nep-hea New Economics Papers
on Health Economics
Issue of 2021‒03‒01
twenty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Mortality Effects and Choice Across Private Health Insurance Plans By Jason Abaluck; Mauricio Caceres Bravo; Peter Hull; Amanda Starc
  2. Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes By Atul Gupta; Sabrina T Howell; Constantine Yannelis; Abhinav Gupta
  3. Nursing Homes in Equilibrium: Implications for Long-term Care Policies By Tatyana Koreshkova; Minjoon Lee
  4. Mergers and Acquisitions in the Markets for Diagnostic Services: Evidence from the Finnish Private Health Care Sector By Mikko Nurminen
  5. Is body weight better distributed among men than among women? A robust normative analysis for France, the UK and the US By Fatiha Bennia; Nicolas Gravel; Brice Magdalou; Patrick Moyes
  6. Eliciting and utilizing willingness to pay: evidence from field trials in northern Ghana By Berry, James; Fischer, Gregory; Guiteras, Raymond
  7. Why we need a new Outcomes-based Value Attribution Framework for Combination Regimens in Oncology By Towse, A.; Lothgren, M.; Steuten, L.; Bruce, A.
  8. International migration and movement of doctors to and within OECD countries - 2000 to 2018: Developments in countries of destination and impact on countries of origin By Karolina Socha-Dietrich; Jean-Christophe Dumont
  9. Japan's Voluntary Lockdown: Further Evidence Based on Age-Specific Mobile Location Data By Tsutomu Watanabe; Tomoyoshi Yabu
  10. Covid-19 and the Political Economy of Mass Hysteria By Bagus, Philipp; Peña Ramos, José Antonio; Sánchez Bayón, Antonio
  11. Unequal mortality during the Spanish Flu By Basco, Sergi; Domenech, Jordi; Roses, Joan R.
  12. COVID-19 Pandemic and Economic Scenarios for Ontario By Miguel Casares; Paul Gomme; Hashmat Khan
  13. Mortality Inequality in Finland By Huttunen, Kristiina; Lombardi, Stefano
  14. Weather, psychological wellbeing and mobility during the first wave of the Covid-19 pandemic By Burdett, A.; Davillas, A.; Etheridge, B.
  15. Deaths of Despair and the Incidence of Excess Mortality in 2020 By Casey B. Mulligan
  16. France's Response to the Covid-19 Pandemic: between a Rock and a Hard Place By Zeynep Or; Coralie Gandré; Isabelle Durand-Zaleski; Monika Steffen
  17. Weather, psychological wellbeing and mobility during the first wave of the Covid-19 pandemic By Burdett, Ashley; Davillas, Apostolos; Etheridge, Ben
  18. Slums and Pandemics By Brotherhood, L.; Cavalcanti, T.; Da Mata, D.; Santos, C.
  19. Perceptions of Canadian Federal Policy Responses to COVID-19 among People with Disabilities and Chronic Health Conditions By Pettinicchio, David; Maroto, Michelle Lee; Lukk, Martin
  20. Worker well-being before and during the COVID-19 restrictions: A longitudinal study in the UK By Diane Pelly; Michael Daly; Liam Delaney; Orla Doyle
  21. Optimal lockdowns: Analysing the efficiency of sanitary policies in Europe during the first wave By Ewen Gallic; Michel Lubrano; Pierre Michel

  1. By: Jason Abaluck (Yale University - School of Management; NBER); Mauricio Caceres Bravo (Brown University - Department of Economics); Peter Hull (University of Chicago - Becker Friedman Institute for Economics; NBER); Amanda Starc (Northwestern University - Kellogg School of Management; NBER)
    Abstract: Competition in health insurance markets may fail to improve health outcomes if consumers are not willing to pay for high quality plans. We document large differences in the mortality rates of Medicare Advantage (MA) plans within local markets. We then show that when high (low) mortality plans exit these markets, enrollees tend to switch to more typical plans and subsequently experience lower (higher) mortality. We develop a framework that uses this variation to estimate the relationship between observed mortality rates and causal mortality effects; we find a tight link. We then extend the framework to study other predictors of mortality effects and estimate consumer willingness to pay. Higher spending plans tend to reduce enrollee mortality, but existing quality ratings are uncorrelated with plan mortality effects. Consumers place little weight on mortality effects when choosing plans. Moving beneficiaries out of the bottom 5% of plans could save tens of thousands of elderly lives each year.
    Date: 2020
  2. By: Atul Gupta (University of Pennsylvania - Health Care Management); Sabrina T Howell (New York University (NYU) - Leonard N. Stern School of Business; National Bureau of Economic Research (NBER)); Constantine Yannelis (University of Chicago); Abhinav Gupta (New York University (NYU) - Department of Finance)
    Abstract: The past two decades have seen a rapid increase in Private Equity (PE) investment in healthcare, a sector in which intensive government subsidy and market frictions could lead high-powered for-profit incentives to be misaligned with the social goal of affordable, quality care. This paper studies the effects of PE ownership on patient welfare at nursing homes. With administrative patient-level data, we use a within-facility differences-in-differences design to address non-random targeting of facilities. We use an instrumental variables strategy to control for the selection of patients into nursing homes. Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases by 11%. We observe operational changes that help to explain these effects, including declines in nursing staff and compliance with standards. Finally, we document a systematic shift in operating costs post-acquisition toward non-patient care items such as monitoring fees, interest, and lease payments.
    Date: 2021
  3. By: Tatyana Koreshkova (Concordia University and CIREQ); Minjoon Lee (Carleton University)
    Abstract: We build an equilibrium model of a nursing home market with decision-makers on both sides of the market. On the demand side, heterogeneous households with stochastic needs for long-term care solve dynamic optimization problems, choosing between in-home and nursing-home care. On the supply side, locally competitive nursing homes decide prices and intensities of care given the household demand. The government subsidizes long-term care of the poorest. The quantitative model successfully generates key empirical patterns. Evaluation of long-term care policies shows that the equilibrium approach is important for the welfare and distributional effects of policies targeting either side of the market.
    Keywords: Long-term Care, Nursing Home, Medicaid.
    JEL: D15 E21 I11 I13
    Date: 2021–01
  4. By: Mikko Nurminen (Turku School of Economics, FI-20014 University of Turku, Finland)
    Abstract: Health care markets in developed countries have become increasingly concentrated, while at the same time there has been an increasing trend of mergers and acquisitions (M&As) in these markets. I study the impact of M&As in the diagnostic procedure market, a market that is an important part of the health care industry and patient care, but has received little attention in this context. I use detailed nationwide register data from the Finnish private health care sector. My difference-in-difference estimates show that M&As increased prices in blood tests in both the acquiring and acquired units, but not in X-rays and MRIs. I additionally estimate a patient demand model that reveals that prices have little impact on the choice of provider while the referring physician's influence is large, potentially contributing to the firms' ability to increase their price margins.
    Keywords: Diagnostic Services, Mergers and Acquisitions, Market Power, Private Health Care
    JEL: L11 I11 J21 K21
    Date: 2021–01
  5. By: Fatiha Bennia (SPMC - Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants - AMU - Aix Marseille Université - APHM - Assistance Publique - Hôpitaux de Marseille); Nicolas Gravel (CSH - Centre de sciences humaines de New Delhi - MEAE - Ministère de l'Europe et des Affaires étrangères - CNRS - Centre National de la Recherche Scientifique, AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Brice Magdalou (CEE-M - Centre d'Economie de l'Environnement - Montpellier - UMR 5211 - UM - Université de Montpellier - CNRS - Centre National de la Recherche Scientifique - Montpellier SupAgro - Institut national d’études supérieures agronomiques de Montpellier - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Patrick Moyes (GREThA - Groupe de Recherche en Economie Théorique et Appliquée - UB - Université de Bordeaux - CNRS - Centre National de la Recherche Scientifique)
    Abstract: We compare distributions of Body Mass Index (BMI) categories among genders in France, the US and the UK on the basis of effciency and inequality considerations. The new normative criteria that we propose are well-suited to the ordinal nature of this variable. Our empirical results, which are supported by robust statistical inference, are twofolds. First, BMI categories are better distributed in France than in the UK, and in the UK than in the US for the two genders. Second, BMI categories happen to be more equally distributed among men than among women in all three countries.
    Keywords: body mass index,equality,effciency,gender,ordinal
    Date: 2021
  6. By: Berry, James; Fischer, Gregory; Guiteras, Raymond
    Abstract: We use the Becker-DeGroot-Marschak (BDM) mechanism to estimate willingness to pay (WTP) for and heterogeneous impacts of clean water technology through a field experiment in Ghana. Although WTP is low relative to cost, demand is inelastic at low prices. Short-run treatment effects are positive throughout the WTP distribution. After 1 year, use and benefits are both increasing in WTP, with negative effects on low-WTP households. Combining estimated treatment effects with house-holds’ WTP implies valuations of health benefits much smaller than typically used by policy makers. We explore differences between BDM and take-it-or-leave-it valuations and make recommendations for implementing BDM in the field.
    Keywords: price mechanism; heterogeneous treatment effects; health behavior; Becker- DeGroot-Marschak; field experiments
    JEL: C93 D12 L11 L31 O12 Q51
    Date: 2020–04–01
  7. By: Towse, A.; Lothgren, M.; Steuten, L.; Bruce, A.
    Abstract: Using medicines in combination can deliver better outcomes for patients across different tumour types and disease stages. Yet many HTA agencies do not find that the expected additional benefits from adding a new medicine to a currently reimbursed medicine represents value for money to the health system. In markets that utilise cost-per-QALY approaches for assessing value, a clinically effective medicine might even be found to be "not cost-effective at zero price" when used as part of a regimen that increases treatment duration. This publication contributes to the emerging debate as to why a new approach is required to address the value attribution problem in combination treatments. It sets out two key concepts required for an understanding of the relative performance of a combination regimen as compared to a monotherapy, considering (i) additive scale and (ii) the relative change in treatment duration as compared to the increase in overall survival. It uses these to illustrate how current HTA approaches, lead in many cases to the add-on therapy not being cost-effective even at zero price. The conceptual framework shows that two attribution approaches – the partial information incremental value approach, and the full information monotherapy ratio approach - are only comparable if an implicit assumption about additive scale is made, which the authors think implausible. They argue that an approach is needed that is able to combine the best features of the two approaches recognising the contribution of each product as a monotherapy, and also recognises their respective contributions to the combination regimen. General principles that might be expected from an attribution mechanism are set out.
    Keywords: Economics of Health Technology Assessment; Value, Affordability, and Decision Making
    JEL: I1
    Date: 2021–02–01
  8. By: Karolina Socha-Dietrich (OECD); Jean-Christophe Dumont (OECD)
    Abstract: This paper presents the most recent data on the number of migrant doctors in the health workforce in the OECD countries, as well as the impact these regular migration flows have on the countries of origin, including an analysis of the developments since 2000. The objective of this paper is to inform policy dialogue at the national and international levels.The share of migrant doctors has continued to rise over the last two decades across the OECD countries, with around two-thirds of all foreign-born or foreign-trained doctors originating from within the OECD area and upper-middle-income countries. The lower-middle-income countries account for around 30% and low-income countries for 3-4% of the foreign-born and 4% of the foreign-trained doctors. In countries of origin that are large, migration to (other) OECD countries has a moderate impact, but some of the relatively smaller countries or those with weak health systems experience significant losses of (needed) health professionals.
    Keywords: migrant doctors
    JEL: F22 J61 O15
    Date: 2021–02–24
  9. By: Tsutomu Watanabe (Graduate School of Economics, University of Tokyo); Tomoyoshi Yabu (Faculty of Business and Commerce, Keio University)
    Abstract: Changes in people's behavior during the COVID-19 pandemic can be regarded as the result of two types of effects: the "intervention effect" (changes resulting from government orders or requests for people to change their behavior) and the "information effect" (voluntary changes in people's behavior based on information about the pandemic). Using mobile location data to construct a stay-at-home measure for different age groups, we examine how the intervention and information effects differ across age groups. Our main findings are as follows. First, the age profile of the intervention effect of the state of emergency declaration in April and May 2020 shows that the degree to which people refrained from going out was smaller for older age groups, who are at a higher risk of serious illness and death, than for younger age groups. Second, the age profile of the information effect shows that, unlike the intervention effect, the degree to which people stayed at home tended to increase with age for weekends and holidays. Thus, while Acemoglu et al. (2020) proposed targeted lockdowns requiring stricter lockdown policies for the oldest group in order to protect those at a high risk of serious illness and death, our findings suggest that Japan's government intervention had a very different effect in that it primarily reduced outings by the young, and what led to the quarantining of older groups at higher risk instead was people's voluntary response to information about the pandemic. Third, the information effect has been on a downward trend since the summer of 2020. While this trend applies to all age groups, it is relatively more pronounced among the young, so that the age profile of the information effect remains upward sloping, suggesting that people's response to information about the pandemic is commensurate with their risk of serious illness and death.
    Date: 2021–02
  10. By: Bagus, Philipp; Peña Ramos, José Antonio; Sánchez Bayón, Antonio
    Abstract: In this article, we aim to develop a political economy of mass hysteria. Using the background of COVID-19, we study past mass hysteria. Negative information which is spread through mass media repetitively can affect public health negatively in the form of nocebo effects and mass hysteria. We argue that mass and digital media in connection with the state may have had adverse consequences during the COVID-19 crisis. The resulting collective hysteria may have contributed to policy errors by governments not in line with health recommendations. While mass hysteria can occur in societies with a minimal state, we show that there exist certain self-corrective mechanisms and limits to the harm inflicted, such as sacrosanct private property rights. However, mass hysteria can be exacerbated and self-reinforcing when the negative information comes from an authoritative source, when the media are politicized, and social networks make the negative information omnipresent. We conclude that the negative long-term effects of mass hysteria are exacerbated by the size of the state.
    Keywords: mass hysteria; nocebo effects; contagion; mass media; social media; public health; law and economics; political economy; groupthink; culture of fear; emotional contagion; anxiety; policy error; COVID-19
    JEL: A10 B53 I10
    Date: 2020–12–26
  11. By: Basco, Sergi; Domenech, Jordi; Roses, Joan R.
    Abstract: The outburst of deaths and cases of Covid-19 around the world has renewed the interest to understand the mortality effects of pandemics across regions, occupations, age and gender. The Spanish Flu is the closest pandemic to Covid-19. Mortality rates in Spain were among the largest in today’s developed countries. Our research documents a substantial heterogeneity on mortality rates across occupations. The highest mortality was on low-income workers. We also record a rural mortality penalty that reversed the historical urban penalty temporally. The higher capacity of certain social groups to isolate themselves from social contact could explain these mortality differentials. However, adjusting mortality evidence by these two factors, there were still large mortality inter-provincial differences for the same occupation and location, suggesting the existence of a regional component in rates of flu contagion possibly related to climatic differences.
    Keywords: pandemics; health inequality; socio-economic mortality differences; urban penalty
    JEL: N0
    Date: 2021–02
  12. By: Miguel Casares (Universidad Pública de Navarra); Paul Gomme (Concordia University, CIRANO and CIREQ); Hashmat Khan (Carleton University)
    Abstract: To study the efficacy of the public policy response to the COVID-19 pandemic, we develop a model of the rich interactions between epidemiology and socioeconomic choices. Preferences feature a "fear of death" that lead individuals to reduce their social activity and work time in the face of the pandemic. The aggregate effect of these reductions is to slow the spread of the coronavirus. We calibrate the model, including public policies, to developments in Ontario in spring 2020. The model fits the epidemiological data quite well, including the second wave starting in late 2020. We find that socioeconomic interventions work well in the short term, resulting in a rapid drop off in new cases. The long run, however, is governed chiefly by health developments. Welfare cost calculations point to synergies between the health and socioeconomic measures.
    Keywords: COVID-19, epidemiology, socioeconomics
    JEL: E10 I18
    Date: 2021–02–05
  13. By: Huttunen, Kristiina; Lombardi, Stefano
    Abstract: We study inequality in mortality in Finland using registry data that covers the whole population for years 1990-2018. We create municipality-level indexes of regional deprivation (poverty rate), and show how age-specifc mortality rates have evolved across regions and over time. The inequality in mortality has been remarkably low over the time period for most age groups. However, among young and prime-age males the mortality rates have been persistently higher in the poorer areas. For these age groups the leading causes of death are deaths of despair (alcohol and suicides) and accidents. For the cohorts that were young during the deep early-1990's recession, we also document higher inequality in middle-age mortality than for cohorts entering the labor market in recovery periods.
    Keywords: Income inequality, mortality, Finland, Local public finance and provision of public services, I14, I12,
    Date: 2021
  14. By: Burdett, A.; Davillas, A.; Etheridge, B.
    Abstract: To reduce infection rates during the first UK wave of the COVID-19 outbreak, a first lockdown was announced on March 23, 2020, with a final easing of the restrictions on July 4, 2020. Among the most important public health costs of lockdown restrictions are the potential adverse effects on mental health and physical activity. Using data from the UK Household Longitudinal Study (UKHLS) and Google COVID-19 Mobility Reports we find evidence of reduced park mobility during the initial period of the first UK lockdown and confirm existing evidence of worsening psychological wellbeing. Linkage with weather data shows that contrary to popular belief, weather conditions do not exacerbate the mental health consequences of the pandemic, while we find systematic links between park mobility and weather over the same period. Our results highlight the importance of promoting the existing guidelines on regular exercise during winter lockdowns.
    Keywords: COVID-19; mental health; mobility; weather conditions;
    JEL: I12 C23
    Date: 2021–02
  15. By: Casey B. Mulligan (University of Chicago - Department of Economics; NBER)
    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.
    Date: 2020
  16. By: Zeynep Or (IRDES Institute for Research and Information in Health Economics); Coralie Gandré (IRDES Institute for Research and Information in Health Economics); Isabelle Durand-Zaleski (AP-HP URCEco Santé Publique Hôpital Henri Mondor); Monika Steffen (PACTE, Université Grenoble-Alpes, Sciences Po Grenoble, CNRS)
    Abstract: France is one of the European countries hardest hit by the Covid-19 pandemic. The pandemic brought into light structural weaknesses of the health system, including its governance and decision making process, but also provoked changes that helped to improve its resilience. We analyse the French experience of Covid-19 in 2020 by critically reviewing major policy measures implemented during the first two waves of the pandemic. France has struggled to find the right balance between the rock of economic and social damage caused by containment measures and the hard alternative of a rapidly spreading pandemic. The response to the first wave, including a full lock-down, was an emergency response that revealed the low level of preparedness for pandemics and the overly hospital-centred provision of health care in France. During the second wave, this response evolved into a more level strategy trying to reconcile health needs in a broader perspective integrating socio-economic considerations, but without fully managing to put in place an effective health strategy. We conclude that to achieve the right balance, France will have to strengthen health system capacity and improve the cooperation between actors at central and local levels with greater participatory decision-making that takes into account local-level realities and the diversity of needs.
    Keywords: Health policy, Covid-19, Governance, France
    JEL: H11 H12 I18
    Date: 2021–02
  17. By: Burdett, Ashley; Davillas, Apostolos; Etheridge, Ben
    Abstract: To reduce infection rates during the first UK wave of the COVID-19 outbreak, a first lockdown was announced on March 23, 2020, with a final easing of the restrictions on July 4, 2020. Among the most important public health costs of lockdown restrictions are the potential adverse effects on mental health and physical activity. Using data from the UK Household Longitudinal Study (UKHLS) and Google COVID-19 Mobility Reports we find evidence of reduced park mobility during the initial period of the first UK lockdown and confirm existing evidence of worsening psychological wellbeing. Linkage with weather data shows that contrary to popular belief, weather conditions do not exacerbate the mental health consequences of the pandemic, while we find systematic links between park mobility and weather over the same period. Our results highlight the importance of promoting the existing guidelines on regular exercise during winter lockdowns.
    Date: 2021–02–16
  18. By: Brotherhood, L.; Cavalcanti, T.; Da Mata, D.; Santos, C.
    Abstract: This paper studies the role of slums in shaping the economic and health dynamics of pandemics. Using data from millions of mobile phones in Brazil, an event-study analysis shows that residents of overcrowded slums engaged in less social distancing after the outbreak of Covid-19. We develop a choice-theoretic equilibrium model in which poorer agents live in high-density slums and others do not. The model is calibrated to Rio de Janeiro. Slum dwellers account for a disproportionately high number of infections and deaths. In a counterfactual scenario without slums, deaths increase in non-slum neighborhoods. Policy simulations indicate that: reallocating medical resources cuts deaths and raises output and the welfare of both groups; mild lockdowns favor slum individuals by mitigating the demand for hospital beds whereas strict confinements mostly delay the evolution of the pandemic; and cash transfers benefit slum residents in detriment of others, highlighting important distributional effects.
    Keywords: Covid-19, slums, health, social distancing, public policies
    JEL: E17 I10 I18 D62 O18 C63
    Date: 2020–08–06
  19. By: Pettinicchio, David; Maroto, Michelle Lee (University of Alberta); Lukk, Martin
    Abstract: This study examines how people with disabilities and chronic health conditions—members of a large and diverse group often overlooked by Canadian public policy—are making sense of the Canadian federal government's response to COVID-19. Using original national online survey data collected in June 2020 (N=1,027), we investigate how members of this group view the government's overall response. Although survey results show broad support for the federal government's pandemic response, findings also indicate fractures based on disability type and specific health condition, political partisanship, region, and experiences with COVID-19. Among these, identification with the Liberal party and receipt of CERB stand out as associated with more positive views. Further examination of qualitative responses shows that these views are also linked to differing perspectives surrounding government benefits and spending, partisan divisions, as well as other social and cultural cleavages.
    Date: 2021–02–08
  20. By: Diane Pelly; Michael Daly; Liam Delaney; Orla Doyle
    Abstract: The potential impact of COVID-19 restrictions on worker well-being is currently unknown. In this study we examine 15 well-being outcomes collected from 621 full-time workers assessed before (November, 2019 - February, 2020) and during (May-June, 2020) the COVID-19 pandemic. Fixed effects analyses are used to investigate how the COVID-19 restrictions and involuntary homeworking affect well-being and job performance. The majority of worker well-being measures are not adversely affected. Homeworkers feel more engaged and autonomous, experience fewer negative emotions and feel more connected to their organisations. However, these improvements come at the expense of reduced homelife satisfaction and job performance.
    Keywords: COVID-19 restrictions; Workers; Homeworking; Subjective well-being; Productivity; Mental health; Job satisfaction; Engagement
    JEL: J08 J24 I31
    Date: 2021–02
  21. By: Ewen Gallic (Aix-Marseille Univ, CNRS, AMSE, Marseille, France.); Michel Lubrano (School of Economics, Jiangxi University of Finance and Economics, China and Aix-Marseille Univ, CNRS, AMSE, Marseille, France.); Pierre Michel (Aix-Marseille Univ, CNRS, AMSE, Marseille, France.)
    Abstract: Uprising in China, the global COVID-19 epidemic soon started to spread out in Europe. As no medical treatment was available, it became urgent to design optimal non-pharmaceutical policies. With the help of a SIR model, we contrast two policies, one based on herd immunity (adopted by Sweden and the Netherlands), the other based on ICU capacity shortage. Both policies led to the danger of a second wave. Policy efficiency corresponds to the absence or limitation of a second wave. The aim of the paper is to measure the efficiency of these policies using statistical models and data. As a measure of efficiency, we propose the ratio of the size of two observed waves using a double sigmoid model coming from the biological growth literature. The Oxford data set provides a policy severity index together with observed number of cases and deaths. This severity index is used to illustrate the key features of national policies for ten European countries and to help for statistical inference. We estimate basic reproduction numbers, identify key moments of the epidemic and provide an instrument for comparing the two reported waves between January and October 2020. We reached the following conclusions. With a soft but long lasting policy, Sweden managed to master the first wave for cases thanks to a low R 0 , but at the cost of a large number of deaths compared to other Nordic countries and Denmark is taken as an example. We predict the failure of herd immunity policy for the Netherlands. We could not identify a clear sanitary policy for large European countries. What we observed was a lack of control for observed cases, but not for deaths.
    Keywords: SIR models, phenomenological models, double sigmoid models, sanitary policies, herd immunity, ICU capacity constraint
    JEL: C22 C54 I18
    Date: 2021–02

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