nep-hea New Economics Papers
on Health Economics
Issue of 2021‒01‒18
thirty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Health Externalities of Downsizing By Ahammer, Alexander; Grübl, Dominik; Winter-Ebmer, Rudolf
  2. Vertical Integration of Healthcare Providers Increases Self-Referrals and Can Reduce Downstream Competition: The Case of Hospital-Owned Skilled Nursing Facilities By David M. Cutler; Leemore Dafny; David C. Grabowski; Steven Lee; Christopher Ody
  3. Demand Shocks, Procurement Policies, and the Nature of Medical Innovation: Evidence from Wartime Prosthetic Device Patents By Jeffrey P. Clemens; Parker Rogers
  4. Do Disability Benefits Hinder Work Resumption after Recovery? By Koning, Pierre; Muller, Paul; Prudon, Roger
  5. The Role of Employees' Age for the Relation between Job Autonomy and Sickness Absence By Grund, Christian; Rubin, Maike
  6. Family Spillover Effects of Marginal Diagnoses: The Case of ADHD By Persson, Petra; Qiu, Xinyao; Rossin-Slater, Maya
  7. Minimum Legal Drinking Age and the Social Gradient in Binge Drinking By Ahammer, Alexander; Bauernschuster, Stefan; Halla, Martin; Lachenmaier, Hannah
  8. An Extra Hour Wasted? Bar Closing Hours and Traffic Accidents in Norway By Green, Colin P.; Krehic, Lana
  9. Do junk food bans in school really reduce childhood overweight? Evidence from Brazil By Pierre Levasseur
  10. An Empirical Assessment of Workload and Migrants' Health in Germany By Ingwersen, Kai; Thomsen, Stephan L.
  11. Family Support in Hard Times: Dynamics of Intergenerational Exchange after Adverse Events By Jessamyn Schaller; Chase S. Eck
  12. The Impacts of a Multifaceted Pre-natal Intervention on Human Capital Accumulation in Early Life By Carneiro, Pedro; Kraftman, Lucy; Mason, Giacomo; Moore, Lucie; Rasul, Imran; Scott, Molly
  13. Age, morbidity, or something else? A residual approach using microdata to measure the impact of technological progress on health care expenditure By Laudicella, Mauro; Di Donni, Paolo; Rose Olsen, Kim; Gyrd-Hansen, Dorte
  14. Minimum Wages and Health: A Reassessment By Allegretto, Sylvia; Nadler, Carl
  15. Does Health Technology Assessment guidance give adequate consideration to decisions about less costly and less effective alternatives? By Susan Griffin; Francesco Fusco; Bhash Naidoo; Matthew Taylor; Simon Walker
  16. Routes to improved mortality monitoring: Evidence from the Kerala MARANAM Study By Gupta, Aashish; Mani, Sneha
  17. Exiting from Lockdowns: Early Evidence from Reopenings in Europe By Jeffrey R. Franks; Bertrand Gruss; Carlos Mulas-Granados; Manasa Patnam; Sebastian Weber
  18. Walking the tightrope: avoiding a lockdown while containing the virus By Balázs Égert; Yvan Guillemette; Fabrice Murtin; David Turner
  19. The Health-Wealth Trade-off during the COVID-19 Pandemic: Communication Matters By Carrieri, Vincenzo; De Paola, Maria; Gioia, Francesca
  20. Lockdown exit and control of the Covid-19 epidemic: group tests can be more effective By Elie Gerschel; Christian Gollier; Olivier Gossner
  21. Fighting the spread of Covid-19 : was the Swiss lockdown worth it? By Nicolò Gatti; Beatrice Retali
  22. Anxiety Increases the Willingness the Willingness to Be Exposed to Covid-19 Risk among Young Adults in France By Fabrice Etilé; Pierre-Yves Geoffard
  23. Assessing Excess Mortality in Times of Pandemics Based on Principal Component Analysis of Weekly Mortality Data -- The Case of COVID-19 By Patrizio Vanella; Ugofilippo Basellini; Berit Lange
  24. Anticipation of COVID-19 Vaccines Reduces Social Distancing By Andersson, Ola; Campos-Mercade, Pol; Meier, Armando N.; Wengström, Erik
  25. Global Mobility and the Threat of Pandemics: Evidence from Three Centuries By Clemens, Michael A.; Ginn, Thomas
  26. Pandemics and Historical Mortality in India By Tumbe, Chinmay
  27. Who Should Get Vaccinated? Individualized Allocation of Vaccines Over SIR Network By Toru Kitagawa; Guanyi Wang
  28. Social Distancing during a Pandemic: The Role of Friends By Michael Bailey; Drew Johnston; Martin Koenen; Theresa Kuchler; Dominic Russel; Johannes Stroebel
  29. Mathematical Modelling for Infectious Viral Disease: the Covid-19 Perspective By Hafeez A. Adekola; Ibrahim A. Adekunle; Haneefat O. Egberongbe; Sefiu A. Onitilo; Idris N. Abdullahi
  30. The Impact of Improved Access to Safe Water on Childhood Health, Schooling and Time Allocation in Rural Zambia By Yasuharu Shimamura; Satoshi Shimizutani; Shimpei Taguchi; Hiroyuki Yamada
  31. Corruption in the Times of Pandemia By Gallego, Jorge; Prem, Mounu; Vargas, Juan F.

  1. By: Ahammer, Alexander (University of Linz); Grübl, Dominik (University of Linz); Winter-Ebmer, Rudolf (University of Linz)
    Abstract: We show that downsizing has substantial externalities on the health of workers who remain in the firm. To this end, we study mass layoff (ML) survivors in Austria, using workers who survive a ML themselves, but a few years in the future, as a control group. Based on high-quality administrative data, we find evidence that downsizing has persistent effects on mental and physical health, and that these effects can be explained by workers fearing for their own jobs. We also show that health externalities due to downsizing imply non-negligible cost for firms, and that wage cuts may have similar effects.
    Keywords: downsizing, mass layoffs, health, job insecurity
    JEL: J63 I12 J23
    Date: 2020–12
  2. By: David M. Cutler; Leemore Dafny; David C. Grabowski; Steven Lee; Christopher Ody
    Abstract: The landscape of the U.S. healthcare industry is changing dramatically as healthcare providers expand both within and across markets. While federal antitrust agencies have mounted several challenges to same-market combinations, they have not challenged any non-horizontal affiliations – including vertical integration of providers along the value chain of production. The Clayton Act prohibits combinations that “substantially lessen” competition; few empirical studies have focused on whether this is the source of harm from vertical combinations. We examine whether hospitals that are vertically integrated with skilled nursing facilities (SNFs) lessen competition among SNFs by foreclosing rival SNFs from access to the most lucrative referrals. Exploiting a plausibly exogenous shock to Medicare reimbursement for SNFs, we find that a 1 percent increase in a patient’s expected profitability to a SNF increases the probability that a hospital self-refers that patient (i.e., to a co-owned SNF) by 2.5 percent. We find no evidence that increased self-referrals improve patient outcomes or change post-discharge Medicare spending. Additional analyses show that when integrated SNFs are divested by their parent hospitals, independent rivals are less likely to exit. Together, the results suggest vertical integration in this setting may reduce downstream competition without offsetting benefits to patients or payers.
    JEL: I18 L22 L40
    Date: 2020–12
  3. By: Jeffrey P. Clemens; Parker Rogers
    Abstract: We analyze wartime prosthetic device patents to investigate how demand and procurement policy can shape medical innovation. We use machine learning tools to develop new data describing the aspects of medical and mechanical innovations that are emphasized in patent documents. Our analysis of historical patents yields three primary facts. First, we find that the U.S. Civil War and World War I led to substantial increases in the quantity of prosthetic device patenting relative to patenting in other medical and mechanical technology classes. Second, we find that the Civil War led inventors to focus broadly on improving aspects of the production process, while World War I did not, consistent with the United States applying a more cost-conscious procurement model during the Civil War. Third, we find that inventors emphasized dimensions of product quality (e.g., a prosthetic’s appearance or comfort) that aligned with differences in buyers’ preferences, as described in the historical record, across wars. We conclude that procurement environments can significantly shape the scientific problems with which inventors engage, including the choice to innovate on quality or cost.
    Keywords: procurement, medical innovation, health care, health economics
    JEL: H57 I10 O31
    Date: 2020
  4. By: Koning, Pierre (Leiden University); Muller, Paul (Free University Amsterdam); Prudon, Roger (Free University Amsterdam)
    Abstract: While a large share of Disability Insurance recipients are expected to recover, outflow rates from temporary disability schemes are typically negligible. We estimate the disincentive effects of disability benefits on the response to a (mental) health improvement using administrative data on all Dutch disability benefit applicants. We compare those below the DI eligibility threshold with those above and find that disincentives significantly reduce work resumption after health improves. Approximately half of the response to recovery is offset by benefits. Structural labor supply model estimates suggest disincentive effects are substantially larger when the workers earnings capacity is fully restored.
    Keywords: disability insurance, mental health, labor supply, health shocks
    JEL: J08 I1 J22
    Date: 2020–12
  5. By: Grund, Christian (RWTH Aachen University); Rubin, Maike (RWTH Aachen University)
    Abstract: We investigate whether job autonomy is associated with employees' sickness absence. We can make use of the representative German Study of Mental Health at Work data. In line with our theoretical considerations, we do find evidence for an inverse relation between employees' job autonomy and days of sickness absence. This relation is only weakly mediated by job satisfaction and particularly relevant for more senior employees.
    Keywords: job autonomy, sickness absence, age, job satisfaction
    JEL: J81 M12
    Date: 2020–12
  6. By: Persson, Petra (Stanford University); Qiu, Xinyao (Stanford University); Rossin-Slater, Maya (Stanford University)
    Abstract: The health care system commonly relies on information about family medical history in the allocation of screenings and in diagnostic processes. At the same time, an emerging literature documents that treatment for "marginally diagnosed" patients often has minimal impacts. This paper shows that reliance on information about relatives' health can perpetuate marginal diagnoses across family members, thereby raising caseloads and health care costs, but without improving patient well-being. We study Attention Deficit Hyperactivity Disorder (ADHD), the most common childhood mental health condition, and document that the younger siblings and cousins of marginally diagnosed children are also more likely to be diagnosed with and treated for ADHD. Moreover, we find that the younger relatives of marginally diagnosed children have no better adult human capital and economic outcomes than the younger relatives of those who are less likely to be diagnosed. Our analysis points to a simple adjustment to physician protocol that can mitigate these marginal diagnosis spillovers.
    Keywords: ADHD, targeting, marginal diagnosis, mental health, family spillovers
    JEL: I14 I18 J13
    Date: 2021–01
  7. By: Ahammer, Alexander (University of Linz); Bauernschuster, Stefan (University of Passau); Halla, Martin (University of Linz); Lachenmaier, Hannah (University of Passau)
    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
  8. By: Green, Colin P. (Norwegian University of Science and Technology (NTNU)); Krehic, Lana (Norwegian University of Science and Technology (NTNU))
    Abstract: Driving under the influence of alcohol is a major cause of fatalities worldwide. There have been a range of legislative and policy interventions that aim to address this. Bar closing hours is one policy with clear implications for drink driving. Existing evidence, largely drawn from one-off policy changes in urban settings, reports mixed evidence that is difficult to generalise. We return to this issue using a setting, Norway, that is advantageous due to large temporal and regional variation in closing times, frequent changes in closing hours, and a lack of other confounding policy changes. We demonstrate an average zero effect of closing hours on traffic accidents that masks large variations in effects, especially in terms of population density, accident severity, and direction of change in closing hours. Our results suggest that estimates from single policy changes may be difficult to generalise, while demonstrating that closing hours have the potential to generate large effects on traffic accidents.
    Keywords: closing hours, alcohol policy, traffic accidents
    JEL: I18 R41
    Date: 2020–12
  9. By: Pierre Levasseur (SADAPT - Sciences pour l'Action et le Développement : Activités, Produits, Territoires - AgroParisTech - Université Paris-Saclay - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)
    Abstract: Childhood overweight and obesity have increased alarmingly in recent decades all over the world, particularly in middle-income countries like Brazil, Mexico and China. In response to the obesity epidemic, several states and governments have introduced restrictions on sales of high-calorie low-nutrient-dense foods and beverages in schools. However, most school canteens around the world continue to offer such unhealthy products. The lack of clear evidence about the impacts of junk food/beverage availability on childhood overweight potentially contributes to delaying the application of regulatory policies. In fact, sales of junk food represent an important source of revenues for schools, especially in contexts of budgetary pressure. Based on a representative sample of Brazilian middle school students, this article takes advantage of local initiatives that began in 2001 aimed at banning sales of junk food and beverages in schools. Among other effects, instrumental variables estimates show that in-school soft drink availability increases male BMI and overweight risk. As expected, the impacts tend to be stronger on non-poor students. No effect was found for girls, probably because of voluntary substitutions with healthier foods to control total calorie intakes and limit weight gain. Alarmingly, in-school junk food/beverage availability is positively correlated with overall junk food/beverage consumption and negatively correlated with overall healthy food intakes. In conclusion, this article provides clear evidence that banning sales of unhealthy products in schools is a useful tool to fight against the worldwide increase in childhood overweight, even in middle-income countries.
    Keywords: Brazil Childhood overweight,Body mass index,Junk food,School bans
    Date: 2020–10–17
  10. By: Ingwersen, Kai (Leibniz University of Hannover); Thomsen, Stephan L. (Leibniz University of Hannover)
    Abstract: Workload and its physical and mental burden can have detrimental effects on individual health. As different jobs are associated with specific patterns of health development, occupational selection of socioeconomic groups can be attributed to health differences in society. Despite a long economic literature that has established native-migrant differences in occupational choice and health behaviour, surprisingly little research so far has been devoted to workload differences and the influence on individual health in this context. We consider differences in workload and related health status for migrants and native Germans through a detailed characterisation of occupational conditions. Based on labour force survey data for the years 2006, 2012 and 2018, our analysis takes a comprehensive set of work-related aspects into account, e.g., work tasks, job requirements, and working conditions. The empirical results show an enhanced perception of workload and related health problems among migrants. Working at the capacity limit has a particularly strong effect on emotional exhaustion, which is countered by a good working atmosphere being beneficial to health. Native Germans are more heavily burdened by high job requirements than migrants, both physically and mentally. However, as job-related factors show similar effects on the health status of males, the poorer health status of migrants could therefore be attributed to a lower utilization of health services.
    Keywords: workload, working conditions, migrants, self-reported health, BIBB/BAuA
    JEL: I14 J15 J81
    Date: 2020–12
  11. By: Jessamyn Schaller; Chase S. Eck
    Abstract: We use an event-study approach to examine changes in intergenerational financial transfers and informal care within families following wealth loss, job exit, widowhood, and health shocks. We find sharp reductions in parental giving to adult children following negative shocks to parents' wealth and earned income, particularly in low-wealth households. Parental giving also decreases with some health shocks and increases following spousal death. Meanwhile, children of low-wealth households increase financial transfers to their parents following adverse shocks and children in both high- and low-wealth households increase their provision of informal care to parents following a wide range of adverse shocks.
    JEL: D10 D14 D15 D64 I10 J14 J26
    Date: 2020–12
  12. By: Carneiro, Pedro (University College London); Kraftman, Lucy (Institute for Fiscal Studies, London); Mason, Giacomo (Competition and Markets Authority); Moore, Lucie (OPM); Rasul, Imran (University College London); Scott, Molly (OPM)
    Abstract: We evaluate an intervention targeting early life nutrition and well-being for households in extreme poverty in Northern Nigeria. The intervention leads to large and sustained improvements in children's anthropometric and health outcomes, including an 8% reduction in stunting four years post-intervention. These impacts are partly driven by information-related channels. However, the certain and substantial flow of cash transfers is also key. They induce positive labor supply responses among women, and enables them to undertake productive investments in livestock. These provide protein rich diets for children, and generate higher household earnings streams long after the cash transfers expire.
    Keywords: nutrition, cash transfers
    JEL: I15 O15
    Date: 2020–12
  13. By: Laudicella, Mauro (University of Southern Denmark, DaCHE - Danish Centre for Health Economics); Di Donni, Paolo (University of Palermo, Economics Department & University of Southern Denmark, DaCHE); Rose Olsen, Kim (University of Southern Denmark, DaCHE - Danish Centre for Health Economics); Gyrd-Hansen, Dorte (University of Southern Denmark, DaCHE - Danish Centre for Health Economics)
    Abstract: This study measures the increment of health care expenditure (HCE) that can be attributed to technological progress and change in medical practice by using a residual approach and microdata. We examine repeated cross-sections of individuals experiencing an initial health shock at different point in time over a ten-year window and capture the impact of unobservable technology and medical practice to which they are exposed after allowing for differences in health and socioeconomic characteristics. We decompose the residual increment in the part that is due to the effect of delaying time to death, i.e. individuals surviving longer after a health shock and thus contributing longer to the demand of care, and the part that is due to increasing intensity of resource use, i.e. the basket of services becoming more expensive to allow for the cost of innovation. We use data from the Danish National Health System that offers universal coverage and is free of charge at the point of access. We find that technological progress and change in medical practice can explain about 60% of the increment of HCE, in line with macroeconomic studies that traditionally investigate this subject.
    Keywords: Health care expenditure; Time-to-death; Ageing; Morbidity; Technological impact
    JEL: H51 I18 O33
    Date: 2020–12–15
  14. By: Allegretto, Sylvia; Nadler, Carl
    Abstract: A growing literature has reported significant health effects of the minimum wage. Yet recently published articles have often focused on broad groups of less educated workers with no more than a high school education, of whom only a small share work in minimum wage jobs. We reassess this evidence, pooling data from the Behavioral Risk Factors Surveillance System from 1993–2017, a common dataset for studying these policies. We focus on less educated young workers age 18–25, who are over twice as likely to earn near the minimum than the groups of adults typically studied. We analyze 21 measures of health care access, preventive practices, behaviors and health status. We find little evidence past policies have influenced young workers’ health on average. We find similar null results from expanded samples that include all less educated workers age 18–54. Our results suggest that the significant effects reported in prior studies using similar samples and methods are unlikely to be attributable to the minimum wage.
    Keywords: Social and Behavioral Sciences, minimum wage, worker health, low-wage workers
    Date: 2020–07–07
  15. By: Susan Griffin (Centre for Health Economics, University of York, York, UK); Francesco Fusco (Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK); Bhash Naidoo (Centre for Guidelines, National Institute for Health and Care Excellence, London, UK); Matthew Taylor (dYork Health Economics Consortium, University of York, York, UK); Simon Walker (Centre for Health Economics, University of York, York, UK)
    Abstract: Cost-effectiveness analysis (CEA) plays a key role informing decision-making in healthcare and, consequently, the interpretation of its results is discussed in formal guidance from health technology assessment (HTA) organisations. A body of research indicates different willingness to pay for more effective interventions than willingness to accept less effective interventions, which some suggest supports application of different cost-effectiveness thresholds depending on whether an intervention is considered more or less effective than the comparator. We review the theoretical basis for the use of differential thresholds within HTA organisations, and question whether they are compatible with coherent decisions and social values. The National Institute for Health and Care Excellence (NICE) is one such organisation, providing recommendations on which healthcare interventions to adopt in the United Kingdom. NICE guidance describes the decision rules it employs, including comparing CEA results to a cost-effectiveness threshold that defines the boundaries beyond which an intervention is no longer considered to provide value for money. Our review of NICE guidance finds that it describes a common threshold range for all alternatives, in line with the theoretical basis for a supply-side threshold. However, we also find that the guidance focuses on the application of the threshold as a decision rule for more effective and more expensive treatments, with less guidance provided on less effective and less expensive treatments. We make suggestions for how HTA organisations can better support application of decision rules to interventions that are less effective and less expensive.
    Keywords: Cost†effectiveness analysis, willingness to pay, willingness to accept, opportunity cost, cost†effectiveness thresholds, priority setting
    Date: 2020–11
  16. By: Gupta, Aashish; Mani, Sneha
    Abstract: Despite having universal mortality registration, vital registration systems in many regions of contemporary developing countries do not receive adequate attention. Using individual-level vital-registration data on more than 2.8 million deaths between 2006 and 2017 from the Kerala MARANAM (Mortality and Registration Assessment and Monitoring) Study, we examine completeness of vital statistics and reliability of mortality rates estimated using them. Our findings show that age-specific mortality rates obtained from vital statistics system in Kerala, a comparatively low-mortality context in a low- and middle-income setting, are more reliable than the ones estimated by India's Sample Registration System. This is particularly true for ages where mortality is low, and for women. Using these data we provide the first set of annual sex-specific life-tables for any state in India. We find that life expectancy at birth was 77.9 years for women in 2017, and 71.4 years for men. Although Kerala is unique in many ways, our findings strengthen the case for more attention to mortality records within developing countries, and for their better dissemination by government agencies.
    Date: 2020–12–30
  17. By: Jeffrey R. Franks; Bertrand Gruss; Carlos Mulas-Granados; Manasa Patnam; Sebastian Weber
    Abstract: European authorities introduced stringent lockdown measures in early 2020 to reduce the transmission of COVID-19. As the first wave of infection curves flattened and the outbreak appeared controlled, most countries started to reopen their economies albeit using diverse strategies. This paper introduces a novel daily database of sectoral reopening measures in Europe during the first-wave and documents that country plans differed significantly in terms of timing, pace, and sequencing of sectoral reopening measures. We then show that reopenings led to a recovery in mobility—a proxy for economic activity—but at the cost of somewhat higher infections. However, the experience with reopening reveals some original dimensions of this trade-off. First, the increase in COVID-19 infections after reopening appears less severe in fatality rates. Second, a given reopening step is associated with a worse reinfection outcome in countries that started reopening earlier on the infection curve or that opened all sectors at a fast pace in a relatively short time. Finally, while opening measures tend to have an amplification effect on subsequent cases when a large fraction of the economy is already open, this effect appears heterogenous across sectors.
    Keywords: Education;COVID-19 ;Health;Public expenditure review;Population and demographics;Pandemics,Lockdowns,Europe,WP,reopening policy,infection curve,infection amplification risk,infection dynamics,infection-death curve,outcome variable
    Date: 2020–10–21
  18. By: Balázs Égert; Yvan Guillemette; Fabrice Murtin; David Turner
    Abstract: Empirical work described in this paper explains the daily evolution of the reproduction rate, R, and mobility for a large sample of countries, in terms of containment and public health policies. This is with a view to providing insight into the appropriate policy stance as countries prepare for a potentially protracted period characterised by new infection waves. While a comprehensive package of containment measures may be necessary when the virus is widespread and can have a large effect on reducing R, they also have effect on mobility and, by extension, economic activity. A wide-ranging package of public health policies – with an emphasis on comprehensive testing, tracing and isolation, but also including mask-wearing and policies directed at vulnerable groups, especially those in care homes – offer the best approach to avoiding a full lockdown while containing the spread of the virus. Such policies may, however, need to be complemented by selective containment measures (such as restricting large public events and international travel or localised lockdowns) both to contain local outbreaks and because implementing some of the recommended public health policies may be difficult to achieve or have unacceptable social costs.
    Keywords: Covid-19, lockdown, mobility, non-pharmaceutical interventions
    JEL: C50 H10 I18 H12
    Date: 2020–12–16
  19. By: Carrieri, Vincenzo (Magna Graecia University); De Paola, Maria (University of Calabria); Gioia, Francesca (University of Milan)
    Abstract: How do people balance health/wealth concerns during a pandemic? And, how does the communication of this trade-off affect individual preferences? We address these questions using a field experiment involving around 2000 students enrolled in a large university in Italy. We design four treatments where the trade-off is communicated using different combinations of a positive framing that focuses on protective strategies and a negative framing which refers to potential costs. We find that positive framing on the health side induces individuals to give greater relevance to the health dimension. The effect is sizeable and highly effective among many different audiences, especially females. Importantly, this triggers a higher level of intention to adhere to social distancing and precautionary behaviors. Moreover, irrespective of the framing, we find a large heterogeneity in students' preferences over the trade-off. Economics students and students who have directly experienced the economic impact of the pandemic are found to favor wealth-centered policies.
    Keywords: COVID-19, health, economic costs, trade-off, framing
    JEL: D04 D83 D84 D91 H12 I10 J10
    Date: 2020–12
  20. By: Elie Gerschel (CREST - Centre de Recherche en Economie et Statistique [Bruz] - ENSAI - Ecole Nationale de la Statistique et de l'Analyse de l'Information [Bruz], X - École polytechnique); Christian Gollier (TSE - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Olivier Gossner (CREST - Centre de Recherche en Economie et Statistique [Bruz] - ENSAI - Ecole Nationale de la Statistique et de l'Analyse de l'Information [Bruz], CNRS - Centre National de la Recherche Scientifique)
    Abstract: The lack of efficient mass testing tools for SARS-CoV-2 virus that causes Covid-19 has contributed to the accelerated spread of the epidemic. Infected people are unaware that they are spreading the disease during the incubation period as well as in asymptomatic cases or cases with mild symptoms. To limit the number of victims of the epidemic, the strategy adopted by most affected countries is therefore social distancing or complete lockdown, a strategy that can only be beneficial for a limited time, given its economic and social cost. Today, the most feasible way out of the stalemate requires widespread screening of the population. Such screening would make it possible to isolate infected people and allow others to leave the lockdown. However, production capacity for SARS-CoV-2 tests is limited. Although production is increasing, it will not allow for sufficiently systematic and frequent screening to permit the lifting of health restrictions. We here describe how the usefulness of each test can be amplified by applying it to the mixture of samples from several individuals. This technique, called group testing, has already been successfully applied on SARS-CoV-2. We show how the group-test method must be calibrated to maximize the usefulness of each available test.
    Date: 2020–04
  21. By: Nicolò Gatti (Istituto di Economia Politica (IdEP), Facoltà di Scienze Economiche, Università della Svizzera italiana, Svizzera); Beatrice Retali (Istituto di Economia Politica (IdEP), Facoltà di Scienze Economiche, Università della Svizzera italiana, Svizzera)
    Abstract: The implementation of a lockdown to control the Covid-19 pandemic has led to a strong debate in several countries. This makes it crucial to shed light on the actual benefits of such kind of policy. To this purpose, we focus on the Swiss lockdown during the first wave of Covid-19 infections and estimate the number of potentially saved lives. To predict the number of deaths in absence of any restrictive measure, we develop a novel age-structured SIRDC model which accounts for age-specific endogenous behaviors. Considering also the additional deaths due to the shortage of healthcare resources, our estimates suggest that the lockdown prevented approximately 35,000 fatalities. The corresponding monetary benefits, computed using the value of statistical life, largely exceed 14% of the Swiss GDP. Our results also show that more than 65% of benefits are concentrated among people older than 65. This calls for some compensation in favor of young generations, who benefit less from the policy despite bearing most of its costs.
    Keywords: Covid-19, lockdown, benefit-cost, behavioral responses, intergenerational inequality
    JEL: H12 I18 D63 D91
    Date: 2021–01
  22. By: Fabrice Etilé (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Pierre-Yves Geoffard (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)
    Abstract: The COVID-19 outbreak has generated significant uncertainty about the future, especially for young adults. Health and economic threats, as well as more diffuse concerns about the consequences of COVID-19, can trigger feelings of anxiety, leading individuals to adopt uncertainty-reducing behaviours. We tested whether anxiety was associated with an increase in willingness to be exposed to the risk of COVID-19 infection (WiRE) using an online survey administered to 3,110 French individuals aged between 18 and 35 years old during the lockdown period (April 2020). Overall, 56.5% of the sample declared a positive WiRE. Unemployment was associated with a higher WiRE (+8.2 percentage points (pp); 95% CI +0.9-15.4 pp). One standard deviation increases in income (+1160€) and psychological state anxiety raised the WiRE by +2.7 pp (95% CI: +1.1-4.4 pp) and +3.9 pp (95% CI: +1.6-6.2 pp), respectively. A one standard deviation increase in perceived hospitalisation risk was associated with a -4.1 pp (95% CI: -6.2-2.1 pp) decrease in the WiRE. Overall, our results suggest that both the prospect of economic losses and psychological anxiety can undermine young adults'adherence to physical distancing recommendations. Public policies targeting young adults must consider both their economic situation and their mental health, and they must use uncertaintyreducing communication strategies.
    Date: 2020–12
  23. By: Patrizio Vanella; Ugofilippo Basellini; Berit Lange
    Abstract: The current outbreak of COVID-19 has called renewed attention to the need for sound statistical analysis for monitoring mortality patterns and trends over time. Excess mortality has been suggested as the most appropriate indicator to measure the overall burden of the pandemic on mortality. As such, excess mortality has received considerable interest during the first months of the COVID-19 pandemic. Previous approaches to estimate excess mortality are somewhat limited, as they do not include sufficiently long-term trends, correlations among different demographic and geographic groups, and the autocorrelations in the mortality time series. This might lead to biased estimates of excess mortality, as random mortality fluctuations may be misinterpreted as excess mortality. We present a blend of classical epidemiological approaches to estimating excess mortality during extraordinary events with an established demographic approach in mortality forecasting, namely a Lee-Carter type model, which covers the named limitations and draws a more realistic picture of the excess mortality. We illustrate our approach using weekly age- and sex-specific mortality data for 19 countries and the current COVID-19 pandemic as a case study. Our proposed model provides a general framework that can be applied to future pandemics as well as to monitor excess mortality from specific causes of deaths.
    Keywords: COVID-19 Pandemic, Excess Mortality Assessment, Mortality Forecasting, Principal Component Analysis, International Mortality Trends, Time Series Analysis, Monte Carlo Simulation, MORTALITE / MORTALITY, EPIDEMIE / EPIDEMICS, ANALYSE DES DONNEES / DATA ANALYSIS
    Date: 2020
  24. By: Andersson, Ola (Department of Economics, Uppsala University, UCFS); Campos-Mercade, Pol (University of Copenhagen, Denmark); Meier, Armando N. (University of Lausanne and University of Basel, Switzerland); Wengström, Erik (Lund University, Sweden, and Hanken School of Economics, Finland)
    Abstract: We show that the anticipation of COVID-19 vaccines reduces voluntary social distancing. In a large-scale preregistered survey experiment with a representative sample, we study whether providing information about the safety, effectiveness, and availability of COVID-19 vaccines affects compliance with public health guidelines. We find that vaccine information reduces peoples’ voluntary social distancing, adherence to hygiene guidelines, and their willingness to stay at home. Vaccine information induces people to believe in a swifter return to normal life and puts their vigilance at ease. The results indicate an important behavioral drawback of the successful vaccine development: An increased focus on vaccines can lead to bad health behaviors and accelerate the spread of the virus. The results imply that, as vaccinations start and the end of the pandemic feels closer, existing policies aimed at increasing social distancing will be less effective and stricter policies might be required.
    Keywords: Economic epidemiology; Social distancing; Vaccination; Information
    JEL: D83 D91 I12 I18
    Date: 2021–01–07
  25. By: Clemens, Michael A. (Center for Global Development); Ginn, Thomas (Center for Global Development)
    Abstract: Countries restrict the overall extent of international travel and migration to balance the expected costs and benefits of mobility. Given the ever-present threat of new, future pandemics, how should permanent restrictions on mobility respond? A simple theoretical framework predicts that reduced exposure to pre-pandemic international mobility causes slightly slower arrival of the pathogen. A standard epidemiological model predicts no decrease in the harm of the pathogen if travel ceases thereafter and only a slight decrease in the harm (for plausible parameters) if travel does not cease. We test these predictions across four global pandemics in three different centuries: the influenza pandemics that began in 1889, 1918, 1957, and 2009. We find that in all cases, even a draconian 50 percent reduction in pre-pandemic international mobility is associated with 1–2 weeks later arrival and no detectable reduction in final mortality. The case for permanent limits on international mobility to reduce the harm of future pandemics is weak.
    Keywords: migration, pandemic, epidemic, disease, health, COVID-19, Coronavirus, flu, influenza, HIV, Zika, SARS, MERS, Spanish flu, Asian flu, Russian flu, Swine flu, H1N1, health systems, mortality, morbidity, mobility, movement, border, international, global, globalization
    JEL: H23 I18 J68
    Date: 2020–12
  26. By: Tumbe, Chinmay
    Abstract: This paper presents selected historical mortality statistics of India and analyses their characteristics and trends. Statistics are collated from a wide range of sources as time series at different regional scales, and particularly for the pandemics related with cholera, plague and influenza between 1817 and 1920. The paper analyses rare burial records in 19th century Calcutta, constructs the global distribution of deaths due to pandemic cholera in the 19th and early 20th century, and provides new mortality estimates of the 1918 influenza pandemic in India. The paper also presents a bibliography of over 250 studies on pandemics and historical mortality in India.
    Date: 2020–12–31
  27. By: Toru Kitagawa; Guanyi Wang
    Abstract: How to allocate vaccines over heterogeneous individuals is one of the important policy decisions in pandemic times. This paper develops a procedure to estimate an individualized vaccine allocation policy under limited supply, exploiting social network data containing individual demographic characteristics and health status. We model spillover effects of the vaccines based on a Heterogeneous-Interacted-SIR network model and estimate an individualized vaccine allocation policy by maximizing an estimated social welfare (public health) criterion incorporating the spillovers. While this optimization problem is generally an NP-hard integer optimization problem, we show that the SIR structure leads to a submodular objective function, and provide a computationally attractive greedy algorithm for approximating a solution that has theoretical performance guarantee. Moreover, we characterise a finite sample welfare regret bound and examine how its uniform convergence rate depends on the complexity and riskiness of social network. In the simulation, we illustrate the importance of considering spillovers by comparing our method with targeting without network information.
    Date: 2020–12
  28. By: Michael Bailey; Drew Johnston; Martin Koenen; Theresa Kuchler; Dominic Russel; Johannes Stroebel
    Abstract: We explore how social network exposure to COVID-19 cases shapes individuals’ social distancing behavior during the early months of the ongoing pandemic. We work with de-identified data from Facebook to show that U.S. users whose friends live in areas with worse coronavirus outbreaks reduce their mobility more than otherwise similar users whose friends live in areas with smaller outbreaks. The effects are quantitatively large: a one standard deviation increase in friend-exposure to COVID-19 cases early in the pandemic results in a 1.2 percentage point increase in the probability that an individual stays home on a given day. As the pandemic progresses, changes in friend-exposure drive changes in social distancing behavior. Given the evolving nature and geography of the pandemic—and hence friend-exposure — these results rule out many alternative explanations for the observed relationships. We also analyze data on public posts and membership in groups advocating to “reopen” the economy to show that our findings can be explained by friend-exposure raising awareness about the risks of the disease and inducing individuals to participate in mitigating public health behavior.
    Keywords: social networks, peer effects, Covid-19, social distancing
    JEL: I00 D83 D85 H00
    Date: 2020
  29. By: Hafeez A. Adekola (Olabisi Onabanjo University, Ago-Iwoye, Nigeria); Ibrahim A. Adekunle (Olabisi Onabanjo University, Ago-Iwoye, Nigeria); Haneefat O. Egberongbe (Olabisi Onabanjo University, Ogun State, Nigeria); Sefiu A. Onitilo (Olabisi Onabanjo University, Ogun State, Nigeria); Idris N. Abdullahi (Ahmadu BelloUniversity, Zaria, Nigeria)
    Abstract: In this study, we examined various forms of mathematical models that are relevant for the containment, risk analysis and features of COVID-19. Greater emphasis was laid on the extension of the Susceptible-Infectious-Recovered (SIR) models for policy relevance in the time of COVID-19. These mathematical models play a significant role in the understanding of COVID-19 transmission mechanisms, structures and features. Considering that the disease has spread sporadically around the world, causing large scale socioeconomic disruption unwitnessed in contemporary ages since World War II, researchers, stakeholders, government and the society at large are actively engaged in finding ways to reduce the rate of infection until a cure or vaccination procedure is established. We advanced argument for the various forms of the mathematical models of epidemics and highlighted their relevance in the containment of COVID-19 at the present time. Mathematical models address the need for understanding the transmission dynamics and other significant factors of the disease that would aid policymakers to make accurate decisions and reduce the rate of transmission of the disease.
    Keywords: Mathematical Models, SIR Models, COVID-19, COVID-19 confirmed cases, COVID-19 attributable deaths
    Date: 2020–01
  30. By: Yasuharu Shimamura (Graduate School of International Cooperation Studies, Kobe University); Satoshi Shimizutani (JICA Ogata Sadako Research Institute for Peace and Development); Shimpei Taguchi (JICA Ogata Sadako Research Institute for Peace and Development, Research Program Division); Hiroyuki Yamada (Faculty of Economics, Keio University)
    Abstract: This paper examines the short term impact of improved access to supremely safe water at newly built boreholes on the health, schooling and time allocation of children in rural Zambia. We employ a difference-in-difference estimation using a dataset collected under a quasi-experimental setting. We observe positive and significant effects of improved access to safe water on the reduction of incidence of diarrhea for pre-school children but not for school age children. On the other hand, we do not find any positive effect on school attendance and even suggest that there is a negative effect on girls living surrounding new boreholes. To understand the mechanism behind this pattern, we examine any changes in the use of time by children with easier access to safe water. We find for girls a significant increase in time spent on water-related household chores including fetching water. Moreover, we observe a significant decrease in the incomegenerating activities of girls. These findings, together with the suggestive evidence of increased demand for supremely safe water available at boreholes with easier access, imply that the burden of water-related household chores appears to shift from mothers to daughters.
    Keywords: fetching water, borehole, waterborne diseases, Zambia, time use
    JEL: I38 J22 J16
    Date: 2020–11–25
  31. By: Gallego, Jorge; Prem, Mounu; Vargas, Juan F.
    Abstract: The public health and economic crisis caused by the COVID-19 pandemic has pushed governments to substantially and swiftly increase spending. Consequently, public procurement rules have been relaxed in many places to expedite transactions. However, this may also create opportunities for inefficiency and corruption. Using contract-level information on public spending from Colombia’s e-procurement platform, and a difference-in-differences identification strategy, we find that municipalities classified by a machine learning algorithm as more prone to corruption react to the spending surge by using a larger proportion of discretionary non-competitive contracts and increasing their average value, especially to procure crisis-related items. Additionally, in places that rank higher on our corruption scale, contracts signed during the emergency are more likely to have cost overruns, be awarded to campaign donors, and exhibit implementation inefficiencies. Our evidence suggests that these negative shocks may increase waste and corruption, and thus governments should bolster instances of monitoring and oversight.
    Date: 2020–12–30

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