nep-hea New Economics Papers
on Health Economics
Issue of 2021‒02‒08
thirty-six papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. A local community course that raises mental wellbeing and pro-sociality By Krekel, Christian; De Neve, Jan-Emmanuel; Fancourt, Daisy; Layard, Richard
  2. Does external medical review reduce disability insurance inflow? By Helge Liebert
  3. Climate Change and Occupational Health: Are There Limits to Our Ability to Adapt? By Marcus Dillender
  4. Uninsured by choice? A choice experiment on long term care insurance By Akaichi, Faical; Costa-Font, Joan; Frank, Richard
  5. Fatality Risk Regulation By Hammitt, James K.; Treich, Nicolas
  6. Selection and Causation in the Parental Education Gradient in Health: Lessons from a Large Sample of Adoptees By Evelina Björkegren; Mikael Lindahl; Mårten Palme; Emilia Simeonova
  7. Public Health Insurance and Medical Spending: Evidence from the ACA Medicaid Expansion By Cortnie Shupe
  8. [Job] Locked and [Un]loaded: The Effect of the Affordable Care Act Dependency Mandate on Reenlistment in the U.S. Army By Michael S. Kofoed; Wyatt J. Frasier
  9. Does the Healthcare Educational Market Respond to Short-Run Local Demand? By Marcus Dillender; Andrew Friedson; Cong Gian; Kosali Simon
  10. Omitting the Obvious: Cohort Effects in 19th and 20th Century BMI Variation By Scott A. Carson
  11. Medical Innovation, Education, and Labor Market Outcomes of Cancer Patients By Sung-Hee Jeon; Vincent Pohl
  12. The Causal Impact of Depression on Cognitive Functioning: Evidence from Europe By Nafilyan, Vahé; Pabon, Mauricio Avendano; de Coulon, Augustin
  13. Looking into the Black Box of “Medical Progress”: Rising Health Expenditures by Illness Type and Age By Friedrich Breyer; Normann Lorenz; Gerald Pruckner; Thomas Schober
  14. Multivariate risk preferences in the QALY model By Attema, Arthur; Frasch, Jona; L'Haridon, Olivier
  15. A Unified Model of Cohort Mortality for Economic Analysis By Adriana Lleras-Muney; Flavien E. Moreau
  16. Economics and mental health: the current scenario By Knapp, Martin; Wong, Gloria
  17. Private and Public Investments in Biomedical Research By Maya M. Durvasula; Lisa Larrimore Ouellette; Heidi L. Williams
  18. Health Returns to Birth Weight: Evidence from Developing Countries By Keshav, Vaibhav
  19. Maternal Mortality Risk and Spousal Differences in the Demand for Children By Nava Ashraf; Erica M. Field; Alessandra Voena; Roberta Ziparo
  20. Private and Social Returns to R&D: Drug Development and Demographics By Efraim Benmelech; Janice C. Eberly; Joshua L. Krieger; Dimitris Papanikolaou
  21. The First Wave of the COVID-19 Pandemic and Its Impact on Socioeconomic Inequality in Psychological Distress in the UK By Davillas, Apostolos; Jones, Andrew M.
  22. Impact of closing schools on mental health during the COVID-19 pandemic: Evidence using panel data from Japan By YAMAMURA, Eiji; Tsutsui, Yoshiro
  23. The causal effects of long-term PM2.5 exposure on COVID-19 in India By Takahiro Yamada; Hiroyuki Yamada; Muthukumara Mani
  24. School Closures During the 1918 Flu Pandemic By Philipp Ager; Katherine Eriksson; Ezra Karger; Peter Nencka; Melissa A. Thomasson
  25. Toward a Uniform Classification of Nurse Practitioner Scope of Practice Laws By Benjamin J. McMichael; Sara Markowitz
  26. The sooner the better: lives saved by the lockdown during the COVID-19 outbreak. The case of Italy By Roy Cerqueti; Raffaella Coppier; Alessandro Girardi; Marco Ventura
  27. Pandemics and Aggregate Demand: a Framework for Policy Analysis By Peter Flaschel; Giorgos Galanis; Daniele Tavani; Roberto Veneziani
  28. Pricing the COVID-19 Vaccine: A Mathematical Approach By Susan Martonosi; Banafsheh Behzad; Kayla Cummings
  29. Social Distancing During a Pandemic: The Role of Friends By Michael Bailey; Drew M. Johnston; Martin Koenen; Theresa Kuchler; Dominic Russel; Johannes Stroebel
  30. Do epidemics impose a trade-off between freedom and health? Evidence from Europe during Covid-19. By Bartolini, Stefano; Sarracino, Francesco; Slater, Giulia
  31. Challenges of Equitable Vaccine Distribution in the COVID-19 Pandemic By Joseph Bae; Darshan Gandhi; Jil Kothari; Sheshank Shankar; Jonah Bae; Parth Patwa; Rohan Sukumaran; Sethuraman T. V.; Krutika Mishra; Srinidhi Murali; Aishwariya Saxena; Kasia Jakimowicz; Vivek Sharma; Rohan Iyer; Ashley Mehra; Alex Radunsky; Priyanshi Katiyar; Sunaina Anand; Shailesh Advani; Jagjit Dhaliwal; Ramesh Raskar
  32. COVID-19, jobs and the future of work in the LDCs a (disheartening) preliminary account By Parisotto, Aurelio.; Elsheikhi, Adam.
  33. The Future after COVID-19: Healthcare, Digitalization and Inequality By Julia M. Puaschunder
  34. Twitter Subjective Well-Being Indicator During COVID-19 Pandemic: A Cross-Country Comparative Study By Tiziana Carpi; Airo Hino; Stefano Maria Iacus; Giuseppe Porro
  35. Changing patterns of domestic abuse during Covid-19 lockdown By Ria Ivandic; Tom Kirchmaier; Ben Linton
  36. Globalization and pandemics By Pol Antràs; Stephen J. Redding; Esteban Rossi-Hansberg

  1. By: Krekel, Christian; De Neve, Jan-Emmanuel; Fancourt, Daisy; Layard, Richard
    Abstract: Although correlates of mental wellbeing have been extensively studied, relatively little is known about how to effectively raise mental wellbeing in local communities by means of intervention. We conduct a randomised controlled trial of the "Exploring What Matters" course, a scalable social-psychological intervention aimed at raising general adult population mental wellbeing and pro-sociality. The manualised course is run by non-expert volunteers in their local communities and to date has been conducted in more than 26 countries around the world. We find that it has strong, positive causal effects on participants' selfreported subjective wellbeing (life satisfaction increases by about 63% of a standard deviation) and prosociality (social trust increases by about 53% of a standard deviation) while reducing measures of mental ill health (PHQ-9 and GAD-7 decrease by about 50% and 42% of a standard deviation, respectively). Impacts seem to be sustained two months post-treatment. We complement self-reported outcomes with biomarkers collected through saliva samples, including cortisol and a range of cytokines involved in inflammatory response. These move consistently into the hypothesised direction but are noisy and do not reach statistical significance at conventional levels
    Keywords: international trade; export demand; import competition; productivity; allocative efficiency; misallocation
    JEL: C93 I12 I31
    Date: 2020–01
  2. By: Helge Liebert
    Abstract: This paper investigates the effects of introducing external medical review for disability insurance (DI) in a system relying on treating physician testimony for eligibility determination. Using a unique policy change and administrative data from Switzerland, I show that medical review reduces DI incidence by 23%. Incidence reductions are closely tied to difficult-to-diagnose conditions, suggesting inaccurate assessments by treating physicians. Due to a partial benefit system, reductions in full benefit awards are partly offset by increases in partial benefits. More intense screening also increases labor market participation. Existing benefit recipients are downgraded and lose part of their benefit income when scheduled medical reviews occur. Back-of-the-envelope calculations indicate that external medical review is highly cost-effective. Under additional assumptions, the results provide a lower bound of the effect on the false positive award error rate.
    Date: 2021–01
  3. By: Marcus Dillender (W.E. Upjohn Institute for Employment Research)
    Abstract: This study considers the relationship between temperature and occupational health. The results indicate that both high and low temperatures increase injury rates and that high temperatures have more severe adverse effects in warmer climates, which suggests that avoiding the adverse effects of high temperatures may be easier for workers when hot days are rarer. While research on the effect of temperature on mortality finds substantial capacity for adaption with current technology, the results presented here suggest that outdoor workers face challenges in adapting to high temperatures.
    Keywords: Multipliers, agglomeration economies, congestion effects, high-technology industries
    JEL: R11 R23
    Date: 2019–02
  4. By: Akaichi, Faical; Costa-Font, Joan; Frank, Richard
    Abstract: We examine evidence from two unique discrete choice experiments (DCE) on long term care insurance and values several of its relevant attributes. More specifically, the experiments examine choices made by a large sample made of 15,298 individuals in the United States with and without insurance. We study the valuation of a number of insurance attributes, namely the daily insurance benefit, insurance coverage, the compulsory and voluntary nature of the insurance policy design, alongside the costs (insurance premium) and health requirements. This paper elicits both respondents’ preferences and willingness to pay (WTP) for these care insurance's attributes using a random parameter logit model, and assesses the heterogeneity of choice responses using demographic, socioeconomic and attitudinal motivations to segment response to insurance choices. We find that an increase in the insurance premium by an additional $100 would reduce insurance uptake by 1pp. Insurance policy uptake is higher when it provides benefits for the lifetime (the monthly marginal WTP being $178.64), and voluntary (the monthly marginal WTP increases by an extra $74.71) as opposed to universal, and when it forgoes health checks (the monthly marginal WTP increases by an extra 28US$).
    Keywords: long term care insurance; constrained choices; self-insurance; behavioural constraints; insurance design
    JEL: I18 I31
    Date: 2020–05–01
  5. By: Hammitt, James K.; Treich, Nicolas
    Abstract: Environmental, transportation, occupational, and other regulations that reduce fatality risk are frequently evaluated using benefit-cost analysis (BCA). We examine how risk reductions are valued under BCA, utilitarian and prioritarian SWFs. The social value of risk reduction (SVRR) to an individual is the rate of increase of social welfare for a small decrease to the individual’s current-period fatality risk. Under BCA, the SVRR is the individual’s value per statistical life (VSL), which is increasing in wealth and baseline risk. Under utilitarian and prioritarian SWFs, the SVRR is far less sensitive to income; it can decrease with income for prioritarian SWFs that exhibit sufficient inequality aversion. The SVRR increases with or is independent of baseline risk. Like VSL, it can increase or decrease with age, but prioritarian SWFs assign larger SVRR to younger relative to older individuals than does the utilitarian SWF. Extensions to catastrophe aversion and nonfatal health risks are discussed.
    Keywords: mortality; regulation; benefit-cost analysis; value of a statistical life; fair innings; age; income; catastrophe aversion; prioritarian; utilitarian
    Date: 2021–01
  6. By: Evelina Björkegren; Mikael Lindahl; Mårten Palme; Emilia Simeonova
    Abstract: We use data from a large sample of adoptees born in Sweden to study to what extent the well-established association between parental educational attainments and adult health of the child generation can be attributed to pre- or post-birth factors, respectively. We find a significant association between the educational attainment of the adopting parents and child health outcomes as adults. These results suggest that growing up in a better-educated household has long-term effects on health outcomes. Our analysis of the mechanisms behind the results suggests that formation of human capital, and in particular cognitive and non-cognitive skills, may be important.
    JEL: I1 I12 I14 I26
    Date: 2020–12
  7. By: Cortnie Shupe
    Abstract: This paper investigates the short-run impact of public insurance expansion under the Affordable Care Act on out-of-pocket medical spending (OOP) and risk exposure among low-income, eligible households as well as the incidence of the cost of providing insurance. Using data from the Medical Expenditures Panel Survey (MEPS), I exploit exogenous variation in Medicaid eligibility rules across states, income groups and time. I find that public insurance eligibility reduced mean OOP by 18.2% among targeted households, but it did not causally increase total expenditures among beneficiaries. Rather, Medicaid expansion shifted the burden of payment from eligible households and private insurance (17% reduction) to taxpayers in the form of public insurance (45.7% increase). The efficiency of these public funds can be summarized by a Marginal Value of Public Funds ranging from 0.06 to 0.59 that is highest for households with at least one pre-existing condition.
    Keywords: public health insurance, risk protection, MVPF, Medicaid, out-of-pocket expenditures, Affordable Care Act
    JEL: D04 D61 H44 I13
    Date: 2021
  8. By: Michael S. Kofoed (United States Military Academy); Wyatt J. Frasier (United States Army)
    Abstract: One concern with employer-based health insurance is job lock or the inability for employees to leave their current employment for better opportunities for fear of losing benefits. We use the implementation of the Affordable Care Act’s dependency mandate as a natural experiment. Data from the United States Army overcome some limitations in previous studies including the ability to examine workers with fixed contract expiration dates, uniform pay, and health coverage. We find that the ACA decreased reenlistment rates by 3.13 percent for enlisted soldiers aged 23–25. We also find that younger veterans who leave the army are more likely to attend college. These findings show that the ACA reduced job lock and increased college-going.
    Keywords: Affordable Care Act, Job Lock, Military Enlistment, GI Bill
    JEL: I13 J22 H56
    Date: 2019–02
  9. By: Marcus Dillender (University of Illinois at Chicago); Andrew Friedson (University of Colorado-Denver); Cong Gian (Indiana University); Kosali Simon (Indiana University)
    Abstract: The Patient Protection and Affordable Care Act (ACA) increased demand for healthcare across the U.S., but it is unclear if or how the supply side has responded to meet this demand. In this paper, we take advantage of plausibly exogenous geographical heterogeneity in the ACA in order to examine the response of the healthcare education sector to increased demand for healthcare services. We look across educational fields, types of degrees, and types of institutions; we pay particular attention to settings where our conceptual model predicts heightened responses. We find no statistically significant evidence of increases in graduates and can rule out fairly modest effects. This implies that healthcare production may have adjusted to increased demand from insurance expansion in other ways rather than primarily through new graduates from local healthcare educational markets.
    Keywords: healthcare workforce, demand for schooling, educational pipeline, Affordable Care Act, Medicaid expansion
    JEL: I13 I23 J21
    Date: 2019–08
  10. By: Scott A. Carson
    Abstract: Peer and cohort effects are important in health economics, and obesity may be related to social relationships, where obese individuals interact with other obese individuals. There were significant 19th century cohort effects, where BMIs were related to the cohort that an individual belonged. After accounting for individual relationships between BMI, demographic, socioeconomic, and residential characteristics, there were significant cohort effects associated with race, residence, and age. Moreover, cohort effects reduce the size of the individual relationships between BMI, race, and age, but results are mixed for BMI and residence. This indicates that historical cohort effects are important in BMI and obesity studies.
    Keywords: 19th century BMIs, health cohort effects
    JEL: C10 C40 D10 I10 N30
    Date: 2021
  11. By: Sung-Hee Jeon (Statistics Canada); Vincent Pohl (University of Georgia)
    Abstract: Innovations in cancer treatment have lowered mortality, but little is known about their economic benefits. We assess the effect of two decades of improvements in cancer treatment options on the labor market outcomes of breast and prostate cancer patients. In addition, we compare this effect across cancer patients with different levels of educational attainment. We estimate the effect of medical innovation on cancer patients’ labor market outcomes employing tax return and cancer registry data from Canada and measuring medical innovation by using the number of approved drugs and a quality-adjusted patent index. While cancer patients are less likely to work after their diagnosis, we find that the innovations in cancer treatment during the 1990s and 2000s reduced the negative employment effects of cancer by 63–70 percent. These benefits of medical innovation are limited to cancer patients with postsecondary education, raising concerns about unequal access to improved treatment options.
    Keywords: medical innovation, breast cancer, prostate cancer, labor supply, employment, earnings, returns to education
    JEL: I12 I14 I24 I26 J22 O31
    Date: 2019–03
  12. By: Nafilyan, Vahé (London School of Hygiene & Tropical Medicine); Pabon, Mauricio Avendano (King's College London); de Coulon, Augustin (King's College London)
    Abstract: Cognitive skills are important determinants of employment and productivity in older adults. Although cognitive decline is often linked to changes in mental health, the causal nature of the association between mental illness and cognitive performance is not established. In this paper, we analyse the effect of depressive symptoms on cognitive function. Based on longitudinal data for older adults of working age, we use an instrumental variable approach to show that worsening depressive symptoms lead to a decline in cognitive skills. The economic consequences of impaired cognition caused by depressive symptoms may be a large component of mental illness's social costs.
    Keywords: cognitive skills, mental health, longitudinal data
    JEL: J24 I10
    Date: 2021–01
  13. By: Friedrich Breyer; Normann Lorenz; Gerald Pruckner; Thomas Schober
    Abstract: There is agreement among health economists that on the whole medical innovation causes health care expenditures (HCE) to rise. This paper analyzes for which diagnoses and in which age groups HCE per patient have grown significantly faster than average HCE. We distinguish decedents (patients in their last four years of life) from survivors and use a unique dataset comprising detailed HCE of all members of a regional health insurance fund in Upper Austria for the period 2005-2018. Our results indicate that among decedents in particular the expenditures for treatment of neoplasms have exceeded the general trend in HCE. This confirms that medical progress for this group of diseases has been particularly strong over the last 15 years. For survivors, we find a noticeable growth in cases and cost per case for pregnancies and childbirth and also for treatment of mental and behavioral disorders. The pattern of expenditures over age groups shows that among decedents the younger age groups (below 75) exhibit both the highest HCE per capita and the highest expenditure growth over time. For survivors, we find a steady increase in annual per capita HCE over age in both sexes, but the highest growth rates are observed in the age groups between 20 and 50 years.
    Keywords: health care expenditures.
    JEL: H51 J11 I19
    Date: 2021–01
  14. By: Attema, Arthur; Frasch, Jona; L'Haridon, Olivier
    Abstract: In recent years the interest in multivariate and higher-order risk preferences has increased noticeably. A growing body of literature has demonstrated both the relevance and the impact of these preferences in several domains, although for health the empirical evidence is lacking. In this study we empirically measure multivariate and higher-order risk preferences for quality of life and longevity, the two elements of the Quality-Adjusted Life Year (QALY) model. We observe overwhelming support for correlation seeking between these two attributes as well as significant evidence of cross-imprudence and cross-intemperance. These findings indicate that higher-order risk preferences appear to deviate more from neutrality for health than for money. Furthermore, we test if preferences for a risky treatment for a disease affecting only quality of life, depend on life expectancy. Our results show no systematic evidence of such a relation, although there is a marginally significant positive relation between riskiness of the comorbidity affecting life expectancy and risk aversion for a treatment affecting quality of life. We therefore observe no definitive deviation from the QALY model, although the model appears to be more robust when expected longevity is high.
    Keywords: correlation attitude, prudence, QALYs, risk apportionment, risk aversion
    JEL: I10
    Date: 2020–07–09
  15. By: Adriana Lleras-Muney; Flavien E. Moreau
    Abstract: We propose a dynamic production function of population health and mortality from birth onwards. Our parsimonious model provides an excellent fit for the mortality and survival curves for both primate and human populations since 1816. The model sheds light on the dynamics behind many phenomena documented in the literature, including (i) the existence and evolution of mortality gradients across socio-economic statuses, (ii) non-monotonic dynamic effects of in-utero shocks, (iii) persistent or “scarring” effects of wars and (iv) mortality displacement after large temporary shocks such as extreme weather.
    JEL: I10 J11
    Date: 2020–12
  16. By: Knapp, Martin; Wong, Gloria
    Abstract: Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.
    Keywords: Economic evaluation; cost-benefit; cost-effectiveness; cost-utility; dementia; depression; mental health policy; psychosis; return on investment
    JEL: N0
    Date: 2020–02–01
  17. By: Maya M. Durvasula; Lisa Larrimore Ouellette; Heidi L. Williams
    Abstract: Recent policy attention has focused on proposals to reduce prices for drugs that have received public funding. From an implementation perspective, such policies rely on public disclosure of government support for research. In this paper, we highlight two conceptual problems with past attempts to measure these public disclosures, and construct a new data set which corrects for these problems. Our corrected measures suggest that under-reporting of public research support is less of an issue than previously thought.
    JEL: I1 O3
    Date: 2021–01
  18. By: Keshav, 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
  19. By: Nava Ashraf; Erica M. Field; Alessandra Voena; Roberta Ziparo
    Abstract: Fertility decisions are often made by partners who may disagree. We develop a model in which an initial gender gap in ideal fertility prevents effective communication between spouses about the costs of childbearing incurred by women. This mechanism is likely to further widen the spousal disagreement over fertility in environments where maternal health risk is high and imperfectly observed. We design an intervention to experimentally vary exposure to information about maternal health costs to either the husband or the wife on a sample of approximately 500 couples in peri-urban Lusaka, in Zambia. At baseline, husbands display lower knowledge of maternal mortality and morbidity compared to their wives. At followup, about one year after the intervention, women whose husbands are treated experience a 43% reduction in the probability of being pregnant. Consistent with our hypothesis, men who are directly treated report lower desired fertility and have more accurate beliefs about their wife’s desired fertility than the husbands of treated women. Couples in which the husband is treated also increase communication about family planning, and experience greater marital satisfaction.
    JEL: J11 J13
    Date: 2020–12
  20. By: Efraim Benmelech; Janice C. Eberly; Joshua L. Krieger; Dimitris Papanikolaou
    Abstract: Investment in intangible capital—in particular, research and development—increased dramatically since the 1990s. However, productivity growth remains sluggish in recent years. One potential reason is that a significant share of the increase in intangible investment is geared toward consumer products such as pharmaceutical drugs with limited spillovers to productivity. We document that a significant share of R&D spending in the U.S. is done by pharmaceutical firms and is geared to developing drugs for the older patients. Increased life expectancy and quality of life among the elderly increases welfare but may not be reflected in estimates of total factor productivity.
    JEL: I10 I15 L65 O32 O34 O40
    Date: 2021–01
  21. By: Davillas, Apostolos (University of East Anglia); Jones, Andrew M. (University of York)
    Abstract: We use data from the UK Household Longitudinal Study (UKHLS) to compare measures of socioeconomic inequality in psychological distress, measured by the General Health Questionnaire (GHQ), before (Waves 9 and the Interim 2019 Wave) and during the first wave of the COVID-19 pandemic (April to July 2020). Based on a caseness measure, the prevalence of psychological distress increased from 18.5% to 27.7% between the 2019 Wave and April 2020 with some reversion to earlier levels in subsequent months. Also, there was a systematic increase in total inequality in the Likert GHQ-12 score. However, measures of relative socioeconomic inequality have not increased. A Shapley-Shorrocks decomposition analysis shows that during the peak of the first wave of the pandemic (April 2020) other socioeconomic factors declined in their share of socioeconomic inequality, while age and gender account for a larger share. The most notable increase is evident for younger women. The contribution of working in an industry related to the COVID-19 response played a small role at Wave 9 and the Interim 2019 Wave, but more than tripled its share in April 2020. As the first wave of COVID-19 progressed, the contribution of demographics declined from their peak level in April and chronic health conditions, housing conditions, and neighbourhood characteristics increased their contributions to socioeconomic inequality.
    Keywords: mental health, GHQ, socioeconomic inequality, health equity, COVID-19, psychological distress
    JEL: C1 D63 I12 I14
    Date: 2021–01
  22. By: YAMAMURA, Eiji; Tsutsui, Yoshiro
    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 student’s 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.
    Keywords: COVID-19; mental health; children; school closure; primary school; gender difference
    JEL: I13 I18 J01
    Date: 2020–10–15
  23. By: Takahiro Yamada (The World Bank); Hiroyuki Yamada (Faculty of Economics, Keio University); Muthukumara Mani (The World Bank)
    Abstract: This study investigates the causal effects of long-term PM2.5 exposure on COVID-19 deaths, fatality rates and cases in India by using an instrumental variables approach based on thermal inversion episodes. The estimation results indicate that a 1% increase in long-term exposure to PM2.5 leads to an increase in COVID-19 deaths by 5.7 percentage points and an increase in the COVID-19 fatality rate by 0.027 percentage points, but this exposure is not necessarily correlated with COVID-19 cases. People with underlying health conditions such as respiratory illness caused by exposure to air pollution might have a higher risk of death following SARS-CoV-2 infection. This finding might also apply to other countries where high levels of air pollution are a critical issue in terms of development and public health.
    Keywords: COVID-19, Ambient Air Pollution, Instrumental Variables Approach, Thermal Inversion, India
    JEL: Q53 I15 O13
    Date: 2021–01–05
  24. By: Philipp Ager; Katherine Eriksson; Ezra Karger; Peter Nencka; Melissa A. Thomasson
    Abstract: The COVID-19 pandemic has reignited interest in responses to the 1918-19 influenza pandemic, the last comparable U.S. public health emergency. During both pandemics, many state and local governments made the controversial decision to close schools. We study the short- and long-run effects of 1918-19 pandemic-related school closures on children. We find precise null effects of school closures in 1918 on school attendance in 1919-20 using newly collected data on the exact timing of school closures for 168 cities in 1918-19. Linking affected children to their adult outcomes in the 1940 census, we also find precise null effects of school closures on adult educational attainment, wage income, non-wage income, and hours worked in 1940. Our results are not inconsistent with an emerging literature that finds negative short-run effects of COVID-19-related school closures on learning. The situation in 1918 was starkly different from today: (1) schools closed in 1918 for many fewer days on average, (2) the 1918 virus was much deadlier to young adults and children, boosting absenteeism even in schools that stayed open, and (3) the lack of effective remote learning platforms in 1918 may have reduced the scope for school closures to increase socioeconomic inequality.
    JEL: I20 N32
    Date: 2020–12
  25. By: Benjamin J. McMichael; Sara Markowitz
    Abstract: Over the last several decades, nurse practitioners have assumed increasingly important roles in the healthcare system. However, some state scope of practice laws limit the ability of nurse practitioners to deliver care by requiring physician supervision of their practices and prescribing activities. A robust literature has evolved around examining the role of these scope of practice laws in various contexts, including labor market outcomes, healthcare access, healthcare prices, and the delivery of care for specific diseases. Unfortunately, these studies use different, and sometimes conflicting, measures of scope of practice laws, limiting their comparability and overall usefulness to policymakers and future researchers. We address this salient problem by providing a consistent coding of nurse practitioner scope of practice laws over a 23-year period based on actual statutory and regulatory language. Our classification of scope of practice laws solves an important problem within this growing literature and provides a solid legal foundation for researchers as they continue to investigate the effects of these laws.
    JEL: I1 K0
    Date: 2020–12
  26. By: Roy Cerqueti; Raffaella Coppier; Alessandro Girardi; Marco Ventura
    Abstract: This paper estimates the effects of non-pharmaceutical interventions - mainly, the lockdown - on the COVID-19 mortality rate for the case of Italy, the first Western country to impose a national shelter-in-place order. We use a new estimator, the Augmented Synthetic Control Method (ASCM), that overcomes some limits of the standard Synthetic Control Method (SCM). The results are twofold. From a methodological point of view, the ASCM outperforms the SCM in that the latter cannot select a valid donor set, assigning all the weights to only one country (Spain) while placing zero weights to all the remaining. From an empirical point of view, we find strong evidence of the effectiveness of non-pharmaceutical interventions in avoiding losses of human lives in Italy: conservative estimates indicate that for each human life actually lost, in the absence of lockdown there would have been on average other 1.15, the policy saved in total 20,400 human lives.
    Date: 2021–01
  27. By: Peter Flaschel; Giorgos Galanis; Daniele Tavani; Roberto Veneziani
    Abstract: This paper studies the interaction between epidemiological dynamics and the dynamics of economic activity in a demand-driven model in the structuralist/post-Keynesian tradition. On the one hand, rising aggregate demand increases the contact rate and therefore the probability of exposure to a virus. On the other hand, rising infection lowers aggregate demand because of reduced household spending. The resulting framework is well-suited for policy analysis through numerical exercises. We show that, first, laissez-faire gives rise to sharp fluctuations in demand and infections before herd immunity is achieved. Second, absent any restrictions on economic activity, physical distancing measures have rather limited mitigating effects. Third, lockdowns are effective, especially at reducing death rates while buying time before a vaccine is available, at the cost of a slightly more pronounced downturn in economic activity compared with alternative policies. This casts some doubt on the so-called “lives versus livelihood” policy trade-off. However, we also highlight the importance of policies aimed at mitigating the effects of the epidemic on workers’ income.
    Keywords: pandemic, aggregate demand, distribution, public policy
    JEL: E12 E25 E60 H00 I10
    Date: 2021–01
  28. By: Susan Martonosi; Banafsheh Behzad; Kayla Cummings
    Abstract: According to the World Health Organization, development of the COVID-19 vaccine is occurring in record time. Administration of the vaccine has started the same year as the declaration of the COVID-19 pandemic. The United Nations emphasized the importance of providing COVID-19 vaccines as "a global public good", which is accessible and affordable world-wide. Pricing the COVID-19 vaccines is a controversial topic. We use optimization and game theoretic approaches to model the COVID-19 U.S. vaccine market as a duopoly with two manufacturers Pfizer-BioNTech and Moderna. The results suggest that even in the context of very high production and distribution costs, the government can negotiate prices with the manufacturers to keep public sector prices as low as possible while meeting demand and ensuring each manufacturer earns a target profit. Furthermore, these prices are consistent with those currently predicted in the media.
    Date: 2020–12
  29. By: Michael Bailey; Drew M. 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.
    JEL: D83 D85 H0 I0
    Date: 2020–12
  30. By: Bartolini, Stefano; Sarracino, Francesco; Slater, Giulia
    Abstract: The extent to which governments’ policies for the containment of Covid-19 relied on voluntary compliance or on enforced social and economic restrictions, differs substantially across countries. Why so? The answer to this question is important because economic and psychological costs of an epidemic surge with the severity of restrictions. As the risk of infections increased in recent decades, it is critical to understand what enables a society to contain epidemics with mild restrictions of citizens’ freedoms. Our answer is that trust in others and in public institutions allows for less stringent containment policies. We collected data on policy stringency, speed of decline of new contagions and mortality during the first wave of Covid-19 in Europe. After accounting for various confounding factors, we find that governments of more trustful countries introduced less stringent policies, burdening the society with lower economic and psychological costs. This did not come at the expense of public health: holding policy stringency constant, high trust countries report lower mortality, as well as lower number and faster decline of new contagions than others. We conclude that the trade-off between freedom and health during epidemics depends on a country’s trust level: the more people trust others and institutions, the more this trade-off fades. Therefore, promoting trust in others and in institutions is a critical challenge for contemporary societies.
    Keywords: Covid-19 Social capital Interpersonal trust Institutional trust Policy stringency Containment Freedom Collective action Social distancing Europe
    JEL: H12 I18 Z13
    Date: 2020–12–29
  31. By: Joseph Bae; Darshan Gandhi; Jil Kothari; Sheshank Shankar; Jonah Bae; Parth Patwa; Rohan Sukumaran; Sethuraman T. V.; Krutika Mishra; Srinidhi Murali; Aishwariya Saxena; Kasia Jakimowicz; Vivek Sharma; Rohan Iyer; Ashley Mehra; Alex Radunsky; Priyanshi Katiyar; Sunaina Anand; Shailesh Advani; Jagjit Dhaliwal; Ramesh Raskar
    Abstract: As several COVID-19 vaccine candidates approach approval for human use, governments around the world are preparing comprehensive standards for vaccine distribution and monitoring to avoid long-term consequences that may result from rush-to-market. In this early draft article, we identify challenges for vaccine distribution in four core areas - logistics, health outcomes, user-centric impact, and communication. Each of these challenges is analyzed against five critical consequences impacting disease-spread, individual behaviour, society, the economy, and data privacy. Disparities in equitable distribution, vaccine efficacy, duration of immunity, multi-dose adherence, and privacy-focused record keeping are among the most critical difficulties that must be addressed. While many of these challenges have been previously identified and planned for, some have not been acknowledged from a comprehensive view to account for unprecedented repercussions in specific subsets of the population.
    Date: 2020–11
  32. By: Parisotto, Aurelio.; Elsheikhi, Adam.
    Abstract: This paper provides an overview of the evolution of the COVID-19-induced health and labour market crises in the Least Developed Countries (LDCs), drawing on a large set of available data and sources. It highlights how the outbreak is affecting jobs and incomes via multiple channels of transmission. It looks at policy responses so far and provides some suggestions for national employment and economic policies, as well as international support to help LDCs on their path to a job-rich recovery and future resilience.
    Keywords: least developed countries, labour market analysis, COVID-19
    Date: 2020
  33. By: Julia M. Puaschunder (The New School, Department of Economics, USA)
    Abstract: The ongoing COVID-19 crisis accounts for one of the most unpredicted economic disruptions in the history of humankind. COVID-19 as an external shock implies widespread and sustainable changes in the way humans live, work and interact on a global scale. With economic turmoil and social perturbation opens an abyss of novel and unprecedentedly described inequalities in the legal and economic spheres. The paper addresses novel trends that may spring out of COVID-19 in the healthcare sector, in regards to digitalization and inequality. Studying these forward-looking trend predictions aids us to understand the challenges that lie ahead in our post-COVID-19 world to come.
    Keywords: Access to healthcare, Artificial Intelligence (AI), Behavioral economics, Behavioral insights, Comparative law, Coronavirus, Corporations, Corporate governance, COVID-19, Crisis, Digitalization, Digi-disruption, Economic growth, Healthcare, Herd immunity, History of pandemics, Interest rate, Legal frameworks, Market disruption, Pandemic, Public policy, Technology, Technological changes
    Date: 2020–11
  34. By: Tiziana Carpi; Airo Hino; Stefano Maria Iacus; Giuseppe Porro
    Abstract: This study analyzes the impact of the COVID-19 pandemic on the subjective well-being as measured through Twitter data indicators for Japan and Italy. It turns out that, overall, the subjective well-being dropped by 11.7% for Italy and 8.3% for Japan in the first nine months of 2020 compared to the last two months of 2019 and even more compared to the historical mean of the indexes. Through a data science approach we try to identify the possible causes of this drop down by considering several explanatory variables including, climate and air quality data, number of COVID-19 cases and deaths, Facebook Covid and flu symptoms global survey, Google Trends data and coronavirus-related searches, Google mobility data, policy intervention measures, economic variables and their Google Trends proxies, as well as health and stress proxy variables based on big data. We show that a simple static regression model is not able to capture the complexity of well-being and therefore we propose a dynamic elastic net approach to show how different group of factors may impact the well-being in different periods, even over a short time length, and showing further country-specific aspects. Finally, a structural equation modeling analysis tries to address the causal relationships among the COVID-19 factors and subjective well-being showing that, overall, prolonged mobility restrictions,flu and Covid-like symptoms, economic uncertainty, social distancing and news about the pandemic have negative effects on the subjective well-being.
    Date: 2021–01
  35. By: Ria Ivandic; Tom Kirchmaier; Ben Linton
    Abstract: The effects of preventing a COVID-19 health crisis have had unintended consequences on domestic abuse (DA) victimization. We contribute to the literature on domestic abuse in lockdown by providing insight on how changing patterns of domestic abuse can explain differences in magnitudes reported across studies. We examine the patterns of domestic abuse during the COVID-19 lockdown in Greater London and find that the lockdown changed the nature of reporting and the type of relationship the abuse occurs within. While abuse by current partners as well as family members increased on average by 8.1% and 17.1% respectively over the lockdown period, abuse by ex-partners declined by 11.4%. These findings show that reporting the average change in domestic abuse during lockdown can be misleading when designing a policy response. Moreover, we show that all the increase in domestic abuse calls is driven by third party reporting, particularly evident in areas with high density. This suggests that under reporting is present in the lockdown, particularly in households where the abuse cannot be reported by an outsider. Although these findings pertain to the COVID-19 lockdown, they also highlight the role that victim exposure and proximity has in affecting domestic abuse.
    Keywords: crime, Covid-19, lockdown, domestic abuse, domestic violence
    JEL: J12
    Date: 2020–11
  36. By: Pol Antràs; Stephen J. Redding; Esteban Rossi-Hansberg
    Abstract: We develop a model of human interaction to analyze the relationship between globalization and pandemics. Our framework provides joint microfoundations for the gravity equation for international trade and the Susceptible-Infected-Recovered (SIR) model of disease dynamics. We show that there are cross-country epidemiological externalities, such that whether a global pandemic breaks out depends critically on the disease environment in the country with the highest rates of domestic infection. A deepening of global integration can either increase or decrease the range of parameters for which a pandemic occurs, and can generate multiple waves of infection when a single wave would otherwise occur in the closed economy. If agents do not internalize the threat of infection, larger deaths in a more unhealthy country raise its relative wage, thus generating a form of general equilibrium social distancing. Once agents internalize the threat of infection, the more unhealthy country typically experiences a reduction in its relative wage through individual-level social distancing. Incorporating these individual-level responses is central to generating large reductions in the ratio of trade to output and implies that the pandemic has substantial effects on aggregate welfare, through both deaths and reduced gains from trade.
    Keywords: Globalization, Pandemics, Gravity Equation, SIR Model
    JEL: F15 F23 I10
    Date: 2020–09

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