nep-hea New Economics Papers
on Health Economics
Issue of 2020‒11‒23
28 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Socioeconomic Status and the Experience of Pain: An Example from Knees By David M. Cutler; Ellen Meara; Susan Stewart
  2. The Age Profile of Life-satisfaction After Age 65 in the U.S. By Péter Hudomiet; Michael D. Hurd; Susann Rohwedder
  3. What a drag it is getting old? Mental health and loneliness beyond age 50 By Jan van Ours
  4. Does the longitudinal association between neighbourhood cohesion and mental health differ by ethnicity? Results from the UK Household Longitudinal Survey By Chum, Antony; Teo, Celine; Azra, Karanpreet Kaur
  5. Aging and Health Care Expenditure: A non-parametric approach By Breyer, Friedrich; Lorenz, Normann; Ihle, Peter
  6. Job Loss and Health Spillovers in the Family By Gathmann, Christina; Huttunen, Kristiina; Jenström, Laura; Saaksvuori, Lauri; Stitzing, Robin
  7. Side Effects of Labor Market Policies By Caliendo, Marco; Mahlstedt, Robert; van den Berg, Gerard J.; Vikström, Johan
  8. How Would Medicare for All Affect Health System Capacity? Evidence from Medicare for Some By Jeffrey Clemens; Joshua D. Gottlieb; Jeffrey Hicks
  9. Asymmetric Demand Response when Prices Increase and Decrease: The Case of Child Healthcare By Toshiaki Iizuka; Hitoshi Shigeoka
  10. Price and Saliency in Health Care: When Can Targeted Nudges Change Behaviors? By Walker, Brigham
  11. The Regressive Costs of Drinking Water Contaminant Avoidance By Hyde, Kelly
  12. Pollution, children’s health and the evolution of human capital inequality By Karine Constant; Marion Davin
  13. Do soda taxes affect the consumption and health of school-aged children? Evidence from France and Hungary By Gangl, Selina
  14. Higher Order Risk Preferences: New Experimental Measures, Determinants and Field Behavior By Sebastian Schneider; Matthias Sutter
  15. Choices and Outcomes in Assignment Mechanisms: The Allocation of Deceased Donor Kidneys By Nikhil Agarwal; Charles Hodgson; Paulo Somaini
  16. The Effects of Parental Retirement on Adult Children’s Labor Supply: Evidence From China By Wu, Qi; Gao, Xin
  17. Relative Deprivation and Suicide Risk in South Korea By Pak, Tae-Young; Choung, Youngjoo
  18. Who Married, (to) Whom, and Where? Trends in Marriage in the United States, 1850-1940 By Claudia Olivetti; M. Daniele Paserman; Laura Salisbury; E. Anna Weber
  19. COVID–19 and Gaza: a policy recommendation to establish the Gazan Medical Reserve Corps By Mahayosnand, Ponn P; Sabra, DM; Sabra, ZM
  20. Economic Benefits of COVID-19 Screening Tests By Andrew Atkeson; Michael Droste; Michael J. Mina; James H. Stock
  21. Can Women Empowerment Help to Reduce Open Defecation in India: Evidence from NFHS 4 By Amrita Chatterjee; Shriya Agarwal
  22. How do the Covid-19 Prevention Measures Interact with Sustainable Development Goals? By Shima Beigi
  23. Optimal Testing and Social Distancing of Individuals With Private Health Signals By Thomas Tröger
  24. Inference under Superspreading: Determinants of SARS-CoV-2 Transmission in Germany By Patrick W. Schmidt
  25. Static and Dynamic Inefficiencies in an Optimizing Model of Epidemics By Garibaldi, Pietro; Moen, Espen R.; Pissarides, Christopher A.
  26. Insights from Optimal Pandemic Shielding in a Multi-Group SEIR Framework By Philipp Bach; Victor Chernozhukov; Martin Spindler
  27. The Japanese Textile Sector and the Influenza Pandemic of 1918-1920 By Ilan Noy; Toshihiro Okubo; Eric Strobl
  28. COVID-19 Surgical Abortion Restriction Did Not Reduce Visits to Abortion Clinics By Martin Andersen; Sylvia Bryan; David Slusky

  1. By: David M. Cutler; Ellen Meara; Susan Stewart
    Abstract: Reports of pain differ markedly across socioeconomic groups and are correlated with outcomes such as functional limitations and disability insurance receipt. This paper examines the differential experience of pain by education. We focus on knee pain, the most common musculoskeletal complaint. Comparing clinical interpretation of knee x-rays of people with and without pain, there are few differences in presence or clinical severity of arthritis across education groups. In contrast, less educated people report more pain for any given objective measure of arthritis. After confirming that reported pain maps to objective measures like walking speed and range of motion, we test four theories for differential experience of pain: differences in obesity, physically demanding occupations, psychological factors, and medical treatment differences. We find that physical demands on the job and obesity each explain about one-third of the education gradient in knee pain. There is an interaction between the two; physical requirements on the job are associated with knee pain primarily in those who are obese. In contrast, psychological traits and access to medical care explain little of the difference in reported pain by education level. These findings imply that educational gradients in pain are likely to persist or even widen as the need for physically demanding occupations—like home health aides and personal service workers—grows in importance with the aging population, and the working population continues to be obese.
    JEL: I1 J21
    Date: 2020–10
  2. By: Péter Hudomiet; Michael D. Hurd; Susann Rohwedder
    Abstract: Although income and wealth are frequently used as indicators of well-being, they are increasingly augmented with subjective measures such as life satisfaction to capture broader dimensions of individuals’ well-being. Based on data from large surveys of individuals, life satisfaction in cross-section increases with age beyond retirement into advanced old age. It may seem puzzling that average life satisfaction would be higher at older ages because older individuals are more likely to experience chronic or acute health conditions, or the loss of a spouse. Accordingly, this empirical pattern has been called the “paradox of well-being.” We examine the age profile of life satisfaction of the U.S. population age 65 and older in the Health and Retirement Study (HRS) and also find increasing life satisfaction at older ages in cross-section. But based on the longitudinal dimension of the HRS life satisfaction significantly declines with age and the rate of decline accelerates with age. Widowing and health shocks play important roles in this decline. We reconcile the cross-section and longitudinal measurements by showing that both differential mortality and differential non-response bias the cross-sectional age profile upward: individuals with higher life satisfaction and in better health tend to live longer and to remain in the survey, causing average values to increase. We conclude that the optimistic view about increasing life satisfaction at older ages based on cross-sectional data is not warranted.
    JEL: I14 I31 J14
    Date: 2020–10
  3. By: Jan van Ours (Erasmus University Rotterdam)
    Abstract: This paper studies mental health and loneliness in the Netherlands for individuals beyond age 50. The analysis is based on panel data over the period 2008 to 2018 and focuses on the effects of life events and aging. It appears that mental health gets worse and loneliness increases if individuals lose their partner or become unemployed. On average, mental health of males and high educated females improves at retirement. With respect to aging, the main conclusions are that mental health improves while loneliness goes down at least up to the high 70s. From the perspective of mental health and loneliness it does not seem to be a drag getting old.
    Keywords: mental health, loneliness, age, old people
    JEL: I31 J14
    Date: 2020–11–10
  4. By: Chum, Antony; Teo, Celine; Azra, Karanpreet Kaur
    Abstract: Purpose While the association between neighbourhood cohesion and mental health has been widely studied in the general population, the effects of neighbourhood cohesion across ethnic groups is not well understood. Ethnicity is often left out of study design, many studies do not consider effect modification by ethnicity, or they rely on overly simplistic ethnic categories. Methods Data from the UK household longitudinal study was used to investigate whether changes in neighbourhood cohesion is independently associated with changes in mental health (measured using the GHQ) over 9 years (2009 to 2018), and whether the association differed across 17 ethnic groups. The study used a fixed-effect modelling approach that includes within-person estimators that allows each participant to act as their own control. Results Compared to British white, the following ethnic groups all saw a similar improvement in GHQ (-0.76, 95% CI -0.83 to -0.70) for each point increase in neighbourhood cohesion: Irish, any other White, White and Asian mixed, Chinese, Caribbean, African, any other Black, Arab, and others. Some ethnic groups saw stronger improvements in mental for each point increase in neighbourhood cohesion, including White and Black Caribbean mixed, any other mixed, Indian, Pakistani, any other Asian, with the strongest effect seen in Bangladeshi participants (-2.52. 95% CI -3.48 to -1.56). Conclusion Our study highlights the importance of ethnocultural data in research examining neighbourhood effects on mental health. Future research should evaluate policies to improve neighbourhood cohesion for ethnic minorities to address ethnic mental health disparities.
    Date: 2020–11–03
  5. By: Breyer, Friedrich; Lorenz, Normann; Ihle, Peter
    Abstract: One of the most important controversies in health economics concerns the question whether the imminent aging of the population in most OECD countries will increase per-capita health care expenditures (HCE). Proponents of the "red-herring hypothesis" argue that this is not the case because most of the correlation of age and HCE is due to the compression of the mortality rate in old age and the high costs of dying. The evidence for this hypothesis is, however, mixed. Our contribution to this debate is mainly methodological: We argue that the relationship of age, time to death (TTD) and HCE should be estimated non-parametrically. Using a large panel data set from the German Statutory Health Insurance, we demonstrate that the non-parametric approach is particularly useful to answer the question whether age still has an impact on HCE once TTD is taken into account and find that it is clearly the case. This relationship is even more pronounced for long-term care expenditures (LTCE). We then show that the age-expenditure relationship is not stable over time: for many age classes, HCE in the last year of life grow considerably faster than HCE of survivors. We explore the impact of these findings on the simulation of future HCE and find that population aging will in fact contribute to rising HCE in the coming decades. However, the total impact of demographics on future HCE and LTCE is dwarfed by the exogenous time trend, which is due to medical progress and increasing generosity of public LTC insurance.
    Keywords: health care expenditures,aging,red-herring hypothesis,non-parametric regression
    JEL: H51
    Date: 2020
  6. By: Gathmann, Christina; Huttunen, Kristiina; Jenström, Laura; Saaksvuori, Lauri; Stitzing, Robin
    Abstract: A sizable literature documents that displaced workers suffer substantial negative consequences in the labor market and health. These effects may extend to the partner or spouse through household decision-making. Using administrative data of all workers and firms matched to mortality and patient records, we document a stunning asymmetry: when a man loses his job in a plant closure, both the man and the spouse suffer negative health consequences. When a woman loses here job, in contrast, we find no such dire health consequences. We explore three explanations for this phenomenon: the role of spousal labor supply, the size of earnings and income losses, and the importance of family structure and gender roles. Spousal labor supply responses are very small despite limited insurance through public transfers. The size of income losses and gender roles seem to play a role for explaining the observed asymmetry.
    JEL: I12 I14 J65 J12
    Date: 2020
  7. By: Caliendo, Marco (University of Potsdam); Mahlstedt, Robert (University of Copenhagen); van den Berg, Gerard J. (University of Bristol); Vikström, Johan (IFAU)
    Abstract: Labor market policy tools such as training and sanctions are commonly used to help bring workers back to work. By analogy to medical treatments, the individual exposure to these tools may have side effects. We study effects on health using individual-level population registers on labor market events outcomes, drug prescriptions and sickness absence, comparing outcomes before and after exposure to training and sanctions. We find that training improves cardiovascular and mental health and lowers sickness absence. The results suggest that this is not due to improved employment prospects but rather to instantaneous features of participation such as, perhaps, the adoption of a more rigorous daily routine. Unemployment benefits sanctions cause a short-run deterioration of mental health, possibly due higher stress levels, but this tapers out quickly.
    Keywords: unemployment, health, sickness, prescriptions, mental health, drugs, training, depression, cardiovascular disease, sanctions
    JEL: J68 I12 I18 H51
    Date: 2020–11
  8. By: Jeffrey Clemens; Joshua D. Gottlieb; Jeffrey Hicks
    Abstract: Proposals to create a national health care plan such as "Medicare for All" rely heavily on reducing the prices that insurers pay for health care. These changes affect physicians' short-run incentives for care provision and may also change health care providers' incentives to invest in capacity, thereby influencing the availability of care in the long term. We provide evidence on these responses using a major Medicare payment change combined with survey data on physicians' time use. We find evidence that physicians increase their time spent on capacity building when remuneration increases, and that they are subsequently more willing to accept new patients---especially those who may be the residual claimants on marginal capacity. These forces imply that short-run supply curves likely differ from long-run supply curves. Policymakers need to account for how major changes to payment incentives would influence the investments that determine health system capacity.
    JEL: H51 I11 I13
    Date: 2020–11
  9. By: Toshiaki Iizuka; Hitoshi Shigeoka
    Abstract: This study tests whether demand responds symmetrically to price increases and decreases—a seemingly obvious proposition under conventional demand theory that has not been rigorously tested. Exploiting rapid expansion in municipal subsidies for child healthcare in a difference-in-differences framework, we find evidence against it: when coinsurance, our price measure, increases from 0% to 30%, the demand response is more than twice that to a price decrease from 30% to 0%, a result consistent with loss aversion. This result indicates that, while economists and policymakers pay little attention, the price change direction matters, and that welfare analysis should incorporate this direction.
    JEL: I11 I13 I18 J13
    Date: 2020–11
  10. By: Walker, Brigham (Tulane University)
    Abstract: This paper takes advantage of a natural experiment to examine the relationship between the price and saliency of health services. A large employer e-mailed individually-targeted health education encouraging high-value care to high-risk employees. Weeks before the program launched, a company reorganization affecting about a quarter of employees resulted in that group not receiving the intervention. Using event study, difference-in-differences, and triple differences methods, I find that costlier services are associated with relatively less utilization and that prior use was associated with relatively more utilization following the campaigns. These results may inform employer, governmental, and health insurer choices concerning low-cost interventions seeking to shift health behaviors, and may also be relevant in other settings in which targeted informational nudges are deployed.
    Keywords: nudges, health care, price, saliency, information, prior beliefs
    JEL: I1 D8
    Date: 2020–11
  11. By: Hyde, Kelly
    Abstract: Up to 45 million Americans in a given year are potentially exposed to contaminated drinking water, increasing their risk of adverse health outcomes. Existing literature has demonstrated that individuals respond to drinking water quality violations by increasing their purchases of bottled water and filtration avoidance, thereby avoiding exposure to contaminants. This paper demonstrates that poorer households, for whom the costs of avoidance comprise a greater share of disposable income, bear disproportionate costs of water quality violations in the United States. Following a health-based water quality violation, poor households' expenditure on nutritious grocery products in a nationally representative panel differentially decreases by approximately $7 per month. This is associated with a decrease of about 1,500 calories per household member per day, placing these individuals at a higher risk of food insecurity. This finding suggests that the indirect costs of drinking water contamination through economic channels exacerbate health disparities associated with poverty.
    Date: 2020
  12. By: Karine Constant (ERUDITE - Equipe de Recherche sur l’Utilisation des Données Individuelles en lien avec la Théorie Economique - UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12 - UNIV GUSTAVE EIFFEL - Université Gustave Eiffel); Marion Davin (CEE-M - Centre d'Economie de l'Environnement - Montpellier - FRE2010 - UM - Université de Montpellier - CNRS - Centre National de la Recherche Scientifique - Montpellier SupAgro - Institut national d’études supérieures agronomiques de Montpellier - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)
    Abstract: This article examines how pollution and its health effects during childhood can affect the dynamics of inequalities among households. In a model in which children's health is endogenously determined by pollution and the health investments of parents, we show that the economy may exhibit inequality in the long run and be stuck in an inequality trap with steadily increasing disparities, because of pollution. We investigate if an environmental policy, consisting in taxing the polluting production to fund pollution abatement, can address this issue. We find that it can decrease inequality in the long run and enable to escape from the trap if the emission intensity is not too high and if initial disparities are not too wide. Otherwise, we reveal that a policy mix with an additional subsidy to health expenditure may be a better option, at least if parental investment on children's health is sufficiently efficient.
    Keywords: Pollution,Health,Human capital,Childhood,Overlapping generations,Inequality.
    Date: 2020–11–05
  13. By: Gangl, Selina
    Abstract: This paper examines the effect of soda taxes on the consumption behaviour and health of school-aged children in Europe: Hungary imposed a "Public Health Product Tax" on several unhealthy products including sodas in 2011. France introduced solely a tax on sodas, containing sugar or artificial sweeteners, in 2012. In order to exploit spatial variation, I use a semi- parametric difference-in-differences (DID) approach. Since the policies differ in Hungary and France, I analyse the effects separately by using a neighbouring country without a soda tax as control group. The results show a counter-intuitive positive effect of the tax on the soda consumption in Hungary. Reasons for this finding might be a substitution of unhealthy products as well as the decreased amount of sugar in sodas. The effect of the soda tax in France is as expected negative, but insignificant which might be caused by a low tax rate. The body mass index (BMI) is not affected by the tax in any country. Consequently, policy makers should think carefully about the design, aim, and the tax rate, as well as the possible reaction of manufacturers before implementing a soda tax.
    Keywords: Soda tax,consumption,health,semi-parametric difference-in-differences,HBSC
    JEL: H25 I12 I18 L66
    Date: 2020
  14. By: Sebastian Schneider (Max Planck Institute for Research on Collective Goods, Bonn); Matthias Sutter (Max Planck Institute for Research on Collective Goods, Bonn)
    Abstract: We use a novel method to elicit and measure higher order risk preferences (prudence and temperance) in an experiment with 658 adolescents. In line with theoretical predictions, we find that higher order risk preferences – particularly prudence – are strongly related to adolescents' field behavior, including their financial decision making, eco-friendly behavior, and health status, including addictive behavior. Most importantly, we show that dropping prudence and temperance from the analysis of students' field behavior would yield largely misleading conclusions about the relation of risk aversion to these domains of field behavior. Thus our paper puts previous work that ignored higher order risk preferences into an encompassing perspective and clarifies which orders of risk preferences can help understand field behavior of adolescents.
    Keywords: Higher order risk preferences, prudence, temperance, risk aversion, field behavior, adolescents, health, addictive behavior, smartphone addiction, experiment
    JEL: C93 D81 D91 J13
    Date: 2020–08
  15. By: Nikhil Agarwal; Charles Hodgson; Paulo Somaini
    Abstract: While the mechanism design paradigm emphasizes notions of efficiency based on agent preferences, policymakers often focus on alternative objectives. School districts emphasize educational achievement, and transplantation communities focus on patient survival. It is unclear whether choice-based mechanisms perform well when assessed based on these outcomes. This paper evaluates the assignment mechanism for allocating deceased donor kidneys on the basis of patient life-years from transplantion (LYFT). We examine the role of choice in increasing LYFT and compare equilibrium assignments to benchmarks that remove choice. Our model combines choices and outcomes in order to study how selection induced in the mechanism affects LYFT. We show how to identify and estimate the model using quasi-experimental variation resulting from the mechanism. The estimates suggest that the design in use selects patients with better post-transplant survival prospects and matches them well, resulting in an average LYFT of 8.78, which is 0.92 years more than a random assignment. However, the aggregate LYFT can be increased to 13.84. Realizing the majority of the gains requires transplanting relatively healthy patients, who would have longer life expectancies even without a transplant. Therefore, a policymaker faces a dilemma between transplanting patients who are sicker and those for whom life will be extended the longest.
    JEL: C36 D47 I14
    Date: 2020–11
  16. By: Wu, Qi; Gao, Xin
    Abstract: Aging and an increasing retired population are a global challenge. Previous studies suggest that retirement affects economic behaviors of the retiree and his or her spouse, including consumption, health outcome, and time use. However, little is known about the intergenerational effects of parental retirement on adult children. This paper studies the effects of parental retirement on adult children's labor supply through intergenerational time and monetary transfer. We exploit the mandatory retirement age in China as the cut-off point and apply a regression discontinuity (RD) approach to four waves of the China Family Panel Studies (CFPS) Dataset. Our findings suggest that parental retirement reduces adult children's annual hours of labor supply by 3 to 4 percent. This reduction is especially pronounced for female children. We find that the reduction can be explained by parents' increasing demand for time and care from children due to the significant drop in parents' self-rated health upon retirement. Although both male and female children increased their monetary and time transfers to parents, we find that parents tend to make more transfers to sons compared to daughters. Daughters are also more likely to make transfers to parents after they retire, both in terms of money and in terms of time. We therefore urge policy makers to increase formal eldercare provisions and provide workplace amenities such as flexible working hours, especially for female employees.
    Keywords: Retirement, Labor Supply, Intergenerational Transfer, Gender Role
    JEL: D13 D64 J0 J22 J26
    Date: 2020–10–23
  17. By: Pak, Tae-Young; Choung, Youngjoo
    Abstract: Psychosocial stress and the related biochemical response have been hypothesized as a potential mechanism underlying the link between relative deprivation and mortality. While suicide is known as the likely manifestation of severe mental illness, less is known about the effect that relative deprivation has on suicide risk. Using the 2012 to 2018 waves of the Korean Welfare Panel Study, we examined the association between relative deprivation in income and suicide risk among South Koreans aged 25 or older. Relative deprivation is assessed with the Yitzhaki index, Deaton index, and income rank within the reference group, and suicide risk is measured as suicidal ideation and suicide planning or attempt in the preceding year. Adjusted for absolute income and other socioeconomic characteristics, the odds ratios of reporting suicidal ideation for each 10000k KRW (8300 USD) increase in the Yitzhaki index were around 1.42 (95% CI: 1.08-1.87) to 1.72 (95% CI: 1.30-2.28). The estimated odds ratios were in the range of 1.70 (95% CI: 1.04-2.78) to 1.95 (95% CI: 1.26-3.02) for suicide planning or attempt. The association between relative deprivation in income and suicidal ideation was found significant only for men, not for women. The inferences were robust to various definitions of relative deprivation and reference group. Taken together, our findings suggest that relative deprivation in income is independently associated with higher odds of suicidal ideation and suicide planning or attempt over and above the effect of absolute income and material living conditions. Narrowing the income gap between individuals would be an effective policy response to a suicide epidemic in South Korea.
    Keywords: Income inequality; Social comparison; Yitzhaki index; Suicidal ideation; Suicide planning; South Korea
    JEL: I10 I15 I32
    Date: 2020–01–21
  18. By: Claudia Olivetti; M. Daniele Paserman; Laura Salisbury; E. Anna Weber
    Abstract: We present new findings about the relationship between marriage and socioeconomic background in the United States in the late 19th and early 20th Centuries. Imputing socioeconomic status of family of origin from first names, we document a socioeconomic gradient for women in the probability of marriage and the socioeconomic status of husbands. This socioeconomic gradient becomes steeper over time. We investigate the degree to which it can be explained by occupational income divergence across geographic regions. Regional divergence explains about one half of the socioeconomic divergence in the probability of marriage, and almost all of the increase in marital sorting. Differences in urbanization rates and the share of foreign-born across states drive most of these differences, while other factors (the scholarization rate, the sex ratio and the share in manufacturing) play a smaller role.
    JEL: J12 J62 N31 N32 N91 N92
    Date: 2020–10
  19. By: Mahayosnand, Ponn P; Sabra, DM; Sabra, ZM
    Abstract: This paper serves as a policy recommendation to develop a collaborative public–private interdisciplinary healthcare system known as the Gazan Medical Reserve Corps (Reserves) during the COVID–19 pandemic. Due to the high concentration of educated unemployed in Gaza, the Reserves would draw from recent medical school graduates and unemployed physicians. Although initial funds must be awarded by the government and international community to launch the Reserves, the proposed four evidence–based divisions of the Reserves are designed to make a self-sustaining and financially–sound entity. Our literature review demonstrates that the United Nations, various interest groups, and numerous researchers recommend the work of each of the proposed divisions as necessary aspects of a long–term health sector. The Reserves would work with humanitarian organizations, such as the United Nations Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA) and International Medical Corps (IMC), in cooperation with the World Health Organization (WHO). It is a goal to ultimately transition Gaza out of the need for short–term aid and assistance. The Reserves would also work alongside the local health entities and facilities already present in Gaza, such as the medical schools, hospitals, and clinics.
    Date: 2020–11–01
  20. By: Andrew Atkeson; Michael Droste; Michael J. Mina; James H. Stock
    Abstract: We assess the economic value of screening testing programs as a policy response to the ongoing COVID-19 pandemic. We find that the fiscal, macroeconomic, and health benefits of rapid SARS-CoV-2 screening testing programs far exceed their costs, with the ratio of economic benefits to costs typically in the range of 2-15 (depending on program details), not counting the monetized value of lives saved. Unless the screening test is highly specific, however, the signal value of the screening test alone is low, leading to concerns about adherence. Confirmatory testing increases the net economic benefits of screening tests by reducing the number of healthy workers in quarantine and by increasing adherence to quarantine measures. The analysis is undertaken using a behavioral SIR model for the United States with 5 age groups, 66 economic sectors, screening and diagnostic testing, and partial adherence to instructions to quarantine or to isolate.
    Keywords: Epidemiological models; Macroeconomics; Antigen testing; COVID-19
    JEL: E00 I0
    Date: 2020–11–09
  21. By: Amrita Chatterjee (Assistant Professor, Madras School of Economics, Chennai, India); Shriya Agarwal (Associate, Idinsight Pvt. Ltd)
    Abstract: In this paper, it is argued that women, because of being disproportionately affected by lack of sanitation, can influence the household to build a toilet at home and therefore reduce the incidence of open defecation. Thus, the objective of this paper is to analyze the role that women empowerment can play in reducing open defecation at the household level. Using the National Family Health Survey (NFHS-4) for 2015-2016 for a cross section of 17 major states of India, the paper suggests that greater women autonomy in the form of higher decision making power and greater freedom of movement leads to increased chances of toilets in the house. Secondly, women can be influential neither by virtue of being the head of the household nor by working but only if such positions of power are complemented with education and media exposure. A district level analysis using Quantile regression suggests that the role of women autonomy is more pronounced in the well performing districts compared to districts with more open defecation. The importance of media exposure and education got reinforced.
    Keywords: : Sanitation; women empowerment, education, logistic regression, quantile regression
    JEL: J16 D1 B23
    Date: 2019–12
  22. By: Shima Beigi
    Abstract: Washing hands, social distancing and staying at home are the preventive measures set in place to contain the spread of the COVID-19, a disease caused by SARS-CoV-2. These measures, although straightforward to follow, highlight the tip of an imbalanced socio-economic and socio-technological iceberg. Here, a System Dynamic (SD) model of COVID-19 preventive measures and their correlation with the 17 Sustainable Development Goals (SDGs) is presented. The result demonstrates a better informed view of the COVID-19 vulnerability landscape. This novel qualitative approach refreshes debates on the future of SDGS amid the crisis and provides a powerful mental representation for decision makers to find leverage points that aid in preventing long-term disruptive impacts of this health crisis on people, planet and economy. There is a need for further tailor-made and real-time qualitative and quantitative scientific research to calibrate the criticality of meeting the SDGS targets in different countries according to ongoing lessons learned from this health crisis.
    Date: 2020–10
  23. By: Thomas Tröger
    Abstract: We consider individuals who are privately informed about the probability of being infected by a potentially dangerous disease. Depending on its private health signal, an individual may assign a positive or negative value to getting tested for the disease. Individuals dislike social distancing. The government has scarce testing capacities and scarce resources for enforcing social-distance keeping. We solve the government's problem of setting up an optimal testing-and-social-distancing schedule, taking into account that individuals may lie about their private health signal. Rather than modelling the infection dynamics, we take a snapshot view, that is, we ask what should be done at a particular point in time to curb the current spread of the disease while taking the current well-being of the individuals into account as well. If testing capacities are sufficiently scarce, then it can be optimal to test only a randomly selected fraction of those who want to be tested, and require maximal social distancing precisely for those individuals who wanted a test and ended up not belonging to the tested fraction.
    Date: 2020–11
  24. By: Patrick W. Schmidt
    Abstract: Superspreading complicates the study of SARS-CoV-2 transmission. I propose a model for aggregated case data that accounts for superspreading and improves statistical inference. In a Bayesian framework, the model is estimated on German data featuring over 60,000 cases with date of symptom onset and age group. Several factors were associated with a strong reduction in transmission: public awareness rising, testing and tracing, information on local incidence, and high temperature. Immunity after infection, school and restaurant closures, stay-at-home orders, and mandatory face covering were associated with a smaller reduction in transmission. The data suggests that public distancing rules increased transmission in young adults. Information on local incidence was associated with a reduction in transmission of up to 44% (95%-CI: [40%, 48%]), which suggests a prominent role of behavioral adaptations to local risk of infection. Testing and tracing reduced transmission by 15% (95%-CI: [9%,20%]), where the effect was strongest among the elderly. Extrapolating weather effects, I estimate that transmission increases by 53% (95%-CI: [43%, 64%]) in colder seasons.
    Date: 2020–11
  25. By: Garibaldi, Pietro (University of Turin); Moen, Espen R. (Norwegian Business School (BI)); Pissarides, Christopher A. (London School of Economics)
    Abstract: In an optimizing model of epidemics several externalities arise when agents shield to avoid infection. Optimizing behaviour delays herd immunity but also reduces overall infections to approximately the minimum consistent with herd immunity. For reasonable parameter values, and with no vaccine, we find that agents delay too much because of a "rat race to shield": they shield too much in the hope that others catch the disease and reach herd immunity. This and other externalities drive large wedges between private and social outcomes. The expectation of a vaccine reverses the effects, and agents shield too little.
    Keywords: SIR models, matching model, COVID-19, social distancing, rat race, herd immunity
    JEL: A12 I10 J18 D61 D62
    Date: 2020–11
  26. By: Philipp Bach; Victor Chernozhukov; Martin Spindler
    Abstract: The COVID-19 pandemic constitutes one of the largest threats in recent decades to the health and economic welfare of populations globally. In this paper, we analyze different types of policy measures designed to fight the spread of the virus and minimize economic losses. Our analysis builds on a multi-group SEIR model, which extends the multi-group SIR model introduced by Acemoglu et al.~(2020). We adjust the underlying social interaction patterns and consider an extended set of policy measures. The model is calibrated for Germany. Despite the trade-off between COVID-19 prevention and economic activity that is inherent to shielding policies, our results show that efficiency gains can be achieved by targeting such policies towards different age groups. Alternative policies such as physical distancing can be employed to reduce the degree of targeting and the intensity and duration of shielding. Our results show that a comprehensive approach that combines multiple policy measures simultaneously can effectively mitigate population mortality and economic harm.
    Date: 2020–11
  27. By: Ilan Noy; Toshihiro Okubo; Eric Strobl
    Abstract: The COVID-19 pandemic has brought into sharp relief the connection between the epidemiology of a virus, the structure of the economy and society that becomes exposed to it, and the actions chosen by government and by individuals and communities to combat it or ameliorate its economic impact. Surprisingly, there has not been much research on the economy of the 1918-1920 influenza pandemic, even though it likely was the highest mortality event in the 20th century, more lethal than the two World Wars. This paper focuses on Japan, which as a minor participant, was not directly affected by World War I. We exploit the diversity of experiences with the pandemic and its attendant policy responses across Japanese prefectures; and investigate the importance of the pandemic (measured by excess mortality), and of non-pharmaceutical policy interventions (NPIs) in determining the economic impact of the pandemic. We do so by focusing on the production and employment in the textile sector, given the availability of data and the general importance of the sector for emerging economies (as Japan was at the time). We investigate the role of NPIs in ameliorating the economic costs for the sector during the pandemic years (1918-1920), and indeed find that the implemented NPIs were effective in ameliorating the pandemic’s economic consequences, rather than worsening them. In this case, there was no trade-off between money and life, but rather the two were complimentary.
    Keywords: pandemic, influenza, Japan, textiles, non-pharmaceutical interventions
    JEL: H75 I15
    Date: 2020
  28. By: Martin Andersen; Sylvia Bryan; David Slusky
    Abstract: Due to COVID-19, 33 states banned elective medical procedures, and 13 of these states included surgical abortions. We collected street addresses of abortion clinics and linked them to SafeGraph’s data on counts of visitors. We found a 32 percent decrease in clinics visits in February-May of 2020 compared to 2019. States that banned elective procedures saw an additional 23 percent decrease in visits. However, there was no significant additional decrease in the states that explicitly banned surgical abortions. We estimate that the decrease in foot traffic over these four months reduced abortions by 9 percent in 2020 relative to 2019.
    JEL: H75 I18 J13
    Date: 2020–11

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.