nep-hea New Economics Papers
on Health Economics
Issue of 2020‒11‒09
28 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Liquidity Sensitivity of Healthcare Consumption: Evidence from Social Security Payments By Tal Gross; Timothy Layton; Daniel Prinz
  2. Impact of Consequence Information on Insurance Choice By Anya Samek; Justin R. Sydnor
  3. Moneyball in Medicare: Heterogeneous Treatment Effects By Edward C. Norton; Emily J. Lawton; Jun Li
  4. The Federal Effort to Desegregate Southern Hospitals and the Black-White Infant Mortality Gap By D. Mark Anderson; Kerwin Kofi Charles; Daniel I. Rees
  5. Peer Gender and Mental Health By Getik, Demid; Meier, Armando N.
  6. Peers, Gender, and Long-Term Depression By Giulietti, Corrado; Vlassopoulos, Michael; Zenou, Yves
  7. School Selectivity, Peers, and Mental Health By Bütikofer, Aline; Ginja, Rita; Landaud, Fanny; Løken, Katrine
  8. Does Higher Education Reduce Mortality? Evidence from a Natural Experiment in Chile By Prem, M; Bautista, M. A.; González, F; Martínez, L. R.; Muñoz, P
  9. In Sickness and in Health? Health Shocks and Relationship Breakdown: Empirical Evidence from Germany By Christian Bünnings; Lucas Hafner; Simon Reif; Harald Tauchmann
  10. How does the mental health and wellbeing of teachers compare to other professions? Evidence from eleven survey datasets By John Jerrim; Sam Sims; Rebecca Allen; Hannah Taylor
  11. Lead in Drinking Water and Birth Outcomes: A Tale of Two Water Treatment Plants By Dhaval M. Dave; Muzhe Yang
  12. Death of Coal and Breath of Life: The Effect of Power Plant Closure on Local Air Quality By Jason Brown; Colton Tousey
  13. Information Integration, Coordination Failures, and Quality of Prescribing By Böckerman, Petri; Laine, Liisa T.; Nurminen, Mikko; Saxell, Tanja
  14. Age-Related Taxation of Bequests in the Presence of a Dependency Risk By Marie-Louise Leroux; Pierre Pestieau
  15. The Value of Redistribution: Natural Resources and the Formation of Human Capital under Weak Institutions By Jorge M. Agüero; Carlos Felipe Balcázar; Stanislao Maldonado; Hugo Ñopo
  16. Developing a whole systems obesity classification for the UK Biobank Cohort By Clark, Stephen; Birkin, Mark; Lomax, Nik; Morris, Michelle
  17. Identifying causal channels of policy reforms with multiple treatments and different types of selection By Annabelle Doerr; Anthony Strittmatter
  18. Twin Estimates of the Effects of Prenatal Environment, Child Biology, and Parental Bias on Sex Differences in Early Age Mortality By Roland Pongou
  19. Optimal fuel taxation with suboptimal health choices By Sulikova, Simona; van den Bijgaart, Inge; Klenert, David; Mattauch, Linus
  20. Adolescent nutrition in West Africa: A rapid review of the research evidence By Verstraeten, Roosmarijn; Salm, Leah; Diop, Loty; Diatta, Ampa; Touré, Mariama
  21. Income elasticity of demand for health care and it's change over time: Across the income groups and levels of health expenditure in India. By Dubey, Jay Dev
  22. Economic valuation of setting up a social health enterprise in urban poor-resource setting in Kenya By H.P.P. Donfouet; S.F. Mohamed; P. Otieno; E. Wambiya; M.K. Mutua; G. Danaei
  23. Migration and the labour market impacts of COVID-19 By Nathan Barker; C. Austin Davis; Paula López-Peña; Harrison Mitchell; A. Mushfiq Mobarak; Karim Naguib; Maira Emy Reimão; Ashish Shenoy; Corey Vernot
  24. Economics and Epidemics: Evidence from an Estimated Spatial Econ-SIR Model By Mark Bognanni; Douglas Hanley; Daniel Kolliner; Kurt Mitman
  25. Lessons from Pandemics: Computational agent-based model approach for estimation of downstream and upstream measures to achieve requisite societal behavioural changes By Pradipta Banerjee; Subhrabrata Choudhury
  26. The Full Recession: Private Versus Social Costs of Covid-19 By Cordoba, Juan Carlos; Ripoll, Marla; Yang, Siqiang
  27. How did Japan cope with COVID-19? Big Data and purchasing behavior (Japanese) By KONISHI Yoko; SAITO Takashi; ISHIKAWA Toshiki; IGEI Naoya
  28. Socioeconomic Network Heterogeneity and Pandemic Policy Response By Akbarpour, Mohammad; Cook, Cody; Marzuoli, Aude; Mongey, Simon; Nagaraj, Abhishek; Saccarola, Matteo; Tebaldi, Pietro; Vasserman, Shoshana; Yang, Hanbin

  1. By: Tal Gross; Timothy Layton; Daniel Prinz
    Abstract: Some consumers lack the cash needed to pay for medical care. As a result, they either delay care until they can pay for it or they forgo the care altogether. To test for such a possibility, we study the distribution of monthly Social Security checks among Medicare Part D enrollees. When Social Security checks are distributed, prescription fills increase by 6-12 percent. In that sense, drug consumption of low-income Medicare recipients is "liquidity sensitive." We then study recipients who transition onto a program that eliminates copayments. When those recipients do not face copayments, their drug consumption becomes less liquidity sensitive. That finding implies that, beyond risk protection, generous insurance also provides recipients with the ability to consume healthcare when they need it rather than when they have cash. Further, we find that recipients whose drug consumption is most liquidity sensitive exhibit price elasticities of demand that are twice the size of the average elasticity, suggesting that more-generous insurance causes recipients both to re-time prescription filling and also to start filling prescriptions that they otherwise would not fill. We present a stylized model that uses this finding to call into question the conventional interpretation of demand-response to price as solely inefficient moral hazard.
    JEL: H0 I1 I13
    Date: 2020–10
  2. By: Anya Samek; Justin R. Sydnor
    Abstract: Insurance choices are often hard to rationalize by standard theory and frequently appear sub-optimal. A key reason may be that people are unable to map the cost-sharing features of plans to their distribution of financial consequences. We develop and experimentally test a decision aid that provides this mapping to simplify comparisons of plan options. In two experiments mirroring typical health insurance decisions, we find that when people choose plans using standard feature-based information, they violate dominance at high rates. Our distribution-based decision aid substantially reduces dominance violations, and also changes choice patterns in situations where there is no dominant option. Choice patterns under feature-based menus can be most easily rationalized by models of heuristic choices, such as minimizing premium or deductible. With the decision aid, though, significantly more people have choice patterns that are better explained by expected utility theory. We compare our distribution-based approach to an alternative of providing estimates of the expected value of costs, which is the most common decision-support available in most insurance markets. Providing expected values affects choices in a similar direction as our consequence-based approach, but in a more muted fashion, and is only about half as effective at reducing dominance violations.
    JEL: D81 D83 G22 I13
    Date: 2020–10
  3. By: Edward C. Norton; Emily J. Lawton; Jun Li
    Abstract: One of the most important changes to the United States health care system over the last two decades is the emergence of pay-for-performance as a way to encourage hospitals and other providers to improve quality of care. Unlike fee-for-service, these value-based purchasing programs measure aspects of quality and financially reward hospitals that are outstanding or at least improving in their care. Prior research has shown that hospitals often improve more when the marginal financial incentives are larger. However, the exact relationship between marginal financial incentives and year-over-year improvement in measures remains unclear. In this study, we use national 2015 2018 data on approximately 2,700 hospitals to estimate how hospitals respond to pay-for-performance incentives in the Hospital Value-Based Purchasing (HVBP) Program. We show that this relationship is non-linear, has strong serial correlation, is somewhat similar for safety-net hospitals as non-safety-net hospitals, and is proportional to the size of the Medicare patient population.
    JEL: I11 I18
    Date: 2020–10
  4. By: D. Mark Anderson; Kerwin Kofi Charles; Daniel I. Rees
    Abstract: In 1966, Southern hospitals were barred from participating in the Medicare program unless they discontinued their long-standing practice of racial segregation. Using data from five Deep South states and exploiting county-level variation in Medicare certification dates, we find that gaining access to an ostensibly integrated hospital had no effect on the Black-White infant mortality gap, although it may have discouraged small numbers of Black mothers from giving birth at home attended by a midwife. These results are consistent with descriptions of the federal hospital desegregation campaign as producing only cosmetic changes and illustrate the limits of anti-discrimination policies imposed upon reluctant actors.
    JEL: I1 I14 J1 N12
    Date: 2020–10
  5. By: Getik, Demid; Meier, Armando N.
    Abstract: Adolescent mental health is key for later well-being. Yet, causal evidence on environmental drivers of adolescent mental health is scant. We study how an important classroom feature---the gender composition in compulsory-school---affects mental health. We use Swedish administrative data (N=576,285) to link variation in gender composition across classrooms within cohorts to mental health. We find that a higher share of female peers in a classroom increases the incidence of mental health diagnoses, particularly among boys. The effect persists into adulthood. Peer composition is thus an important and persistent driver of mental health.
    Keywords: school, gender, peer effects, mental health
    JEL: I12 I19 I21 I31 J16 J24
    Date: 2020–10
  6. By: Giulietti, Corrado (University of Southampton, UK); Vlassopoulos, Michael (University of Southampton, UK); Zenou, Yves (Monash University)
    Abstract: This study investigates whether exposure to peer depression in adolescence affects own depression in adulthood. We find a significant long-term depression peer effect for females but not for males in a sample of U.S. adolescents who are followed into adulthood. An increase of one standard deviation of the share of own-gender peers (schoolmates) who are depressed increases the probability of depression in adulthood by 2.6 percentage points for females (or 11.5% of mean depression). We also find that the peer effect is already present in the short term when girls are still in school and provide suggestive evidence for why it persists over time. In particular, we show that peer depression negatively affects the probability of college attendance and the likelihood of working, and leads to a reduction in income of adult females. Further analysis reveals that individuals from families with a lower socioeconomic background are more susceptible to peer influence, thereby suggesting that family can function as a buffer.
    Keywords: Peer effects; Depression; Contagion; Gender; Family background; Adolescence; Policy
    JEL: I12 Z13
    Date: 2020–10–13
  7. By: Bütikofer, Aline (Dept. of Economics, Norwegian School of Economics and Business Administration); Ginja, Rita (Department of Economics, University of Bergen); Landaud, Fanny (Dept. of Economics, Norwegian School of Economics and Business Administration); Løken, Katrine (Dept. of Economics, Norwegian School of Economics and Business Administration)
    Abstract: Although many students suffer from anxiety and depression, and students often identify school pressure and concerns about their futures as the main reasons for their worries, little is known about the consequences of a selective school environment on students’ physical and mental health. In this paper, we draw on rich administrative data and the features of the high school assignment system in the largest Norwegian cities to consider the long-term consequences of enrollment in a more selective high school. Using a regression discontinuity analysis, we show that eligibility to enroll in a more selective high school increases the probability of enrollment in higher education and decreases the probability of diagnosis or treatment by a general medical practitioner for psychological symptoms and diseases. We further document that enrolling in a more selective high school has a greater positive impact when there are larger changes in the student–teacher ratio, teachers’ age, and the proportion of female teachers. These findings suggest that changes in teacher characteristics are important for better understanding the effects of a more selective school environment.
    Keywords: School selectivity; Mental health
    JEL: I00 I10 I20
    Date: 2020–10–14
  8. By: Prem, M; Bautista, M. A.; González, F; Martínez, L. R.; Muñoz, P
    Abstract: We exploit the sharp downward kink in college enrollment experienced by cohorts reaching college age after the 1973 military coup in Chile to study the causal effect of higher education on mortality. Using micro-data from the vital statistics for 1994-2017, we document an upward kink in the age-adjusted yearly mortality rate among the affected cohorts. Leveraging the kink in college enrollment, we estimate a negative effect of college on mortality, which is larger for men, but also sizable for women. Intermediate labor market outcomes (e.g., labor force participation) explain 30% of the reduction in mortality. A similar upward kink in mortality over multiple time horizons is also present among hospitalized patients in the affected cohorts, with observable characteristics (i.e. diagnostic, hospital, insurance) explaining over 40%. Survey responses reveal that college substantially improves access to private health care, but has mixed effects on health behaviors.
    Keywords: Mortality; Higher education; Chile; Mortality rate of the university population in Chile; Relationship educational level mortality
    JEL: I12 I14 I26
    Date: 2020–10–26
  9. By: Christian Bünnings; Lucas Hafner; Simon Reif; Harald Tauchmann
    Abstract: From an economic perspective, marriage and long-term partnership can be seen as a risk-pooling device. This informal insurance contract is, however, not fully enforceable. Each partner is free to leave when his or her support is needed in case of an adverse life event. An adverse health shock is a prominent example for such events. Since relationship breakdown itself is an extremely stressful experience, partnership may backfire as informal insurance against health risks, if health shocks increase the likelihood of relationship breakdown. We address this question empirically, using survey data from Germany. Results from various matching estimators indicate that adverse shocks to mental health substantially increase the probability of a couple splitting up over the following two years. In contrast, there is little effect of a sharp decrease in physical health on relationship stability. If at all, physical health shocks that hit both partners simultaneously stabilize a relationship.
    Keywords: separation, partnership dissolution, health shock, MCS, PCS, matching
    JEL: I12 J12 D13
    Date: 2020
  10. By: John Jerrim (UCL Social Research Institute); Sam Sims (UCL Centre for Education Policy and Equalising Opportunities); Rebecca Allen (University of Brighton); Hannah Taylor (University of Oxford)
    Abstract: There is growing concern about the mental health and wellbeing of teachers globally, with the stress caused by the job thought to be a key factor driving many to leave the profession. It is often claimed that teachers have worse mental health and wellbeing outcomes than other occupational groups. Yet academic evidence on this matter remains limited, with some studies supporting this notion, while a handful of others do not. We contribute to this debate by providing the largest, most comprehensive analysis of differences in mental health and wellbeing between teachers and other professional workers to date. Drawing upon data from across eleven social surveys, we find little evidence that teachers have worse health and wellbeing outcomes than other occupational groups. Research in this area should shift away from whether teachers are disproportionately affected by such issues towards strengthening the evidence on the likely drivers of mental ill-health within the education profession.
    Keywords: Teachers, wellbeing, mental health, occupational comparisons
    JEL: I12
    Date: 2020–10–01
  11. By: Dhaval M. Dave; Muzhe Yang
    Abstract: The recent drinking water crisis in Newark, New Jersey's largest city, has renewed concerns about the lead-in-water crisis becoming a persistent and widespread problem owing to the nation's aging infrastructure. We exploit a unique natural experiment in Newark, which exogenously exposed some women in the city to higher levels of lead in tap water but not others, to identify a causal effect of prenatal lead exposure on fetal health. Using birth data that contain information on mothers' exact residential addresses, we find robust and consistent evidence that prenatal exposure to lead significantly raises the probability of low birth weight or preterm births by approximately 1.4 to 1.9 percentage points (14-22 percent), and the adverse effects are largely concentrated among mothers of lower socioeconomic status. Our findings have important policy implications in light of the long-term impact of compromised health at birth and the substantial number of lead water pipes that remain in use as part of our aging infrastructure.
    JEL: H75 I12 I18 Q53 Q58
    Date: 2020–10
  12. By: Jason Brown; Colton Tousey
    Abstract: The number of U.S. coal-fired power plants declined by nearly 250 between 2001 and 2018. Given that burning coal generates large amounts of particulate matter, which is known to have adverse health effects, the closure of a coal-fired power plant should improve local air quality. Using spatial panel data from air quality monitor stations and coal-fired power plants, we estimate the relationship between plant closure and local air quality. We find that on average, the levels of particulate matter within 25 and 50 mile buffers around air quality monitors declined between 7 and 14 percent with each closure. We estimate that closure is associated with a 0.6 percent decline in local mortality probabilities. In terms of the value of a statistical life, the median local benefit of a coal power plant closure has ranged between $1 and $4 billion or 5 to 15 percent of local GDP since the early 2000s.
    Keywords: Air quality; Coal; Plant closures
    JEL: Q35 Q53 R11
    Date: 2020–10–15
  13. By: Böckerman, Petri; Laine, Liisa T.; Nurminen, Mikko; Saxell, Tanja
    Abstract: Poor information flows hamper coordination, potentially leading to suboptimal decisions in health care. We examine the effects of a nationwide policy of information integration on the quality of prescribing. We use the rollout of an electronic prescribing system in Finland and prescription-level administrative data. We find no effect on the probability of co-prescribing harmful drug combinations in urban regions. In rural regions, this probability reduces substantially, by 35 percent. The effect is driven by prescriptions from unspecialized physicians and from multiple physicians. Improving the local information environment thus enhances coordination and narrows differences in the quality of prescribing.
    Keywords: health information technology, digitalization, e-prescribing, integration, quality of prescribing, public policy, Local public finance and provision of public services, H51, H75,
    Date: 2020
  14. By: Marie-Louise Leroux; Pierre Pestieau
    Abstract: This paper studies the design of the optimal linear taxation of bequests when individuals differ in wage as well as in their risks of both mortality and old-age dependence. We assume that the government cannot distinguish between bequests motives, that is whether bequests resulted from precautionary reasons or from pure joy of giving reasons. Instead, we assume that it only observes the timing of bequests, that is whether they are made early in life or late in life. We show that, if the government is utilitarian, whether the taxation of early bequests should be given priority over the taxation of late bequests depends on the magnitude of insurance and redistributive concerns. While the efficiency concern unambiguously recommends taxation of early bequests, redistributive concerns yield ambiguous results. This indeterminacy comes from the fact that, in case of late death, the government cannot observe the health status of the deceased. Whether the taxation of early bequests should be given priority depends on the specific relationships between wages and both risks of early death and of old-age dependence, as well as on the concavity of the joy of giving utility function. If the government is Rawlsian, it is optimal to tax early bequests if the survival chances of the poorest agents are very low. If they survive, but their chances to remain autonomous are very low, it is then optimal to tax early bequests if the poorest agents contribute relatively less to the taxation of early bequests than to the taxation of late bequests or if the joy of giving utility is extremely concave.
    Keywords: bequest taxation, long term care, utilitarianism, Rawlsian welfare criterion, old-age dependency
    JEL: H21 H23 I14
    Date: 2020
  15. By: Jorge M. Agüero (University of Connecticut); Carlos Felipe Balcázar (New York University); Stanislao Maldonado (Universidad del Rosario); Hugo Ñopo (Grupo de Analisis de Desarrollo)
    Abstract: We exploit time and spatial variation generated by the commodities boom to measure the effect of natural resources on human capital formation in Peru, a country with low governance indicators. Combining test scores from over two million students and district-level administrative data of mining taxes redistributed to local governments, we find sizable effects on student learning from the redistribution. However, and consistent with recent political economy models, the relationship is non-monotonic. Based on these models, we identify improvements in school expenditure and infrastructure, together with increases in health outcomes of adults and children, as key mechanisms explaining the effect we find for redistribution. Policy implications for the avoidance of the natural resource curse are discussed.
    Keywords: Resource booms, academic achievement, intergovernmental transfers
    JEL: H7 H23 I25 O15 Q32
    Date: 2020–10
  16. By: Clark, Stephen; Birkin, Mark; Lomax, Nik; Morris, Michelle
    Abstract: The number of people who are obese and overweight presents a global challenge, and the development of effective interventions is hampered by a lack of research which takes in to account a joined up, whole systems approach to understanding the drivers of the phenomena. We need to better understand the collective characteristics and behaviours of the overweight and obese population and how these differ from those who maintain a healthy weight. Using the UK Biobank cohort of 500 000 adults, we develop an obesity classification system using k-means clustering. Variable selection from UK Biobank is informed by the Foresight whole system obesity map across key domains (Societal Influences, Individual Psychology, Individual Physiology, Individual Physical Activity, Physical Activity Environment). This paper presents the first study of UK Biobank participants to adopt this whole systems approach. Our classification identifies six groups of people, similar in respect to their exposure to known drivers of obesity: ‘Younger, active and working hard’, ‘Retirees with good lifestyle’ , ‘Stressed, sedentary and struggling’, Older with poor lifestyle’, ‘Younger, busy professionals’ and ‘Younger, fitter families’. Pen portraits are developed to describe the characteristics of these different groups. Multinomial logistic regression is used to demonstrate that the classification can effectively detect groups of individuals more likely to be overweight or obese. The group identified as ‘Younger, fitter families’ are observed to have a higher proportion of healthy weight, while three groups have increased relative risk of being overweight or obese: ‘Younger, active and working hard’, ‘Stressed, sedentary and struggling’ and ‘Older with poor lifestyles’. This work presents an innovative new approach to better understand the whole systems drivers of obesity which has the potential to produce meaningful tools for policy makers to better target interventions across the whole system to reduce overweight and obesity.
    Date: 2020–10–14
  17. By: Annabelle Doerr; Anthony Strittmatter
    Abstract: We study the identification of channels of policy reforms with multiple treatments and different types of selection for each treatment. We disentangle reform effects into policy effects, selection effects, and time effects under the assumption of conditional independence, common trends, and an additional exclusion restriction on the non-treated. Furthermore, we show the identification of direct- and indirect policy effects after imposing additional sequential conditional independence assumptions on mediating variables. We illustrate the approach using the German reform of the allocation system of vocational training for unemployed persons. The reform changed the allocation of training from a mandatory system to a voluntary voucher system. Simultaneously, the selection criteria for participants changed, and the reform altered the composition of course types. We consider the course composition as a mediator of the policy reform. We show that the empirical evidence from previous studies reverses when considering the course composition. This has important implications for policy conclusions.
    Date: 2020–10
  18. By: Roland Pongou
    Abstract: Sex differences in early age mortality have been explained in prior literature by differences in biological make-up and gender discrimination in the allocation of household resources. Studies estimating the effects of these factors have generally assumed that offspring sex ratio is random, which is implausible in view of recent evidence that the sex of a child is partly determined by prenatal environmental factors. These factors may also affect child health and survival in utero or after birth, which implies that conventional approaches to explaining sex differences in mortality are likely to yield biased estimates. We propose a methodology for decomposing these differences into the effects of prenatal environment, child biology, and parental preferences. Using a large sample of twins, we compare mortality rates in male-female twin pairs in India, a region known for discriminating against daughters, and sub-Saharan Africa, a region where sons and daughters are thought to be valued by their parents about equally. We find that: (1) prenatal environment positively affects the mortality of male children; (2) biological make-up of the latter contributes to their excess mortality, but its effect has been previously overestimated; and (3) parental discrimination against female children in India negatively affects their survival; but failure to control for the effects of prenatal and biological factors leads conventional approaches to underestimating its effect by 237 percent during infancy, and 44 percent during childhood.
    Date: 2020–10
  19. By: Sulikova, Simona (University of Oxford); van den Bijgaart, Inge (Department of Economics, School of Business, Economics and Law, Göteborg University); Klenert, David (Joint Research Centre, European Commission,); Mattauch, Linus (University of Oxford)
    Abstract: Transport has a large number of significant externalities including carbon emissions, air pollution, accidents, and congestion. Active travel such as cycling and walking can reduce these externalities. Moreover, public health research has identified additional social gains from active travel due to health benefits of increased physical exercise. In fact, on a per mile basis, these benefits dominate the external social costs from car use by two orders of magnitude. We introduce health benefits and active travel options into an optimal taxation model of transport externalities to study appropriate policy responses. We characterise the optimal second-best fuel tax analytically: when physical exercise is considered welfare-enhancing, the optimal fuel tax increases. Under central parameter assumptions it rises by 49% in the US and 36% in the UK. This is due to the low fuel price elasticity of active travel. We argue that fuel taxes should be implemented jointly with other policies aimed at increasing the uptake of active travel to reap its full health benefits.
    Keywords: Transport Externalities; Congestion; Active travel; Fuel; Health Behaviour; Optimal Taxation
    JEL: H23 I12 Q58
    Date: 2020–10
  20. By: Verstraeten, Roosmarijn; Salm, Leah; Diop, Loty; Diatta, Ampa; Touré, Mariama
    Abstract: Adolescence is an important period of physical and cognitive development during which optimal nutrition is crucial. It is an essential time for forming preferences and habits and a key window of opportunity for influencing adult health. In West Africa, while undernutrition rates remains high, there has also been a steady rise in overweight and obesity, and an increasing share of mortality and morbidity due to diet-related noncommunicable diseases (DR-NCDs) among adolescents. f concern is that adolescents are experiencing these diseases earlier in life than previous generations. It is crucial to address adolescents’ nutrition to prevent them from carrying malnutrition into adulthood and to protect their overall health later in life.
    Keywords: WEST AFRICA, AFRICA SOUTH OF SAHARA, AFRICA, nutrition, adolescents, malnutrition, policies, obesity, diet, health, adolescent nutrition, adolescent health
    Date: 2020
  21. By: Dubey, Jay Dev (National Institute of Public Finance and Policy)
    Abstract: This study computes income elasticity of out-of-pocket healthcare expenditures of Indian households both across the income groups using the Spline regression model and across the level of health expenditure based on the Quintile regression technique using survey data collected in 2014 and 2018. Healthcare is found to be a necessary good in all cases, with significant decline in its income elasticity over time. The changes from 2014 to 2018 makes income elasticity higher for lowest income group compared to other income groups for all forms of health expenditure in rural areas and for outpatient and non-medical expenditure in urban areas. The overall trend for total health expenditure and outpatient expenditure implies that in times of severe health crisis needing expensive treatments, any income increase would lead to higher increase in health expenditure compared to minor health care needs, leading catastrophic health expenditure and impoverishment in case of poor households.
    Keywords: Healthcare expenditure ; Income Elasticity ; Spline Estimation ; Catastrophe ; Quintile Regression
    Date: 2020–10
  22. By: H.P.P. Donfouet (CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR1 - Université de Rennes 1 - UNIV-RENNES - Université de Rennes - CNRS - Centre National de la Recherche Scientifique, APHRC Campus - African Population and Health Research Center, Inc); S.F. Mohamed (APHRC Campus - African Population and Health Research Center, Inc); P. Otieno (APHRC Campus - African Population and Health Research Center, Inc); E. Wambiya (APHRC Campus - African Population and Health Research Center, Inc); M.K. Mutua (APHRC Campus - African Population and Health Research Center, Inc); G. Danaei (Harvard T.H. Chan School of Public Health)
    Abstract: The failure of the market and government to provide quality healthcare services have been the motivation to set up social health enterprise. However, the value for money associated with setting up a social health enterprise in sub-Sahara African countries has been relatively unexplored in the literature. The study presents the first empirical estimates of the mean willingness-to-pay (WTP) for setting up a social health enterprise that will simultaneously run a health center and provide health insurance scheme in an urban resource-poor setting and explores whether the benefits outweigh the costs. The contingent valuation method is used to estimate the mean WTP for the health insurance scheme proposed by the social health enterprise in Viwandani slum (Nairobi, Kenya). The survey was conducted between June and July 2018 on 300 households. We find that the feasibility of setting up a social health enterprise could be promising with 97 percent of respondents willing to pay about US$ 2 per person per month for a scheme that would provide quality healthcare services. More importantly, setting up the social health enterprise will yield a positive net profit, and investors could expect US$ 1.11 in benefits for each US$ 1 of costs of investment in setting up the social health enterprise. We, therefore, conclude that this health policy in this urban resource-poor setting could be a viable solution to reach the neglected urban households in the Kenyan slums.
    Keywords: Contingent valuation method,Cost-benefit analysis,Social health enterprise
    Date: 2020
  23. By: Nathan Barker; C. Austin Davis; Paula López-Peña; Harrison Mitchell; A. Mushfiq Mobarak; Karim Naguib; Maira Emy Reimão; Ashish Shenoy; Corey Vernot
    Abstract: Using detailed microdata, we document how migration-dependent households are especially vulnerable during the COVID-19 pandemic. We create pre- and post-COVID panel datasets for three populations in Bangladesh and Nepal, leveraging experimental and observational variation in prior migration dependence. We report 25 per cent greater declines in earnings and fourfold greater prevalence of food insecurity among migrant households since March. Causes include lower migration rates, less remittance income per migrant, isolation in origin communities, and greater health risks.
    Keywords: Migration, COVID-19, panel, Bangladesh, Nepal
    Date: 2020
  24. By: Mark Bognanni; Douglas Hanley; Daniel Kolliner; Kurt Mitman
    Abstract: Economic analysis of effective policies for managing epidemics requires an integrated economic and epidemiological approach. We develop and estimate a spatial, micro-founded model of the joint evolution of economic variables and the spread of an epidemic. We empirically discipline the model using new U.S. county-level data on health, mobility, employment outcomes, and non-pharmaceutical interventions (NPIs) at a daily frequency. Absent policy or medical interventions, the model predicts an initial period of exponential growth in new cases, followed by a protracted period of roughly constant case levels and reduced economic activity. Nevertheless, if vaccine development proved impossible, and suppression cannot entirely eradicate the disease, a utilitarian policymaker cannot improve significantly over the laissez-faire equilibrium by using lockdowns. Conversely, if a vaccine will arrive within two years, NPIs can improve upon the laissez-faire outcome by dramatically decreasing the number of infectious agents and keeping infections low until vaccine arrival. Mitigation measures that reduce viral transmission (e.g., mask-wearing) both reduce the virus's spread and increase economic activity.
    Keywords: Epidemics; Covid-19; Econ-sir; Economic policy
    JEL: E60 I10
    Date: 2020–10–23
  25. By: Pradipta Banerjee; Subhrabrata Choudhury
    Abstract: Pandemics such as COVID-19 have lethal potential for inflicting long-lasting cyclic devastations if required preventive, curative and reformative steps are not taken up in time which puts forth mammoth multi-dimensional challenges for survival before mankind. Scientists and policymakers all around are striving to achieve R $\leq$ 1 alongside having less number of CoVID-19 patients. Lockdowns all across the globe have been implemented for the sake of social physical distancing. However, even if the desired R value status is achieved it becomes nowhere near safe. As normal social activity and inter-regional travel resumes, danger of contraction of the virus from undetected asymptomatic carriers and reactivation of the virus in previously affected patients looms over. The virus poses further threat due to its chances of resurgence, its mutative and adaptive nature thereby giving limited medical respite. The problems intensify with increasing population density whilst varying with several socio-economic-geo-cultural and human activity parameters. Such zoonotic pandemics unravel the primary challenges of all countries in securing the general wellbeing of the society. Ensuring a mechanism for policy designs envisaging crisis scenarios through continuous analysis of real-time region-specific data about societal activities and disease/health indicators can be the only solution. An approach perspective is discussed for addressing the tightly-coupled UN Sustainable goals (2, 3, 6, 12 and 13) for developing a general-scale computational agent-based model to estimate the downstream and upstream measures for achieving requisite societal behavioural changes with the prognostic knowledge concerning the conditions and options for future scenarios of stable sustainability.
    Date: 2020–10
  26. By: Cordoba, Juan Carlos; Ripoll, Marla; Yang, Siqiang
    Abstract: Official recession figures ignore the costs associated with the loss of human life due to COVID-19. This paper constructs "full recession" measures that take into account the death toll. Key for the estimates are the number of dead, the individual's willingness to accept mortality risk, and society's willingness to accept inequality. Our model features tractable heterogeneity, constant relative risk aversion to mortality risk, and age-specific survival rates. Using an estimated death toll of 400 thousand people for the US during a year, and a baseline 10% recession, we find that the corresponding full recession is 26% on average across individuals, 17% for a median voter, 13% for a planner with mild aversion to inequality, and 19% for a planner with larger aversion. Regarding the overall cost of the pandemic, we find that individuals would be willing to pay, on average, 41% of one-year consumption to fully avoid the pre-lockdown 1.9 million deaths from COVID-19. A median voter would be willing to pay 23%, a social planner with mild aversion to inequality only 11%, while a log-planner would pay 73%.
    Date: 2020–10–28
  27. By: KONISHI Yoko; SAITO Takashi; ISHIKAWA Toshiki; IGEI Naoya
    Abstract: Japan has been recognized for having successfully controlled the spread of the coronavirus disease (COVID-19) pandemic. This study aims to gather insights to combat the spread of infection in our daily lives by observing our purchasing behavior. We use point of sales data from supermarkets, convenience stores, home centers, drug stores, and electronics retail stores for a nationwide analysis. Our analysis revealed the following. First, the Japanese actively prevented the spread of infection by voluntarily wearing masks, using alcohol-based disinfectants, and gargling. Second, people willingly stayed home during the semi-lockdown. Third, infection prevention essentials continued to be purchased during periods of both low and high levels of infection. We conclude that continuing to prevent the pandemic with masks, hand washing and sanitizing, and gargling, along with spending more time at home and maintaining safe distancing, will be effective in reducing the spread of the virus. Finally, the infections and deaths were primarily concentrated in the metropolitan area and Kansai region, where the nature of the spread of the infection was different compared to that in small and middle-sized prefectures.
    Date: 2020–09
  28. By: Akbarpour, Mohammad (Stanford U); Cook, Cody (Stanford U); Marzuoli, Aude (Overland Park, Kansas); Mongey, Simon (U of Chicago); Nagaraj, Abhishek (U of California, Berkeley); Saccarola, Matteo (U of Chicago); Tebaldi, Pietro (U of Chicago); Vasserman, Shoshana (Stanford U); Yang, Hanbin (Harvard U)
    Abstract: We develop a heterogeneous-agents network-based model to analyze alternative policies during a pandemic outbreak, accounting for health and economic trade-offs within the same empirical framework. We leverage a variety of data sources, including data on individuals' mobility and encounters across metropolitan areas, health records, and measures of the possibility to be productively working from home. This combination of data sources allows us to build a framework in which the severity of a disease outbreak varies across locations and industries, and across individuals who differ by age, occupation, and preexisting health conditions. We use this framework to analyze the impact of different social distancing policies in the context of the COVID-19 outbreaks across US metropolitan areas. Our results highlight how outcomes vary across areas in relation to the underlying heterogeneity in population density, social network structures, population health, and employment characteristics. We find that policies by which individuals who can work from home continue to do so, or in which schools and firms alternate schedules across different groups of students and employees, can be effective in limiting the health and healthcare costs of the pandemic outbreak while also reducing employment losses.
    JEL: H12 H75 I18
    Date: 2020–06

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