nep-hea New Economics Papers
on Health Economics
Issue of 2020‒10‒19
39 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Health Insurance Menu Design for Large Employers By Kate Ho; Robin S. Lee
  2. A Satellite Account for Health in the United States By David M. Cutler; Kaushik Ghosh; Kassandra Messer; Trivellore Raghunathan; Allison B. Rosen; Susan T. Stewart
  3. Rules vs. Discretion: Treatment of Mental Illness in U.S. Adolescents By Emily Cuddy; Janet Currie
  4. Mental health and the response to financial incentives: evidence from a survey incentives experiment By Kung, Claryn S. J.; Johnston, David W.; Shields, Michael A.
  5. Anticipation of Deteriorating Health and Information Avoidance By Johannes Schünemann; Holger Strulik; Timo Trimborn
  6. Identifying Marginal Treatment Effects in the Presence of Sample Selection By Bartalotti, Otávio; Kedagni, Desire; Possebom, Vitor
  7. Do-It-Yourself medicine? The impact of light cannabis liberalization on prescription drugs By Vincenzo Carrieri; Leonardo Madio; Francesco Principe
  8. Does Obamacare Care? A Fuzzy Difference-in-Discontinuities Approach By Galindo-Silva, Hector; Somé, Nibene Habib; Tchuente, Guy
  9. Transfer Payment Systems and Financial Distress: Insights from Health Insurance Premium Subsidies By Schmid, Christian P. R.; Schreiner, Nicolas; Stutzer, Alois
  10. Industrial Robots, Workers’ Safety, and Health By Rania Gihleb; Osea Giuntella; Luca Stella; Tianyi Wang
  11. Predictors of Sleep Recall Bias in College Students By Srivastava, Pranjal; Takegami, Mina; Chen, Ching-Hua
  12. Health of Elderly Parents, Their Children's Labor Supply, and the Role of Migrant Care Workers By Wolfgang Frimmel; Martin Halla; Jörg Paetzold; Julia Schmieder
  13. Forgetting-by-not-doing: The case of surgeons and cesarean sections. By Gabriel A. Facchini Palma
  14. Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon By Gabriel A. Facchini Palma
  15. Deterrence Effects of Antifraud and Abuse Enforcement in Health Care By David H. Howard; Ian McCarthy
  16. A Calculation of the Social Returns to Innovation By Benjamin F. Jones; Lawrence H. Summers
  17. Saving Neonatal Lives for a Quarter By Valente, Christine; Sievertsen, Hans Henrik; Puri, Mahesh C.
  18. The Relationship between Subjective Wellbeing and Subjective Wellbeing Inequality: Taking Ordinality and Skewness Seriously. By Arthur Grimes; Stephen P. Jenkins; Florencia Tranquilli
  19. In and out of unemployment - labour market dynamics and the role of testosterone By Peter Eibich; Ricky Kanabar; Alexander Plum; Julian Schmied
  20. Concessions, Violence, and Indirect Rule: Evidence from the Congo Free State By Sara Lowes; Eduardo Montero
  21. Changes in Healthcare Utilization, Spending, and Perceived Health during COVID–19: A Longitudinal Study from Singapore By Ahn, SangNam; Kim, Seonghoon; Koh, Kanghyock
  22. SIR Economic Epidemiological Models with Disease Induced Mortality By Aditya Goenka; Lin Liu; Nguyen, Manh-Hung
  23. Modeling optimal quarantines under infectious disease related mortality By Aditya Goenka; Lin Liu; Nguyen, Manh-Hung
  24. COVID-19 and primary care: A critical need for strengthening emergency preparedness across health systems By Sultana, Abida; Bhattacharya, Sudip; Hossain, Md Mahbub
  25. Close encounters on the verge of a pandemic: the role of social contacts on the spread and mortality of COVID-19 By Cristini, Annalisa; Trivin, Pedro
  26. Who Should Work from Home during a Pandemic? The Wage-Infection Trade-off By Sangmin Aum; Sang Yoon (Tim) Lee; Yongseok Shin
  27. The Impact of COVID-19 on Subjective Well-Being: Evidence from Singapore By Cheng, Terence Chai; Kim, Seonghoon; Koh, Kanghyock
  28. A Cost/Benefit Analysis of Clinical Trial Designs for COVID-19 Vaccine Candidates By Donald A. Berry; Scott Berry; Peter Hale; Leah Isakov; Andrew W. Lo; Kien Wei Siah; Chi Heem Wong
  29. Automation and reallocation: The lasting legacy of COVID-19 in Canada By Blit, Joel
  30. The Distribution of COVID-19 Related Risks By Patrick Baylis; Pierre-Loup Beauregard; Marie Connolly; Nicole Fortin; David A. Green; Pablo Gutierrez Cubillos; Sam Gyetvay; Catherine Haeck; Timea Laura Molnar; Gaëlle Simard-Duplain; Henry E. Siu; Maria teNyenhuis; Casey Warman
  31. Face Masks, Public Policies and Slowing the Spread of COVID-19: Evidence from Canada By Alexander Karaivanov; Shih En Lu; Hitoshi Shigeoka; Cong Chen; Stephanie Pamplona
  32. Life Expectancy During the Covid-19 Pandemic: A Semi-Parametric Difference-in-Differences Analysis By Polemis, Michael; Stengos, Thanasis
  33. COVID-19 Mortality and Contemporaneous Air Pollution By Wes Austin; Stefano Carattini; John Gomez Mahecha; Michael Pesko
  34. A Rational-ChoiceModel of Covid-19 Transmission with Endogenous Quarantining and Two-sided Prevention By Bhattacharya, Joydeep; Chakraborty, Shankha; Yu, Xiumei
  35. The Gender Gap in Aversion to COVID-19 Exposure: Evidence from Professional Tennis By Kowalik, Zuzanna; Lewandowski, Piotr
  36. COVID-19 Changed Tastes for Safety-Net Programs By Alex Rees-Jones; John D'Attoma; Amedeo Piolatto; Luca Salvadori
  37. An Economic Model of Health-vs-Wealth Prioritization during Covid-19: Optimal Lockdown, Network Centrality, and Segregation By Pongou, Roland; Tchuente, Guy; Tondji, Jean-Baptiste
  38. Maine Employment Change During the Early Months of the COVID-19 Pandemic: A Shift-Share Analysis By Todd, Gabe
  39. The Impact of COVID-19 on Small Business Owners: The First Three Months after Social-Distancing Restrictions By Fairlie, Robert W.

  1. By: Kate Ho; Robin S. Lee
    Abstract: We explore the challenges faced by a large employer designing a health insurance plan menu for its employees. Using detailed administrative data from Harvard University, we estimate a model of plan choice and utilization, and evaluate the benefits of cost sharing and plan variety. For a single plan with a generous out-of-pocket maximum, we find that a modest coinsurance rate of approximately 30% with a zero deductible maximizes average employee surplus. Gains from offering choice are limited if based solely on financial dimensions, but can be economically significant if paired with other features that appeal to sicker households.
    JEL: I11 I13 L2
    Date: 2020–09
  2. By: David M. Cutler; Kaushik Ghosh; Kassandra Messer; Trivellore Raghunathan; Allison B. Rosen; Susan T. Stewart
    Abstract: Estimating medical care productivity is a central economic challenge. This paper develops a satellite account for the US health sector that appropriately measures health care productivity and applies that to the elderly population between 1999 and 2012. The central output of the satellite account is health. The primary input is medical care; we also examine the impact of behavioral risk factors. Our empirical work measures the change in medical spending and health outcomes for a comprehensive set of 80 conditions. We estimate that medical care has positive productivity as a whole, with aggregate productivity growth of 9% over the time period. However, there is significant heterogeneity in productivity by condition. At the upper end, care for cardiovascular disease has been extremely productive. In contrast, care for people with mental illness and musculoskeletal conditions has been costly but not productive.
    JEL: E2 I10 I11 I12 I38
    Date: 2020–09
  3. By: Emily Cuddy; Janet Currie
    Abstract: Mental health disorders are a leading cause of disability worldwide. Many mental health disorders start in adolescence and appropriate treatment at the outset may improve trajectories. We use a large national data base of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next two years. We find that receiving follow up mental health treatment in the first three months after an initial mental health claim increases the total cost of care over the next 24 months. These higher costs are entirely accounted for by children who receive treatment that is not consistent with practice guidelines. Our estimates imply that, within 24 months, children who initially received a red-flag drug have 205% higher costs than those of the average treated child and are 131% more likely to have used an emergency room or experienced a hospitalization. These results show that large numbers of U.S. children are receiving mental health care that falls outside of accepted guidelines and poses risks to their health. In doing so, they provide support for the guidelines themselves, and demonstrate that analyses of large-scale claims data can provide a useful complement to clinical research studies in identifying best practices.
    JEL: I1 I11
    Date: 2020–10
  4. By: Kung, Claryn S. J.; Johnston, David W.; Shields, Michael A.
    Abstract: Although mental health disorders such as anxiety and depression are common, there is little research on whether individuals in poor mental health react differently from others to financial incentives. This paper exploits an experiment from the UK Understanding Society Innovation Panel to assess how the participation response to randomly-assigned financial incentives differs by mental health status. We find that individuals in good mental health are more likely to respond when offered a higher financial incentive, whereas those in poor mental health are indifferent to the increased incentive. We find no comparable differences for physical health.
    Keywords: mental health; financial incentives; survey incentives experiment
    JEL: C93 I10
    Date: 2018–11–01
  5. By: Johannes Schünemann (University of Fribourg, Department of Economics); Holger Strulik (University of Goettingen, Department of Economics); Timo Trimborn (Department of Economics and Business Economics, Aarhus University)
    Abstract: We integrate anticipatory utility and endogenous beliefs about future negative health shocks into a life-cycle model of physiological aging. Individuals care about their future utility derived from their health status and form endogenous beliefs about the probability of a negative health shock. We calibrate the model with data from gerontology and use the model to predict medical testing decisions of individuals. We find that anticipation in combination with endogenous beliefs provides a quantitatively strong motive to avoid medical testing for Huntington's disease which explains the low testing rates found empirically. We also study the case of breast and ovarian cancer and provide an explanation for why testing rates depend on the individual's income when treatment is available.
    Keywords: Health, Anticipation, Longevity, Health behavior, Beliefs, Information avoidance
    JEL: D11 D91 I12 J17
    Date: 2020–09–30
  6. By: Bartalotti, Otávio; Kedagni, Desire; Possebom, Vitor
    Abstract: This article presents identification results for the marginal treatment effect (MTE) when there is sample selection. We show that the MTE is partially identified for individuals who are always observed regardless of treatment, and we derive sharp bounds on this parameter under four sets of assumptions. The first identification result combines the standard MTE assumptions without any restrictions to the sample selection mechanism. The second result imposes monotonicity of the sample selection variable with respect to the treatment, considerably shrinking the identified set. Third, we incorporate a stochastic dominance assumption which tightens the lower bound for the MTE. Finally, we provide a set of conditions that allows point identification for completeness. Our analysis extends to discrete instruments and distributional MTE. All the results rely on a mixture reformulation of the problem where the mixture weights are identified. We therefore extend the Lee (2009) trimming procedure to the MTE context. We propose some preliminary estimators for the bounds derived, provide a numerical example and simulations that corroborate the bounds feasibility and usefulness as an empirical tool. In future drafts, we plan to highlight the practical relevance of the results by analyzing the impacts of managed health care options on health outcomes and expenditures, following Deb, Munkin, and Trivedi (2006).
    Date: 2019–09–15
  7. By: Vincenzo Carrieri (UMG - Università degli Studi "Magna Graecia" di Catanzaro [Catanzaro, Italie]); Leonardo Madio (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); Francesco Principe (Erasmus University School of Economics - Erasmus university)
    Abstract: Governments worldwide are increasingly concerned about the booming use of CBD (cannabidiol) products. However, we know little about the impact of their liberalization. We study a unique case of unintended liberalization of a CBD-based product (light cannabis) that occurred in Italy in 2017. Using unique and high-frequency data on prescription drug sales and by exploiting the staggered local availability of the new product in each Italian province, we document a significant substitution effect between light cannabis and anxiolytics, sedatives, opioids, anti-depressants and anti-psychotics. Results are informative for regulators and suggest that bans on light cannabis use would disregard the needs of patients to seek effective reliefs of their symptoms.
    Keywords: Light cannabis,self-medication,marijuana,difference-in-difference,prescription drugs,CBD.
    Date: 2020–12
  8. By: Galindo-Silva, Hector; Somé, Nibene Habib; Tchuente, Guy
    Abstract: This paper explores the use of a fuzzy regression discontinuity design where multiple treatments are applied at the threshold. The identification results show that, under the very strong assumption that the change in the probability of treatment at the cutoff is equal across treatments, a differencein- discontinuities estimator identifies the treatment effect of interest. The point estimates of the treatment effect using a simple fuzzy difference-in-discontinuities design are biased if the change in the probability of a treatment applying at the cutoff differs across treatments. Modifications of the fuzzy difference-in-discontinuities approach that rely on milder assumptions are also proposed. Our results suggest caution is needed when applying before-and-after methods in the presence of fuzzy discontinuities. Using data from the National Health Interview Survey, we apply this new identification strategy to evaluate the causal effect of the Affordable Care Act (ACA) on older Americans' health care access and utilization. Our results suggest that the ACA has (1) led to a 5% increase in the hospitalization rate of elderly Americans, (2) increased the probability of delaying care for cost reasons by 3.6%, and (3) exacerbated cost-related barriers to follow-up care and continuity of care: 7.0% more elderly individuals could not afford prescriptions, 7.2% more could not see a specialist, and 5.5% more could not afford a follow-up visit. Our results can be explained by an increase in the demand for health services without a corresponding adjustment in supply following the implementation of the ACA.
    Keywords: Fuzzy Difference-in-Discontinuities,Identification,Regression Discontinuity Design,Affordable Care Act
    JEL: C13 I12 I13 I18
    Date: 2020
  9. By: Schmid, Christian P. R. (CSS Institute for Empirical Health Economics); Schreiner, Nicolas (University of Basel); Stutzer, Alois (University of Basel)
    Abstract: How should payment systems of means-tested benefits be designed to improve the financial situation of needy recipients most effectively? We study this question in the context of mandatory health insurance in Switzerland, where recipients initially received either a cash transfer or subsidized insurance premiums (a form of in-kind transfer). A federal reform in 2014 forced cantons (i.e. states) to universally switch to in-kind provision. We exploit this setting based on a difference-in-differences design, analyzing rich individual-level accounting data and applying a machine learning approach to identify cash recipients prior to the reform. We find that switching from cash to in-kind transfers reduces the likelihood of late premiums payments by about 20% and of government debt collection for long-term missed payments by approximately 16%. There is no evidence for a negative spillover effect on the timely payment of the non-subsidized coinsurance bills for health services after the regime change.
    Keywords: health insurance, transfers, cash subsidies, in-kind transfers, financial distress, debt collection
    JEL: D14 H24 I13
    Date: 2020–10
  10. By: Rania Gihleb; Osea Giuntella; Luca Stella; Tianyi Wang
    Abstract: This study explores the relationship between the adoption of industrial robots and workplace injuries using data from the United States (US) and Germany. Our empirical analyses, based on establishment-level data for the US, suggest that a one standard deviation increase in robot exposure reduces work-related injuries by approximately 16%. These results are driven by manufacturing firms (–28%), while we detect no impact on sectors that were less exposed to industrial robots. We also show that the US counties that are more exposed to robot penetration experience a significant increase in drug- or alcohol-related deaths and mental health problems, consistent with the extant evidence of negative effects on labor market outcomes in the US. Employing individual longitudinal data from Germany, we exploit within-individual changes in robot exposure and document similar effects on job physical intensity (–4%) and disability (–5%), but no evidence of significant effects on mental health and work and life satisfaction, consistent with the lack of significant impacts of robot penetration on labor market outcomes in Germany.
    Keywords: Robot-exposure, work-related health risks
    JEL: I10 J0
    Date: 2020
  11. By: Srivastava, Pranjal; Takegami, Mina; Chen, Ching-Hua
    Abstract: College students are known to have unhealthy levels of sleep. Using data from the StudentLife Dataset, we analyzed the predictors of “recall bias” regarding sleep. We compared the average of a running, daily, self-reported sleep value over a period of time to the average sleep amount perceived by the students in their PSQI (Pittsburgh Sleep Quality Index) tests. We found that the variability in the measure of self-assessment of health was related to errors in sleep recall, as were some individual parameters.
    Date: 2020–09–21
  12. By: Wolfgang Frimmel; Martin Halla; Jörg Paetzold; Julia Schmieder
    Abstract: We estimate the impact of parental health on adult children’s labor market outcomes. We focus on health shocks which increase care dependency abruptly. Our estimation strategy exploits the variation in the timing of shocks across treated families. Empirical results based on Austrian administrative data show a significant negative impact on labor market activities of children. This effect is more pronounced for daughters and for children who live close to their parents. Further analyses suggest informal caregiving as the most likely mechanism. The effect is muted after a liberalization of the formal care market, which sharply increased the supply of foreign care workers.
    Keywords: Informal care, formal care, aging, health, labor supply, labor migration
    JEL: J14 J22 I11 I18 R23
    Date: 2020
  13. By: Gabriel A. Facchini Palma (Department of Applied Economics, Universidad Autónoma de Barcelona, 08193, Bellaterra, Spain)
    Abstract: This paper provides new evidence on the link between patient outcome and physician experience. Using birth certificates data from a large hospital in Italy, I analyze whether cesarean section surgeons who have performed more procedures in the recent past observe an improvement in performance. By using data from the Italian health care system, where patients are not allowed to choose their physician, I lower concerns of potential reverse causality (selective referral). I find evidence indicating a strong learning-by-doing effect: for emergent cases, a one standard deviation increase in recent experience reduces the likelihood of neonatal intensive care unit admission by nearly 2.9 percentage points (12%) and of being born with a low Apgar Score by about 1.3 percentage points (9.5%), all else equal. This effect is not present for the case of elective C-sections.
    Keywords: Learning-by-doing, human capital, experience, volume, cesarean section, productivity
    JEL: J24 I10 I18
    Date: 2020–10
  14. By: Gabriel A. Facchini Palma (Department of Applied Economics, Universidad Autónoma de Barcelona, 08193, Bellaterra, Spain)
    Abstract: This paper examines how workload affects the provision of care in a large but understudied segment of the healthcare sector – maternity wards. I use detailed patient-level administrative data on childbirth, and exploit quasi-random assignment of unscheduled patients to different staffing ratios. I find that patients who at admission observe a higher ratio of patients-to-midwives are more likely to receive a C-section. I show that this result is not attributable to patients’ differential sorting across workload levels. Instead, I find evidence that C-sections are used to alleviate midwives’ workload -they are faster than vaginal births and performed by physicians. I also exploit patient’s civil status to determine whether the effect varies with patient’s bargaining power -single women are on average more likely to be alone in the delivery room. Consistent with induced demand, only single patients are more likely to receive a C-section when admitted at high workload levels.
    Keywords: cesarean section, workload, midwives, physician induced demand, bargaining power
    JEL: D82 H42 H51 I18 J13 J16 J22
    Date: 2020–09
  15. By: David H. Howard; Ian McCarthy
    Abstract: Estimates of the benefits of antifraud enforcement in health care typically focus on direct monetary damages. Deterrence effects are acknowledged but unquantified. We evaluate the impact of a Department of Justice investigation of hospitals accused of billing Medicare for unnecessary implantable cardiac defibrillator (ICD) procedures on their use. Using 100% inpatient and outpatient procedure data from Florida, we estimate that the investigation caused a 22% decline in unnecessary ICD implantations. The present value of savings nationally over a 10 year period is $2.7 billion, nearly 10 times larger than the $280 million in settlements the Department of Justice recovered from hospitals. The investigation had a large and long-lasting effect on physician behavior, indicating the utility of antifraud enforcement as a tool for reducing wasteful medical care.
    JEL: I18 K42
    Date: 2020–10
  16. By: Benjamin F. Jones; Lawrence H. Summers
    Abstract: This paper estimates the social returns to investments in innovation. The disparate spillovers associated with innovation, including imitation, business stealing, and intertemporal spillovers, have made calculations of the social returns difficult. Here we provide an economy-wide calculation that nets out the many spillover margins. We further assess the role of capital investment, diffusion delays, learning-by-doing, productivity mismeasurement, health outcomes, and international spillovers in assessing the average social returns. Overall, our estimates suggest that the social returns are very large. Even under conservative assumptions, innovation efforts produce social benefits that are many multiples of the investment costs.
    JEL: O3 O4
    Date: 2020–09
  17. By: Valente, Christine (University of Bristol); Sievertsen, Hans Henrik (University of Bristol); Puri, Mahesh C. (Center for Research on Environment, Health and Population Activities)
    Abstract: Over 400,000 children die annually from neonatal sepsis, despite several RCTs finding that this can be prevented by chlorhexidine cord care (CHX) for only US$0.23 per dose. Unresolved heterogeneity in findings and other RCT scalability concerns contribute to slow CHX adoption. Studying the first national CHX roll-out — in Nepal — we find that CHX reduces neonatal mortality by 56 percent for births predicted to take place at home. We find no effect for predicted health facility births, which is consistent with heterogeneity in prior experimental estimates. Conditional on predicted place of delivery, there is little significant treatment effect heterogeneity.
    Keywords: neonatal mortality, chlorhexidine, Nepal
    JEL: I18 J13 O15
    Date: 2020–09
  18. By: Arthur Grimes (Motu Economic and Public Policy Research); Stephen P. Jenkins (London School of Economics and Political Science, and IZA); Florencia Tranquilli (Motu Economic and Public Policy Research, and Victoria University of Wellington)
    Abstract: We argue that the relationship between individual satisfaction with life (SWL) and SWL inequality is more complex than described by leading earlier research such as Goff, Helliwell, and Mayraz (Economic Inquiry, 2018). Using inequality indices appropriate for ordinal data, our analysis using the World Values Survey reveals that skewness of the SWL distribution, not only inequality, matters for individual SWL outcomes; so too does whether we look upwards or downwards at the (skewed) distribution. Our results are consistent with there being negative (positive) externalities for an individual’s SWL from seeing people who are low (high) in the SWL distribution.
    Keywords: subjective wellbeing, ordinal data, inequality, skewness, WVS
    JEL: D31 D63 I31
    Date: 2020–10
  19. By: Peter Eibich (Max Planck Institute for Demographic Research, Rostock, Germany); Ricky Kanabar; Alexander Plum; Julian Schmied (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Biological processes have provided new insights into diverging labour market trajectories. In this paper, we use population variation in testosterone levels to explain transition probabilities into and out of unemployment. We follow individual employment histories for 1,771 initially employed and 109 initially unemployed British men from the UK Household Longitudinal Study (“Understanding Society”) between 2009 and 2015. To account for unobserved heterogeneity, we apply dynamic random effect models. We find that individuals with high testosterone levels are more likely to become unemployed, but they are also more likely to exit unemployment. Based on previous studies and descriptive evidence, we argue that these effects are likely driven by personality traits and occupational sorting of men with high testosterone levels. Our findings suggest that latent biological processes can affect job search behaviour and labour market outcomes, without necessarily relating to illness and disability.
    Keywords: United Kingdom
    JEL: J1 Z0
    Date: 2020
  20. By: Sara Lowes; Eduardo Montero
    Abstract: All colonial powers granted concessions to private companies to extract natural resources during the colonial era. Within Africa, these concessions were characterized by indirect rule and violence. We use the arbitrarily defined borders of rubber concessions granted in the north of the Congo Free State to examine the causal effects of this form of economic organization on development. We find that historical exposure to the concessions causes significantly worse education, wealth, and health outcomes. To examine mechanisms, we collect survey and experimental data from individuals near a former concession boundary. We find that village chiefs inside the former concessions provide fewer public goods, are less likely to be elected, and are more likely to be hereditary. However, individuals within the concessions are more trusting, more cohesive, and more supportive of sharing income. The results are relevant for the many places that were designated as concessions to private companies during the colonial era.
    JEL: D72 N47 O15 O43 Z1 Z13
    Date: 2020–10
  21. By: Ahn, SangNam (University of Memphis); Kim, Seonghoon (Singapore Management University); Koh, Kanghyock (Korea University)
    Abstract: The COVID–19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. Using monthly panel data of nationally representative middle-aged and older Singaporeans, we examined the associations of the pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health. At its peak, doctor visits decreased by 30% and out-of-pocket medical spending decreased by 23%, mostly driven by reductions in inpatient and outpatient care. Although there were little changes in self-reported health and sleep quality, COVID–19 increased depressive symptoms by 4%. We argue that it is imperative to monitor COVID–19's long-term health effects among non-COVID–19 patients since our findings indicated delayed healthcare and worsened mental health during the outbreak.
    Keywords: COVID–19, pandemic, healthcare utilization, healthcare spending, self-reported health status, mental health
    JEL: I12 I18
    Date: 2020–09
  22. By: Aditya Goenka (University of Birmingham); Lin Liu (University of Liverpool); Nguyen, Manh-Hung (Toulouse School of Economics)
    Abstract: This paper studies an optimal growth model where health expenditures (alternatively lockdowns) can be made to reduce infectivity of the disease when there is an infectious disease with SIR dynamics and infections can cause disease related mortality. We study implications of two different SIR models - with early mortality and with late mortality from the disease - on health outcomes, optimal response and on economic outcomes in equilibrium. We characterize the steady states and show how these vary when varying mortality. The outcomes are sensitive to the specification of the epidemiology model. We also study sufficiency conditions and provide the first results in economic models with SIR dynamics with and without 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, SIR model, mortality, sufficiency conditions, economic growth, lockdown, prevention, health expenditure.
    JEL: E13 E22 D50 D63 I10 I15 I18 O41 C61
    Date: 2020–10
  23. By: Aditya Goenka (University of Birmingham); Lin Liu (University of Liverpool); Nguyen, Manh-Hung (Toulouse School of Economics)
    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.
    JEL: E13 E22 D50 D63 I10 I15 I18 O41 C61
    Date: 2020–10
  24. By: Sultana, Abida; Bhattacharya, Sudip; Hossain, Md Mahbub
    Abstract: The coronavirus disease (COVID-19) pandemic has disrupted every frontier of human lives. When it comes to emergency care for any health emergency for individuals, or primary care where people make their first contact with the health system in a country, this pandemic has shown the lack of preparedness on delivering medical care in both settings. An integrative yet holistic perspective is needed to strengthen emergency medicine and primary care across health systems, which may enable us to save more lives during this pandemic and be better prepared for the next one.
    Date: 2020–09–13
  25. By: Cristini, Annalisa; Trivin, Pedro
    Abstract: Close proximity interactions facilitate the spread of COVID-19, which is predominantly transmitted via droplets. In this paper we study to what extend the transmission and mortality of the virus are related to social habits regarding physical interactions. Using regional data for a maximum of 8 European countries we find that a standard deviation increase in the percentage of people having daily face-to-face contacts raises COVID-19 cases by 10% but does not affect the number of fatalities. Analyzing the effects by type of contact, we observe that only the interactions with friends are relevant for the transmission and mortality of the virus. Additionally, our results show that this impact is reinforced by the presence of inter-generational families in the region. Finally, we find evidence of a negative relationship between civic habits and the growth rate of contagion between April and June 2020.
    Keywords: COVID-19; Social contacts; Virus contagion.
    JEL: I1 I12 I18
    Date: 2020–09–22
  26. By: Sangmin Aum; Sang Yoon (Tim) Lee; Yongseok Shin
    Abstract: Shutting down the workplace is an effective means of reducing contagion, but can incur large economic losses. We construct an exposure index, which measures infection risks across occupations, and a work-from-home index, which gauges the ease with which a job can be performed remotely across both industries and occupations. Because the two indices are negatively correlated but distinct, the economic costs of containing a pandemic can be minimized by only sending home those jobs that are highly exposed but easy to perform from home. Compared to a lockdown of all non-essential jobs, the optimal policy attains the same reduction in aggregate exposure (32 percent) with one-third fewer workers sent home (24 vs. 36 percent) and with only half the loss in aggregate wages (15 vs. 30 percent). A move from the lockdown to the optimal policy reduces the exposure of low-wage workers the most and the wage loss of the high-wage workers the most, although everyone's wage losses become smaller. A constrained optimal policy under which health workers cannot be sent home still achieves the same exposure reduction with a one-third smaller loss in aggregate wages (19 vs. 30 percent).
    JEL: E24 I14 J21
    Date: 2020–10
  27. By: Cheng, Terence Chai (University of Adelaide); Kim, Seonghoon (Singapore Management University); Koh, Kanghyock (Korea University)
    Abstract: We provide novel evidence on how the COVID-19 global health and economic crisis is affecting overall life satisfaction and domain-specific satisfaction using data from a monthly longitudinal survey of middle-aged and older Singaporeans. Using a difference-in-differences framework, we document large declines in overall life satisfaction and domain-specific satisfaction during the COVID-19 outbreak, except satisfaction with health. These declines coincide with the introduction of a nationwide lockdown, with life satisfaction remaining below its pre-pandemic levels even after the lockdown is lifted. We also find that individuals who report a drop in household income during the COVID-19 outbreak experience a decline in overall life satisfaction almost twice as large as those who do not report any income loss.
    Keywords: COVID-19, pandemic, life satisfaction, subjective well-being, individual-level monthly panel data, difference-in-differences
    JEL: E2 I12 I31
    Date: 2020–09
  28. By: Donald A. Berry; Scott Berry; Peter Hale; Leah Isakov; Andrew W. Lo; Kien Wei Siah; Chi Heem Wong
    Abstract: We compare and contrast the expected duration and number of infections and deaths averted among several designs for clinical trials of COVID-19 vaccine candidates, including traditional randomized clinical trials and adaptive and human challenge trials. Using epidemiological models calibrated to the current pandemic, we simulate the time course of each clinical trial design for 504 unique combinations of parameters, allowing us to determine which trial design is most effective for a given scenario. A human challenge trial provides maximal net benefits—averting an additional 1.1M infections and 8,000 deaths in the U.S. compared to the next best clinical trial design—if its set-up time is short or the pandemic spreads slowly. In most of the other cases, an adaptive trial provides greater net benefits.
    JEL: C15 H12 H51 I1 I11
    Date: 2020–10
  29. By: Blit, Joel
    Abstract: Recent evidence suggests that recessions play a crucial role in promoting automation and the reallocation of productive resources. Consistent with this, I show that in the three previous Canadian recessions, routine jobs were disproportionately lost. COVID-19 is likely to have a similar impact, but bigger because superimposed onto the usual recessionary transformational forces are health-specific incentives to automate. Using O*NET data, I construct an index of COVID-19 health risk and of routine task intensity to measure health incentives to automate and the feasibility of doing so. Across occupations, income groups, industries, and regions, the two indices are strongly negatively correlated, suggesting that automation will not be overly focused and that it may penetrate into hitherto relatively unaffected sectors like health and education. Nevertheless, office and health support workers are likely to be disproportionately affected, as will the retail and hospitality industries. The impacts will also be primarily felt by families toward the bottom of the income distribution and in smaller cities.
    Keywords: COVID-19,recessions,productivity,innovation,automation
    JEL: O33 O40 E32 J24
    Date: 2020
  30. By: Patrick Baylis; Pierre-Loup Beauregard; Marie Connolly; Nicole Fortin; David A. Green; Pablo Gutierrez Cubillos; Sam Gyetvay; Catherine Haeck; Timea Laura Molnar; Gaëlle Simard-Duplain; Henry E. Siu; Maria teNyenhuis; Casey Warman
    Abstract: This paper documents two COVID-related risks, viral risk and employment risk, and their distributions across the Canadian population. The measurement of viral risk is based on the VSE COVID Risk/Reward Assessment Tool, created to assist policymakers in determining the impacts of economic shutdowns and re-openings over the course of the pandemic. We document that women are more concentrated in high viral risk occupations and that this is the source of their greater employment loss over the course of the pandemic so far. They were also less likely to maintain one form of contact with their former employers, reducing employment recovery rates. Low educated workers face the same virus risk rates as high educated workers but much higher employment losses. Based on a rough counterfactual exercise, this is largely accounted for by their lower likelihood of switching to working from home which, in turn, is related to living conditions such as living in crowded dwellings. For both women and the low educated, existing inequities in their occupational distributions and living situations have resulted in them bearing a disproportionate amount of the risk emerging from the pandemic. Assortative matching in couples has tended to exacerbate risk inequities.
    JEL: E32 I18 J15 J16 J21
    Date: 2020–10
  31. By: Alexander Karaivanov; Shih En Lu; Hitoshi Shigeoka; Cong Chen; Stephanie Pamplona
    Abstract: We estimate the impact of mask mandates and other non-pharmaceutical interventions (NPI) on COVID-19 case growth in Canada, including regulations on businesses and gatherings, school closures, travel and self-isolation, and long-term care homes. We partially account for behavioral responses using Google mobility data. Our identification approach exploits variation in the timing of indoor face mask mandates staggered over two months in the 34 public health regions in Ontario, Canada's most populous province. We find that, in the first few weeks after implementation, mask mandates are associated with a reduction of 25 percent in the weekly number of new COVID-19 cases. Additional analysis with province-level data provides corroborating evidence. Counterfactual policy simulations suggest that mandating indoor masks nationwide in early July could have reduced the weekly number of new cases in Canada by 25 to 40 percent in mid-August, which translates into 700 to 1,100 fewer cases per week.
    JEL: C23 I12 I18
    Date: 2020–10
  32. By: Polemis, Michael; Stengos, Thanasis
    Abstract: The scope of this note is to investigate the causal effects of the COVID-19 pandemic on life expectancy over a sample of 47 countries split into two groups. The first one includes countries that have adopted general lockdown measures (treatment group), while the second one consists of countries that have imposed social distancing measures other than a national lockdown (control group). The investigated period starts from the first confirmed European case back (25.01.2020) until 28.07.2020 and covers the first wave of the pandemic for the sample countries. The empirical results based on a Semi-Parametric Difference-in-Differences framework, suggest a decline in life expectancy at birth estimated to 1.38 years on average even though the countries who did implement the lockdown measures were motivated and willing to do so. However, the decrease in life expectancy would have been double (2.9 years) in the absence of such willingness to adopt the policy. Lastly, the findings support the argument that national lockdown would be an effective policy tool to the hands of regulators and health practitioners to mitigate the negative effects of the pandemic infection it is pursued by motivated and willing participant countries.
    Keywords: Covid-19; Life expectancy; Lockdown; Social distancing; Semi-parametric Difference-in-Differences
    JEL: C23 I12
    Date: 2020–09–22
  33. By: Wes Austin (Georgia State University, USA); Stefano Carattini (Georgia State University, USA); John Gomez Mahecha (Georgia State University, USA); Michael Pesko (Georgia State University, USA)
    Abstract: We examine the relationship between contemporaneous fine particulate matter exposure and COVID-19 morbidity and mortality using an instrumental variable approach based on wind direction. Harnessing daily changes in county-level wind direction, we show that arguably exogenous fluctuations in local air quality impact the rate of confirmed cases and deaths from COVID-19. In our preferred high dimensional fixed effects specification with state-level policy and social distancing controls, we find that a one µg=m^3 increase in PM 2.5 increases the number of confirmed cases by roughly 2% from the mean case rate in a county. These effects tend to increase in magnitude over longer time horizons, being twice as large over a 3-day period. Meanwhile, a one µg=m^3 increase in PM 2.5 increases the same-day death rate by 3% from the mean. Our estimates are robust to a host of sensitivity tests. These results suggest that air pollution plays an important role in mediating the severity of respiratory syndromes such as COVID-19, for which progressive respiratory failure is the primary cause of death, and that policy levers to improve air quality may lead to improvements in COVID-19 outcomes.
    Date: 2020–10
  34. By: Bhattacharya, Joydeep; Chakraborty, Shankha; Yu, Xiumei
    Abstract: This paper offers a parsimonious, rational-choice model to study the effect of pre-existing inequalities on the transmission of COVID-19. Agents decide whether to "go out" (or self-quarantine) and, if so, whether to wear protection such as masks. Three elements distinguish the model from existing work. First, non-symptomatic agents do not know if they are infected. Second, some of these agents unknowingly transmit infections. Third, we permit two-sided prevention via the use of non-pharmaceutical interventions: the probability of a person catching the virus from another depends on protection choices made by each. We find that a mean-preserving increase in pre-existing income inequality unambiguously increases the equilibrium proportion of unprotected, socializing agents and may increase or decrease the proportion who self-quarantine. Strikingly, while higher pre-COVID inequality may or may not raise the overall risk of infection, it increases the risk of disease in social interactions.
    Date: 2020–08–15
  35. By: Kowalik, Zuzanna (Institute for Structural Research (IBS)); Lewandowski, Piotr (Institute for Structural Research (IBS))
    Abstract: We study the gender differences in aversion to COVID-19 exposure. We use a natural experiment of the 2020 US Open, which was organized in the country with the highest number of COVID-19 cases and deaths, and was the first major professional tennis tournament that was held after the season had been paused for six months. We analyze the gender gap in the propensity to voluntarily withdraw because of COVID-19 concerns among players who were eligible and fit to play. We find that female players were significantly more likely than male players to have withdrawn from the 2020 US Open. While players from countries characterized by relatively high levels of trust and patience and relatively low levels of risk-taking were more likely to have withdrawn than their counterparts from other countries, female players exhibited significantly higher levels of aversion to pandemic exposure than male players even after cross-country differences in preferences are accounted for. About 15% of the probability of withdrawing that is explained by our model can be attributed to gender.
    Keywords: COVID-19, exposure to disease, gender, aversion, tennis
    JEL: J16 I12 J44
    Date: 2020–10
  36. By: Alex Rees-Jones; John D'Attoma; Amedeo Piolatto; Luca Salvadori
    Abstract: In June 2020, we surveyed 2,516 Americans regarding their preferences for both short- and long-term expansions to government-provided healthcare and unemployment insurance programs. We find that support for such programs is positively associated with (a) COVID-19 deaths and infections in the respondent’s county, (b) the pandemic-induced change in the unemployment rate in the respondent’s county, and (c) survey elicitations of the respondent’s perceptions of COVID-19’s consequences. These associations persist when controlling for pre-COVID-19 political ideology and demographics. These results suggest that real or perceived exposure to COVID-19’s consequences has influenced support for expansions to the U.S. safety-net system.
    JEL: H2 H5
    Date: 2020–09
  37. By: Pongou, Roland; Tchuente, Guy; Tondji, Jean-Baptiste
    Abstract: We address the problem of finding the optimal lockdown and reopening policy during a pandemic like COVID-19 for a social planner who prioritizes health over the economy. Agents are connected through a fuzzy network of contacts, and the planner's objective is to determine the policy that contains the spread of infection below a tolerable incidence level, and that maximizes the present discounted value of real income, in that order of priority. We show theoretically that the planner's problem has a unique solution. The optimal policy depends both on the configuration of the contact network and the tolerated infection incidence. Using simulations, we apply these theoretical findings to: (i) quantify the trade-off between the economic cost of the pandemic and the infection incidence allowed by the social planner, and show how this trade-off depends on network configuration; (ii) understand the correlation between different measures of network centrality and individual lockdown probability, and derive implications for the optimal design of surveys on social distancing behavior and network structure; and (iii) analyze how segregation induces differential health and economic dynamics in minority and majority populations, also illustrating the crucial role of patient zero in these dynamics.
    Keywords: COVID-19,health-vs-wealth prioritization,economic cost,fuzzy networks,network centrality,segregation,patient zero,optimally targeted lockdown policy
    JEL: E61 H12 I18
    Date: 2020
  38. By: Todd, Gabe
    Abstract: The Maine economy experienced an 11-percent reduction in employment from February to July of 2020, with job losses of 18 percent from February to April and a 10-percent increase from April to July. Of the employment decline of 57,100 jobs from February to July, about 85 percent of the loss is related to the performance of the U.S. economy, and 16 percent is associated with factors that are unique to Maine. Over the period of extreme job loss from February to April and the employment gains that happened between April and July, there’s wide heterogeneity in the performance of industry sectors in Maine. For example, the sectors of Health Care and Social Assistance, and Accommodation and Food Services performed worse than expected (based on employment change nationally and Maine’s industry mix) from February to April, followed by a period of better than expected performance in Maine from April to July. The Retail Trade sector is one of several industries in Maine that outperformed the sector nationally between February and April, and from April to July of 2020.
    Keywords: COVID-19, Employment change, Shift-share analysis, Maine
    JEL: I12 R11 R12
    Date: 2020–09–26
  39. By: Fairlie, Robert W. (University of California, Santa Cruz)
    Abstract: Social distancing restrictions and health- and economic-driven demand shifts from COVID-19 are expected to shutter many small businesses and entrepreneurial ventures, but there is very little early evidence on impacts. This paper provides the first analysis of impacts of the pandemic on the number of active small businesses in the United States using nationally representative data from the April 2020 CPS – the first month fully capturing early effects. The number of active business owners in the United States plummeted by 3.3 million or 22 percent over the crucial two-month window from February to April 2020. The drop in active business owners was the largest on record, and losses to business activity were felt across nearly all industries. African-American businesses were hit especially hard experiencing a 41 percent drop in business activity. Latinx business owner activity fell by 32 percent, and Asian business owner activity dropped by 26 percent. Simulations indicate that industry compositions partly placed these groups at a higher risk of business activity losses. Immigrant business owners experienced substantial losses in business activity of 36 percent. Female business owners were also disproportionately affected (25 percent drop in business activity). Continuing the analysis in May and June, the number of active business owners remained low – down by 15 percent and 8 percent, respectively. The continued losses in May and June, and partial rebounds from April were felt across all demographic groups and most industries. These findings of early-stage losses to small business activity have important implications for policy, income losses, and future economic inequality.
    Keywords: small business, entrepreneurship, business owners, self-employment, COVID-19, coronavirus, shelter in place restrictions, social distancing restrictions, minority business, female
    JEL: J15 J16 L26
    Date: 2020–09

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