nep-hea New Economics Papers
on Health Economics
Issue of 2020‒11‒30
twenty-six papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Hospital Allocation and Racial Disparities in Health Care By Amitabh Chandra; Pragya Kakani; Adam Sacarny
  2. Monitoring institutions in health care markets: Experimental evidence By Silvia Angerer; Daniela Glätzle-Rützler; ChristianWaibel
  3. The Effects of Vietnam-Era Military Service on the Long-Term Health of Veterans: A Bounds Analysis By Xintong Wang; Carlos A. Flores; Alfonso Flores-Lagunes
  4. Missouri’s Medicaid Contraction and Consumer Financial Outcomes By James Bailey; Nathan Blascak; Vyacheslav Mikhed
  5. Heterogeneous effect of health insurance on financial risk: Evidence from two successive surveys in Ghana By Samuel Ampaw; Simon Appleton; Xuyan Lou
  6. Ambient heat and human sleep By Kelton Minor; Andreas Bjerre-Nielsen; Sigga Svala Jonasdottir; Sune Lehmann; Nick Obradovich
  7. Extreme Temperature, Mortality and Occupation By Luis Sarmiento; Thomas Longden
  8. Pollution, children’s health and the evolution of human capital inequality By Karine Constant; Marion Davin
  9. Household Food Insecurity and U.S. Department of Housing and Urban Development Federal Housing Assistance By HELMS, VERONICA E.; COLEMAN-JENSEN, ALISHA; GRAY, REGINA; BRUCKER, DEBRA L.
  10. Pauses and reversals of infant mortality decline in India in 2017 and 2018 By Drèze, Jean; Gupta, Aashish; Parashar, Sai Ankit; Sharma, Kanika
  11. Kidney Disease, Donation, and Transplantation in East Africa By Mpaka Ayamba, Peter
  12. Determinants of Child Malnutrition in Mauritania By Yahya Abou Ly
  13. Estimating the Causal Impact of Macroeconomic Conditions on Income-Related Mortality By Gerdtham, Ulf-G.; Heckley, Gawain; Lissdaniels, Johannes
  14. Government as the First Investor in Biopharmaceutical Innovation: Evidence From New Drug Approvals 2010 - 2019 By Ekaterina Galkina Cleary; Matthew J. Jackson; Fred D. Ledley
  15. Patent-related actions taken in WTO members in response to the COVID-19 pandemic By Wu, Xiaoping; Khazin, Bassam Peter
  16. Nursing Home Quality, COVID-19 Deaths, and Excess Mortality By Christopher J. Cronin; William N. Evans
  17. Economic Benefits of COVID-19 Screening Tests By Andrew Atkeson; Michael C. Droste; Michael Mina; James H. Stock
  18. An Early Assessment of Curfew and Second COVID-19 Lock-down on Virus Propagation in France By Christelle Baunez; Mickael Degoulet; Stéphane Luchini; Patrick A. Pintus
  19. Combatting Covid-19 - On Relative Performance of the Indian States By Sugata Marjit; Anish Kumar Mukhopadhyay; Medha Chatterjee
  20. "Potential Impact of Daycare Closures on Parental Child Caregiving in Turkey" By Emel Memis; Ebru Kongar
  21. An analysis of policy decisions to combat SARS-CoV-2 transmission: comparing the available evidence and policies of public face masking to social distancing By Larsen, David; Kmush, Brittany; Asiago-Reddy, Elizabeth; Dinero, Rachel E.; Church, Rachael L.; Khan, Soniza; Lane, Sandra; Shaw, Andrea V.; Narine, Lutchmie
  22. Impact of COVID-19 lockdowns on individual mobility and the importance of socioeconomic factors By Julien Maire
  23. How Effective Are Social Distancing Policies? Evidence on the Fight Against COVID-19 By Ulrich Glogowsky; Emanuel Hansen; Simeon Schächtele
  24. Counting the Dead: COVID-19 and Mortality in Québec and British Columbia By Yann Décarie; Pierre-Carl Michaud
  25. Externalities, incentives, government failure, and the Coronavirus outbreak By de Oliveira Souza, Thiago
  26. Life and Death During the First Six Months of the COVID-19 Pandemic: An analysis of cross-country differences in changes in quantity and quality of life By Lykke E. Andersen; Alejandra Gonzales Rocabado

  1. By: Amitabh Chandra; Pragya Kakani; Adam Sacarny
    Abstract: We develop a simple framework to measure the role of hospital allocation in racial disparities in health care and use it to study Black and white Medicare patients who are treated for heart attacks – a condition where virtually everyone receives care, hospital care is highly effective, and hospital quality has been validated. We report four facts. (1) Black patients receive care at lower-performing hospitals than white patients, even when they live in the same hospital market or ZIP code within a hospital market. (2) Over the past two decades, the gap in performance between hospitals treating Black and white patients shrank by over two-thirds. (3) This progress is due to more rapid performance improvement at hospitals that tended to treat Black patients, rather than faster reallocation of Black patients to better hospitals. (4) Hospital performance improvement is correlated with adoption of a high-return low-cost input, beta-blockers. Closing remaining disparities in allocation and harnessing the forces of performance improvement, including technology diffusion, may be novel levers to further reduce disparities.
    JEL: D24 I11 I14
    Date: 2020–10
  2. By: Silvia Angerer; Daniela Glätzle-Rützler; ChristianWaibel
    Abstract: This paper investigates the impact of monitoring institutions on market outcomes in health care. Health care markets are characterized by asymmetric information. Physicians have an information advantage over patients with respect to the appropriate treatment for the patient and may exploit this informational advantage by over- and underprovision as well as by overcharging. We introduce two types of costly monitoring, endogenous and exogenous. When monitoring detects misbehavior, physicians have to pay a fine. Endogenous monitoring can be requested by patients, whereas exogenous monitoring is performed randomly by a third party. We present a toy model that enables us to derive hypotheses and to test them in a laboratory experiment. Our results show that introducing endogenous monitoring reduces the level of undertreatment and overcharging. Even under high monitoring costs, the threat of patient monitoring is sufficient to discipline physicians. Introducing exogenous monitoring also reduces undertreatment and overcharging when it is performed sufficiently frequently. Market efficiency increases when endogenous monitoring is introduced as well as when exogenous monitoring is implemented with sufficient frequency. Our results, therefore, suggest that monitoring may be a feasible instrument to improve outcomes in health care markets.
    Keywords: Credence goods, physician behavior, undertreatment, overtreatment, overcharging, monitoring, laboratory experiment
    JEL: C91 D82 I11
    Date: 2020
  3. By: Xintong Wang (Department of Accounting, Economics, and Finance, Slippery Rock University of Pennsylvania); Carlos A. Flores (Orfalea College of Business, California Polytechnic State University); Alfonso Flores-Lagunes (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244)
    Abstract: We analyze the short- and long-term effects of the U.S. Vietnam-era military service on veterans’ health outcomes using a restricted version of the National Health Interview Survey 1974-2013 and employing the draft lotteries as an instrumental variable (IV). We start by assessing whether the draft lotteries, which have been used as an IV in prior literature, satisfy the exclusion restriction by placing bounds on its net or direct effect on the health outcomes of draft avoiders. Since we do not find evidence against the validity of the IV, we assume its validity in conducting inference on the health effects of military service for individuals who comply with the draft-lotteries assignment (the “compliers”), as well as for those who volunteer for enlistment (the “always-takers”). The causal analysis for volunteers, who represent over 75% of veterans, is novel in this literature that typically focuses on the compliers. Since the effect for volunteers is not point-identified, we employ bounds that rely on a mild mean weak monotonicity assumption. We examine a large array of health outcomes and behaviors, including mortality, up to 40 years after the end of the Vietnam War. We do not find consistent evidence of detrimental health effects on compliers, in line with prior literature. For volunteers, however, we document that their estimated bounds show statistically significant detrimental health effects that appear 20 years after the end of the conflict. As a group, veterans experience similar statistically significant detrimental health effects from military service. These findings have implications for policies regarding compensation and health care of veterans after service
    Keywords: Veteran Health, Treatment Effects, Bounds, Instrumental Variables
    JEL: I22 C31 C36
    Date: 2020–11
  4. By: James Bailey; Nathan Blascak; Vyacheslav Mikhed
    Abstract: In July 2005, a set of cuts to Medicaid eligibility and coverage went into effect in the state of Missouri. These cuts resulted in the elimination of the Medical Assistance for Workers with Disabilities program, more stringent eligibility requirements, and less generous Medicaid coverage for those who retained their eligibility. Overall, these cuts removed about 100,000 Missourians from the program and reduced the value of the insurance for the remaining enrollees. Using data from the Medical Expenditure Panel Survey, we show how these cuts increased out-of-pocket medical spending for individuals living in Missouri. Using data from the Federal Reserve Bank of New York/Equifax Consumer Credit Panel (CCP) and employing a border discontinuity differences-in-differences empirical strategy, we show that the Medicaid reform led to increases in both credit card borrowing and debt in third-party collections. When comparing our results with the broader literature on Medicaid and consumer finance, which has generally measured the effects of Medicaid expansions rather than cuts, our results suggest there are important asymmetries in the financial effects of shrinking a public health insurance program when compared with a public health insurance expansion.
    Keywords: Medicaid; health insurance; consumer credit
    JEL: I13 I18 G51 G52
    Date: 2020–11–02
  5. By: Samuel Ampaw; Simon Appleton; Xuyan Lou
    Abstract: This paper evaluates the heterogeneous effect of health insurance on out-of-pocket healthcare expenditure (OOPHE), using merged data from the Ghana Living Standards Survey and Ghana Health Service reports. It applies conditional-mixed process and censored quantile instrumental variable estimators to tackle censoring and endogeneity. We instrument household insurance rate with community insurance rate (exclusive of the observed household) and control for community unobservables. The quantile regression allows the insurance effect to differ across the distribution of OOPHE. We further perform separate analyses by the types of OOPHE and selected covariates. The results show that insurance reduced OOPHE and the incidence of catastrophic OOPHE in 2013, but not in 2017. Besides, households in the higher expenditure quantiles benefitted more from coverage than those in the median and lower quantiles did in 2013. Also, the insurance benefits accrued exclusively to the wealthiest households, households with older heads, and users of outpatient services in 2013. Lastly, the 2013 survey reveals that families with female heads and those whose heads had primary education benefitted more from health insurance than their counterparts in the other subgroups did. The paper concludes that same health insurance can have varied financial risk implications at different periods, across the distribution of OOPHE, and among various household categories.
    Keywords: health insurance, financial risk protection, out-of-pocket healthcare expenditure, catastrophic healthcare expenditure, quantile regression, Ghana
    Date: 2020
  6. By: Kelton Minor; Andreas Bjerre-Nielsen; Sigga Svala Jonasdottir; Sune Lehmann; Nick Obradovich
    Abstract: Ambient temperatures are rising globally, with the greatest increases recorded at night. Concurrently, the prevalence of insufficient sleep is increasing in many populations, with substantial costs to human health and well-being. Even though nearly a third of the human lifespan is spent asleep, it remains unknown whether temperature and weather impact objective measures of sleep in real-world settings, globally. Here we link billions of sleep measurements from wearable devices comprising over 7 million nighttime sleep records across 68 countries to local daily meteorological data from 2015 to 2017. Rising nighttime temperatures shorten within-person sleep duration primarily through delayed onset, increasing the probability of insufficient sleep. The effect of temperature on sleep loss is substantially larger for residents from lower income countries and older adults, and females are affected more than are males. Nighttime temperature increases inflict the greatest sleep loss during summer and fall months, and we do not find evidence of short-term acclimatization. Coupling historical behavioral measurements with output from climate models, we project that climate change will further erode human sleep, producing substantial geographic inequalities. Our findings have significant implications for adaptation planning and illuminate a pathway through which rising temperatures may globally impact public health.
    Date: 2020–11
  7. By: Luis Sarmiento (European Institute of Economics and the Environment, and German Institute of Economic Research); Thomas Longden (Crawford School of Public Policy, Australian National University)
    Abstract: Even though a worker’s occupation is a crucial determinant of temperature-related mortality, only a handful of studies assess its effect across different labor groups. This study contributes to the literature on temperature and mortality by examining the impact of heat and cold across agricultural, informal, blue-collar, white-collar, and unemployed workers. Results show that white-collar workers are significantly more resilient to extreme temperatures than other labor groups, especially the elderly/retired, agrarian, and informal laborers. Additionally, we provide evidence that climate zones influence the effect and that extreme temperatures lead to a higher likelihood of heart attacks, diabetes, and influenza/pneumonia-related mortality.
    Date: 2020–11
  8. 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
    Abstract: The U.S. Department of Housing and Urban Development (HUD) provides housing rental assistance to more than 4.5 million low-income households. Using health survey data from the National Health Interview Survey (NHIS) linked to Federal housing administrative data, household food insecurity was assessed among adults receiving housing assistance at the time of their NHIS interview during 2011 and 2012 (n=2,089). Food-insecure households had difficulty at times providing adequate food for all their members due to limited resources. Among NHIS adult respondents receiving HUD assistance, 37.2 percent reported household food insecurity (including low and very low food security), while 19.1 percent experienced very low food security, the more severe range of food insecurity characterized by disrupted eating patterns and reduced food intake. Analyses revealed that adults in the Housing Choice Voucher program were significantly more likely to report household food insecurity than adults in other HUD programs (Public Housing and Multifamily Housing), net of other characteristics. Although housing assistance programs are designed to free financial resources associated with housing cost burden, household food insecurity is still prominent among low-income, HUD-assisted adults.
    Keywords: Food Security and Poverty
    Date: 2020–11
  10. By: Drèze, Jean; Gupta, Aashish; Parashar, Sai Ankit; Sharma, Kanika
    Abstract: This note examines recent trends in infant mortality in India, based on summary reports from the Sample Registration System (SRS). We find evidence of slowdown, pauses, and reversals in infant mortality decline in large parts of India in 2017 and 2018, the last two years for which SRS data are available. In urban areas, the infant mortality rate stagnated at 23 deaths per 1,000 births between 2016 and 2018. Worse, overall infant mortality increased in the poorer states of Chhattisgarh, Jharkhand, Madhya Pradesh, and Uttar Pradesh in this period. This occurred despite sustained improvements in household access to sanitation and clean fuel. One possible interpretation of these findings is that, in addition to their impact on unemployment and poverty, the demonetization experiment in late 2016 and the subsequent economic slowdown had an adverse effect on child health. In any case, these trends reinforce earlier evidence of faltering human development in India in recent years.
    Date: 2020–11–08
  11. By: Mpaka Ayamba, Peter (The Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise)
    Abstract: The burden of kidney failure remains largely underreported in East Africa. Health systems face numerous challenges including a lack of kidney registries, shortages of trained skilled healthcare workers, alack of diagnostic support, alack of equipment, and underdeveloped policies to govern the provision of treatment for kidney failure. Kidney transplantation, an effective treatment option against kidney failure, is underused primarily because of its cost and the lack of laws governing it. In this paper, the author discusses the salient issues affecting kidney donation and transplantation in East Africa.
    Keywords: Risk factors; kidney donation; transplantation; compensation to donors; laws; costs; Uganda; East Africa
    JEL: I11 I18
    Date: 2020–10
  12. By: Yahya Abou Ly (Cheikh Anta Diop University)
    Abstract: The empirical context of this research is in an environment where malnutrition is a real public health concern. The objective of this study was to identify the determinants of the nutritional state of children under the age of five years in Mauritania. Using data obtained from multiple indicators cluster surveys (MICS) in Mauritania in 2007 and 2015, we undertook fixed-effects clusters techniques to control for unobserved heterogeneity. The empirical results demonstrate that the age and sex of a child, level of education of the mother, the standards of living of the household, the area of residence, the availability and use of health care services and access to drinking water are all important factors for the good health of children in Mauritania. These findings suggests improvements in nutritional health, for example, by education of girls until completion of secondary school; an improvement in the conditions of households that are headed by women and an expansion in the coverage rate of multi-purpose health centres.
    Date: 2020
  13. By: Gerdtham, Ulf-G. (Department of Economics, Lund University); Heckley, Gawain (Health Economics Unit, Department of Clinical Sciences (Malmö), Lund University, Sweden); Lissdaniels, Johannes (Health Economics Unit, Department of Clinical Sciences (Malmö), Lund University, Sweden)
    Abstract: To-date the macroeconomic conditions-mortality literature on income-related inequality in mortality has relied on subgroup analysis, mainly using income as a stratification variable, but this nearly always causes selection bias yielding results that are hard to interpret. To solve this bad control problem, we apply a novel technique based on recentered influence function regression of overall income-related mortality measures, like the commonly used concentration index. We also highlight the importance of: i) measurement of relative versus absolute inequality; ii) measurement of inequality by population-level statistics of inequality (concentration indices) versus subgroup analysis; iii) measurement of short versus long-term income. We illustrate these issues and our suggested solution using detailed individual-level administrative data from Sweden. Our findings show that there overall is a (insignificant) counter-cyclical impact on mortality and its income-related inequality. During a sub-period of pronounced and significant counter-cyclical mortality we find support for accompanying counter-cyclical income-related inequality, but only when using short-term income.
    Keywords: Mortality; Macroeconomic conditions; Unemployment; Recentered influence function; Inequality; Concentration index.
    JEL: E32 I14
    Date: 2020–11–09
  14. By: Ekaterina Galkina Cleary (Bentley Univeristy); Matthew J. Jackson (Bentley University); Fred D. Ledley (Bentley University)
    Abstract: The discovery and development of new medicines classically involves a linear process of basic biomedical research to uncover potential targets for drug action, followed by applied, or translational, research to identify candidate products and establish their effectiveness and safety. This Working Paper describes the public sector contribution to that process by tracing funding from the National Institutes of Health (NIH) related to published research on each of the 356 new drugs approved by the U.S. Food and Drug Administration from 2010-2019 as well as research on their 219 biological targets. Specifically, we describe the timelines of clinical development for these products and proxy measures of their importance, including designations as first-in-class or expedited approvals. We model the maturation of basic research on the biological targets to determine the initiation and established points of this research and demonstrate that none of these products were approved before this enabling research passed the established point. This body of essential research comprised 2 million publications, of which 424 thousand were supported by 515 thousand Funding Years of NIH Project support totaling $195 billion. Research on the 356 drugs comprised 244 thousand publications, of which 39 thousand were supported by 64 thousand Funding Years of NIH Project support totaling $36 billion. Overall, NIH funding contributed to research associated with every new drug approved from 2010-2019, totaling $230 billion. This funding supported investigator-initiated Research Projects, Cooperative Agreements for government-led research on topics of particular importance, as well as Research Program Projects and Centers and training to support the research infrastructure. This NIH funding also produced 22 thousand patents, which provided marketing exclusivity for 27 (8.6%) of the drugs approved 2010-2019. These data demonstrate the essential role of public sector-funded basic research in drug discovery and development, as well as the scale and character of this funding. It also demonstrates the limited mechanisms available for recognizing the value created by these early investments and ensuring appropriate public returns. This analysis demonstrates the importance of sustained public investment in basic biomedical science as well as the need for policy innovations that fully realize the value of public sector investments in pharmaceutical innovation that ensure that these investments yield meaningful improvements in health.
    Keywords: innovation, basic research, translational science, technology transfer, NIH funding, Bayh-Dole, public policy, federal funding.
    JEL: G35 H1 H4 H5 L2 O3
    Date: 2020–08–05
  15. By: Wu, Xiaoping; Khazin, Bassam Peter
    Abstract: COVID-19, caused by SARS-Cov-2, was declared to be a pandemic by the World Health Organization on 11 March 2020. Since then, the issue of the relationship between patent protection and the development of and access to medical treatments and technologies - a longstanding and enduringly important public policy issue - has become central to the debate on the linkages between IP, innovation, access, and public health between stakeholders with divergent interests. This working paper provides an overview of the patent landscape of medical treatments and technologies related to COVID-19, and of the patent status of two investigational medical treatments: remdesivir and lopinavir/ritonavir. It then presents various patent-related actions taken by legislators, policymakers, industry sectors, and civil society organizations in WTO Members since the outbreak. Furthermore, it elaborates on patent-related policy options provided by the TRIPS Agreement, and WTO Members' national implementation and utilization of these options in their response to the COVID-19 pandemic.
    Keywords: COVID-19 pandemic,patent,open innovation,patentable subject matter,repurposed medicines,exceptions and limitations,licences,government use,transition periods,LDCs,WTO,TRIPS
    JEL: K11 K15 K30 O30 O31 O34 I18
    Date: 2020
  16. By: Christopher J. Cronin; William N. Evans
    Abstract: The COVID-19 pandemic in the US has been particularly devastating for nursing home residents. A key question is how have some nursing homes been able to effectively protect their residents, while others have not? Using data on the universe of US nursing homes, we examine whether establishment quality is predictive of COVID-19 mortality. Higher-quality nursing homes, as measured by inspection ratings, have substantially lower COVID-19 mortality. Quality does not predict the ability to prevent any COVID-19 resident or staff cases, but higher-quality establishments prevent the spread of resident infections conditional on having one. Preventing COVID-19 cases and deaths may come at some cost, as high-quality homes have substantially higher non-COVID deaths, a result consistent with high excess non-COVID mortality among the elderly since March. The positive correlation between establishment quality and non-COVID mortality is driven entirely by nursing homes located in counties with below-median COVID-19 case rates. As a result, high-quality homes in these counties have significantly more total deaths than their low-quality counterparts. The concentration of excess death in low-risk areas suggests that future suffering could be avoided with more nuanced guidelines, such as those recently suggested by CMS that outline a role for in-person visits in lower-risk areas.
    JEL: I1 I18
    Date: 2020–10
  17. By: Andrew Atkeson; Michael C. Droste; Michael 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 4-15 (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.
    JEL: E60 I10
    Date: 2020–10
  18. By: Christelle Baunez (Aix-Marseille Univ, CNRS, Institut Neurosciences Timone); Mickael Degoulet (Aix-Marseille Univ, CNRS, Institut Neurosciences Timone); Stéphane Luchini (Aix-Marseille Univ, CNRS, AMSE, Marseille, France.); Patrick A. Pintus (Aix-Marseille Univ, CNRS, AMSE, Marseille, France.)
    Abstract: This note provides an early assessment of the reinforced measures to curb the COVID-19 pandemic in France, which include a curfew of selected areas and culminate in a second COVID-19-related lock-down that started on October 30, 2020 and is still ongoing. We analyse the change in virus propagation across age groups and across départements using an acceleration index introduced in Baunez et al. (2020). We find that while the pandemic is still in the acceleration regime, acceleration decreased notably with curfew measures and this more rapidly so for the more vulnerable population group, that is, for people older than 60. Acceleration continued to decline under lock-down, but more so for the active population under 60 than for those above 60. For the youngest population aged 0 to 19, curfew measures did not reduce acceleration but lock-down does. This suggests that if health policies aim at protecting the elderly population generally more at risk to suffer severe consequences from COVID-19, curfew measures may be effective enough. However, looking at the departmental map of France, we find that curfews have not necessarily been imposed in départements where acceleration was the largest.
    Keywords: COVID-19; effects of curfew and lock-down; acceleration index; real-time analysis; France
    JEL: I18 H12
    Date: 2020–11
  19. By: Sugata Marjit; Anish Kumar Mukhopadhyay; Medha Chatterjee
    Abstract: The purpose of this paper is to construct a relative performance index for the States in India in terms of their performance in combatting Covid-19 pandemic. The data is analyzed up to August, 2020, though the methodology used can be readily extended to update the index. The methodology can be applied to other developing countries with similar background. We use population density and the extent of tests conducted to fine tune the index. The association between per capita health expenditure and relative performance indices reveals that there are states where relatively sound health infrastructure has not ensured better performance in curing patients and those relatively weak have done better. But with a multi-dimensional health infrastructure index such anomaly tends to disappear.
    Keywords: infectious disease, morbidity, mortality, human development, population health
    JEL: I12 I15
    Date: 2020
  20. By: Emel Memis; Ebru Kongar
    Abstract: Daycares closed on March 16, 2020 in Turkey to prevent the spread of COVID-19. At the same time, the two most common nonparental childcare arrangements in Turkey--care of children by grandparents and nannies--became undesirable due to health concerns and in some cases also unfeasible due to the partial lockdown for individuals under the age of 20 and over the age of 64. We estimate the potential impact of new constraints on nonparental childcare arrangements due to the pandemic on parental caregiving time of married parents of preschool-age children by using data from the 2014-15 Turkish Time Use Survey. Comparing how parental caregiving time varies by gender and use of nonparental childcare arrangements, we find that new constraints on nonparental childcare arrangements during the pandemic have potentially increased the gender difference in parental caregiving time by an hour and forty minutes in Turkey.
    Keywords: Gender Economics; Time Use; Unpaid Labor; Turkey; COVID-19
    JEL: D13 J16 J22
    Date: 2020–11
  21. By: Larsen, David; Kmush, Brittany; Asiago-Reddy, Elizabeth; Dinero, Rachel E.; Church, Rachael L.; Khan, Soniza; Lane, Sandra; Shaw, Andrea V.; Narine, Lutchmie
    Abstract: As the COVID-19 pandemic spread throughout the world in early 2020, many country leaders endorsed social distancing policies to reduce transmission. Public face masking policies, however, were only endorsed by a few countries in eastern Asia until recently. Herein, we review the theory and evidence behind public face masking and social distancing. We find a complete absence of adequate randomized trials for social distancing and only a few for public masking, but similar levels of evidence that both interventions could work to reduce the spread of the SARS-CoV-2 virus. Given the similar levels of evidence, it is strange that social distancing was promoted in the absence of public face masking policies, particularly so with the detrimental emotional, social, and economic side effects that social distancing entails. In the future, possible interventions to combat pandemic illness should be evaluated against the entire body of evidence rather than upon the absence or presence of adequate randomized trials.
    Date: 2020–11–10
  22. By: Julien Maire (Peterson Institute for International Economics)
    Abstract: In March 2020, most countries implemented stringent measures—closing schools and workplaces, limiting public gatherings, and curbing travel—to reduce the spread of the SARS-CoV-2 virus, which causes COVID-19. Using the Oxford Stringency Index and smartphone data from Google, Maire examines the effects of the stringent measures implemented in March–May 2020 on individual mobility. The results suggest that stringent measures were more effective at reducing individual mobility in higher-income countries than in lower-income countries and that the differences reflect factors such as extreme poverty, perception of risk, the share of vulnerable employment, number of hospital beds, age distribution of the population, and population density. Understanding how the effects of lockdown measures on individual mobility differed across countries is important to determine the effectiveness of such measures on health outcomes and their impact on economic activity.
    Date: 2020–11
  23. By: Ulrich Glogowsky; Emanuel Hansen (Universtität Köln); Simeon Schächtele (Inter-American Development Bank)
    Abstract: To fight the spread of COVID-19, many countries implemented social distancing policies. This is the first paper that examines the effects of the German social distancing policies on behavior and the epidemic’s spread. Exploiting the staggered timing of COVID-19 outbreaks in extended event-study models, we find that the policies heavily reduced mobility and contagion. In comparison to a no-social-distancing benchmark, within three weeks, the policies avoided 84% of the potential COVID-19 cases (point estimate: 499.3K) and 66% of the potential fatalities (5.4K). The policies’ relative effects were smaller for individuals above 60 and in rural areas.
    Keywords: COVID-19, Coronavirus, social distancing policies, policy evaluation, mobility, fatalities
    JEL: I18 H12 I12
    Date: 2020–11
  24. By: Yann Décarie; Pierre-Carl Michaud
    Abstract: The first wave of the pandemic has led to excess mortality across the globe. Canada was no exception. But, the experience of provinces has been very different, and the objective of this paper is to investigate these differences focusing on two extreme cases. We contrast the mortality experience of British Columbia with that of Québec to understand how large differences in mortality during the pandemic emerged across these two provinces. We find that most of the differences can be found in excess mortality in institutions (nursing homes) and that both travel restrictions, differences in how deaths are recorded, differences in the seasonality of the flu or differences in how the pandemic spread across different economic segments of the population cannot explain these differences. We also document that the reported death toll from COVID is larger than excess mortality in Quebec, by about 30%, due to lower mortality from other causes of death, in particular malignant tumors, heart disease and respiratory problems.
    Keywords: excess mortality, COVID-19, nursing homes, cause of death.
    JEL: I18 J11
    Date: 2020
  25. By: de Oliveira Souza, Thiago (Department of Business and Economics)
    Abstract: This paper derives and simulates a compartmental model of the Coronavirus outbreak in which individuals have self-interested reactions to the threat of infection, proportional to the heterogeneous risk of complications that they face. As long as high-risk individuals perceive infection as sufficiently undesirable, the externalities created by the free circulation of low-risk individuals are positive and potentially reduce the total number of infections by approximately 100 million in the U.S. (including every high-risk individual). In this case, the social interaction of low-risk individuals should be subsidized, according to the same market failure arguments used to justify broad confinement mandates, which constitute government failures.
    Keywords: Externalities; government failure; Coronavirus; Covid-19; pandemic
    JEL: C02 D62 H40 I10
    Date: 2020–11–02
  26. By: Lykke E. Andersen (Executive Director at Sustainable Development Solutions Network Bolivia); Alejandra Gonzales Rocabado (Assistant Director at Sustainable Development Solutions Network Bolivia)
    Abstract: This study carries out a cross-country analysis of changes in quantity and quality of life during the first six months of the COVID-19 pandemic (11 March to 11 September 2020) for 124 countries. Changes in quantity of life are measured as life years lost to COVID-19, including excess deaths not officially reported as COVID-19 deaths. Changes in quality of life are proxied by the average change in daily mobility, compared to a pre-COVID baseline. We find a significant negative correlation between the two, meaning that the countries with the biggest reductions in mobility are also the countries with the biggest losses of life years. We calculate that about 15 million life years were lost during the first six months of the pandemic, corresponding to 0.006% of all expected life years. For comparison, at least three times more life years are lost every six months due to children dying of diarrhea. About 28 million life years are created every day from babies being born, so the first six months of the pandemic set us back about 14 hours in terms of quantity of life. The setbacks in terms of quality of life are several orders of magnitude larger. Some countries have suffered more than a 50% reduction in mobility sustained over half a year, with devastating effects on many aspects of quality of life. Globally, the equivalent of 400 million full-time jobs were lost. GDP is estimated to have been set back about three years, poverty about five years, and the tourism industry about 20 years. The already large inequalities in access to quality education have been further widened, leaving hundreds of millions of disadvantaged children farther behind. Even countries that have managed the pandemic relatively well are suffering large economic contractions due to the negative spill-over effects from other countries. We still have a long way to go before this pandemic is over, and we urgently need to course-correct in order not to cause even more harm than has already been done. The paper provides a series of recommendations on what needs to be done to minimize total harm.
    Keywords: COVID-19, pandemic, life years, mobility, quality of life .
    JEL: H12 I14 I18 I38
    Date: 2020–10

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