nep-hea New Economics Papers
on Health Economics
Issue of 2020‒12‒21
27 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Economic Studies on the Opioid Crisis: A Review By Johanna Catherine Maclean; Justine Mallatt; Christopher J. Ruhm; Kosali Simon
  2. How Do Mass Shootings Affect Community Wellbeing? By Aparna Soni; Erdal Tekin
  3. The Federal Effort to Desegregate Southern Hospitals and the Black-White Infant Mortality Gap By Anderson, D. Mark; Charles, Kerwin Kofi; Rees, Daniel I.
  4. Liquidity Constraints and Demand for Healthcare: Evidence from Danish Welfare Recipients By Frederik Plesner Lyngse
  5. The Effects of Incentivizing Early Prenatal Care on Infant Health By Kamila Cygan-Rehm; Krzysztof Karbownik
  6. Immigration Enforcement and Infant Health By Amuedo-Dorantes, Catalina; Churchill, Brandyn F.; Song, Yang
  7. Economic Preferences and Obesity: Evidence from a Clinical Lab-in-Field Experiment By Pastore, Chiara; Schurer, Stefanie; Tymula, Agnieszka; Fuller, Nicholas; Caterson, Ian
  8. A Random Forest a Day Keeps the Doctor Away By Markus Eyting
  9. Top-up Design and Health Care Expenditure: Evidence from Cardiac Stents By Ginger Zhe Jin; Hsienming Lien; Xuezhen Tao
  10. Did taller people live longer? Influence of height on life span in rural Spain, 1835-2019 By Francisco J. Marco-Gracia; Javier Puche
  11. Corruption and mental health: Evidence from Vietnam By Smriti Sharma; Saurabh Singhal; Finn Tarp
  12. Chronic diseases in Italy: Does socioeconomic status carry weight? By Giovanni Crea; Valentina Beretta
  13. Unmet Health Care Need and Income-Related Horizontal Equity in Access during the COVID-19 Pandemic By Davillas, Apostolos; Jones, Andrew M.
  14. The Impact of the COVID-19 Pandemic and Policy Response on Health Care Utilization: Evidence from County-level Medical Claims and Cellphone data By Jonathan H. Cantor; Neeraj Sood; Dena Bravata; Megan Pera; Christopher M. Whaley
  15. The Impact of COVID-19 on the Mobility Needs of an Aging Population in Contra Costa County By Ragland, David R PhD, MPH; Schor, Glenn PhD, MPH; Felschundneff, Grace
  16. Retail Pharmacies and Drug Diversion during the Opioid Epidemic By Janssen, Aljoscha; Zhang, Xuan
  17. Optimal Vaccine Subsidies for Endemic and Epidemic Diseases By Matthew Goodkin-Gold; Michael Kremer; Christopher M. Snyder; Heidi L. Williams
  18. The potential impact of co-residence structures on socio-demographic inequalities in COVID-19 mortality By Giorgi, Julien; Boertien, Diederik
  19. COVID-19: a biopolitical odyssey By Sathyamala, C.
  20. Divided We Fall: International Health and Trade Coordination During a Pandemic By Viral Acharya; Zhengyang Jiang; Robert J. Richmond; Ernst-Ludwig von Thadden
  21. Building an Epidemiology of Happiness By John F. Helliwell; David Gyarmati; Craig Joyce; Heather Orpana
  22. An Early Assessment of Curfew and Second COVID-19 Lock-down on Virus Propagation in France By Christelle Baunez; Mickael Degoulet; Stéphane Luchini; Patrick Pintus; Miriam Teschl
  23. Designing Efficient Contact Tracing Through Risk-Based Quarantining By Andrew Perrault; Marie Charpignon; Jonathan Gruber; Milind Tambe; Maimuna Majumder
  24. Raising COVID-19 Awareness in Rural Communities: A Randomized Experiment in Bangladesh and India By Abu Siddique; Tabassum Rahman; Debayan Pakrashi; Asad Islam; Firoz Ahmed
  25. Face masks considerably reduce COVID-19 cases in Germany By Mitze, Timo; Kosfeld, Reinhold; Rode, Johannes; Wälde, Klaus
  26. Variations in COVID strategies: Determinants and lessons By S. Nazrul Islam; Hoi Wai Jackie Cheng; Kristinn Sv. Helgason; Hiroshi Kawamura; Marcelo LaFleur
  27. China and COVID-19: a shock to its economy, a metaphor for its development By Magnus, George

  1. By: Johanna Catherine Maclean; Justine Mallatt; Christopher J. Ruhm; Kosali Simon
    Abstract: The United States has experienced an unprecedented crisis related to the misuse of and addiction to opioids. As of 2018, 128 Americans die each day of an opioid overdose, and total economic costs associated with opioid misuse are estimated to be more than $500 billion annually. The crisis has evolved in three phases, starting in the 1990s and continuing through 2010 with a massive increase in use of prescribed opioids associated with lax prescribing regulations and aggressive marketing efforts by the pharmaceutical industry. A second phase included tightening restrictions on prescribed opioids, reformulation of some commonly misused prescription medications, and a shift to heroin consumption over the period 2010 to 2013. Since 2013, the third phase of the crisis has included a movement towards synthetic opioids, especially fentanyl, and a continued tightening of opioid prescribing regulations, along with the growth of both harm reduction and addiction treatment access policies. Economic research, using innovative frameworks, causal methods, and rich data, has added to our understanding of the causes and consequences of the crisis. This body of research also identifies intended and unintended impacts of policies designed to address the crisis. Although there is general agreement that the causes of the crisis include a combination of supply- and demand-side factors, and interactions between them, there is less consensus regarding the relative importance of each. Studies show that regulations can reduce opioid prescribing but may have less impact on root causes of the crisis and, in some cases, have spillover effects resulting in greater use of more harmful substances obtained in illicit markets, where regulation is less possible. There are effective opioid use disorder treatments available, but access, stigma, and cost hurdles have stifled utilization, resulting in a large degree of under-treatment in the U.S. How challenges brought about by the COVID-19 pandemic may intersect with the opioid crisis is unclear. Emerging areas for future research include understanding how societal and healthcare systems disruptions affect opioid use, as well as which regulations and policies most effectively reduce potentially inappropriate prescription opioid use and illicit opioid sources without unintended negative consequences.
    JEL: I1 J01
    Date: 2020–11
  2. By: Aparna Soni; Erdal Tekin
    Abstract: Over the past four decades, more than 2,300 people have been the victims of mass shootings involving a firearm in the United States. Research shows that mass shootings have significant detrimental effects on the direct victims and their families. However, relatively little is known about the extent to which the impacts of these tragedies are transmitted into communities where they occur, and how they influence people beyond those directly affected. This study uses nationally representative data from the Gallup-Healthways survey to assess the spillover effects of mass shootings on community wellbeing and emotional health outcomes that capture community satisfaction, sense of safety, and levels of stress and worry. We leverage differences in the timing of mass shooting events across counties between 2008 and 2017. We find that mass shootings reduce both community wellbeing and emotional health. According to our results, a mass shooting is associated with a 27 percentage point decline in the likelihood of having excellent community wellbeing and a 13 percentage point decline in the likelihood of having excellent emotional health four weeks following the incident. The effects are stronger and longer lasting among individuals exposed to deadlier mass shootings. Furthermore, the reductions in wellbeing are greater for parents with children below age 18. Our findings suggest that mass shootings have significant societal costs and create negative spillover effects that extend beyond those immediately exposed.
    JEL: I1 I12 I18 I31 K4
    Date: 2020–11
  3. By: Anderson, D. Mark (Montana State University); Charles, Kerwin Kofi (Harris School, University of Chicago); Rees, Daniel I. (University of Colorado Denver)
    Abstract: In 1966, Southern hospitals were barred from participating in Medicare 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.
    Keywords: hospital desegregation, black infant mortality, Medicare, civil rights
    JEL: I14 I18 N32
    Date: 2020–12
  4. By: Frederik Plesner Lyngse (Department of Economics, University of Copenhagen)
    Abstract: Are low-income individuals relying on government transfers liquidity constrained by the end of the month to a degree that they postpone medical treatment? I investigate this question using Danish administrative data comprising the universe of welfare recipients and the filling of all prescription drugs. I find that on transfer income payday, recipients have a 52% increase in the propensity to fill a prescription. By separating prophylaxis drugs used to treat chronic conditions, where the patient can anticipate the need to fill the prescription, e.g. cholesterol-lowering statins, I find an increase of up to 99% increase on payday. Even for drugs used to treat acute conditions, where timely treatment is essential, I find a 22% increase on payday for antibiotics and a 5-8% decrease in the four days preceding payday. Lastly, exploiting the difference in day the doctor write the prescription and the day the patient fill it, I show that liquidity constraints is the key operating mechanism for postponing antibiotic treatment.
    Keywords: health behavior, health insurance, health and inequality, prescription drugs, payday
    JEL: I12 I13 I14
    Date: 2020–10–12
  5. By: Kamila Cygan-Rehm; Krzysztof Karbownik
    Abstract: We investigated the effects of the timing of early prenatal care on infant health by exploiting a reform that required expectant mothers to initiate prenatal care during the first ten weeks of gestation to obtain a one-time monetary transfer paid after childbirth. Applying a difference-in-differences design to individual-level data on the population of births and fetal deaths, we identified small but statistically significant positive effects of the policy on neonatal health. We further provide suggestive evidence that improved maternal health-related knowledge and behaviors during pregnancy are plausible channels through which the reform might have affected fetal health.
    JEL: I12 I18 J13
    Date: 2020–11
  6. By: Amuedo-Dorantes, Catalina (University of California, Merced); Churchill, Brandyn F. (Vanderbilt University); Song, Yang (Colgate University)
    Abstract: The past two decades have been characterized by an unprecedented increase in interior immigration enforcement and heightened stress due to fears of family separation and loss of income among undocumented immigrants. Using vital statistics on infant births from the National Center of Health Statistics for the 2003 through 2016 period and a difference-in-differences design, we compare the health outcomes of infants with likely undocumented mothers before and after the intensification of immigration enforcement within U.S. counties. We find that intensified enforcement, especially during the third trimester, increases the likelihood of low birth weight (
    Keywords: immigration enforcement, undocumented immigrants, infant health
    JEL: I10 I12 K37
    Date: 2020–11
  7. By: Pastore, Chiara (University of York); Schurer, Stefanie (University of Sydney); Tymula, Agnieszka (University of Sydney); Fuller, Nicholas (University of Sydney); Caterson, Ian (University of Sydney)
    Abstract: We study economic decision-making of 284 people with obesity and pre-diabetes who participated in a 6-months randomised controlled trial to control weight and prevent diabetes. To elicit preferences, we use incentive-compatible experimental tasks that participants completed during their medical screening examination. We find that, on average, participants are risk averse, show no evidence of present bias, and have impatience levels comparable to healthy samples described in the international literature. Variations in present bias and impatience are not significantly associated with variations in markers of obesity. But we find a significant negative association between risk tolerance and BMI and other markers of obesity for women. A 1 standard deviation increase in risk tolerance is associated with a 0.2 standard deviation drop in BMI and waist circumference. Impatience moderates the link between risk tolerance and obesity. We replicate the key finding of interaction effects between risk and time preferences using survey data from a nationally representative sample of 6,281 Australians with similar characteristics. Deviating markedly from the literature, we conclude that risk tolerance brings benefits for health outcomes if combined with patience in this understudied but highly policy-relevant population.
    Keywords: impatience, risk tolerance, obesity, incentive-compatible economic experiment, lab-in-field experiment
    JEL: C9 D9 D81 I12
    Date: 2020–12
  8. By: Markus Eyting (Johannes Gutenberg University)
    Abstract: Using a unique dataset from a German health check-up provider including detailed individual questionnaire data as well as medical test data, I apply a random forest to predict several health risk factors. I evaluate the prediction performance using various metrics and find decent prediction qualities across all outcomes. By identifying the most relevant predictor variables, I compile concise and validated questionnaire tools to identify individuals’ blood pressure, blood glucose, and cholesterol levels, their risk of a coronary heart disease, whether or not they suffer from plaque or a metabolic syndrome as well as their relative fitness levels. In a second step, I compare the prediction results to physician predictions of the same patient observations. I find that the random forest outperforms the physicians if predictions are based on the same information set. When additionally providing the physicians with the random forest predictions for a particular patient observation, the physicians align with the random forest predictions. Finally, while the random forest considers various psychological scales, the physicians focus on family health history information instead.
    Date: 2020–12–07
  9. By: Ginger Zhe Jin; Hsienming Lien; Xuezhen Tao
    Abstract: Since 2006, Taiwan's National Health Insurance (NHI) covers the full cost of baseline treatment in cardiac stents (bare-metal stents, BMS), but requires patients to pay the incremental cost of more expensive treatments (drug-eluting stents, DES). Within this "top-up" design, we study how hospitals respond to a 26% cut of the NHI reimbursement rate in 2009. We find hospitals do not raise the DES prices from patients, but increase BMS usage per admission by 18%, recouping up to 30% of the revenue loss in 2009-2010. Overall, the rate cut is effective in reducing NHI expenditure despite hospitals' moral hazard adjustment.
    JEL: G22 I11 I18
    Date: 2020–11
  10. By: Francisco J. Marco-Gracia (Universidad de Zaragoza); Javier Puche (Universidad de Zaragoza)
    Abstract: This article analyses the relationship between male height and age at death among adults born between 1835 and 1939 in fourteen villages in north-east Spain. A total of 1,488 conscripts who died between 1868 and 2019 have been included in the analysis. The height data have been obtained from conscriptions for military service; demographic and socioeconomic data of the deceased were obtained from parish archives and censuses. The data were linked according to nominative criteria using family reconstitution methods. The results suggest that there has been a positive relationship between height and life span in the long-term. For the birth cohorts of 1835-1869, conscripts with a height of 170 cm or more lived on average 7.6 years longer than individuals measuring less than 160 cm. This biological difference disappeared for the birth cohort of 1900-1939 due to a progressive improvement in health and nutrition conditions, benefiting especially the short conscripts.
    Keywords: Heights, Life span, Biological inequality, rural Spain, 1835-2019
    JEL: I10 I14 I15 N33 N34
    Date: 2020–12
  11. By: Smriti Sharma (Newcastle University); Saurabh Singhal (Lancaster University & IZA); Finn Tarp (Department of Economics, University of Copenhagen)
    Abstract: While there is substantial corruption in developing countries, the costs imposed by corruption on individuals and households are little understood. This study examines the relationship between exposure to local corruption and mental health, as measured by depressive symptoms. We use two large data sets – one cross-sectional and one panel – collected across rural Vietnam. After controlling for individual and regional characteristics, we find strong and consistent evidence that day-to-day petty corruption is positively associated with psychological distress. Our results are robust to a variety of specification checks. Further, we find that the relationship between corruption and mental health is stronger for women, and that there are no heterogeneous effects by poverty status. An examination of the underlying mechanisms shows that reductions in income and trust associated with higher corruption may play a role. Finally, using a difference-in-difference estimation strategy, we also provide suggestive evidence that a recent high profile anti-corruption campaign had significant positive effects on mental health. Overall, our findings indicate that there may be substantial psychosocial and mental health benefits from efforts to reduce corruption and improve rural governance structures.
    Keywords: corruption, anti-corruption, mental health, depression, Vietnam
    JEL: I3 I15 O12 D73 P3
    Date: 2020–11–12
  12. By: Giovanni Crea (Università di Pavia); Valentina Beretta (Università di Pavia)
    Abstract: We estimate income-related inequality in chronic patients in Italy and analyze its dynamics over time. Data come from the 2005, 2005, and 2013 waves of the Indagine Multiscopo sulle Famiglie, Condizioni di salute e ricorso ai servizi sanitari”, carried out by ISTAT. Results show an increase over time in chronic disease prevalence, higher for women than for men. This study provides evidence for chronic conditions inequalities in Italy. Indeed, chronic conditions are concentrated among poor people. In particular, over time, the prevalence of chronicity did not reduce for poor people, while it increased in richer people.
    Keywords: chronic conditions, socioeconomic status, inequality, concentration index, Italy
    Date: 2020–04
  13. By: Davillas, Apostolos (University of East Anglia); Jones, Andrew M. (University of York)
    Abstract: Using monthly data from the Understanding Society (UKHLS) COVID-19 Survey we analyse the evolution of unmet need and assess how the UK health care system performed against the norm of horizontal equity in health care access during the first wave of COVID-19 wave. Unmet need was most evident for hospital care, and less pronounced for primary health services (medical helplines, GP consultations, local pharmacist advice, over the counter medications and prescriptions). Despite this, there is no evidence that horizontal equity, with respect to income, was violated for NHS hospital outpatient and inpatient care during the first wave of the pandemic. There is evidence of pro-rich inequities in access to GP consultations, prescriptions and medical helplines at the peak of the first wave, but these were eliminated as the pandemic progressed. There are persistent pro-rich inequities for services that relate to individuals' ability to pay (over the counter medications and advice from the local pharmacist).
    Keywords: inequity, COVID-19, unmet need, health care, UKHLS
    JEL: C1 D63 I14
    Date: 2020–11
  14. By: Jonathan H. Cantor; Neeraj Sood; Dena Bravata; Megan Pera; Christopher M. Whaley
    Abstract: The COVID-19 pandemic has forced federal, state and local policymakers to respond by legislating, enacting, and enforcing social distancing policies. However, the impact of these policies on healthcare utilization in the United States has been largely unexplored. We examine the impact of county-level shelter in place ordinances on healthcare utilization using two unique datasets—employer-sponsored insurance for over 6 million people in the US and cell phone location data. We find that introduction of these policies was associated with reductions in the use of preventive care, elective care, and the number of weekly visits to physician offices and hospitals. However, controlling for county-level exposure to the COVID-19 pandemic reduces the impact of these policies. Our results imply that while social distancing policies do lead to reductions in healthcare utilization, much of these reductions would have occurred even in the absence of these policies.
    JEL: I0 I1 I12 I18
    Date: 2020–11
  15. By: Ragland, David R PhD, MPH; Schor, Glenn PhD, MPH; Felschundneff, Grace
    Abstract: In 2018, SafeTREC conducted a survey on transportation mobility issues among older adults in California. A follow-up survey planned for 2020, just as the COVID-19 pandemic changed life for all residents, was redesigned to assess mobility needs and changes during the Shelter-in-Place order and focused on COVID-19 impacts. Results indicate that the COVID-19 pandemic and subsequent Shelter-in-Place order have had a major impact on senior mobility. Communications for many were restricted to phone, email, texts, social media and video chats. Among those with a medical problem, just over 60% called a doctor or nurse line or went to a doctor’s office, while 11.2% went to an emergency room, and 8.6% did nothing. A total of 8% of respondents said they had run out of food or other important items during the Shelter-in-Place order. Rates of exercise outside the home dropped 20% between January and June 2020, and while over 60% sought outside entertainment in January 2020, by June 2020, nearly 70% accessed their entertainment online at home. Almost 80% of working respondents feared spreading or contracting COVID-19 because of their work or related transportation. Almost 20% felt a lack of companionship or closeness sometimes or often. Over 30% were worried about their current or long-term finances. A total of 84.5% strongly agreed or agreed that the Shelter-in-Place order was necessary. None of the respondents to the follow-up survey were diagnosed with COVID-19, and 88.2% were not concerned about risk of exposure from any member of their household.
    Keywords: Medicine and Health Sciences, Social and Behavioral Sciences, Mobility, accessibility, aged, travel behavior, surveys, demographics, communicable diseases, public health, COVID-19
    Date: 2020–11–01
  16. By: Janssen, Aljoscha (Singapore Management University); Zhang, Xuan (Singapore Management university)
    Abstract: This study investigates the role of retail pharmacy ownership in the opioid epidemic in the United States by comparing independently owned pharmacies’ and chain pharmacies’ prescription opioid dispensing practices. Using data of prescription opioid orders at the pharmacy level between 2006 and 2012, we find that compared to chain pharmacies within the same ZIP code area, independent pharmacies on average dispense 40.9% more opioids and 61.7% more OxyContin. We further confirm that after being acquired by a chain, a previously independent pharmacy reduces dispensing of opioids by 31.7% and OxyContin by 43%. Using the Oxy-Contin reformulation in 2010, which reduced the demand for diversion for illegal recreational use but not the demand for medical use, we show that half of the difference in dispensed Oxy-Contin doses between independent and chain pharmacies can be attributed to drug diversion. In addition, we find that independent pharmacies’ OxyContin dispensing is higher in areas with greater competition. Furthermore, a larger county-level recreational demand is correlated with a larger difference between independent and chain pharmacies’ prescription opioid dispensing. We discuss two reasons that may explain why independent pharmacies are more likely to be linked to drug diversion. First, they have stronger financial incentives due to lower expected costs of misdoing. Second, they may have less information on patients’ prescription drug use history. Prescription drug monitoring programs help to reduce the information gap between independent and chain pharmacies to some extent, but monitoring of small independent pharmacies needs to be strengthened.
    Keywords: Pharmacy; Ownership; Prescription opioids; Drug diversion
    JEL: I11 I18 L22
    Date: 2020–12–10
  17. By: Matthew Goodkin-Gold; Michael Kremer; Christopher M. Snyder; Heidi L. Williams
    Abstract: Vaccines exert a positive externality, reducing spread of disease from the consumer to others, providing a rationale for subsidies. We study how optimal subsidies vary with disease characteristics by integrating a standard epidemiological model into a vaccine market with rational economic agents. In the steady-state equilibrium for an endemic disease, across market structures ranging from competition to monopoly, the marginal externality and optimal subsidy are non-monotonic in disease infectiousness, peaking for diseases that spread quickly but not so quickly as to drive all consumers to become vaccinated. Motivated by the Covid-19 pandemic, we adapt the analysis to study a vaccine campaign introduced at a point in time against an emerging epidemic. While the nonmonotonic pattern of the optimal subsidy persists, new findings emerge. Universal vaccination with a perfectly effective vaccine becomes a viable firm strategy: the marginal consumer is still willing to pay since those infected before vaccine rollout remain a source of transmission. We derive a simple condition under which vaccination exhibits increasing social returns, providing an argument for concentrating a capacity-constrained campaign in few regions. We discuss a variety of extensions and calibrations of the results to vaccines and other mitigation measures targeting existing diseases.
    JEL: D4 I18 L11 L65 O31
    Date: 2020–11
  18. By: Giorgi, Julien; Boertien, Diederik
    Abstract: During the COVID-19 pandemic, confinement measures were adopted across the world to limit the spread of the virus. In France, these measures were applied between March 17 and May 10. Using high-quality population census data and focusing on co-residence structures on French territory, this article analyses how co-residence patterns unevenly put different socio-demographic groups at risk of being infected and dying from COVID-19. The research ambition is to quantify the possible impact of co-residence structures heterogeneity on socioeconomic inequalities in mortality stemming from within-household transmission of the virus. Using a simulation approach, the article highlights the existence of theoretical pronounced inequalities of vulnerability to COVID-19 related to cohabitation structures as well as a reversal of the social gradient of vulnerability when the age of the infected person increases. Among young age categories, infection is simulated to lead to more deaths in the less educated or foreign-born populations. Among the older ones, the inverse holds with infections having a greater potential to provoke deaths through the transmission of the virus within households headed by a highly educated or a native-born person. Demographic patterns such as the cohabitation of multiple generations and the survival of both partners of a couple help to explain these results. Even though inter-generational co-residence and large households are more common among the lower educated and foreign born in general, the higher educated are more likely to still live with their partner at higher ages.
    Date: 2020–11–30
  19. By: Sathyamala, C.
    Abstract: This paper examines how and why a zoonotic, ‘novel’ coronavirus disease, Covid-19, became a pandemic of such magnitude as to bring the world to a standstill for several months. Though the WHO inaccurately projected Covid-19 as the first pandemic by a coronavirus, it had been preceded by two others also caused by a similar coronavirus: SARS (severe acute respiratory syndrome) in 2002-03 and MERS (Middle East respiratory syndrome) in 2014. In fact, following the SARS pandemic, the possibility of the emergence of pathogenic, virulent, ‘novel’ strains had been predicted. Therefore, the emergence of Covid-19 coronavirus should have come as no surprise, yet ‘preparedness’ to deal with the emergency was seriously lacking. A major reason for the worldwide escalation was due to the inordinate delay in Covid-19 pandemic declaration by the WHO till geographical spread and severity had heightened considerably. This enabled the justification of draconian ‘suppression’ measures based on questionable science. This paper argues that the ‘lockdown’ strategy coming after the virus had seeded across countries initiating local transmission, was a political decision wrapped up in epidemiological parlance to give it a scientific veneer. Using the Foucauldian interpretation of the public health responses to three diseases – leprosy, plague and smallpox –as models for three distinct forms of power techniques, this paper explores the biopolitical reasons for the adoption of the ‘plague’ model of governance which exercised ‘in full’, a transparent, unobstructed power as the almost universal blueprint across the world to contain Covid-19.
    Keywords: Covid-19, coronavirus, pandemic, World Health Organization, disease modelling, capitalism, biopolitics
    Date: 2020–12–09
  20. By: Viral Acharya; Zhengyang Jiang; Robert J. Richmond; Ernst-Ludwig von Thadden
    Abstract: We analyse the role of international trade and health coordination in times of a pandemic by building a two-economy, two-good trade model integrated into a micro-founded SIR model of infection dynamics. Uncoordinated governments with national mandates can adopt (i) containment policies to suppress infection spread domestically, and (ii) (import) tariffs to prevent infection coming from abroad. The efficient, i.e., coordinated, risk-sharing arrangement dynamically adjusts both policy instruments to share infection and economic risks internationally. However, in Nash equilibrium, uncoordinated trade policies robustly feature inefficiently high tariffs that peak with the pandemic in the foreign economy. This distorts terms of trade dynamics and magnifies the welfare costs of tariff wars during a pandemic due to lower levels of consumption and production as well as smaller gains via diversification of infection curves across economies.
    Keywords: International Trade, Tariffs, SIR model, COVID-19, Health policies, Terms of trade
    Date: 2020–12
  21. By: John F. Helliwell; David Gyarmati; Craig Joyce; Heather Orpana
    Abstract: Starting from the assumption that improving well-being is the central consideration for public policies, we show how subjective well-being research can help, and already is helping, to choose public policies based on their consequences for all aspects of life. The core of the paper lies in examples where the methods we propose, often in systematic experimental contexts, have already been used to guide the evaluation and ranking of alternative policy options in public health, education, workplace training, and social welfare. The arrival of COVID-19 has increased the urgency for a well-being focus, since the policy decisions being faced by governments dealing with the pandemic require an approach much broader than provided by more typical policy evaluations in all disciplines, including especially the social context and the distribution of costs and consequences. A broader approach to policy design and choice is fully consistent with the underlying aims of epidemiology, with similar gains likely in other policy disciplines. A focus on subjective well-being as an umbrella measure of welfare might help to restore to economics the breadth of purpose and methods it had two centuries ago, when happiness was considered the appropriate goal for private actions and public policies.
    JEL: H12 H51 I14 I18 I31
    Date: 2020–11
  22. By: Christelle Baunez (INT - Institut de Neurosciences de la Timone - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique); Mickael Degoulet (INT - Institut de Neurosciences de la Timone - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique); Stéphane Luchini (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Patrick Pintus (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Miriam Teschl (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)
    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
    Date: 2020–11–12
  23. By: Andrew Perrault; Marie Charpignon; Jonathan Gruber; Milind Tambe; Maimuna Majumder
    Abstract: Contact tracing for COVID-19 is especially challenging because transmission often occurs in the absence of symptoms and because a purported 20% of cases cause 80% of infections, resulting in a small risk of infection for some contacts and a high risk for others. Here, we introduce risk-based quarantine, a system for contact tracing where each cluster (a group of individuals with a common source of exposure) is observed for symptoms when tracing begins, and clusters that do not display them are released from quarantine. We show that, under our assumptions, risk-based quarantine reduces the amount of quarantine time served by more than 30%, while achieving a reduction in transmission similar to standard contact tracing policies where all contacts are quarantined for two weeks. We compare our proposed risk-based quarantine approach against test-driven release policies, which fail to achieve a comparable level of transmission reduction due to the inability of tests to detect exposed people who are not yet infectious but will eventually become so. Additionally, test-based release policies are expensive, limiting their effectiveness in low-resource environments, whereas the costs imposed by risk-based quarantine are primarily in terms of labor and organization.
    JEL: I18
    Date: 2020–11
  24. By: Abu Siddique (Economics Group, Technical University of Munich); Tabassum Rahman (School of Medicine and Public Health, University of Newcastle); Debayan Pakrashi (Department of Economic Sciences, Indian Institute of Technology Kanpur); Asad Islam (Centre for Development Economics and Sustainability (CDES) and Department of Economics, Monash University); Firoz Ahmed (Economics Discipline, Khulna University)
    Abstract: Effective health information campaigns play an important role in raising public awareness and encouraging preventive and health-promoting behavior. We study the extent to which awareness campaigns promoting simple COVID-19 precautionary measures foster health-preserving behavior among people in rural communities. Two weeks after the lockdowns in March 2020, we conducted a randomized controlled trial in Bangladesh and India targeting people living in remote rural areas to disseminate validated COVID-19 information over the phone. We find that relative to the information provided via text messages, discussing various precautions over the phone can significantly improve rural people's awareness and induce compliance with COVID-19 public health guidelines. We also find compliance to be substantially higher among women, which is partially due to their concerns about the health of household members, and increased awareness. The compliance also persists after three months of the campaign. These findings help shed light on the importance of health communication methods during public health crises for remote rural communities in developing countries, where rumors and myths about diseases are often ubiquitous, and disseminating validated health information remains a challenge.
    Keywords: COVID-19, health communications, awareness campaign, compliance, RCT
    Date: 2020–12
  25. By: Mitze, Timo; Kosfeld, Reinhold; Rode, Johannes; Wälde, Klaus
    Abstract: Mitigating the spread of COVID-19 is the objective of most governments. It is of utmost importance to understand how effective various public health measures are. We study the effectiveness of face masks. We employ public regional data about reported severe acute respiratory syndrome coronavirus 2 infections for Germany. As face masks became mandatory at different points in time across German regions, we can compare the rise in infections in regions with masks and regions without masks. Weighing various estimates, we conclude that 20 d after becoming mandatory face masks have reduced the number of new infections by around 45%. As economic costs are close to zero compared to other public health measures, masks seem to be a cost-effective means to combat COVID-19.We use the synthetic control method to analyze the effect of face masks on the spread of COVID-19 in Germany. Our identification approach exploits regional variation in the point in time when wearing of face masks became mandatory in public transport and shops. Depending on the region we consider, we find that face masks reduced the number of newly registered severe acute respiratory syndrome coronavirus 2 infections between 15% and 75% over a period of 20 days after their mandatory introduction. Assessing the credibility of the various estimates, we conclude that face masks reduce the daily growth rate of reported infections by around 47%.Public health data have been deposited in FigShare ( All study data are included in the paper and SI Appendix.
    Date: 2020
  26. By: S. Nazrul Islam; Hoi Wai Jackie Cheng; Kristinn Sv. Helgason; Hiroshi Kawamura; Marcelo LaFleur
    Abstract: This paper examines the experience of a set of countries that performed relatively well in coping with the COVID-19 crisis. The goal is to garner insights and lessons that can help countries that may experience initial or second-round outbreaks of the pandemic in the future. The paper finds healthcare, social protection, and overall governance systems as the three main determinants of COVID-19 strategies and their success. Though unique country-specific factors played an important role in confronting the pandemic in some countries, their role was generally mediated through one or the other of the above three main determinants. The findings of the paper suggest that establishing universal healthcare and social protection systems and improvement of governance need to be taken up as an immediate task – and not as a distant goal – even by developing countries. In view of the possibility of recurrence of epidemics in the future, this task has become important.
    Keywords: COVID-19; Social protection; Healthcare system; Containment measures; Trace-Test-Quarantine; Sustainable development
    JEL: H12 H51 H53 H55 I18 J65 P50
    Date: 2020–11
  27. By: Magnus, George
    Abstract: The Chinese government’s draconian actions to control the coronavirus seem to be producing a remarkable economic contraction. As so many are unable to attend or resume work at the moment, the government’s palliative economic measures may gain little traction. Although the demand shock will eventually fade, other longer-term issues will surely endure. The supply shock will be less obvious but more corrosive. The government’s questionable conduct in managing the public health crisis has unveiled significant features about governance in Xi’s China that can be mapped on to China’s development. While this crisis is the biggest challenge Xi has faced, there is little doubt that he will survive it, champion the party’s role in the nation’s rescue, and feel emboldened to continue with his authoritarian governance. Yet it is this that, in the long run, will prove incompatible with China’s economic development ambitions.
    Keywords: coronavirus; Covid-19
    JEL: N0
    Date: 2020–02

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