nep-hea New Economics Papers
on Health Economics
Issue of 2021‒01‒25
37 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Improving Healthy Eating in Children: Experimental Evidence By Charness, Gary; Cobo-Reyes, Ramón; Eyster, Erik; Katz, Gabriel; Sánchez, Ángela; Sutter, Matthias
  2. How well targeted are soda taxes? By Pierre Dubois; Rachel Griffith; Martin O'Connell
  3. School Selectivity, Peers, and Mental Health By Bütikofer, Aline; Ginja, Rita; Landaud, Fanny; Løken, Katrine V.
  4. Exposure to a School Shooting and Subsequent Well-Being By Phillip B. Levine; Robin McKnight
  5. Illicit Drugs and the Decline of the Middle Class By Grossmann, Volker; Strulik, Holger
  6. Opium Price Shocks and Prescription Opioids in the US By Deiana, C.; Giua, L.; Nisticò, R.
  7. The OxyContin Reformulation Revisited: New Evidence From Improved Definitions of Markets and Substitutes By Shiyu Zhang; Daniel Guth
  8. Going Through The Roof: On Prices for Drugs Sold Through Insurance By Jurjen Kamphorst; Vladimir Karamychev
  9. Public and Private Options in Practice: The Military Health System By Michael D. Frakes; Jonathan Gruber; Timothy Justicz
  10. Urgent Care Centers, Hospital Performance and Population Health By Bhalotra, Sonia R.; Nunes, Letícia; Rocha, Rudi
  11. Supply-Side Variation in the Use of Emergency Departments By Dan Zeltzer; Liran Einav; Avichai Chasid; Ran D. Balicer
  12. Partial Identification in Nonseparable Binary Response Models with Endogenous Regressors By Jiaying Gu; Thomas M. Russell
  13. Conscription and Military Service: Do They Result in Future Violent and Non-Violent Incarcerations and Recidivism? By Wang, Xintong; Flores-Lagunes, Alfonso
  14. The Effects of Vietnam-Era Military Service on the Long-Term Health of Veterans: A Bounds Analysis By Wang, Xintong; Flores, Carlos A.; Flores-Lagunes, Alfonso
  15. How Important Is Health Inequality for Lifetime Earnings Inequality? By Roozbeh Hosseini; Karen A. Kopecky; Kai Zhao
  16. Health Returns to Birth Weight: Evidence from Developing Countries By Kamble, Vaibhav
  17. A Model for Dual Healthcare Market with Congestion Differentiation By Damien Besancenot; Karine Lamiraud; Radu Vranceanu
  18. Political Institutions and Health Expenditure By Johannes Blum; Florian Dorn; Axel Heuer
  19. Why Does Consumption Fluctuate in Old Age and How Should the Government Insure it? By Margherita Borella; Mariacristina De Nardi
  20. Market forces in healthcare insurance: the impact of healthcare reform on regulated competition revisited By Jacob Bikker; Jack Bekooij
  21. Publicly funded hospital care: expenditure growth and its determinants By Nigel Rice; María José Aragón
  22. Fostering participation in digital public health interventions: The case of digital contact tracing By Rehse, Dominik; Tremöhlen, Felix
  23. Upswing in Industrial Activity and Infant Mortality during Late 19th Century US By Nahid Tavassoli; Hamid Noghanibehambari; Farzaneh Noghani; Mostafa Toranji
  24. Impact of closing schools on mental health during the COVID-19 pandemic: Evidence using panel data from Japan By Eiji Yamamura; Yoshiro Tsutsui
  25. A Framework for Estimating Health Spending in Response to COVID-19 By Paolo Dudine; Klaus-Peter Hellwig; Samir Jahan
  26. Deaths of Despair and the Incidence of Excess Mortality in 2020 By Casey B. Mulligan
  27. Information and Inequality in the Time of a Pandemic By Allan Dizioli; Roberto Pinheiro
  28. Going Viral: A Gravity Model of Infectious Diseases and Tourism Flows By Serhan Cevik
  29. Stigma and Misconceptions in the Time of the COVID-19 Pandemic: A Field Experiment in India By Islam, Asadul; Pakrashi, Debayan; Vlassopoulos, Michael; Wang, Liang Choon
  30. Racial Disparities in COVID-19 and Excess Mortality in Minnesota By Wrigley-Field, Elizabeth; Garcia, Sarah; Leider, Jonathon P.; Robertson, Christopher; Wurtz, Rebecca
  31. Social Distancing, Quarantine, Contact Tracing, and Testing: Implications of an Augmented SEIR Model By Andreas Hornstein
  32. A TIP Against the COVID-19 Pandemic By Reda Cherif; Fuad Hasanov
  33. Integrated Epi-Econ Assessment By Timo Boppart; Karl Harmenberg; John Hassler; Per Krusell; Jonna Olsson
  34. Labour Market Shocks during the COVID-19 Pandemic, Inequalities and Child Outcomes By Hupkau, Claudia; Isphording, Ingo E.; Machin, Stephen; Ruiz-Valenzuela, Jenifer
  35. Face masks considerably reduce COVID-19 cases in Germany By Mitze, Timo; Kosfeld, Reinhold; Rode, Johannes; Wälde, Klaus
  36. The economics of stop-and-go epidemic control By Claudius Gros; Daniel Gros
  37. Japan’s Voluntary Lockdown By Tsutomu Watanabe; Yabu Tomoyoshi

  1. By: Charness, Gary (University of California, Santa Barbara); Cobo-Reyes, Ramón (University of Essex); Eyster, Erik (University of California, Santa Barbara); Katz, Gabriel (University of Exeter); Sánchez, Ángela (NYU and Federal Reserve Bank of Minneapolis); Sutter, Matthias (Max Planck Institute for Research on Collective Goods)
    Abstract: We present a field experiment to study the effects of non-monetary incentives on healthy food choices of 282 children in elementary schools. Previous interventions have typically paid participants for healthy eating, but this often may not be feasible. We introduce a system where food items are graded based on their nutritional value, involving parents or classmates as change agents by providing them with information regarding the food choices of their children or friends. We find parents' involvement in the decision process to be particularly beneficial in boosting healthy food choices, with very strong results that persist months after the intervention.
    Keywords: healthy eating, children, parents, non-monetary incentives, field experiment
    JEL: C93 I12
    Date: 2020–12
  2. By: Pierre Dubois (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); Rachel Griffith (IFS - Laboratory of the Institute for Fiscal Studies - Institute for Fiscal Studies); Martin O'Connell (IFS - Laboratory of the Institute for Fiscal Studies - Institute for Fiscal Studies)
    Abstract: Soda taxes aim to reduce excessive sugar consumption. Policymakers highlight the young, particularly from poor backgrounds, and high sugar consumers as groups whose behavior they would most like to influence. There are also concerns about the policy being regressive. We assess who are most impacted by soda taxes. We estimate demand using micro longitudinal data covering on-the-go purchases, and exploit the panel dimension to estimate individual specific preferences. We relate these preferences and counterfactual predictions to individual characteristics and show that soda taxes are relatively effective at targeting the sugar intake of the young, are less successful at targeting the intake of those with high total dietary sugar, and are unlikely to be strongly regressive especially if consumers benefit from averted internalities.
    Keywords: Preference heterogeneity,Discrete choice demand,Pass-through,Soda tax
    Date: 2020–11
  3. By: Bütikofer, Aline (Norwegian School of Economics); Ginja, Rita (University of Bergen, Department of Economics); Landaud, Fanny (Norwegian School of Economics); Løken, Katrine V. (Norwegian School of Economics)
    Abstract: Although many students suffer from anxiety and depression, and students often identify school pressure and concerns about their futures as the main reasons for their worries, little is known about the consequences of a selective school environment on students’ physical and mental health. In this paper, we draw on rich administrative data and the features of the high school assignment system in the largest Norwegian cities to consider the long-term consequences of enrollment in a more selective high school. Using a regression discontinuity analysis, we show that eligibility to enroll in a more selective high school increases the probability of enrollment in higher education and decreases the probability of diagnosis or treatment by a general Medical practitioner for psychological symptoms and diseases. We further document that enrolling in a more selective high school has a greater positive impact when there are larger changes in the student–teacher ratio, teachers’ age, and the proportion of female teachers. These findings suggest that changes in teacher characteristics are important for better understanding the effects of a more selective school environment.
    Keywords: Parental Leave; Firm-Specific Human Capital; Statistical Discrimination; School Selectivity; Peers; Mental Health;
    JEL: I12 I21 I24 J13 J16 J21 J22 J31
    Date: 2020–10–12
  4. By: Phillip B. Levine; Robin McKnight
    Abstract: This paper examines the impact of school shootings on the educational performance and long-term health consequences of students who survive them, highlighting the impact of indiscriminate, high-fatality incidents. Initially, we focus on test scores in the years following a shooting. We also examine whether exposure to a shooting affects chronic absenteeism, which may play a role in explaining any such effect, and school expenditures, which may counteract it. We analyze national, school-district level data and additional school-level data from Connecticut in this part of the analysis. In terms of effects on health status, we focus on its most extreme measure, mortality in the years following a shooting. In this part of the analysis, we analyze county-level data on mortality by cause. In all analyses, we treat the timing of these events as random, enabling us to identify causal effects. Our results indicate that indiscriminate, high-fatality school shootings, such as those that occurred at Sandy Hook and Columbine, have considerable adverse effects on students exposed to them. We cannot rule out substantive effects of other types of shootings with fewer or no fatalities.
    JEL: I18 I21
    Date: 2020–12
  5. By: Grossmann, Volker (University of Fribourg); Strulik, Holger (Leibniz University of Hannover)
    Abstract: Empirical evidence for the U.S. suggests that illicit consumption of opioids increases in association with socio-economic deprivation of the middle-class. To explore the underlying mechanisms, we set up a task-based labor market model with endogenous mental health status and a health care system. The decline of tasks that were historically performed by the middle class and the associated decline in socio-economic status increases the share of mentally distressed middle class workers. Mentally distressed workers can mitigate their hardships by the intake of illicit drugs or by consuming health goods. We argue that explaining the rise in illicit drug use among the U.S. middle class requires an interaction of socio-economic decline and falling opioid prices, i.e. one factor in isolation is insufficient. Our analysis also points to a central role of the health care system. Extending mental health care could motivate the mentally distressed to abstain from illicit drug consumption.
    Keywords: socio-economic deprivation, Illicit drugs, mental distress, middle class, health insurance
    JEL: I10 H51
    Date: 2021–01
  6. By: Deiana, C.; Giua, L.; Nisticò, R.
    Abstract: We investigate the effect of opium price shocks on the per capita dispensation of prescription opioids in the US. Using quarterly county-level data for 2003-2016, three main results emerge. First, reductions in opium prices significantly increase the quantity of opioids prescribed, and the more so in counties with higher ex-ante demand for analgesics, as captured by the incidence of mining sites. Second, the increase involves natural and semi-synthetic but not fully-synthetic opioids, suggesting that the effect is moderated by the amount of opium contained in the products. Third, the impact is larger prior to 2010, when overdose deaths were more related to the misuse of natural and semi-synthetic prescription opioids. Our additional firm-level estimates reveal that supply-side economic incentives have played a relevant role in the opioid epidemic. Advertising expenses of opioid producers increase following negative opium price shocks and so do their stock prices and profits.
    Keywords: prescription opioids; drugs; opium price; overdose deaths; crime;
    JEL: I11 I12 I18 L65
    Date: 2020–12
  7. By: Shiyu Zhang; Daniel Guth
    Abstract: The opioid epidemic began with prescription pain relievers. In 2010 Purdue Pharma reformulated OxyContin to make it more difficult to abuse. OxyContin misuse fell dramatically, and concurrently heroin deaths began to rise. Previous research overlooked generic oxycodone and argued that the reformulation induced OxyContin users to switch directly to heroin. Using a novel and fine-grained source of all oxycodone sales from 2006-2014, we show that the reformulation led users to substitute from OxyContin to generic oxycodone, and the reformulation had no overall impact on opioid or heroin mortality. In fact, generic oxycodone, instead of OxyContin, was the driving factor in the transition to heroin. Finally, we show that by omitting generic oxycodone we recover the results of the literature. These findings highlight the important role generic oxycodone played in the opioid epidemic and the limited effectiveness of a partial supply-side intervention.
    Date: 2021–01
  8. By: Jurjen Kamphorst (Erasmus University Rotterdam); Vladimir Karamychev (Erasmus University Rotterdam)
    Abstract: We offer a theory of how the combination of budget constraints and insurance drives up prices. A natural context for our theory is the health care market, where drug prices can be very high. Our model predicts that monopoly prices for orphan drugs are inversely related to the prevalence up until a maximum price. This is supported by empirical evidence in the literature. As a result, prices of drugs sold by a monopoly treating rare serious diseases are doomed to go sky high.
    Keywords: Monopoly pricing, Insurance, Orphan Drugs
    JEL: D42 G22 I13
    Date: 2021–01–14
  9. By: Michael D. Frakes; Jonathan Gruber; Timothy Justicz
    Abstract: Recent debates over health care reform, including in the context of the Military Health System (MHS) and Veterans Health Administration, highlight the dispute between public and private provision of health care services. Using novel data on childbirth claims from the MHS and drawing on the combination of plausibly exogenous patient moves and heterogeneity across bases in the availability of base hospitals, we identify the impact of receiving obstetrical care on versus off military bases. We find evidence that off-base care is associated with slightly greater resource intensity, but also notably better outcomes, suggesting marginal efficiency gains from care privatization.
    JEL: H1 H51 I18
    Date: 2020–12
  10. By: Bhalotra, Sonia R. (University of Essex); Nunes, Letícia (Instituto de Estudos para Politicas de Saúde (IEPS)); Rocha, Rudi (São Paulo School of Business Administration)
    Abstract: Hospitals are under increasing pressure as they bear a growing burden of chronic disease while also dealing with emergency cases that do not all require hospital care. Many countries have responded by introducing alternative facilities that provide 24/7 care for basic and medium-complexity cases. Using administrative data, we investigate impacts of the opening of these intermediate facilities (UPA) in the state of Rio de Janeiro in Brazil. We find that an UPA opening in the catchment area of a hospital reduces hospital outpatient procedures and admissions and that this is associated with improved hospital performance, indicated by a decline in inpatient mortality. This does not appear to derive from a change in the risk profile of cases going to hospital but rather from hospital resources being re-focused. In a significant departure from related research, we identify displacement by investigating population-level outcomes. Our most striking result is that a large share of the decline in hospital mortality is offset by deaths in UPAs, though there remains a net decline in deaths from cardiovascular conditions that are typically amenable to primary care.
    Keywords: urgent care centers, hospital performance, displacement effects, health outcomes
    JEL: I11 I15 I18
    Date: 2020–12
  11. By: Dan Zeltzer; Liran Einav; Avichai Chasid; Ran D. Balicer
    Abstract: We study the role of person-specific and place-specific factors in explaining geographic variation in emergency department (ED) utilization using detailed data on 150,000 patients who moved regions within Israel. We document that about half of the destination-origin differences in the average ED utilization rate across districts translates to the change (up or down) in movers’ propensity to visit the ED. In contrast, we find no change in the probability of having an unplanned hospital admission (that is, via the ED), implying that the entire change in ED use by movers is driven by ED visits that do not lead to hospital admission. Similar results are obtained in a complementary event study, which uses hospital entry as a source of variation. The results from both approaches suggest that supply-side variation in ED access affects only the less severe cases—for which close substitutes likely exist—and that variation across ED physicians in their propensity to admit patients is not explained by place-specific factors, such as differences in incentives, capacity, or diagnostic quality.
    JEL: I11
    Date: 2020–12
  12. By: Jiaying Gu; Thomas M. Russell
    Abstract: This paper considers (partial) identification of a variety of parameters, including counterfactual choice probabilities, in a general class of binary response models with possibly endogenous regressors. Importantly, our framework allows for nonseparable index functions with multi-dimensional latent variables, and does not require parametric distributional assumptions. We demonstrate how various functional form, independence, and monotonicity assumptions can be imposed as constraints in our optimization procedure to tighten the identified set, and we show how these assumptions have meaningful interpretations in terms of restrictions on latent types. In the special case when the index function is linear in the latent variables, we leverage results in computational geometry to provide a tractable means of constructing the sharp set of constraints for our optimization problems. Finally, we apply our method to study the effects of health insurance on the decision to seek medical treatment.
    Date: 2021–01
  13. By: Wang, Xintong (Slippery Rock University of Pennsylvania); Flores-Lagunes, Alfonso (Syracuse University)
    Abstract: Employing nonparametric bounds, we examine the effect of military service on incarceration outcomes using the Vietnam draft lotteries as a possibly invalid instrumental variable for military service. The draft is allowed to have a direct effect on the outcomes independently of military service, disposing of the exclusion restriction. We find: (i) suggestive but not strong statistical evidence that the direct effect of the draft increases the incarceration rate for violent offenses for a particular cohort of draft avoiders, and (ii) military service increases the incarceration rate for violent and nonviolent crimes of white volunteers and veterans in certain birth cohorts.
    Keywords: conscription, military service, incarceration, crime, nonparametric bounds
    JEL: K4 C31 C36
    Date: 2020–12
  14. By: Wang, Xintong (Binghamton University, New York); Flores, Carlos A. (California Polytechnic State University); Flores-Lagunes, Alfonso (Syracuse University)
    Abstract: We analyze the short- and long-term effects of the U.S. Vietnam-era military service on veterans' health outcomes using a restricted version of the National Health Interview Survey 1974-2013 and employing the draft lotteries as an instrumental variable (IV). We start by assessing whether the draft lotteries, which have been used as an IV in prior literature, satisfy the exclusion restriction by placing bounds on its net or direct effect on the health outcomes of individuals who are non-veterans regardless of their draft eligibility (the "never takers"). Since we do not find evidence against the validity of the IV, we assume its validity in conducting inference on the health effects of military service for individuals who comply with the draft-lotteries assignment (the "compliers"), as well as for those who volunteer for enlistment (the "always takers"). The causal analysis for volunteers, who represent over 75% of veterans, is novel in this literature that typically focuses on the compliers. Since the effect for volunteers is not point-identified, we employ bounds that rely on a mild mean weak monotonicity assumption. We examine a large array of health outcomes and behaviors, including mortality, up to 40 years after the end of the Vietnam War. We do not find consistent evidence of detrimental health effects on compliers, in line with prior literature. For volunteers, however, we document that their estimated bounds show statistically significant detrimental health effects that appear 20 years after the end of the conflict. As a group, veterans experience similar statistically significant detrimental health effects from military service. These findings have implications for policies regarding compensation and health care of veterans after service.
    Keywords: veteran health, treatment effects, bounds, instrumental variables
    JEL: I12 C31 C36
    Date: 2021–01
  15. By: Roozbeh Hosseini; Karen A. Kopecky; Kai Zhao
    Abstract: Using a dynamic panel approach, we provide empirical evidence that negative health shocks reduce earnings. The effect is primarily driven by the participation margin and is concentrated in less educated individuals and those with poor health. We build a dynamic, general equilibrium, life cycle model that is consistent with these findings. In the model, individuals whose health is risky and heterogeneous choose to either work, or not work and apply for social security disability insurance (SSDI). Health affects individuals’ productivity, SSDI access, disutility from work, mortality, and medical expenses. Calibrating the model to the United States, we find that health inequality is an important source of lifetime earnings inequality: nearly 29 percent of the variation in lifetime earnings at age 65 is due to the fact that Americans face risky and heterogeneous life cycle health profiles. A decomposition exercise reveals that the primary reason why individuals in the United States in poor health have low lifetime earnings is because they have a high probability of obtaining SSDI benefits. In other words, the SSDI program is an important contributor to lifetime earnings inequality. Despite this, we show that it is ex ante welfare improving and, if anything, should be expanded.
    Keywords: earnings; health; frailty; inequality; disability; dynamic panel estimation; life-cycle models
    JEL: D52 D91 E21 H53 I13 I18
    Date: 2021–01–04
  16. By: Kamble, Vaibhav
    Abstract: This paper explores the effect of birth weight on a series of anthropometric outcomes among children. We use a panel of individual-level data from 39 developing countries covering the years 1999-2018 and attempt to solve the Endogeneity using mother fixed effect and twin fixed-effect strategies. The results suggest that improvements in birth weight result in statistically and economically significant improvements in children's anthropometric outcomes. An additional 100 grams birth weight is associated with a 0.43 and 0.25 units increase in weight for age percentile and height for age percentile, respectively. The links are stronger among low educated mothers and poorer households. The observed protective effect of birth weight on infant mortality suggests that the true effects of birth weight on children’s outcomes are larger and that the estimated effects probably understate the true effects.
    Keywords: Health, Fetal Origin Hypothesis, Children Anthropometry, Height for Age, Weight for Age, Birth Weight, Twin Fixed Effect
    JEL: D10 I15 J13 P36
    Date: 2021–01–05
  17. By: Damien Besancenot (UP - Université de Paris, LIRAES - EA 4470 - Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé - UP - Université de Paris); Karine Lamiraud (ESSEC Business School - Essec Business School, THEMA - Théorie économique, modélisation et applications - CNRS - Centre National de la Recherche Scientifique - CY - CY Cergy Paris Université); Radu Vranceanu (ESSEC Business School - Essec Business School, THEMA - Théorie économique, modélisation et applications - CNRS - Centre National de la Recherche Scientifique - CY - CY Cergy Paris Université)
    Abstract: The French market for specialist physician care has a dual legal structure: physicians must exclusively work in sector 1 and charge regulated fees or in sector 2, where they can freely set their fees. Patient out-of-pocket payments in sector 2 are partially covered by private insurance. The primary differentiating factor between both sectors is the number of patients per specialist, which in turn directly affects the overall quality of the service provided. We built an equilibrium model to analyse both specialists decisions about which sector to work in, and patients choice of physician and therefore sector. More specifically, the model allowed us to study the effect of changes in prices and economy-wide patient-to-specialist ratios on profits and patients utility associated with the services provided in each sector.
    Keywords: Dual market,Congestion,Regulation,Balance billing
    Date: 2020–11–22
  18. By: Johannes Blum; Florian Dorn; Axel Heuer
    Abstract: We examine how political institutions influence health expenditure by using a panel of 151 developing and developed countries for the years 2000 to 2015 and four measures of democracy. Our pooled OLS analysis shows that democracies have 20–30% higher government health expenditure relative to GDP than their autocratic counterparts. An instrumental variable approach which exploits the regional diffusion of democracy confirms the positive effect of democracy on government health expenditure. Panel fixed effects and event study models also suggest a positive within-country effect of democratization on government health expenditure within a short period after regime transition. Democratic rule, however, does not turn out to significantly influence private health expenditure compared to autocracies. We conclude that democracies may care more for their citizens and strive to decrease inequalities in the access to health care.
    Keywords: Democracy, panel data, instrumental variable, development, health expenditure
    JEL: I15 I18 H51 P50 C23 C26
    Date: 2021
  19. By: Margherita Borella; Mariacristina De Nardi
    Abstract: In old age, consumption can fluctuate because of shocks to available resources and because health shocks affect utility from consumption. We find that even temporary drops in income and health are associated with drops in consumption and most of the effect of temporary drops in health on consumption stems from the reduction in the marginal utility from consumption that they generate. More precisely, after a health shock, richer households adjust their consumption of luxury goods because their utility of consuming them changes. Poorer households, instead, adjust both their necessary and luxury consumption because of changing resources and utility from consumption.
    JEL: D10 D11 D12 D14 E20 E21 H20 H31 H51
    Date: 2020–10–23
  20. By: Jacob Bikker; Jack Bekooij
    Abstract: This paper investigates the impact of market forces on competitive behaviour and efficiency in healthcare by investigating the Dutch healthcare insurance reform in 2006. This reform replaced the dual system of public and private insurance with a single compulsory health insurance scheme, in which insurance providers compete for customers in a free market. We measure competition directly from either shifts in market shares, or developments in profits. Using formal tests we find that in each approach a structural break occurs after the reform: competition is significantly higher after 2006 than before. Several robustness tests confirm this outcome. Nevertheless, we find that the health insurance sector is still less competitive than the banking, manufacturing and service industries, and even less competitive than life insurance.
    Keywords: (regulated) competition; concentration; healthcare insurance; performance-conduct-structure model; Boone-indicator; scale economies
    JEL: G22 H51
    Date: 2021–01
  21. By: Nigel Rice (Centre for Health Economics, University of York, UK); María José Aragón (Centre for Health Economics, University of York, UK)
    Abstract: Understanding the drivers of growth in health care expenditure is crucial for forecasting future health care requirements and for the efficient use of resources. We consider total hospital admitted care expenditure in England between 2009/10 and 2016/17. Decomposition techniques are used to separate changes in expenditure into elements due to changes in the distribution of characteristics, of both individuals and the services they receive, and due to changes in the impact of characteristics on expenditures. Growth in aggregate expenditure was due to increases in total patient admissions together with a substantial shift towards episodes of non-elective care, particularly the use of long-stay care. Decomposition of patient level expenditure suggests efficiency gains in treatment across the full distribution of expenditures, but that these were outweighed by structural changes towards a greater proportion of patients presenting with high-dimensional comorbidities. This is particularly relevant at the top end of the expenditure distribution and accounts for a large proportion of the total expenditure growth.
    Keywords: Health Care Expenditure Growth, decompositions, Hospital Episode Statistics
    JEL: C1 I1
    Date: 2021–01
  22. By: Rehse, Dominik; Tremöhlen, Felix
    Abstract: The SARS-CoV-2 pandemic has made all the more clear that public health is a public good. Public health interventions try to encourage contributions to this public good. Digital public health interventions are increasingly being used to complement traditional public health interventions. The rollout of digital contact tracing apps during the SARS-CoV-2 pandemic is a prominent example. We review the literature on how participation in such digital public health interventions could be fostered, provide an overview of digital contact tracing as one such intervention, provide policy recommendations on how to increase its adoption and usage as well as recommendations for further research.
    Keywords: Public health,Public good,Public health intervention,Digital contact tracing
    JEL: H41 I12 I18
    Date: 2020
  23. By: Nahid Tavassoli; Hamid Noghanibehambari; Farzaneh Noghani; Mostafa Toranji
    Abstract: This paper aims to assess the effects of industrial pollution on infant mortality between the years 1850-1940 using full count decennial censuses. In this period, US economy experienced a tremendous rise in industrial activity with significant variation among different counties in absorbing manufacturing industries. Since manufacturing industries are shown to be the main source of pollution, we use the share of employment at the county level in this industry to proxy for space-time variation in industrial pollution. Since male embryos are more vulnerable to external stressors like pollution during prenatal development, they will face higher likelihood of fetal death. Therefore, we proxy infant mortality with different measures of gender ratio. We show that the upswing in industrial pollution during late nineteenth century and early twentieth century has led to an increase in infant mortality. The results are consistent and robust across different scenarios, measures for our proxies, and aggregation levels. We find that infants and more specifically male infants had paid the price of pollution during upswing in industrial growth at the dawn of the 20th century. Contemporary datasets are used to verify the validity of the proxies. Some policy implications are discussed.
    Date: 2021–01
  24. By: Eiji Yamamura; Yoshiro Tsutsui
    Abstract: The spread of the novel coronavirus disease caused schools in Japan to close to cope with the pandemic. In response to this, parents of students were obliged to care for their children during the daytime when they were usually at school. Does the increase in burden of childcare influence parents mental health? Based on short panel data from mid-March to mid-April 2020, we explored how school closures influenced the mental health of parents with school-aged children. Using the fixed effects model, we found that school closures lead to students mothers suffering from worse mental health than other females, while the fathers mental health did not differ from other males. This tendency was only observed for less educated mothers who had children attending primary school, but not those attending junior high school. The contribution of this paper is to show that school closures increased the inequality of mental health between genders and the educational background of parents.
    Date: 2021–01
  25. By: Paolo Dudine; Klaus-Peter Hellwig; Samir Jahan
    Abstract: We estimate the additional health spending necessary to treat COVID-19 patients. We expand a Susceptible Infected Recovered model to project the number of people requiring hospitalization, use information about healthcare costs by country, and make assumptions about capacity constraints in the health sector. Without social distancing and lockdowns, countries would need to expand health systems ten-fold, on average, to assist all COVID-19 patients in need of hospitalization. Under capacity constraints, effective social distancing and quarantine reduce the additional health spending from a range of $0.6–1 trillion globally to $130–231 billion, and the fatality rate from 1.2 to 0.2 percent, on average.
    Keywords: Health care spending;Health;Population and demographics;COVID-19 ;Capacity utilization;WP,health sector,health system,reproduction number,fatality rate,cost parameter
    Date: 2020–07–24
  26. By: Casey B. Mulligan
    Abstract: Weekly mortality through October 3 is partitioned into normal deaths, COVID, and nonCOVID excess deaths (NCEDs). Before March, the excess is negative for the elderly, likely due to the mild flu season. From March onward, excess deaths are approximately 250,000 of which about 17,000 appear to be a COVID undercount and 30,000 non-COVID. Deaths of despair (drug overdose, suicide, alcohol) in 2017 and 2018 are good predictors of the demographic groups with NCEDs in 2020. The NCEDs are disproportionately experienced by men aged 15-55, including men aged 15-25. Local data on opioid overdoses further support the hypothesis that the pandemic and recession were associated with a 10 to 60 percent increase in deaths of despair above already high pre-pandemic levels.
    JEL: H22 I18 L51
    Date: 2020–12
  27. By: Allan Dizioli; Roberto Pinheiro
    Abstract: We introduce two types of agent heterogeneity in a calibrated epidemiological search model. First, some agents cannot afford staying home to minimize their virus exposure, while others can. Our results show that these poor agents bear most of the epidemic’s health costs. Moreover, we show that having more agents who do not change their behavior during the pandemic could lead to a deeper recession. Second, agents are heterogeneous in developing symptoms. We show that diseases with higher share of asymptomatic cases, even if less lethal, lead to worse health and economic outcomes. Public policies such as testing, quarantining, and lockdowns are particularly beneficial in economies with a larger share of poor agents. However, lockdowns lose effectiveness when part of the agents take precautions to minimize virus exposure independent of government actions.
    Keywords: Health;Labor supply;Labor;Public expenditure review;Population and demographics;WP,infection rate,asymptomatic infection
    Date: 2020–09–11
  28. By: Serhan Cevik
    Abstract: This paper develops a gravity model framework to estimate the impact of infectious diseases on bilateral tourism flows among 38,184 pairs of countries over the period 1995–2017. The results confirm that international tourism is adversely affected by disease risk, and the magnitude of this negative effect is statistically and economically significant. In the case of SARS, for example, a 10 percent rise in confirmed cases leads to a reduction of as much as 9 percent in tourist arrivals. Furthermore, while infectious diseases appear to have a smaller and statistically insignificant negative effect on tourism flows to advanced economies, the magnitude and statistical significance of the impact of infectious diseases are much greater in developing countries, where such diseases tend to be more prevalent and health infrastructure lags behind.
    Keywords: Communicable diseases;Tourism;COVID-19 ;Ebola;Health;WP,infectious disease,yellow fever
    Date: 2020–07–03
  29. By: Islam, Asadul (Monash University); Pakrashi, Debayan (Indian Institute of Technology Kanpur); Vlassopoulos, Michael (University of Southampton); Wang, Liang Choon (Monash University)
    Abstract: A hidden cost of the COVID-19 pandemic is the stigma associated with the disease for those infected and groups that are considered as more likely to be infected. This paper examines whether the provision of accurate and focused information about COVID-19 from a reliable source can reduce stigmatization. We carry out a randomized field experiment in the state of Uttar Pradesh, India, in which we provide an information brief about COVID-19 by phone to a random subsample of participants to address stigma and misconceptions. We find that the information brief decreases stigmatization of COVID-19 patients and certain groups such as religious minorities, lower-caste groups, and frontline workers (healthcare, police), and reduces the belief that infection cases are more prevalent among certain marginalized social and economic groups (Muslims, low caste, rural-poor population). We provide suggestive evidence that improved knowledge about the prevention and transmission of COVID-19 and reduced stress about the disease are important channels for these effects.
    Keywords: stigma, COVID-19, misconceptions, information, experiment, infodemics
    JEL: D83 I18 J16 J18
    Date: 2020–12
  30. By: Wrigley-Field, Elizabeth; Garcia, Sarah; Leider, Jonathon P.; Robertson, Christopher; Wurtz, Rebecca
    Abstract: The COVID-19 pandemic has produced vastly disproportionate deaths for communities of color in the United States. Minnesota seemingly stands out as an exception to this national pattern, with white Minnesotans accounting for 80% of the population and 82% of COVID-19 deaths. We examine confirmed COVID mortality alongside deaths indirectly attributable to the pandemic -- ‘excess mortality’ -- in Minnesota. This analysis reveals profound racial disparities: age-adjusted excess mortality rates for whites are exceeded by a factor of 2.8-5.3 for all other racial groups, with the highest rates among Black, Latino, and Native Minnesotans. The seemingly small disparities in COVID deaths in Minnesota reflect the interaction of three factors: the natural history of the disease whose early toll was heavily concentrated in nursing homes; an exceptionally divergent age distribution in the state; and a greatly different proportion of excess mortality captured in confirmed-COVID rates for white Minnesotans compared with most other groups.
    Date: 2020–12–06
  31. By: Andreas Hornstein
    Abstract: This paper modifies the basic SEIR model to incorporate demand for health care. The model is used to study the relative effectiveness of policy interventions that include social distancing, quarantine, contact tracing, and random testing. A version of the model that is calibrated to the Ferguson et al. (2020) model suggests that permanent, high-intensity social distancing reduces mortality rates and peak ICU demand substantially, but that a policy that relaxes high-intensity social distancing over time in the context of a permanent efficient quarantine regime is even more effective and also likely to be less disruptive for the economy. Adding contact tracing and random testing to this policy further improves outcomes. However, given the uncertainty surrounding the disease parameters, especially the transmission rate of the disease and the effectiveness of policies, the uncertainty for health outcomes is very large.
    Keywords: SEIR; SEIR Model; Social Distancing; COVID-19
    Date: 2020–05–08
  32. By: Reda Cherif; Fuad Hasanov
    Abstract: A universal testing and isolation policy is the most viable way to vanquish a pandemic. Its implementation requires: (i) an epidemiological rather than clinical approach to testing, sacrificing accuracy for scalability, convenience and speed; and (ii) state intervention to ramp up production, similar to True Industrial Policy (TIP), on a global level to achieve a scale and speed the market alone would fail to provide. We sketch a strategy to tackle market failures and implement smart testing, especially in densely populated areas. The estimated cost of testing is dwarfed by its return, mitigating the economic fallout of the pandemic.
    Keywords: Population and demographics;Health;Early warning systems;Public expenditure review;Labor;WP,production capacity,value chain,false positive
    Date: 2020–07–03
  33. By: Timo Boppart; Karl Harmenberg; John Hassler; Per Krusell; Jonna Olsson
    Abstract: We formulate an economic time use model and add to it an epidemiological SIR block. In the event of an epidemic, households shift their leisure time from activities with a high degree of social interaction to activities with less, and also choose to work more from home. Our model highlights the different actions taken by young individuals, who are less severely affected by the disease, and by old individuals, who are more vulnerable. We calibrate our model to time use data from ATUS, employment data, epidemiological data, and estimates of the value of a statistical life. There are qualitative as well as quantitative differences between the competitive equilibrium and social planner allocation and, moreover, these depend critically on when a cure arrives. Due to the role played by social activities in people's welfare, simple indicators such as deaths and GDP are insuffcient for judging outcomes in our economy.
    JEL: E10 I10
    Date: 2020–12
  34. By: Hupkau, Claudia (CUNEF, Madrid); Isphording, Ingo E. (IZA); Machin, Stephen (London School of Economics); Ruiz-Valenzuela, Jenifer (London School of Economics)
    Abstract: We study the effect of negative labour market shocks borne by parents during the Covid-19 crisis on resource and time investments in children and the channels through which negative labour market shocks experienced by parents might affect children. Using data collected in the UK before and during the pandemic, we show that fathers and mothers that were already disadvantaged were more likely to have suffered negative earnings and employment shocks. These shocks had an immediate intergenerational impact: Children whose fathers reported an earnings drop to zero are significantly less likely to have received additional paid learning resources compared to similar children whose fathers did not experience a drop in earnings. Potentially offsetting this, they received about 30 more mins of parental help with schoolwork per day. Parental mental health is negatively affected when they experience earnings losses, and fathers who experience a full loss in earnings were less likely to quarrel or talk about things that matter with their kids than fathers who did not suffer earnings drops. The interactions between labour market shocks, parental investments and school closures are likely to have important implications for future inequality.
    Keywords: job loss, job insecurity, child outcomes
    JEL: J63 J65 I20 I24
    Date: 2020–12
  35. By: Mitze, Timo; Kosfeld, Reinhold; Rode, Johannes; Wälde, Klaus
    Abstract: Mitigating the spread of COVID-19 is the objective of most governments. It is of utmost importance to understand how effective various public health measures are. We study the effectiveness of face masks. We employ public regional data about reported severe acute respiratory syndrome coronavirus 2 infections for Germany. As face masks became mandatory at different points in time across German regions, we can compare the rise in infections in regions with masks and regions without masks. Weighing various estimates, we conclude that 20 d after becoming mandatory face masks have reduced the number of new infections by around 45%. As economic costs are close to zero compared to other public health measures, masks seem to be a cost-effective means to combat COVID-19.We use the synthetic control method to analyze the effect of face masks on the spread of COVID-19 in Germany. Our identification approach exploits regional variation in the point in time when wearing of face masks became mandatory in public transport and shops. Depending on the region we consider, we find that face masks reduced the number of newly registered severe acute respiratory syndrome coronavirus 2 infections between 15% and 75% over a period of 20 days after their mandatory introduction. Assessing the credibility of the various estimates, we conclude that face masks reduce the daily growth rate of reported infections by around 47%. Public health data have been deposited in FigShare ( All study data are included in the paper and SI Appendix.
    Date: 2020
  36. By: Claudius Gros; Daniel Gros
    Abstract: We analyze 'stop and go' containment policies which produces infection cycles as periods of tight lock-downs are followed by periods of falling infection rates, which then lead to a relaxation of containment measures, allowing cases to increase again until another lock-down is imposed. The policies followed by several European countries seem to fit this pattern. We show that 'stop and go' should lead to lower medical costs than keeping infections at the midpoint between the highs and lows produced by 'stop and go'. Increasing the upper and reducing the lower limits of a stop and go policy by the same amount would lower the average medical load. But increasing the upper and lowering the lower limit while keeping the geometric average constant would have the opposite impact. We also show that with economic costs proportional to containment, any path that brings infections back to the original level (technically a closed cycle) has the same overall economic cost.
    Date: 2020–12
  37. By: Tsutomu Watanabe; Yabu Tomoyoshi
    Abstract: Japans government has taken a number of measures, including declaring a state of emergency, to combat the spread COVID-19. We examine the mechanisms through which the governments policies have led to changes in peoples behavior. Using smartphone location data, we construct a daily prefecture-level stay-at-home measure to identify the following two effects: (1) the effect that citizens refrained from going out in line with the governments request, and (2) the effect that government announcements reinforced awareness with regard to the seriousness of the pandemic and people voluntarily refrained from going out. Our main findings are as follows. First, the declaration of the state of emergency reduced the number of people leaving their homes by 8.6% through the first channel, which is of the same order of magnitude as the estimate by Goolsbee and Syverson (2020) for lockdowns in the United States. Second, a 1% increase in new infections in a prefecture reduces peoples outings in that prefecture by 0.026%. Third, the governments requests are responsible for about one quarter of the decrease in outings in Tokyo, while the remaining three quarters are the result of citizens obtaining new information through government announcements and the daily release of the number of infections. Our results suggest that what is necessary to contain the spread of COVID-19 is not strong, legally binding measures but the provision of appropriate information that encourages people to change their behavior.
    Date: 2020–09

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