nep-hea New Economics Papers
on Health Economics
Issue of 2021‒01‒11
48 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Minimum Legal Drinking Age and the Social Gradient in Binge Drinking By Alexander Ahammer; Stefan Bauernschuster; Martin Halla; Hannah Lachenmaier
  2. Mental Health Effects of Same-Sex Marriage Legalization By Shuai Chen; Jan van Ours
  3. Why is End-of-Life Spending So High? Evidence from Cancer Patients By Dan Zeltzer; Liran Einav; Amy Finkelstein; Tzvi Shir; Salomon M. Stemmer; Ran D. Balicer
  4. Performance Pay in Insurance Markets: Evidence from Medicare By Michele Fioretti; Hongming Wang
  5. Do State Tobacco 21 Laws Work? By Calvin Bryan; Benjamin Hansen; Drew McNichols; Joseph J. Sabia
  6. The Effect of Education on Smoking Decisions in the United States By Sang T. Truong
  7. Terrorism, Mental Health, Risky Behaviors and Human Capital: Evidence from Iraq By Ahmed Elsayed
  8. Urban Mortality and the Repeal of Federal Prohibition By David S. Jacks; Krishna Pendakur; Hitoshi Shigeoka
  9. The Effect of Unemployment Benefits on Health and Living Standards in Turkey: Evidence from Structural Equation Modelling and Regression Discontinuity Design By Eleftherios Giovanis; Oznur Ozdamar; Burcu Özdas
  10. The Effects of a Large-Scale Mental-Health Reform: Evidence from Brazil By Dias, Mateus; Fontes, Luiz Felipe
  11. Corruption and Mental Health: Evidence from Vietnam By Sharma, Smriti; Singhal, Saurabh; Tarp, Finn
  12. Did the introduction of the benefit cap in Britain harm mental health? A natural experiment approach By Mark Fransham; Ruth Patrick; Aaron Reeves; Kitty Stewart
  13. Gender Identity, Race, and Ethnicity Discrimination in Access to Mental Health Care: Preliminary Evidence from a Multi-Wave Audit Field Experiment By Patrick Button; Eva Dils; Benjamin Harrell; Luca Fumarco; David Schwegman
  14. Contagion at Work By Anna Houstecka; Dongya Koh; Raül Santaeulàlia-Llopis
  15. Long-term unemployment subsidies and middle-age disadvantaged workers’ health By José Ignacio Garcia-Pérez; Manuel Serrano-Alarcón; Judit Vall Castelló
  16. Healthy Climate, Healthy Bodies: Optimal Fuel Taxation and Physical Activity By Inge van den Bijgaart; David Klenert; Linus Mattauch; Simona Sulikova
  17. Long-term effects of Agent Orange on health capital in Vietnam By Nobuaki Yamashita; Trong-Anh Trinh
  18. The Causal Effect of Education on Cancer Risk and Survival in England and Wales By Potente, Cecilia
  19. How Spillovers from Appointment Reminders Improve Health Clinic Efficiency By Claire E. Boone; Pablo A. Celhay; Paul Gertler; Tadeja Gracner; Josefina Rodriguez
  20. Finding Optimal Cancer Treatment using Markov Decision Process to Improve Overall Health and Quality of Life By Navonil Deb; Abhinandan Dalal; Gopal Krishna Basak
  21. How do migrations affect under-five mortality in rural areas? Evidence from Niakhar, Senegal By Ulrich Nguemdjo; Bruno Ventelou
  22. The Impact of the Large-Scale Migration on the Unmet Healthcare Needs of the Nativeborn Population in A Host Country: Evidence from Turkey By Hüseyin Ikizler; Emre Yüksel; Hüsniye Burçin Ikizler
  23. Progressivity of Out-of-Pocket Payments and its Determinants Decomposed Over Time By Steven F. Koch; Naomi Setshegetso
  24. Information Integration, Coordination Failures, and Quality of Prescribing By Böckerman, Petri; Laine, Liisa T.; Nurminen, Mikko; Saxell, Tanja
  25. Is Excess (Fe)Male Mortality Caused by the Prenatal Environment, Child Biology, or Parental Discrimination? New Evidence from Male-Female Twins By Roland Pongou
  26. Children of War: Conflict and Child Welfare in Iraq By Reham Rizk; Colette Salemi
  27. Tradition and mortality: Evidence from twin infanticide in Africa By Fenske, James; Wang, Shizhou
  28. Hospital inpatients costs dynamics at older ages: A frequency-severity approach By Avalosse, Hervé; Denuit, Michel; Lucas, Nathalie
  29. Pension Policies, Retirement and Human Capital Depreciation in Late Adulthood By Nikolov, Plamen; Adelman, Alan
  30. Patterns of Red and Processed Meat Consumption across Generations: A Shift from the Traditional Mediterranean Diet By Cinzia Di Novi; Anna Marenzi; Francesca Zantomio
  31. Addressing the dilemma of India’s state dependency on Alcohol: ‘New-Soft’ Paternalism approach By Jolad, Shivakumar; Ravi, Chaitanya
  32. Evolving from a rum state: Australia’s alcohol consumption By Kym Anderson
  33. We shouldn’t count chickens before they hatch: results-based financing and the challenges of cost-effectiveness analysis By Elisabeth Paul; Garrett Brown; Tim Ensor; Gorik Ooms; Remco van de Pas; Valéry Ridde
  34. Tax Policy Measures to Combat the SARS-CoV-2 Pandemic and Considerations to Improve Tax Compliance: A Behavioral Perspective By James Alm; Kay Blaufus; Martin Fochmann; Erich Kirchler; Peter N. C. Mohr; Nina E. Olson; Benno Torgler
  35. Heterogeneity in the Support for Mandatory Masks Unveiled By Muhammad Maaz; Anastasios Papanastasiou; Bradley J. Ruffle; Angela L. Zhang
  36. Did COVID-19 Change Life Insurance Offerings? By Timothy F. Harris; Aaron Yelowitz; Charles J. Courtemanche
  37. Epidemics, inequality and poverty in preindustrial and early industrial times By Alfani, Guido
  38. Interventions with Positive Side-Effects: COVID-19 Non-Pharmaceutical Interventions and Infectious Diseases in Europe By Kaiser, Micha; Otterbach, Steffen; Sousa-Poza, Alfonso; Bloom, David E.
  39. An actuarial approach for modeling pandemic risk By Hainaut, Donatien
  40. The Great Influenza Pandemic of 1918–20: An interpretative survey in the time of COVID-19 By Prema-chandra Athukorala; Chaturica Athukorala
  41. Does Contact Tracing Work? Quasi-Experimental Evidence from an Excel Error in England By Fetzer, Thiemo; Graeber, Thomas
  42. Divided We Fall: International Health and Trade Coordination During a Pandemic By Viral V. Acharya; Zhengyang Jiang; Robert J. Richmond; Ernst-Ludwig von Thadden
  43. The Grandkids Aren't Alright: The Intergenerational Effects of Prenatal Pollution Exposure By Jonathan Colmer; John Voorheis
  44. The Impact of Organizational Boundaries on Healthcare Coordination and Utilization By Leila Agha; Keith Marzilli Ericson; Xiaoxi Zhao
  45. When to release the lockdown: A wellbeing framework for analysing costs and benefits By Andrew Clark; Jan-Emmanuel De Neve; Daisy Fancourt; Nancy Hey; Christian Krekel; Richard Layard; Gus O'Donnell
  46. An Economic Model of Health-vs-Wealth Prioritization During COVID-19: Optimal Lockdown, Network Centrality, and Segregation By Roland Pongou; Guy Tchuente; Jean-Baptiste Tondji
  47. Work, care and gender during the COVID-19 crisis By Hupkau, Claudia; Petrongolo, Barbara
  48. Once the great lockdown is lifted: Post COVID-19 options for the economy By Ritzen, Jozef M.

  1. By: Alexander Ahammer; Stefan Bauernschuster; Martin Halla; Hannah Lachenmaier
    Abstract: Low minimum legal drinking ages (MLDAs), as prevalent in many European countries, are severely understudied. We use rich survey and administrative data to estimate the impact of the Austrian MLDA of 16 on teenage drinking behavior and morbidity. Regression discontinuity estimates show that legal access to alcohol increases the frequency and intensity of drinking, which results in more hospital admissions due to alcohol intoxication. The effects are stronger for boys and teenagers with low socioeconomic background. The policy’s impact is not driven by access. Data from an annual large-scale field study shows that about 25 percent of all retailers sell even hard liquor to underage customers. In line with this, perceived access to alcohol is very high and hardly changes at the MLDA. However, teenagers consider binge drinking at weekends to be less harmful after gaining legal access.
    Keywords: Alcohol, minimum legal drinking age, morbidity.
    JEL: I12 I18 H75 J13
    Date: 2020–12
  2. By: Shuai Chen (Luxembourg Institute of Socio-Economic Research); Jan van Ours (Erasmus University Rotterdam)
    Abstract: Sexual minorities have had worse than average mental health, which may have to do with actual or perceived discrimination. Same-sex marriage legalization (SSML) is a typical anti-discrimination policy removing marital restrictions for sexual minorities. We study how this legislation affected mental health of sexual minorities in the Netherlands. Conducting a difference-in-differences analysis, we compare changes in mental health following the legalization between sexual minorities and heterosexuals. We find that SSML improved mental health of both married and non-married sexual minorities, which implies that marriage is not the only channel. Examinations of alternative mechanisms combined with literature suggest that the legislation may also take effect by improving societal tolerance as well as stabilizing partnerships and enriching the choice basket of partnership forms for sexual minorities.
    Keywords: Same-sex marriage, Mental health, Sexual minorities
    JEL: I12 I18 J12 J15 K36
    Date: 2021–01–04
  3. By: Dan Zeltzer; Liran Einav; Amy Finkelstein; Tzvi Shir; Salomon M. Stemmer; Ran D. Balicer
    Abstract: The concentration of healthcare spending at the end of life is widely documented but poorly understood. To gain insight, we focus on patients newly diagnosed with cancer. They display the familiar pattern: even among cancer patients with similar initial prognoses, monthly spending in the year post diagnosis is over twice as high for those who die within the year than those who survive. This elevated spending on decedents is almost entirely driven by higher inpatient spending, particularly low-intensity admissions, which rise as the prognosis deteriorates. However, even for patients with very poor prognoses at the time of admission, most low-intensity admissions do not result in death, making it difficult to target spending reductions. We also find that among patients with the same cancer type and initial prognosis, end-of-life spending is substantially more elevated for younger patients compared to older patients, suggesting that treatment decisions are not exclusively present-focused. Taken together, these results provide a richer understanding of the sources of high end-of-life spending, without revealing any natural “remedies.”
    JEL: I10 J17
    Date: 2020–12
  4. By: Michele Fioretti (Department of Economics, Sciences Po); Hongming Wang (Center for Global Economic Systems, Hitotsubashi University)
    Abstract: Public procurement bodies increasingly resort to pay-for-performance contracts to promote efficient spending. We show that firm responses to pay-for-performance can widen the inequality in accessing social services. Focusing on the U.S. Medicare Advantage market, we find that insurers with higher quality ratings responded to bonus payments by selecting healthier enrollees with premium differences across counties. Selection is profitable because the quality rating fails to adjust for differences in the health of enrollees. Selection inflated the bonus payments and shifted the supply of high-rated insurance to the healthiest counties, hurting the healthcare access of sicker patients in the riskiest counties.
    Keywords: pay-for-performance, Medicare Advantage, risk selection, quality ratings, health insurance access
    JEL: I
    Date: 2020
  5. By: Calvin Bryan; Benjamin Hansen; Drew McNichols; Joseph J. Sabia
    Abstract: Tobacco 21 (T-21) laws prohibit the sale of tobacco products to individuals under age 21. This study is the first to comprehensively examine the impacts of statewide T-21 laws on youth tobacco consumption, including spillovers to minor teens. Using data from the 2009-2019 Behavioral Risk Factor Surveillance Survey (BRFSS) and a difference-in-differences approach, we find that the enactment of a statewide T-21 law was associated with a 2.5 to 4.0 percentage-point decline in smoking participation among 18-to-20-year-olds. A causal interpretation of our estimates is supported by event-study analyses and falsification tests for young adults ages 21 and older. Next, using data from the 2009-2019 State Youth Risky Behavior Surveys (YRBS), we find that statewide T-21 laws reduced tobacco cigarette and electronic cigarette (e-cigarette) consumption among 18-year-old high school students. We also find that the public health benefits of T-21 laws extend to 16-to-17-year-olds, a group that relies heavily on the “social market” — including 18-year-old peers — to access tobacco. We conclude increasing the minimum legal purchasing age for tobacco to 21 appears to be a more effective current policy strategy to deter youth smoking than raising cigarette taxes.
    JEL: I12 I18 K42
    Date: 2020–12
  6. By: Sang T. Truong
    Abstract: This paper explores the link between education and the decision to start smoking as well as the decision to quit smoking. Data is gathered from IPUMS CPS and Centers for Disease Control and Prevention. Probit analysis (with the use of probability weight and robust standard error) indicates that every additional year of education will reduce the 2.3 percentage point of the smoking probability and will add 3.53 percentage point in quitting likelihood, holding home restriction, public restriction, cigarette price, family income, age, gender, race, and ethnicity constant. I believe that tobacco epidemic is a serious global issue that may be mitigated by using careful regulations on smoking restriction and education.
    Date: 2020–11
  7. By: Ahmed Elsayed (IZA, Maastricht University)
    Abstract: This paper investigates the causal impact of terrorism on mental health, risky behaviors and human capital accumulation. Using a unique identification strategy by merging geocoded data on terrorism from the Global Terrorism Database (GTD) with unique data on young Iraqi individuals born between 1979-1999, the paper shows that individuals exposed to terror attacks in childhood are affected negatively in terms of mental health, and are more likely to engage in risky behavior (e.g., smoking and alcohol consumption). They are also less likely to finish compulsory and secondary education, compared to those who experienced terror at later stages of life. Heterogeneity analyses show that the negative impact on education attainment is more pronounced among boys and children of higher socio-economic background
    Date: 2020–12–20
  8. By: David S. Jacks; Krishna Pendakur; Hitoshi Shigeoka
    Abstract: Federal prohibition from 1920 to 1933 was one of the most ambitious policy interventions in US history. However, due to the political concessions necessary to bring about repeal, the removal of restrictions on alcohol after 1933 was not uniform. Using new data on city-level variation in alcohol prohibition from 1933 to 1936, we investigate whether the repeal of federal prohibition affected multiple causes of urban (non-infant) mortality. We find that city-level repeal is associated with a 14.7% decrease in homicide rates and a 10.1% decrease in mortality rates associated with other accidents (including accidental poisonings). Thus, the repeal of federal prohibition could have led to an annual reduction of as many as 3,400 urban deaths. Combined with previous results showing large increases in infant mortality, this suggests that nonetheless repeal most likely had negative effects on all-cause mortality and, thereby, public health in the US.
    JEL: H73 I18 J1 N3
    Date: 2020–12
  9. By: Eleftherios Giovanis (Manchester Metropolitan University); Oznur Ozdamar (Izmir University Bakircay); Burcu Özdas (Adnan Menderes University)
    Abstract: Unemployment can negatively affect individuals, their families and communities in various ways. When individuals are out of work may experience mental and physical health problems, material deprivation and poverty. This study aims to examine the impact of unemployment benefits on health and living standards in Turkey. We employ a structural equation modelling (SEM) to take into account the simultaneous relations among the latent variables of health and Standard of Living (SoL). Additionally, we propose a fuzzy Regression Discontinuity Design (FRDD) within the SEM framework to infer for causality. For the empirical analysis we use the panel Income and Living Conditions Survey (ILCS) over the period 2007-2015. Our findings suggest that those who receive these benefits are more likely to report higher levels of health and improve their living standards compared to the non-recipients. Our results indicate a large heterogeneity on the impact of unemployment benefits, as males, low educated individuals and those belonging in the lower levels of income are affected more in terms of their health status and living standards. The majority of earlier studies have focused on the impact of unemployment benefits on labour outcomes. The originality of this study is that we implement the FRDD within the SEM framework to explore simultaneously the impact of unemployment insurance on heath and living standards. Moreover, this framework can be applied in future research studies to infer causality and explore the impact of policies and reforms.
    Date: 2020–12–20
  10. By: Dias, Mateus; Fontes, Luiz Felipe
    Abstract: This paper studies the Brazilian psychiatric reform, which reorganized mental healthcare provision by the public system building a network of community-based services centered on the Psychosocial Care Centers (CAPSs). Our research design exploits the roll-out of CAPSs in a differences-in-differences framework. We show that these centers improved outpatient mental healthcare utilization and reduced hospital admissions due to mental and behavioral disorders. Those reductions were more pronounced for long-stay admissions and among patients with schizophrenia. Additionally, centers delivering substance abuse treatment reduced deaths caused by alcoholic liver disease. Finally, we also find that this shift away from inpatient care increased homicides.
    Keywords: Mental Health, Community care, Psychiatric Reform, CAPS
    JEL: I10 I12 I18
    Date: 2020–11
  11. By: Sharma, Smriti (Newcastle University); Singhal, Saurabh (Lancaster University); Tarp, Finn (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: 2020–12
  12. By: Mark Fransham; Ruth Patrick; Aaron Reeves; Kitty Stewart
    Abstract: In November 2016, the UK government announced they would be lowering the benefit cap, the total amount a family with no-one in full-time employment can receive from the government in social security. This policy change reduced financial support for large (often lone parent) families and those with high housing costs, and broke the link between needs and entitlements in the British social security system. This policy was intended to incentivise people to return to work but it may have also harmed mental health, especially because those affected by the reform may struggle to find appropriate work or move to cheaper housing. We treat this reform as a natural policy experiment, comparing those at-risk of being capped and those who were not, and then examining the risk of experiencing poor mental health both before and after the cap was lowered. The main outcome is a binary measure of self-reported mental health problems. Drawing on data from 1.4 million individuals collected between January 2015 and December 2018, we find that the prevalence of depression or anxiety among those at-risk of being capped increased by 2.6 percentage points (95% confidence interval: 1.33 to 3.88) compared with those at a low risk of being capped. This association is consistent to a variety of sensitivity tests. We conclude that lowering the total amount of financial assistance families can receive in social security may increase the risk of mental ill health and could have the unintended consequence of pushing out-of-work people even further away from the labour market.
    Keywords: benefit cap, welfare reform, mental health
    JEL: I14
    Date: 2020–11
  13. By: Patrick Button; Eva Dils; Benjamin Harrell; Luca Fumarco; David Schwegman
    Abstract: A broad body of interdisciplinary research establishes that transgender and non-binary individuals face discrimination across many contexts, including healthcare. Simultaneously, transgender individuals face various mental health disparities, including higher rates of depression and anxiety, suicidality, and PTSD. Therefore, understanding the role of discrimination in access to mental health care is essential. However, no previous research quantifies the extent to which transgender and non-binary people face discrimination in mental healthcare markets. We provide the first experimental evidence, using an audit study, of the extent to which cisgender women, transgender women, transgender men, non-binary people, and racial and ethnic minorities (African American and Hispanic individuals) face discrimination in access to mental health services. While data collection is ongoing, we find significant discrimination against transgender or non-binary African Americans and Hispanics in access to mental health care appointments.
    JEL: C93 I11 I14 I18 J15 J16
    Date: 2020–12
  14. By: Anna Houstecka; Dongya Koh; Raül Santaeulàlia-Llopis
    Abstract: Using nationally representative micro panel data on flu incidence from the Medical Expenditure Panel Survey in the United States, we show that employed individuals are on average 35.3% more likely to be infected with the virus. Wage earners are more likely to be infected than the unemployed by 30.1% and than individuals out of the labor force by 40.8%. Our results are robust to individual characteristics including vaccinations, health insurance and unobserved heterogeneity. Within the employed, we find an occupation-flu gradient—e.g. sales occupations show 34.1% higher probability of infection than occupations related to farming, fishing and forestry. As a potential mechanism behind this gradient, we study occupation-specific exposure to human contact interaction at work—a score that we construct based on O’NET occupational characteristics—which, as we show, determines flu incidence. All these effects increase with the aggregate flu incidence and are robust to firm size and across industries.
    Keywords: Contagion, flu, employment, unemployment, Occupations, industry, gradient, exposure, human contact, vaccines, lockdown, policy, macroeconomics
    JEL: J01
    Date: 2020–12
  15. By: José Ignacio Garcia-Pérez (Department of Economics, Universidad Pablo de Olavide & FEDEA;); Manuel Serrano-Alarcón (NOVA National School of Public Health, NOVA University of Lisbon Center for Research in Economics and Health, Universitat Pompeu Fabra;); Judit Vall Castelló (Department of Economics, Universitat de Barcelona & Institut D’economia De Barcelona (IEB), Center for Research in Economics and Health, Universitat Pompeu Fabra;)
    Abstract: We estimate the labour market and health effects of a long-term unemployment (LTU) subsidy targeted to middle aged disadvantaged workers. In order to do so, we exploit a Spanish reform introduced in July 2012 that increased the age eligibility threshold to receive the subsidy from 52 to 55. Using a within-cohort identification strategy, we show that men ineligible for the subsidy were more likely to leave the labour force. In terms of health outcomes, although we do not report impacts on hospitalizations when considering the whole sample, we do find significant results when we separate the analysis by main diagnosis and gender. More specifically, we show a reduction by 12.9% in hospitalizations due to injuries as well as a drop by 2 percentage points in the probability of a mental health diagnosis for men who were eligible for the LTU subsidy. Our results highlight the role of long-term unemployment benefits as a protecting device for the health (both physical and mental) of middle aged, low educated men who are in a disadvantaged position in the labour market.
    Keywords: disadvantaged workers, unemployment subsidies, health effects
    JEL: H52 I23 I28 J24
    Date: 2020
  16. By: Inge van den Bijgaart; David Klenert; Linus Mattauch; Simona Sulikova
    Abstract: Transport has significant externalities including carbon emissions and air pollution. Public health research has identified additional social gains from active travel, due to health benefits of physical exercise. Per mile, these benefits greatly exceed the external costs from car use. We introduce active travel into an optimal fuel taxation model and analytically characterise the optimal second-best fuel tax. We find that accounting for active travel benefits increases the optimal fuel tax by 49% in the US and 36% in the UK. Fuel taxes should be implemented jointly with other policies aimed at increasing the uptake of active travel.
    Keywords: transport externalities, congestion, active travel, fuel, health behaviour, optimal taxation
    JEL: H23 I12 Q53 Q54 Q58 R41 R48 Z28
    Date: 2020
  17. By: Nobuaki Yamashita; Trong-Anh Trinh
    Abstract: This paper examines the long-term health effects of Agent Orange—the military herbicide containing the hazardous chemical compound dioxin—which was widely disseminated in South Vietnam during the Vietnam War (1959–1975). Based on data from the US military archives on the herbicide operations, we estimate the prevalence of disabilities among Vietnamese people using the 2009 Population Census. The results demonstrate that the legacy of Agent Orange continues, with ongoing adverse (although small) effects on health even over 30 years since the end of the war. Critically, the health burden of severe mobility disability has been mostly born by women of ethnic minorities in the affected areas.
    Keywords: Vietnam War, Agent Orange, health effects of war, public health
    JEL: I14 I15 J15
    Date: 2020
  18. By: Potente, Cecilia
    Abstract: A growing number of people are diagnosed with cancer over time. A better understanding of educational inequalities in cancer is becoming increasingly important. However, only a few studies have focused the attention on the causal effect of education on cancer risk and mortality. This quasi-experimental design exploits the exogenous variation in compulsory schooling due to policy changes in 1947 and 1972 in England and Wales using data from the ONS Longitudinal Study (ONS LS). These educational reforms affected a large proportion of the population. The identification of the causal effect of education on cancer risk and survival is achieved using the regression discontinuity framework with categorical outcomes. Therefore, this work aims at studying the effect of education on the probability of developing, surviving and dying from cancer. Results show that the 1947 and 1972 educational reforms do not seem to be causally related to cancer incidence and mortality. This study suggests the absence of a causal role of one additional year of compulsory schooling on cancer outcomes. Among the reasons for the absence of causal evidence there are the heterogeneity by cancer site as well as the local effect of the compulsory school reforms.
    Date: 2021–01–07
  19. By: Claire E. Boone; Pablo A. Celhay; Paul Gertler; Tadeja Gracner; Josefina Rodriguez
    Abstract: Missed clinic appointments present a significant burden to health care through disruption of care, inefficient use of staff time and wasted clinical resources. Short message service (SMS) appointment reminders show promise to improve clinics’ management through timely appointment cancellations and efficient re-scheduling, but evidence from large-scale interventions is missing. We study a nationwide SMS appointment reminder program in Chile for chronic disease patients at public primary care clinics. Using longitudinal clinic-level data we find that after two years the program increased clinics’ total number of visits per by 5.1% on average. The program did not change the number of visits by chronic patients eligible to receive the reminder, but it instead increased visits by other patients, ineligible to receive reminders in clinics that adopted the program by 7.4% on average. These results suggest that the appointment reminder systems increased clinics’ ability to care for more patients through timely cancellations and re-scheduling.
    JEL: I1 I11 I12
    Date: 2020–12
  20. By: Navonil Deb; Abhinandan Dalal; Gopal Krishna Basak
    Abstract: Markov Decision Processes and Dynamic Treatment Regimes have grown increasingly popular in the treatment of diseases, including cancer. However, cancer treatment often impacts quality of life drastically, and people often fail to take treatments that are sustainable, affordable and can be adhered to. In this paper, we emphasize the usage of ambient factors like profession, radioactive exposure, food habits on the treatment choice, keeping in mind that the aim is not just to relieve the patient of his disease, but rather to maximize his overall physical, social and mental well being. We delineate a general framework which can directly incorporate a net benefit function from a physician as well as patient's utility, and can incorporate the varying probabilities of exposure and survival of patients of varying medical profiles. We also show by simulations that the optimal choice of actions often is sensitive to extraneous factors, like the financial status of a person (as a proxy for the affordability of treatment), and that these actions should be welcome keeping in mind the overall quality of life.
    Date: 2020–11
  21. By: Ulrich Nguemdjo (Aix-Marseille Univ, CNRS, AMSE and Aix-Marseille Univ, LPED, Marseille, France.); Bruno Ventelou (Aix-Marseille Univ, CNRS, AMSE, Marseille, France.)
    Abstract: This study analyses the relationship between a household member’s migration and child mortality within the family left behind in rural areas. Exploring the richness of the Niakhar Health and Demographic Surveillance System panel, we use high-frequency migration data to investigate the effects of migration on child mortality at the household level over 16 years. Migrations, particularly short-term migrations, are positively associated with the survival probability of under-five children in the household. Also, we find that working age women's short-term migrations impact child mortality more than working age men's short-term migrations. This observation supports hypotheses in the economic literature on the predominant role of women in rural households in obtaining welfare improvements. Moreover, we detect crossover effects between households of the same compound –in line with the idea that African rural families share part of their migration-generated gains with an extended community of neighbors. Lastly, we investigate the effect of a mother's short-term migration on the survival of her under-5 children. The aggregate effect of a mother’s migration on child survival is still positive, but much weaker. Specifically, mother migration during pregnancy seems to enhance the wellbeing of the child, considered immediately after birth. However, when the child is older (more than one year), the absence of the mother tends to decrease the probability of survival.
    Keywords: Niakhar, Senegal, short- and long-term migrations, child mortality
    JEL: I15
    Date: 2020–12
  22. By: Hüseyin Ikizler (Presidency of Strategy and Budget); Emre Yüksel (Presidency of Strategy and Budget); Hüsniye Burçin Ikizler (Ministry of Health)
    Abstract: As of December 2018, Turkey is home to 3.6 million Syrian refugees under temporary protection status. The negative externalities of Syrian refugees may affect the native-born population's needs, precisely healthcare needs. The possible increase in healthcare demand due to population increase may escalate unmet healthcare needs (UHCN). The study contributes to the literature by analyzing refugees' effect on the native-born population's unmet healthcare needs. Our central hypothesis is that mass refugee influx increases the ratio of the UHCN arising mainly from systemic reasons, especially at the beginning of the migration crisis. Using a difference-in-differences approach, we find that the UHCN of the native-born population has increased due to the mass refugee influx. We estimate the magnitude of this increase by nearly 6.3% at the beginning of the refugee crisis. The impact diminishes as the imbalance of demand and supply of healthcare services diminishes.
    Date: 2020–12–20
  23. By: Steven F. Koch (Department of Economics, University of Pretoria, Private Bag X20, Hatfield 0028, Republic of South Africa); Naomi Setshegetso (Department of Economics, University of Pretoria, Private Bag X20, Hatfield 0028, Republic of South Africa and Department of Economics, University of Botswana, Gaborone, South-East District, Republic of Botswana)
    Abstract: This study estimates progressivity of out-of-pocket (OOP) health payments and their determinants using South African Income and Expenditure Surveys. Concentration is decomposed to examine the effect of household determinants on OOP inequality, shedding light on how progressivity/regressivity is related to changes in the concentration and elasticities of the determinants over time. Our results suggest that actual OOP health expenditures are concentrated among non-poor households, although less so now than in the recent past. When OOP health payments are viewed from the perspective of affordability, which instead focuses on the share of payments relative to capacity-to-pay, they are regressive; However, they have become less concentrated amongst poor households, although still regressive, recently. These results appear to be independent of the measure of socioeconomic status employed in the analysis. The results highlight large income and education related disparities and also suggest continued gender and ethnic differences that deserve further attention in policymaking.
    Date: 2020–12
  24. By: Böckerman, Petri (Labour Institute for Economic Research); Laine, Liisa T. (University of Pennsylvania); Nurminen, Mikko (Turku School of Economics); Saxell, Tanja (VATT, Helsinki)
    Abstract: Poor information flows hamper coordination, potentially leading to suboptimal decisions in health care. We examine the effects of a nationwide policy of information integration on the quality of prescribing. We use the rollout of an electronic prescribing system in Finland and prescription-level administrative data. We find no effect on the probability of co-prescribing harmful drug combinations in urban regions. In rural regions, this probability reduces substantially, by 35 percent. The effect is driven by prescriptions from unspecialized physicians and from multiple physicians. Improving the local information environment thus enhances coordination and narrows differences in the quality of prescribing.
    Keywords: health information technology, digitalization, e-prescribing, integration, quality of prescribing, public policy
    JEL: H51 H75
    Date: 2020–12
  25. By: Roland Pongou (Department of Economics, University of Ottawa, Ottawa, ON)
    Abstract: Male-female differences in early age mortality continue to be an important source of child inequality in the world, and are a likely cause of gender disparities in human capital accumulation. Recent literature highlights the important role of the prenatal environment in inducing these differences, in addition to biological influences and gender discrimination in the allocation of resources. However, the distinct roles of these three sets of factors have not been quantified in a unified framework. We propose a new methodology for decomposing male-female differences in mortality into the distinct effects of the prenatal environment, child biology, and parental preferences. We implement this methodology by comparing the mortality sex gap among male-female twins versus all twins in India, a country where daughters are discriminated against, and sub-Saharan Africa, a region where sons and daughters have been found to be valued by their parents about equally. We uncover three main findings: (1) both the prenatal environment and biology increase the mortality risk of boys in these regions; (2) the relative importance of the prenatal environment increases with age, while the effect of biology decreases and even reverses in later childhood; and (3) parental discrimination against girls in India significantly raises their mortality; however, failure to control for the effect of the prenatal environment, biological influences, and the endogeneity of sex determination (due to parental factors and sex-selective abortion) leads traditional methodological approaches to underestimate the effect of discrimination on excess female mortality by 173 percent in the period from birth to 1 year, and by 23 percent between the ages of 1 and 5. Taken together, the findings provide novel quantitative evidence on the relative importance of nature versus nurture in the mortality gap between males and females, and show that the impact of discrimination against girls in certain societies has been underrated.
    Keywords: Male-female differences in mortality; nature versus nurture; prenatal environment; child biology; discrimination against girls; twins; decomposition methodology.
    Date: 2020
  26. By: Reham Rizk (Universities of Canada in Egypt); Colette Salemi (University of Minnesota)
    Abstract: What are the impacts of violent conflict on child health and nutrition? In this paper, we examine conflict events from 2013 to 2018 in Iraq. We match household microdata from the 2018 Multiple Indicator Cluster Survey with conflict event data derived from the Global Database of Events, Language, and Tone (GDLET) to estimate the number of conflicts a child age 0-4 in the MICS data was exposed to during her lifetime. To account for endogenous conflict event locations, we use a two-stage least squares estimation approach in which governorate distance to the Syrian border serves as our instrument. Our results suggest that a 1% increase in conflict frequency results in a significant reduction in height-for-age z-scores of -0.15. We repeat our estimates using alternative conflict data as a robustness check, and the sign and significance of the result holds, though these alternative estimates are smaller in magnitude. Our mechanism analysis suggests that more exposed children were statistically less likely to have been breastfed.
    Date: 2020–12–20
  27. By: Fenske, James (University of Warwick); Wang, Shizhou (University of Oxford)
    Abstract: Mortality of twins relative to singletons is no greater today among African ethnicities that once practiced twin infanticide. We introduce data on historic twin infanticide and merge it with birth records from 23 African countries. We use the full sample, a border sample of adjacent societies with and without past twin infanticide, and a sample of twins. All three samples provide no evidence that past twin infanticide predicts greater differential twin mortality today. Twin infanticide and negative attitudes towards twins were suppressed by Africans, missionaries, and colonial governments. Where these channels were weak, we find evidence of greater twin mortality today.
    Date: 2020
  28. By: Avalosse, Hervé; Denuit, Michel (Université catholique de Louvain, LIDAM/ISBA, Belgium); Lucas, Nathalie (Université catholique de Louvain, LIDAM/ISBA, Belgium)
    Abstract: This paper studies the dynamics in end-of-life inpatients hospital expenses. A new model is proposed for hospital care expenditures based on a frequency-severity decomposition including age, calendar time, longevity dynamics, and time-to-death. These features are treated as continuous explanatory variables in nonlinear regression models with Poisson, Gamma and Tweedie error structures. Proximity to death is controlled for, as well as longevity improvements by including projected life tables into the proposed model. This allows the analyst to isolate the different effects impacting late-life hospital costs. A detailed case study performed on Belgian data illustrates the modeling strategy proposed in this paper. A comparison with the alternative model targeting total costs, not distinguishing between frequency and severity components, demonstrates the superior explanatory power of the proposed approach, revealing that total costs are mainly driven by their frequency component for the data under consideration.
    Keywords: health insurance ; projected life tables ; time-to-death model ; Generalized Additive Model (GAM)
    Date: 2020–01–01
  29. By: Nikolov, Plamen (State University of New York); Adelman, Alan (State University of New York)
    Abstract: Economists have mainly focused on human capital accumulation and considerably less on the causes and consequences of human capital depreciation in late adulthood. Studying human capital depreciation over the life cycle has powerful economic consequences for decision-making in old age. Using data from China, we examine how a new retirement program affects cognitive performance. We find large negative effects of pension benefits on cognitive functioning among the elderly. We detect the most substantial impact of the program on delayed recall, a significant predictor of the onset of dementia. We show suggestive evidence that the program leads to larger negative impacts among women. We demonstrate that retirement and access to a retirement pension plan plays a significant role in explaining cognitive decline at older ages.
    Keywords: life cycle, cognitive functioning, cognition, aging, health, mental retirement, middle-income countries, LMICs, developing countries, China
    JEL: O12 J24 J26 H55 H75 O15
    Date: 2020–12
  30. By: Cinzia Di Novi (Department of Economics, University Of Pavia); Anna Marenzi (Department of Economics, University Of Venice Cà Foscari); Francesca Zantomio (Department of Economics, University Of Venice Cà Foscari)
    Abstract: Social changes, widespread dissemination of Western-type culture, and the globalization of food production and consumption have reduced adherence to the traditional Mediterranean diet (MD) in the Southern European countries where the MD originated. This study explores whether changes in the technology, culture and social welfare that have characterized Italy for decades may have influenced red and processed meat consumption across generations. Such consumption has been associated with a higher risk for cardiovascular disease and colorectal cancer and with negative environmental impacts. To obtain a broad picture of red and processed meat consumption and adherence to the MD across generations, we constructed a Mediterranean composite score that summarizes the frequency of these foods’ consumption. For the purpose of our study, we constructed a pseudo-panel derived from repeated cross-sections of the annual household survey, “Aspects of Daily Life,” that was part of the Multipurpose Survey carried out by the Italian National Statistical Office (ISTAT) from 1997 to 2012. We adopted an APC (Age, Period, Cohort) approach that involves age, period, and cohort effects. Our findings reveal that the oldest generations undertook a major shift from the traditional MD.
    Keywords: red meat, processed meat, health, environmental impact, generations, Mediterranean Diet
    JEL: I12 I15 Q18 Q56 Q57
    Date: 2021
  31. By: Jolad, Shivakumar; Ravi, Chaitanya
    Abstract: Indian states have alcohol policies ranging from strict prohibition to high taxation and overregulation. A pernicious effect of prohibition, in particular, has been the clogging of judiciary, disproportionate impacts on the poor and marginalized and diversion of already limited state capacities. In this article, we examine the role of state policy in India in addressing alcoholism’s deleterious impacts such as economic hardships, domestic violence and high disease burden. We have traced the current policy ambivalence to India’s history with attitudes ranging from permissiveness, colonial-era commodification to prohibition. We argue that India’s current alcohol policy can be understood as a combination of ‘old’ paternalism built on moral-religious ideas and ‘hard’ paternalism where the state interference overrides conscious choice of individual agent. We propose a ‘new-soft,’ post colonial framework which strikes a balance between individual choice, public health, gender parity and state revenues while eschewing disproportionate prosecution and punishment.
    Date: 2021–01–08
  32. By: Kym Anderson
    Abstract: Europeans settlers in the Australian colonies had a reputation of being heavy drinkers. Rum dominated during the first few decades, followed by beer. It took until the 1970s before Australia’s annual per capita consumption of wine exceeded 10 litres, and even then wine represented only one-fifth of national alcohol consumption. But over the next two decades per capita wine consumption nearly trebled and beer consumption shrunk – the opposite of what happened to global alcohol consumption shares. This paper draws on newly compiled datasets (a) to reveal that Australia was not much more alcoholic than Britain or southern Europe during the nineteenth century and (b) to help explain why it took so long for a consumer interest in wine to emerge in Australia.
    Keywords: Alcohol beverage consumption mix; Beverage consumption intensity index; Wine globalization
    JEL: D12 E20 F14
    Date: 2020
  33. By: Elisabeth Paul; Garrett Brown; Tim Ensor; Gorik Ooms; Remco van de Pas; Valéry Ridde
    Abstract: Results-based financing (RBF) is subject to fierce debate and the evidence-base on its cost effectiveness is scarce. To our knowledge, only one cost-effectiveness study of RBF in a lower-middle income country has been published in a peer reviewed journal. That study – in Zambia – concludes that RBF is cost-effective, which was then uncritically repeated in an editorial accompanying its release. Here we would like to warn against readily accepting the conclusion of the cost-effectiveness study of RBF in Zambia, because its conclusions are not straightforward and could be dangerously misleading, especially for those readers unfamiliar with health economics. After outlining the results from the Zambia’s RBF cost-effectiveness study, we point to important methodological issues related to cost-effectiveness analysis, showing how key assumptions produce particular results. We then reflect on how cost-effectiveness is different from efficiency and affordability – which is important, since cost-effectiveness studies often have considerable influence on national health financing strategies and policy priorities. Finally, we provide an alternative reading of the evidence on RBF in Zambia. Namely, when examined from an efficiency point of view, the study actually demonstrates that RBF is less efficient than the simpler alternative of providing more resources to health facilities, unconditioned on performance, which will be of most interest to a government with tight budget constraints. As a result, existing claims that RBF is cost-effective are overstated, requiring further and more nuanced examination with more adequate research methods.
    Keywords: Results-based financing; Cost-effectiveness; Low- and middle-income countries
    Date: 2020–01–01
  34. By: James Alm (Tulane University); Kay Blaufus (University of Hanover); Martin Fochmann (Free University of Berlin); Erich Kirchler (University of Vienna); Peter N. C. Mohr (Free University of Berlin); Nina E. Olson (Center for Taxpayer Rights); Benno Torgler (Queensland University of Technology)
    Abstract: Governments have taken remarkable measures during the SARS-CoV-2 pandemic in their efforts to safeguard citizens’ health and the economy. As a consequence, public debts have reached unprecedented levels, which will require at some point higher taxes. Ensuring that citizens pay these taxes requires consideration of the many factors that will likely affect their tax compliance decisions. In this paper, we reflect from a behavioral economic perspective the impact of tax policy measures on the perception, evaluation, and behavior of citizens and derive considerations to devise appropriate tax policies to ensure compliance in the future. We start with speculations about citizens’ views of governmental restrictions and economic stimulus measures in response to the crisis, we apply these speculations to the acceptance and perceived effectiveness of policy measures on citizens’ tax compliance behaviors, and we finish with their likely impact on determinants of tax compliance. Building on the derived insights, we deduce a set of considerations to improve tax compliance – and to generate the necessary tax revenues to deal with the after-effects of SARS-CoV-2 when the pandemic is under control: communication, transparency and justification of measures, access to support, service provision, audits and penalties in case of free-riding, targeted audits, building social norms of cooperation, consideration of framing effects, development of plans and strategies for the future, and anticipation of hindsight biases.
    Keywords: Covid-19 crisis; Tax compliance; Tehavioral economics; Behavioral taxation
    JEL: H12 H20 H26 D91
    Date: 2021–01
  35. By: Muhammad Maaz; Anastasios Papanastasiou; Bradley J. Ruffle; Angela L. Zhang
    Abstract: Despite well-documented benefits of wearing a mask to reduce COVID-19 transmission, widespread opposition to mandating mask-wearing persists. Both our game-theoretic model and our unique survey dataset point to heterogeneity in the perceived benefits and perceived costs of mask-wearing. Young, healthy, Canadian-born adult males who are politically conservative or without a college education are all more likely to oppose mandatory mask laws, as are individuals who do not take climate change seriously and who express less trust in doctors and in elected officials. Political conservatives disproportionately cite not wanting to live in fear and infringements on personal freedoms as reasons for not wearing masks. Our findings cannot be explained by individuals who substitute physical distancing for mask-wearing. We show that these two precautionary measures are complements.
    Keywords: COVID-19; mandatory protective masks; heterogeneity in beliefs; ideology; political partisanship
    JEL: I12 I18 J38
    Date: 2021–01
  36. By: Timothy F. Harris; Aaron Yelowitz; Charles J. Courtemanche
    Abstract: The profitability of life insurance offerings is contingent on accurate projections and pricing of mortality risk. The COVID-19 pandemic created significant uncertainty, with dire mortality predictions from early forecasts resulting in widespread government intervention and greater individual precaution that reduced the projected death toll. We analyze how life insurance companies changed pricing and offerings in response to COVID-19 using monthly data on term life insurance policies from Compulife. We estimate event-study models that exploit well-established variation in the COVID-19 mortality rate based on age and underlying health status. Despite the increase in mortality risk and significant uncertainty, we find limited evidence that life insurance companies increased premiums or decreased policy offerings due to COVID-19.
    JEL: D81 I13
    Date: 2020–12
  37. By: Alfani, Guido (Bocconi University)
    Abstract: Recent research has explored the distributive consequences of major historical epidemics, and the current crisis triggered by Covid-19 prompts us to look at the past for insights about how pandemics can affect inequalities in income, wealth, and health. The fourteenth-century Black Death, which is usually believed to have led to a significant reduction in economic inequality, has attracted the greatest attention. However, the picture becomes much more complex if other epidemics are considered. This article covers the worst epidemics of preindustrial times, from Justinian’s Plague of 540-41 to the last great European plagues of the seventeenth century, as well as the cholera waves of the nineteenth. It shows how the distributive outcomes of lethal epidemics do not only depend upon mortality rates, but are mediated by a range of factors, chief among them the institutional framework in place at the onset of each crisis. It then explores how past epidemics affected poverty, arguing that highly lethal epidemics could reduce its prevalence through two deeply different mechanisms: redistribution towards the poor, or extermination of the poor. It concludes by recalling the historical connection between the progressive weakening and spacing in time of lethal epidemics and improvements in life expectancy, and by discussing how epidemics affected inequality in health and living standards.
    Keywords: JEL Classification: D31, D63, I14, I30, J11, N30, N33
    Date: 2020
  38. By: Kaiser, Micha (Copenhagen Business School); Otterbach, Steffen (University of Hohenheim); Sousa-Poza, Alfonso (University of Hohenheim); Bloom, David E. (Harvard University)
    Abstract: To assess the efficacy of Covid-19 non-pharmaceutical interventions (NPIs) on infectious disease containment in Europe, we first use weekly 2015-20 data on the spread of influenza and respiratory syncytial virus (RSV) to compare the 2019-20 season of these diseases with the previous five. Although the magnitude of results differs between countries, we document much stronger end-of-season declines in infections in the most recent outbreak than in the earlier ones, implying that they may be driven by NPIs implemented in 2020 to combat Covid-19. To test this conjecture, we use detailed country-specific weekly information on Covid-19 NPIs to estimate several panel models that relate NPI implementation to disease incidence across countries. Not only do certain measures significantly reduce the spread of Covid-19, they also curtail the spread of influenza and RSV. Nonetheless, although we identify workplace closures as a particularly effective measure, we find no evidence for the efficacy of other NPIs such as travel restrictions.
    Keywords: non-pharmaceutical interventions, infectious diseases, Europe, COVID-19
    JEL: H30 H23 H12 I18
    Date: 2020–12
  39. By: Hainaut, Donatien (Université catholique de Louvain, LIDAM/ISBA, Belgium)
    Abstract: This article proposes a model for pandemic risk and two stochastic extensions. It is designed for actuarial valuation of insurance plans providing healthcare and death benefits. The core of our approach relies on a deterministic model that is an efficient alternative to the susceptible-Infected-Recovered (SIR) method. This model explains the evolution of the first waves of COVID-19 in Belgium, Germany, Italy and Spain. Furthermore, it is analytically tractable for fair pure premium calculation. In a first extension, we replace the time by a Gamma stochastic clock. This approach randomizes the timing of the epidemic peak. A second extension consists in adding a Brownian noise and a jump process to explain the erratic evolution of the population of confirmed cases. The jump component allows for local resurgences of the epidemic.
    Keywords: SIR ; epidemic risk ; COVID-19 ; jump-diffusion
    Date: 2020–01–01
  40. By: Prema-chandra Athukorala; Chaturica Athukorala
    Abstract: The Great Influenza Pandemic of 1918-20—commonly known as the Spanish flu—infected over a quarter of the world’s population and killed over 50 million people. It is by far the greatest humanitarian disaster caused by infectious disease in modern history. Epidemiologists and health scientists often draw on this experience to set the plausible upper bound (the ‘worst case scenario’) on future pandemic mortality. The purpose of this study is to piece together and analyse the scattered multi-disciplinary literature on the pandemic in order to place debates on the evolving course of the current COVID-19 crisis in historical perspective. The analysis focuses on the changing characteristics of pathogens and disease over time, the institutional factors that shaped the global spread, and the demographic and socio-economic consequences.
    Keywords: Spanish flu, COVID-19, pandemic, infectious
    JEL: F50 I10 O50 Z1
    Date: 2020
  41. By: Fetzer, Thiemo (University of Warwick, CAGE, CESifo and CEPR); Graeber, Thomas (Harvard Business School, CESifo and IZA)
    Abstract: Contact tracing has been a central pillar of the public health response to the COVID-19 pandemic. Yet, contact tracing measures face substantive challenges in practice and well-identified evidence about their effectiveness remains scarce. This paper exploits quasi-random variation in COVID-19 contact tracing. Between September 25 and October 2, 2020, a total of 15,841 COVID-19 cases in England (around 15 to 20% of all cases) were not immediately referred to the contact tracing system due to a data processing error. Case information was truncated from an Excel spreadsheet after the row limit had been reached, which was discovered on October 3. There is substantial variation in the degree to which different parts of England areas were exposed – by chance – to delayed referrals of COVID-19 cases to to the contact tracing system. We show that more affected areas subsequently experienced a drastic rise in new COVID-19 infections and deaths alongside an increase in the positivity rate and the number of test performed, as well as a decline in the performance of the contact tracing system. Conservative estimates suggest that the failure of timely contact tracing due to the data glitch is associated with more than 125,000 additional infections and over 1,500 additional COVID-19- related deaths. Our findings provide strong quasi-experimental evidence for the effectiveness of contact tracing.
    Keywords: Health, Coronavirus JEL Classification: I31, Z18
    Date: 2020
  42. By: Viral V. Acharya; Zhengyang Jiang; Robert J. Richmond; Ernst-Ludwig von Thadden
    Abstract: We analyze 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.
    JEL: F1 F4 H87 I1
    Date: 2020–12
  43. By: Jonathan Colmer; John Voorheis
    Abstract: Evidence shows that environmental quality shapes human capital at birth with long-run effects on health and welfare. Do these effects, in turn, affect the economic opportunities of future generations? Using newly linked survey and administrative data, providing more than 150 million parent/child links, we show that regulation-induced improvements in air quality that an individual experienced in the womb increase the likelihood that their children, the second generation, attend college 40-50 years later. Intergenerational transmission appears to arise from greater parental resources and investments, rather than heritable, biological channels. Our findings suggest that within-generation estimates of marginal damages substantially underestimate the total welfare effects of improving environmental quality and point to the empirical relevance of environmental quality as a contributor to economic opportunity in the United States.
    JEL: H23 Q53 J00
    Date: 2020–11
  44. By: Leila Agha; Keith Marzilli Ericson; Xiaoxi Zhao
    Abstract: Patients often receive healthcare from providers spread across different firms. Transaction costs, imperfect information, and other frictions can make it difficult to coordinate production across firm boundaries, but we do not know how these challenges affect healthcare. We define and measure organizational concentration: the distribution across organizations of a patient's healthcare. Medicare claims show that organizational concentration varies substantially across physicians and regions, and that patients who move to more concentrated regions have lower healthcare utilization. Further, we show that when primary care physicians (PCPs) with higher organizational concentration exit the local market, their patients switch to more typical PCPs with lower organizational concentration and then have higher healthcare utilization. Patients who switch to a PCP with 1 SD higher organizational concentration have 10% lower healthcare utilization. This finding is robust to controlling for the spread of patient care across providers. Increases in organizational concentration have no detectable effect on emergency department utilization or hospitalization rates, but do predict improvements in diabetes care.
    JEL: D23 I11 L14
    Date: 2020–12
  45. By: Andrew Clark; Jan-Emmanuel De Neve; Daisy Fancourt; Nancy Hey; Christian Krekel; Richard Layard; Gus O'Donnell
    Abstract: In choosing when to end the lockdown, policy-makers have to balance the impact of the decision upon incomes, unemployment, mental health, public confidence and many other factors, as well as (of course) upon the number of deaths from COVID-19. To facilitate the decision it is helpful to forecast each factor using a single metric. We use as our metric the number of Wellbeing-Years resulting from each date of ending the lockdown. This new metric makes it possible to compare the impact of each factor in a way that is relevant to all public policy decisions.
    Keywords: COVID-19, Wellbeing Economics, Cost-Benefit Analysis, Health Policy
    JEL: D6 D61 H12 I31
    Date: 2020–04
  46. By: Roland Pongou (Department of Economics, University of Ottawa, Ottawa, ON); Guy Tchuente (School of Economics, University of Kent); Jean-Baptiste Tondji (Dept. of Economics and Finance, The University of Texas Rio Grande Valley)
    Abstract: We address the problem of finding the optimal lockdown and reopening policy during a pandemic like COVID-19 for a social planner who prioritizes health over short-term wealth accumulation. Agents are connected through a fuzzy network of contacts. The planner's objective is to determine the policy that contains the spread of infection below a tolerable incidence level, which maximizes the present discounted value of real income, in that order of priority. We show theoretically that the planner's problem has a unique solution. The optimal policy depends both on the configuration of the contact network and the tolerated infection incidence. Using simulations, we apply these theoretical findings to: (i) quantify the tradeoff between the economical cost of the pandemic and the infection incidence allowed by the social planner and show how this tradeoff depends on network configuration; (ii) evaluate the correlation between different measures of network centrality and individual lockdown probability, and derive implications for the optimal design of surveys on social distancing behavior and network structure; and (iii) analyze how segregation induces differential health and economic dynamics in minority and majority populations, also illustrating the crucial role of patient zero in these dynamics.
    Keywords: COVID-19, health-vs-wealth prioritization, economic cost, fuzzy networks, network centrality, segregation, patient zero, optimally targeted lockdown policy.
    Date: 2020
  47. By: Hupkau, Claudia; Petrongolo, Barbara
    Abstract: We explore the effects of the COVID-19 crisis and the associated restrictions to economic activity on paid and unpaid work for men and women in the United Kingdom. Using data from the COVID-19 supplement of Understanding Society, we find evidence that labour market outcomes of men and women were roughly equally affected at the extensive margin, as measured by the incidence of job loss or furloughing. But, if anything, women suffered smaller losses at the intensive margin, experiencing slightly smaller changes in hours and earnings. Within the household, women provided on average a larger share of increased childcare needs, but in an important share of households fathers became the primary childcare providers. These distributional consequences of the pandemic may be important to understand its inequality legacy over the longer term.
    Keywords: childcare; Covid-19; gender gaps; time use; coronavirus; WEL/43603
    JEL: D13 J13 J16 J22 J30
    Date: 2020–11–30
  48. By: Ritzen, Jozef M. (UNU-MERIT, Maastricht University)
    Abstract: In 2021 lockdowns still will be necessary to keep COVID-19 in check world-wide. Vaccination might bring sufficient coverage by the end of 2021 for some countries. Priorities in the re-emergence of economies should be for sustainability, health, education, full employment and social cohesion to preserve long-term welfare. Pressures on Government budgets are going to rise in view of the unprecedented high public debt to GDP ratio world-wide. Increased taxation of wealth and of the top 10%-income-group is a superior strategy compared to retrenchment (budget cuts in health, education and social expenditures). International cooperation is top priority. This applies to health, but also to economic and monetary policy: it can lift economic growth in the G20 countries over the short and long run by at least one third. The resumption of trade should be guided by rewarding the achievement of social goals and realizing sustainability. In this way the level playing field is restored for those countries which want to contribute to a sustainable world and to cooperation. International taxation rules for profits should prevent tax havens to make this a negative sum game. This would give developing countries some of the necessary breathing space to re-emerge from the COVID-19 crisis.
    Keywords: COVID-19, employment, economic development, environmental sustainability, social cohesion, education, health, monetary policy, long-term interest rates, conditionalities, taxation, stock market
    JEL: I00 J20 H63 H74 O38 O40 O43 O44 E62 E43 Q58 F18 F23 O52 R30 I25 F30 G15 H25 H87
    Date: 2020–12–18

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