices and raise HPV vaccination rates while keeping innovation incentives. We estimate the global patent buyout price as the present discounted value (PDV) of the future profit stream over the remaining patent length for Merck’s HPV vaccines (Gardasil-4 and 9), which hold 87% of the global HPV vaccine market, in the range of US$ 15.6–27.7 billion (in 2018 US$). The estimated PDV of the profit stream since market introduction amounts to US$ 17.8–42.8 billion and the estimated R&D cost to US$ 1.05–1.21 billion. Thus, we arrive at a ratio of R&D costs to the patent value of the order of 2.5–6.8%. We relate this figure to typical estimates of the probability of success (POS) for clinical trials of vaccines to discuss if patent protection provides Merck with extraordinarily strong price setting power.
    Keywords: Human Papilloma Virus (HPV) vaccine, market power, patent buyout price, patent value, R&D costs
    JEL: I18 L12 L65
    Date: 2020
  8. By: Emilia Barili; Paola Bertoli; Veronica Grembi
    Abstract: Fee equalization in health care brings under a unique tariff several medical treatments, coded under different Diagnosis Related Groups (DRGs). The aim is to improve healthcare quality and efficiency by discouraging unnecessary, but better-paid, treatments. We evaluate its effectiveness on childbirth procedures to reduce overuse of c-sections by equalizing the DRGs for vaginal and cesarean deliveries. Using data from Italy and a difference-in-differences approach, we show that setting an equal fee decreased c-sections by 2.5%. This improved the appropriateness of medical decisions, with more low-risk mothers delivering naturally and no significant changes in the incidence of complications for vaginal deliveries. Our analysis supports the effectiveness of fee equalization in avoiding c-sections, but highlights the marginal role of financial incentives in driving c-section overuse. The observed drop was only temporary and in about a year the use of C-section went back to the initial level. We found a greater reduction in lower quality, more capacity-constrained hospitals. Moreover, the effect is driven by districts where the availability of Ob-Gyn specialists is higher and where women are predominant in the gender composition of Ob-Gyn specialists.
    Keywords: fee equalization, Cesarean sections, difference in differences;
    JEL: K13 K32 I13
    Date: 2020–08
  9. By: Katherine de Bienassis (OECD); Ana Llena-Nozal (OECD); Nicolaas S. Klazinga (OECD)
    Abstract: Long-term care (LTC) institutions are now providing care to a greater number of people, and more residents with chronic conditions and multiple co-morbidities, than ever before. Trends suggest this strain will continue to increase as OECD populations continue to age. The total cost of avoidable admissions to hospitals from LTC facilities in 2016 was almost USD 18 Billion, equivalent to 2.5% of all spending on hospital inpatient care or 4.4% of all spending on LTC. Research shows that over half of the harm that occurs in LTC is preventable, and over 40% of admissions to hospitals from LTC are avoidable. The root causes of these events can be addressed through improved prevention and safety practices and workforce development—including skill-mix and education. Targeted investments in a number of key areas can have a significant impact by mitigating the main cost drivers of adverse events in LTC.
    JEL: I11 I14 I18
    Date: 2020–09–17
  10. By: Gill, Jennifer; Fontrier, Anna-Maria; Kyriopoulos, Dionysis; Kanavos, Panos
    Abstract: Background. External reference pricing (ERP) seeks to rationalize prices and contain costs using foreign prices as a reference for the determination of domestic prices and is often used as the starting point for the facilitation of negotiations between health authorities and pharmaceutical manufacturers. Methods. A systematic literature review was used to identify characteristics of ERP implementation across 29 countries. Primary data collection, in the form of surveys directed at key stakeholders, was also used to supplement data in instances where information received from the systematic literature review was outdated or minimal. Findings from the systematic literature review and primary evidence from key stakeholders were bench-marked against 14 best practice principles inherent to an optimal ERP system.Results. Significant heterogeneity in ERP implementation across countries was identified. Country basket size, pricing calculation, and frequency of price revisions varied between countries. Belgium, France, and South Africa were more likely to adhere to the best practice principles, whilst Bulgaria, Hungary, and Romania had the most instances of non-adherence.Conclusion. The observed heterogeneity has policy implications for governments including globally declining pharmaceutical prices, launch delays in lower income countries, reduced incentive for continued R&D, and reduced access to medicines. Overcoming this issue to ensure that ERP is beneficial to all stakeholders will require a focus on developing sustainable, transparent, simple, and stable systems using a set of key guidelines that should maximize the benefits of the pricing policy.
    Keywords: External reference pricing; Pharmaceutical policy; regulation of pharmaceuticals; Systematic review; Expert consultation
    JEL: I10 I11 I18
    Date: 2019–12–01
  11. By: Lorenti, Angelo; Dudel, Christian; Hale, Jo Mhairi; Myrskylä, Mikko
    Abstract: The ability to work at older ages depends on health and education. Both accumulate starting very early in life. We assess how childhood disadvantages combine with education to affect working and health trajectories. Applying multistate period life tables to data from the Health and Retirement Study (HRS) for the period 2008–2014, we estimate how the residual life expectancy at age 50 is distributed in number of years of work and disability, by number of childhood disadvantages, gender, and race/ethnicity. Our findings indicate that number of childhood disadvantages is negatively associated with work and positively with disability, irrespective of gender and race/ethnicity. Childhood disadvantages intersect with low education resulting in shorter lives, and redistributing life years from work to disability. Among the highly educated, health and work differences between groups of childhood disadvantage are small. Combining multistate models and inverse probability weighting, we show that the return of high education is greater among the most disadvantaged.
    Keywords: childhood adversities; DLE; inequality; inverse probability weighting; life course; multistate models; social stratification; WLE; Max Planck Society
    JEL: R14 J01
    Date: 2020–07–25
  12. By: Trejo, Sam
    Abstract: A person’s birth weight is a robust predictor of their economic, educational, and health outcomes across the life course. But is birth weight simply a proxy for environmental conditions in-utero, or do biological processes related to birth weight themselves play an important role in healthy development during the prenatal period? To examine this question, we utilize an underexplored source variation in birth weight that is largely orthogonal to prenatal environmental conditions: an individual’s genes. We leverage the recent identification of specific genetic variants associated with birth weight to construct polygenic scores in two longitudinal studies and empirically validate and unpack the molecular genetic correlates of birth weight. A 1 SD increase in the birth weight polygenic score is associated with a ~100 gram increase in birth weight; sibling comparisons show this association mostly represents the causal effect of genes. The magnitude of the relationship between polygenic score and birth weight is increased for children who spend longer in the womb and children born to mothers with high maternal body mass index. Finally, the birth weight polygenic score causally affects downstream social and cognitive outcomes, providing support for the hypothesis that birth weight itself is intimately related to healthy prenatal development.
    Date: 2020–08–20
  13. By: Eva M. Berger; Ernst Fehr; Henning Hermes; Daniel Schunk; Kirsten Winkel
    Abstract: Working memory capacity is thought to play an important role for a wide range of cognitive and noncognitive skills such as fluid intelligence, math, reading, the inhibition of pre-potent impulses or more general self-regulation abilities. Because these abilities substantially affect individuals’ life trajectories in terms of health, education, and earnings, the question of whether working memory (WM) training can improve them is of considerable importance. However, whether WM training leads to improvements in these far-transfer skills is contested. Here, we examine the causal impact of WM training embedded in regular school teaching by a randomized educational intervention involving a sample of 6–7 years old first graders. We find substantial immediate and lasting gains in working memory capacity. In addition, we document relatively large positive effects on geometry skills, reading skills, Raven’s fluid IQ measure, the ability to inhibit pre-potent impulses and self-regulation abilities. Moreover, these far-transfer effects emerge over time and only become fully visible after 12-13 months. Finally, we document that 3–4 years after the intervention, the children who received training have a roughly 16 percentage points higher probability of entering the academic track in secondary school.
    Keywords: Human capital, cognitive skills, noncognitive skills, working memory training
    JEL: I20 I21 J24
    Date: 2020–06
  14. By: Philippe Sterkens; Stijn Baert; Claudia Rooman; Eva Derous (-)
    Abstract: Hiring discrimination towards (former) burnout patients has been extensively documented in the literature. To tackle this problem, it is important to understand the underlying mechanisms of such discrimination. Therefore, we conducted a vignette experiment with 425 genuine recruiters and jointly tested the potential stigma against job candidates with a history of burnout that were mentioned earlier in the literature. We found candidates revealing a history of burnout elicit perceptions of requiring work adaptations, likely having more unpleasant collaborations with others as well as diminished health, autonomy, ability to work under pressure, leadership capacity, manageability, and learning ability, when compared to candidates with a comparable gap in working history due to physical injury. Led by perceptions of a reduced ability to work under pressure, the tested perceptions jointly explained over 90% of the effect of revealing burnout on the probability of being invited to a job interview. In addition, the negative effect on interview probability of revealing burnout was stronger when the job vacancy required higher stress tolerance. In contrast, the negative impact of revealing burnout on interview probability appeared weaker when recruiters were women and when recruiters had previously had personal encounters with burnout.
    Keywords: hiring discrimination, burnout, statistical discrimination, taste-based discrimination
    JEL: J71 I14 C83 C91
    Date: 2020–07
  15. By: Leduc, Elisabeth (Free University of Brussels); Tojerow, Ilan (Free University of Brussels)
    Abstract: European countries have increasingly adopted wage subsidies for the sector of domestic services to reduce low-skilled unemployment. Yet, empirical evidence on their effectiveness is scarce. In this paper, we use Belgian administrative data to estimate how participation in the subsidized domestic services sector impacts the labour market outcomes of program participants. Our identification strategy rests on a dynamic event study difference-in-differences model combined with coarsened exact matching. Our findings indicate that such subsidies can be effective in reducing unemployment and inactivity, but only by increasing employment within the subsidized domestic services sector. We also find that program participation deteriorates physical health, thus increasing the worker's probability of claiming disability insurance benefits.
    Keywords: wage subsidies, low-skilled workers, unemployment, disability, domestic services, personal and household services, female employment
    JEL: J08 J24 J28 J38
    Date: 2020–07
  16. By: Ahamad, Mazbahul G (University of Nebraska–Lincoln); Tanin, Fahian
    Abstract: Improving the effectiveness of health interventions is a major challenge in public health research and program development. A large body of literature has found low or no impact of health education and promotional interventions. We aim to develop a conceptual framework in support of intervention designs for preventive health behavior improvement programs and outcomes. The proposed approach is based on a narrative review of empirical literature assessing the limitations of less effective or ineffective field experiments regarding preventive health education and promotion interventions. We found three major limitations regarding the mental model’s balance of treatment and comparison groups, treatment groups’ willingness to adopt suggested behaviors, and the type, length, frequency, intensity, and sequence of treatments. To minimize the influence of these concerns, we propose a mental model-based repeated multifaceted (MRM) intervention design framework to provide an intervention design for improving health education and promotional programs.
    Date: 2020–08–18
  17. By: Guinnane, Timothy; Streb, Jochen
    Abstract: Economists have long argued that introducing social insurance will reduce fertility. The hypothesis relies on standard models: if children are desirable in part because they provide security in case of disability or old age, then state programs that provide insurance against these events should induce couples to substitute away from children in the allocation of wealth. We test this claim using the introduction of social insurance in Germany in the 1880s and 1890s. Bismarck's social-insurance system provided health insurance, workplace-accident insurance, and old age pensions to a majority of the working population. The German case appeals because the social insurance program started on a large scale and was compulsory for covered classes of workers, and because fertility in Germany in this period was still relatively high. Focusing on the state of Prussia, we estimate differences-in-differences models that ask whether marriage and marital fertility reacted to the introduction or extension of the main social insurance programs. For Prussia as a whole we find little impact.
    Keywords: fertility transition,marriage pattern,old-age pension,health insurance,accident insurance
    JEL: J13 H55 N33
    Date: 2019
  18. By: Asongu Acha-Anyi (University of South Africa, Pretoria, South Africa); Paul N. Acha-Anyi (Walter Sisulu University, South Africa); Simplice A. Asongu (Yaoundé, Cameroon); Vanessa Tchamyou (Yaoundé, Cameroon)
    Abstract: Health promotion is an educational tool that can be used to educate and create awareness of health issues through various media forms. The purpose of this study was to explore the use of social media (TB Proof South Africa‘s Facebook page) in creating tuberculosis (TB) awareness. A qualitative case study approach was used to collect data from TB Proof South Africa‘s Facebook page. An in-depth visual analysis of TB Proof South Africa’s Facebook page was carried out over a five-month period (from 1 February to 30 June 2017). The analysis of TB Proof South Africa‘s Facebook page was conducted in order to determine the use of social media for health promotion. Such a comprehensive analysis was aimed at determining if the visuals on this page create awareness on TB as an illness. Common themes were identified including, TB medication, TB patients and healthcare workers raising awareness on TB. The findings have potential implications for health promotion efforts using social media.
    Keywords: Health promotion, social media, facebook, tuberculosis (TB), health communication, TB Proof South Africa
    Date: 2020–01
  19. By: Fischer, Greg; Karlan, Dean; McConnell, Margaret; Raffler, Pia
    Abstract: The way in which a product is distributed can have lasting effects on demand by influencing learning, anchoring price expectations, and shaping perceptions of product value. While these issues apply broadly, they are particularly important for health products in poor countries, where short-term subsidies are common, similar products are often available through both non-profit and for-profit organizations, and expanding access is an important public health goal. We implemented a field experiment in northern Uganda in which three curative health products were distributed door-to-door either free or for sale and by either an NGO or for-profit company. For all three products, subsequent purchase rates were lower after a free distribution. While we see no difference in subsequent purchase rates based on seller type, we find that contemporaneous demand for a newly introduced product is higher when the seller identifies as a not-for-profit organization.
    Keywords: subsidies; health; pricing; learning
    JEL: D11 D12 D83 I11 I18 O12
    Date: 2019–03–01
  20. By: Premand,Patrick; Barry,Oumar
    Abstract: Signs of development delays and malnutrition are widespread among young children in low-income settings. Social protection programs such as cash transfers are increasingly combined with behavioral change promotion or parenting interventions to improve early childhood development. This paper disentangles the effects of behavioral change promotion from cash transfers to poor households through an experiment embedded in a government program in Niger. The study is also designed to identify within-community spillovers from the behavioral change intervention. The findings show that behavioral change promotion affects a range of practices related to nutrition, health, stimulation, and child protection. Local spillovers on parenting practices are also found. Moderate gains in children's socio-emotional development are observed, but there are no improvements in anthropometrics or cognitive development. Cash transfers alone do not alter parenting practices or improve early childhood development. Cash transfers improve welfare and food security at the household level, and the behavioral intervention induces intra-household reallocations toward children.
    Keywords: Disability,Services&Transfers to Poor,Access of Poor to Social Services,Economic Assistance,Health Care Services Industry,Social Protections&Assistance,Early Childhood Development,Reproductive Health,Nutrition,Early Child and Children's Health
    Date: 2020–08–26
  21. By: Doyle, Mary-Alice (London School of Economics); Schurer, Stefanie (University of Sydney); Silburn, Sven (Menzies School of Health Research)
    Abstract: Australia's 'income management' policy requires benefit recipients to spend at least half of their government transfers on essentials (e.g. food, housing). We estimate income management's impact on birth outcomes by exploiting its staggered rollout. By changing parents' consumption patterns, the policy aims to improve child outcomes. We find no evidence of this. Instead, our estimates suggest it reduced average birthweight by 95 grams and increased the probability of low birthweight by 3 percentage points. We explore the mechanisms that may explain this finding. Our study demonstrates how policies that are not carefully implemented and tested can unintentionally escalate existing inequalities.
    Keywords: welfare reform, Aboriginal children, birth outcomes, income management, unintended consequences
    JEL: D04 I14 I38
    Date: 2020–07
  22. By: Goenka, Aditya; Liu, Lin; Nguyen, Manh-Hung
    Abstract: This paper studies optimal quarantines (can also be interpreted as lockdowns or selfisolation) when there is an infectious disease with SIS dynamics and infections can cause disease related mortality in a dynamic general equilibrium neoclassical growth framework. We characterize the optimal decision and the steady states and how these change with changes in effectiveness of quarantine, productivity of working from home, contact rate of disease and rate of mortality from the disease. A standard utilitarian welfare function gives the counter-intuitive result that increasing mortality reduces quarantines but increases mortality and welfare while economic outcomes and infections are largely unaffected. With an extended welfare function incorporating welfare loss due to disease related mortality (or infections generally) however, quarantines increase, and the decreasing infections reduce mortality and increase economic outcomes. Thus, there is no optimal trade-off between health and economic outcomes. We also study sufficiency conditions and provide the first results in economic models with SIS dynamics with disease related mortality - a class of models which are non-convex and have endogenous discounting so that no existing results are applicable.
    Keywords: Infectious diseases; Covid-19; SIS model; mortality; sufficiency conditions;; economic growth; lockdown; quarantine; self-isolation.
    Date: 2020–08
  23. By: Catalina Amuedo-Dorantes; Neeraj Kaushal; Ashley N. Muchow
    Abstract: Using county-level data on COVID-19 mortality and infections, along with county-level information on the adoption of non-pharmaceutical interventions (NPIs) in the United States, we examine how the speed of NPI adoption affected COVID-19 mortality. Our estimates suggest that advancing the date of NPI adoption by one day lowers the COVID-19 death rate by 2.4 percent. This finding proves robust to alternative measures of NPI adoption speed, model specifications that control for testing and mobility, and across various samples: national, restricted to the Northeast region, excluding New York, and excluding the Northeast region. We also find that the adoption speed of NPIs is associated with lower infections, as well as lower non-COVID mortality, suggesting that these measures slowed contagion and the pace at which the healthcare system might have been overburdened by the pandemic. Finally, NPI adoption speed appears to have been less relevant in Republican counties, suggesting that political ideology might have compromised their efficiency.
    JEL: I1 I12 I14
    Date: 2020–08
  24. By: Romano, Alessandro; Sotis, Chiara; Dominioni, Goran; Guidi, Sebastián
    Abstract: Mass media routinely present data on coronavirus disease 2019 (COVID‐19) diffusion with graphs that use either a log scale or a linear scale. We show that the choice of the scale adopted on these graphs has important consequences on how people understand and react to the information conveyed. In particular, we find that when we show the number of COVID‐19 related deaths on a logarithmic scale, people have a less accurate understanding of how the pandemic has developed, make less accurate predictions on its evolution, and have different policy preferences than when they are exposed to a linear scale. Consequently, merely changing the scale the data is presented on can alter public policy preferences and the level of worry about the pandemic, despite the fact that people are routinely exposed to COVID‐19 related information. Providing the public with information in ways they understand better can help improving the response to COVID‐19, thus, mass media and policymakers communicating to the general public should always describe the evolution of the pandemic using a graph on a linear scale, at least as a default option. Our results suggest that framing matters when communicating to the public.
    Keywords: Covid-19; framing; media; public understanding; coronavirus; Wiley
    JEL: D90 D91 I10 I12 I18
    Date: 2020–08–25
  25. By: Gruener, Sven; Krüger, Felix
    Abstract: False news stories cause welfare losses and fatal health consequences. To limit its dissemination, it is essential to know what determines the ability to distinguish between true and false news stories. In our experimental study, we present the subjects corona-related stories taken from the media from various categories (e.g. social isolation, economic consequences, direct health consequences, and “bullshit”). The task is to evaluate the stories as true or false. Besides students with and without healthcare background, we recruit healthcare professionals to increase the external validity of our study. Our main findings are: (i) Healthcare professionals perform similar to students in correctly distinguishing between true and false news stories. (ii) The propensity to engage in analytical thinking and actively open-minded thinking is positively associated with the ability to distinguish between true and false. (iii) We find that the residence of the subjects (East- or West-Germany) plays only a minor role. (iv) If narratives contradict the content of a story, subjects tend to think that the stories are wrong.
    Date: 2020–08–18
  26. By: Bénédicte H. Apouey (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - 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); Alexandra Roulet (INSEAD - Institut Européen d'administration des Affaires, CEPR - Center for Economic Policy Research - CEPR); Isabelle Solal (ESSEC Business School - Essec Business School); Mark Stabile (INSEAD - Institut Européen d'administration des Affaires, CEPR - Center for Economic Policy Research - CEPR)
    Abstract: We set out to explore how precarious workers, particularly those employed in the gig economy, balance financial uncertainty, health risks, and mental well-being. We surveyed and interviewed precarious workers in France during the COVID-19 crisis, in March and April 2020. We oversampled gig economy workers, in particular in driving and food delivery occupations (hereafter drivers and bikers), residing in metropolitan areas. These workers cannot rely on stable incomes and are excluded from the labor protections offered to employees, features which have been exacerbated by the crisis. We analyzed outcomes for precarious workers during the mandatory lockdown in France as an extreme case to better understand how financial precarity relates to health risks and mental well-being. Our analysis revealed that three weeks into the lockdown, 56% of our overall sample had stopped working and respondents had experienced a 28% income drop on average. Gig economy drivers reported a significant 20 percentage point larger income decrease than other workers in our sample. Bikers were significantly more likely to have continued working outside the home during the lockdown. Yet our quantitative analysis also revealed that stress and anxiety levels were not higher for these groups, and that bikers in fact reported significantly lower stress levels during the lockdown. While this positive association between being a biker and mental health may be interpreted in different ways, our qualitative data led to a nuanced understanding of the effect of gig work on mental well-being in this population group.
    Keywords: Gig Economy,Financial Precarity,Health and Well-Being,COVID-19
    Date: 2020–09
  27. By: Sewon Hur
    Abstract: This paper develops a quantitative life cycle model in which economic decisions impact the spread of COVID-19 and, conversely, the virus affects economic decisions. The calibrated model is used to measure the welfare costs of the pandemic across the age, income and wealth distribution and to study the effectiveness of various mitigation policies. In the absence of mitigation, young workers engage in too much economic activity relative to the social optimum, leading to higher rates of infection and death in the aggregate. The paper considers a subsidy-and-tax policy that imposes a tax on consumption and subsidizes reduced work compared to a lockdown policy that caps work hours. Both policies are welfare improving and lead to less infections and deaths. Notably, almost all agents favor the subsidy-and-tax policy, suggesting that there need not be a tradeoff between saving lives and economic welfare.
    Keywords: pandemic; coronavirus; COVID-19
    JEL: D62 E21 E32 E62 I14 I15
    Date: 2020–09–02
  28. By: Serikbayeva, Balzhan; Abdulla, Kanat; Oskenbayev, Yessengali
    Abstract: This study investigates the link between state capacity and deaths from Covid-19. We examine the effects on the Covid-19 case fatality rate of state capacity of countries with an ordered probit estimation controlling for the level of democracy, government policy responses, the share of the elderly population, and health system resource capacity indicators. The study presents strong evidence for the critical role of state capacity in achieving positive policy outcomes. The effect of government effectiveness on the Covid-19 death level is consistently negative and statistically significant, suggesting that increased government effectiveness is significantly associated with decreased Covid-19 fatality rates. The findings show that in the models controlling for government effectiveness and the testing and stay at home requirements policies, non-free countries are more likely to have lower death levels than free countries. The effects of the testing and stay at home requirements policies have expected negative signs. Higher health system capacity represented by higher numbers of hospital beds and doctors is more likely to lower a country’s case fatality rate. A higher proportion of the elderly population is associated with higher death levels from Covid-19.
    Keywords: COVID-19, state capacity, government effectiveness, democracy, policy responses, fatality rate, health system capacity, testing policy
    JEL: H51 H83 I18 J18
    Date: 2020–07–01
  29. By: Etienne Gagnon; Benjamin K. Johannsen; J. David Lopez-Salido
    Abstract: We use an overlapping generation model to explore the implications of mortality during pandemics for the economy's productive capacity. Under current epidemiological projections for the progression of COVID-19, our model suggests that mortality will have, in itself, at most small effects on output and factor prices. The reason is that projected mortality is small in proportion to the population and skewed toward individuals who are retired from the labor force. That said, we show that if the spread of COVID-19 is not contained, or if the ongoing pandemic were to follow a mortality pattern similar to the 1918-1920 Great Influenza pandemic, then the effects on the productive capacity would be economically significant and persist for decades.
    Keywords: Pandemics; Potential output; Real wage; Equilibrium real interest rate; Demographics; COVID-19
    JEL: E21 E27 E43
    Date: 2020–08–19
  30. By: Marina Azzimonti; Alessandra Fogli; Fabrizio Perri; Mark Ponder
    Abstract: We develop an ECON-EPI network model to evaluate policies designed to improve health and economic outcomes during a pandemic. Relative to the standard epidemiological SIR set-up, we explicitly model social contacts among individuals and allow for heterogeneity in their number and stability. In addition, we embed the network in a structural economic model describing how contacts generate economic activity. We calibrate it to the New York metro area during the 2020 COVID-19 crisis and show three main results. First, the ECON-EPI network implies patterns of infections that better match the data compared to the standard SIR. The switching during the early phase of the pandemic from unstable to stable contacts is crucial for this result. Second, the model suggests the design of smart policies that reduce infections and at the same time boost economic activity. Third, the model shows that reopening sectors characterized by numerous and unstable contacts (such as large events or schools) too early leads to fast growth of infections.
    JEL: D85 E23 E65 I18
    Date: 2020–08
  31. By: Luiz Brotherhood; Vahagn Jerbashian
    Abstract: We derive a model in which firms operate in an epidemic environment and internalize infections among their employees in the workplace. The model is calibrated to fit the properties of the Covid-19 epidemic. We show that firms have incentives to fight against infections and can do so very effectively by increasing teleworking and rotating employees between on-site work, teleworking, and leave. Subsidies to sick leave reduce the cost of sick workers and raise workplace infections. Furlough policies are successful in reducing infections and saving lives. Firms delay and weaken the fight against infections during economic downturns.
    Keywords: Covid-19, epidemic, firm behaviour, on-site work, policies, teleworking
    JEL: C63 D20 D21 I10 I18 L23
    Date: 2020
  32. By: Anastasios Papanastasiou; Bradley J. Ruffle; Angela L. Zheng
    Abstract: We study the factors associated with compliance with social-distancing regulations using a unique dataset on the behaviour of Ontarians during the COVID-19 pandemic. To start, we build a simple theoretical model of social distancing in order to understand how some individual and community-level factors in uence compliance. We test our model's predictions by designing and conducting a survey on Ontarians in which we elicit their degree of compliance with current distancing regulations as well as proposed regulations that impose different fine levels on violators or grant wage subsidies to encourage staying at home. In line with the model's predictions, we show that variables related to one's risk of infection (e.g., health status, age, necessity of working outside the home, regional COVID-19 cases) are signi cant predictors of compliance as are gender, political beliefs, risk and time preferences. Furthermore, we demonstrate that fines and wage subsidies can be powerful policy tools for promoting full compliance with regulations.
    Keywords: COVID-19; physical distancing; non-compliance fines; wage subsidies; risk of infection.
    JEL: I12 I18 J38
    Date: 2020–09
  33. By: Timo Mitze; Reinhold Kosfeld; Johannes Rode; Klaus Wälde
    Abstract: We use the synthetic control method to analyze the effect of face masks on the spread of Covid‐19 in Germany. Our identification approach exploits regional variation in the point in time when wearing of face masks became mandatory in public transport and sales shops. Depending on the region we consider, we find that face masks reduced the number of newly registered SARS‐CoV‐2 infections between 15% and 75% over a period of 20 days after their mandatory introduction. Assessing the credibility of the various estimates, we conclude that face masks reduce the daily growth rate of reported infections by around 47%.
    Keywords: Covid-19, public health measures, face masks, synthetic control method
    Date: 2020
  34. By: Arndt, Channing; Davies, Rob; Gabriel, Sherwin; Harris, Laurence; Makrelov, Konstantin; Robinson, Sherman; Levy, Stephanie; Simbanegavi, Witness; van Seventer, Dirk; Anderson, Lillian
    Abstract: Absent vaccines and pharmaceutical interventions, the only tool available to mitigate its demographic effects is some measure of physical distancing, to reduce contagion by breaking social and economic contacts. Policy makers must balance the positive health effects of strong distancing measures, such as lockdowns, against their economic costs, especially the burdens imposed on low income and food insecure households. The distancing measures deployed by South Africa impose large economic costs and have negative implications for the factor distribution of income. Labor with low education levels are much more strongly affected than labor with secondary or tertiary education. As a result, households with low levels of educational attainment and high dependence on labor income would experience an enormous real income shock that would clearly jeopardize the food security of these households. However, in South Africa, total incomes for low income households are significantly insulated by government transfer payments. From public health, income distribution and food security perspectives, the remarkably rapid and severe shocks imposed because of Covid-19 illustrate the value of having in place transfer policies that support vulnerable households in the event of ‘black swan’ type shocks.
    Keywords: Covid-19 impacts; Food security; Income distribution; SAM multiplier Model; COVID-19; coronavirus
    JEL: R14 J01 E6
    Date: 2020–09–01
  35. By: Motta, Matthew
    Abstract: Objective: A vaccine for the novel coronavirus (COVID-19) could prove critical in establishing herd immunity. While past work has documented the prevalence and correlates of vaccine refusal, I assess how a less explored topic -- properties of vaccines themselves (e.g., national origin, efficacy, risk of side effects) -- might influence vaccination intentions. This information can help public health officials preempt differential vaccine demand, and inform health communication campaigns that encourage vaccine uptake. Rationale: Previous research suggests that Americans should be more likely to intend to vaccinate if presented with a US-made vaccine that carries a low risk of minor side effects, is highly effective, is administered in just one dose, and has spent significant time in development. Methods: I administered a conjoint experiment (N = 5,940 trials) in a demographically representative survey (N = 990) of US adults to assess how variation in vaccine properties influence self-reported public vaccination intentions. Results: I find that respondents prefer vaccines that are US-made, over 90% effective, and carry a less than 1% risk of minor side effects. This is potentially problematic, as some leading vaccine candidates are produced outside the US, and may be less effective and more likely to produce minor side effects than respondents would otherwise prefer. Worryingly, intended vaccine refusal rates exceed 30% for a vaccine meeting these optimal characteristics. Encouragingly, though, Americans show no clear preference for vaccines administered in one dose, or developed in under a year, and do not appear to draw a distinction between weakened viral vs. mRNA-based vaccines. Conclusion: Americans’ preferences for a novel coronavirus vaccine may be at odds with the vaccine that ultimately hits the market, posing both policy and health communication challenges for vaccination uptake.
    Date: 2020–08–27
  36. By: Christopher F Baum (Boston College; DIW Berlin; CESIS); Miguel Henry (Greylock McKinnon Associates)
    Abstract: As the COVID-19 pandemic has progressed in the U.S., “hotspots” have been shifting geographically over time to suburban and rural counties showing a high prevalence of the disease. We analyze daily U.S. county-level variations in COVID-19 confirmed case counts to evaluate the spatial dependence between neighboring counties. We find strong evidence of county-level socioeconomic factors influencing the spatial spread. We show the potential of combining spatial econometric techniques and socioeconomic factors in assessing the spatial effects of COVID-19 among neighboring counties.
    Date: 2020–09–11
  37. By: Gianmarco Daniele; Andrea F.M. Martinangeli; Francesco Passarelli; Willem Sas; Lisa Windsteiger
    Abstract: This paper investigates whether the COVID-19 crisis has affected the way we think about (political) institutions, as well as our broader (policy) attitudes and values. We fielded large online survey experiments in Italy, Spain, Germany and the Netherlands, well into the first wave of the epidemic (May-June), and included outcome questions on trust, voting intentions, policies & taxation, and identity & values. With a randomised survey ow we vary whether respondents are given COVID-19 priming questions first, before answering the outcome questions. With this treatment design we can also disentangle the health and economic effects of the crisis, as well as a potential “rally around the ag” component. We find that the crisis has brought about severe drops in interpersonal and institutional trust, as well as lower support for the EU and social welfare spending financed by taxes. This is largely due to economic insecurity, but also because of health concerns. A rallying effect around (scientific) expertise combined with populist policies losing ground forms the other side of this coin, and suggests a rising demand for competent leadership.
    Keywords: COVID-19, social trust, institutional trust, survey experiment, European Union, welfare, health, taxation, accountability, populism, values
    JEL: D72 H51 H53 H55 O52 P52
    Date: 2020
  38. By: ARON, JANINE; Muellbauer, John
    Abstract: In a previous article, we considered key issues for comparing rates of excess mortality between countries and regions, with an application to European countries. This article compares the U.S. with Europe, and U.S. regions with the main European countries. The U.S. policy-makers had multiple advantages over European countries, such as Italy and Spain, in responding to the first wave of the Covid-19 pandemic: more time to react, with excess deaths lagging three weeks behind, and a younger, less densely-populated, less urban population. With the further passage of time, medical knowledge about Covid-19 has improved, health and testing capacities have been built up and practical experience has allowed both the private precautionary responses of citizens and of public policies to develop. This should have given countries and regions, for example, the U.S. South, the West and the Midwest, together accounting for 83 percent of the U.S. population, and where the spread of virus occurred later, a further advantage over those caught up in the first pandemic wave. Despite this, a comparison for the whole of the U.S. with Europe, excluding Russia, shows that the cumulative rate of excess mortality in 2020 was higher in the U.S.. And for the U.S. Northeast, the most comparable U.S. region, being closest to major European countries in the timing of the pandemic, and in population-density, age and urbanisation, the plausible measures of excess mortality prove substantially worse than for the worst-affected countries in Europe. These findings contradict recent claims by the U.S. President.
    Date: 2020–08–25
  39. By: Bonacini, Luca; Gallo, Giovanni; Patriarca, Fabrizio
    Abstract: Identifying structural breaks in the dynamics of COVID-19 contagion is crucial to promptly assess policies and evaluate the effectiveness of lockdown measures. However, official data record infections after a critical and unpredictable delay. Moreover, people react to the health risks of the virus and also anticipate lockdowns. All of this makes it complex to quickly and accurately detect changing patterns in the virus’s infection dynamic. We propose a machine learning procedure to identify structural breaks in the time series of COVID-19 cases. We consider the case of Italy, an early-affected country that was unprepared for the situation, and detect the dates of structural breaks induced by three national lockdowns so as to evaluate their effects and identify some related policy issues. The strong but significantly delayed effect of the first lockdown suggests a relevant announcement effect. In contrast, the last lockdown had significantly less impact. The proposed methodology is robust as a real-time procedure for early detection of the structural breaks: the impact of the first two lockdowns could have been correctly identified just the day after they actually occurred.
    Keywords: COVID-19,coronavirus,lockdown,machine learning
    JEL: C63 I12 I18
    Date: 2020

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