nep-hea New Economics Papers
on Health Economics
Issue of 2021‒03‒29
thirty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Health Costs of Cost-Sharing By Amitabh Chandra; Evan Flack; Ziad Obermeyer
  2. The Health Toll of Import Competition By Jerôme Adda; Yarine Fawaz
  3. Time Aggregation in Health Insurance Deductibles By Long Hong; Corina Mommaerts
  4. The Formation and Malleability of Dietary Habits: A Field Experiment with Low Income Families By Michèle Belot; Noémi Berlin; Jonathan James; Valeria Skafida
  5. Education Gradients in Mortality Trends by Gender and Race By Adam A. Leive; Christopher J. Ruhm
  6. The Medicaid Expansion and the Uptake of Medication-assisted Treatment for Opioid Use Disorder: Evidence from the Rhode Island All-payer Claims Database, 2012–2018 By Mary A. Burke; Riley Sullivan
  7. Performance Pay and Alcohol Use in Germany By Baktash, Mehrzad B.; Heywood, John S.; Jirjahn, Uwe
  8. The impact of retirement on the healthiness of food purchases By Marit Hinnosaar
  9. A Longitudinal Analysis of the impact of Health Shocks on the wealth: Evidence from England By Sana Tabassum; Ashok Thomas
  10. The introduction of Bismarck's social security system and its effects on marriage and fertility in Prussia By Guinnane, Timothy; Streb, Jochen
  11. Competition in French hospital: Does it impact the patient management in healthcare? By Carine Milcent
  12. Maternal depression and child human capital: A genetic instrumental-variable approach By Giorgia Menta; Anthony Lepinteur; Andrew Clark; Simone Ghislandi; Conchita Ambrosio
  13. From Fees to Free: User Fee Removal, Maternal Health Care Utilization and Child Health in Zambia By Yohan Renard
  14. Regional variation in the supply of general and medical practitioners and its consequences for inpatient service utilization By Stroka, Magdalena A.
  15. Social isolation, health dynamics, and mortality: Evidence across 21 Europe countries By Yarine Fawaz; Pedro Mira
  16. Vaccination Planning under Uncertainty, with Application to Covid-19 By Charles F. Manski
  17. Care provision at the time of the Covid-19: who suffers most? By Elena Bassoli; Agar Brugiavini; Irene Ferrari
  18. Use of telehealth: evidence from French teleconsultation for women's healthcare, prior and during COVID-19 pandemic By Carine Milcent; Saad Zbiri
  19. Women in Distress: Mental Health and the COVID-19 Pandemic By Emilia Barili; Veronica Grembi; Anna Rosso
  20. Why Covid19 will not be gone soon: Lessons from the institutional economics of smallpox vaccination in 19th Century Germany By Katharina Muhlhoff
  21. A Poorly Understood Disease? The Evolution of the Income Gradient in Excess Mortality Due to COVID-19 within Urban Areas By Paul Brandily; Clément Brébion; Simon Briole; Laura Khoury
  22. A Parsimonious Behavioral SEIR Model of the 2020 COVID Epidemic in the United States and the United Kingdom By Andrew Atkeson
  23. COVID-19: Erroneous Modelling and Its Policy Implications By Bar-On, Yinon; Baron, Tatiana; Cornfeld, Ofer; Milo, Ron; Yashiv, Eran
  24. The effect of social distancing on the reach of an epidemic in social networks. By Gutin, Gregory; Hirano, Tomohiro; Hwang, Sung-Ha; Neary, Philip R; Toda, Alexis Akira
  25. Optimal lockdowns: Analysing the efficiency of sanitary policies in Europe during the first wave By Ewen Gallic; Michel Lubrano; Pierre Michel
  26. Family Ties and the Pandemic: Some Evidence from Sars-CoV-2 By Digialleonardo, Luca; Mare, Mauro; Motroni, Antonello; Porcelli, Francesco
  27. Can Hearts Change Minds? Social media Endorsements and Policy Preferences By Pierluigi Conzo; Andrea Gallice; Juan S. Morales; Margaret Samahita; Laura K. Taylor
  28. The Effect of Public Corruption on Covid-19 Fatality Rate: A Cross-Country Examination By Mohammad Reza Farzanegan
  29. Are epidemiological indicators misleading under uncertainty? An evaluation and a remedy from an economic perspective By Christelle Baunez; Mickaël Degoulet; Stéphane Luchini; Patrick A. Pintus; Miriam Teschl
  30. The impacts of the COVID-19 pandemic on higher education students in New Zealand By Michael P. Cameron; Barbara Fogarty-Perry; Gemma Piercy
  31. Source of healing or bone of contention? Trust in the German healthcare system during the coronavirus crisis By Busemeyer, Marius R.

  1. By: Amitabh Chandra; Evan Flack; Ziad Obermeyer
    Abstract: We use the design of Medicare’s prescription drug benefit program to demonstrate three facts about the health consequences of cost-sharing. First, we show that an as-if-random increase of 33.6% in out-of-pocket price (11.0 percentage points (p.p.) change in coinsurance, or $10.40 per drug) causes a 22.6% drop in total drug consumption ($61.20), and a 32.7% increase in monthly mortality (0.048 p.p.). Second, we trace this mortality effect to cutbacks in life-saving medicines like statins and antihypertensives, for which clinical trials show large mortality benefits. We find no indication that these reductions in demand affect only ‘low-value’ drugs; on the contrary, those at the highest risk of heart attack and stroke, who would benefit the most from statins and antihypertensives, cut back more on these drugs than lower risk patients. Similar patterns exist for other drug–disease pairs, and irrespective of socioeconomic circumstance. Finally, we document that when faced with complex, high-dimensional choice problems, patients respond in simple, perverse ways. Specifically, price increases cause 18.0% more patients (2.8 p.p.) to fill no drugs, regardless of how many drugs they had been on previously, or their health risks. This decision mechanically results in larger absolute reductions in utilization for those on many drugs. We conclude that cost-sharing schemes should be evaluated based on their overall impact on welfare, which can be very different from the price elasticity of demand.
    JEL: I12 I13
    Date: 2021–02
  2. By: Jerôme Adda (Bocconi University and IZA); Yarine Fawaz (CEMFI, Centro de Estudios Monetarios y Financieros)
    Abstract: This paper assesses the effect of import competition on the labor market and health outcomes of US workers. We first show that import shocks affect employment and income, but only in areas where jobs are more intense in routine tasks. Exploiting over 40 million individual observations on health and mortality, we find that import had a detrimental effect on physical and mental health that is concentrated in those areas and exhibits strong persistence. It decreased health care utilisation and increased hospitalisation for a large set of conditions, more difficult to treat. The mortality hazard of workers in manufacturing increased by up to 6 percent per billion dollar import increase.
    Keywords: Import competition, routine tasks, health, health behaviour, hospitalisation, mortality.
    JEL: F16 I12 I18
    Date: 2020–06
  3. By: Long Hong; Corina Mommaerts
    Abstract: Health insurance plans increasingly pay for expenses only beyond a large annual deductible. This paper explores the implications of deductibles that reset over shorter timespans. We develop a model of insurance demand between two actuarially equivalent deductible policies, in which one deductible is larger and resets annually and the other deductible is smaller and resets biannually. Our model incorporates borrowing constraints, moral hazard, mid-year contract switching, and delayable care. Calibrations using claims data show that the liquidity benefits of resetting deductibles can generate welfare gains of 6-10% of premium costs, particularly for individuals with borrowing constraints.
    JEL: D15 D81 G22 G52 I13
    Date: 2021–02
  4. By: Michèle Belot (Cornell University); Noémi Berlin (EconomiX - UPN - Université Paris Nanterre - CNRS - Centre National de la Recherche Scientifique, CNRS - Centre National de la Recherche Scientifique); Jonathan James (University of Bath [Bath]); Valeria Skafida (University of Edinburgh)
    Abstract: We conduct a field experiment to evaluate the extent to which dietary habits are malleable early on in childhood and later in life. We implement two treatments one that targets what people eat, the other that targets the timing and frequency of food intake. 285 low income families with young children were recruited and assigned either to a control group or one of the two treatments, each of them lasting for 12 consecutive weeks. In one treatment, families received food groceries at home for free for 12 weeks and were asked to prepare five specific healthy meals per week. In the other treatment, families were simply asked to reduce snacking and eat at regular times. We collected a range of measures of food preferences, dietary intake, as well as BMI and biomarkers based on blood samples. We find evidence that children's BMI distribution shifted significantly relative to the control group, i.e. they became relatively "thinner". We also find some evidence that their preferences have been affected by both treatments. On the other hand, we find little evidence of effects on parents. We conclude that exposure to a healthy diet and regularity of food intake possibly play a role in shaping dietary habits, but influencing dietary choices later on in life remains a major challenge.
    Date: 2021–03–03
  5. By: Adam A. Leive; Christopher J. Ruhm
    Abstract: We examine gender and race differences in education-mortality trends among 25-64 year olds in the United States from 2001-2018. The data indicate that the relationships are heterogeneous with larger mortality reductions for less educated non-Hispanic blacks than other races and mixed results at higher levels of schooling. We also investigate the causes of death associated with changes in overall mortality rates and identify key differences across race groups and education quartiles. Drug overdoses represent the single most important contributor to increased death rates for all groups, but the sizes of these effects vary sharply. Cardiovascular disease, cancer, and HIV are the most significant sources of mortality rate reductions, with the patterns again heterogeneous across sex, race, and educational attainment. These results suggest the limitations of focusing on all-cause mortality rates when attempting to determine the sources of positive and negative health shocks affecting population subgroups. Examining specific causes of death can provide a more nuanced understanding of these trends.
    JEL: I10 I12 I14 I24 J10
    Date: 2021–01
  6. By: Mary A. Burke; Riley Sullivan
    Abstract: This article uses the all-payer claims database for the state of Rhode Island to assess recent progress in the state toward the goal of expanding access to medication-assisted treatment (MAT) for opioid use disorder (OUD). The analysis highlights the role played by the Affordable Care Act (ACA) and the associated Medicaid expansion in furthering that goal. Using measures that account for changes in health insurance enrollment, we find that the MAT rate per 100,000 enrollees in Rhode Island effectively doubled between 2012 and 2018, while the prevalence of OUD in the sample also doubled over the same period. Taken at face value, it would appear that the growth in the MAT rate over the period was just sufficient to meet the increased need for treatment. However, when we analyze the trends in MAT rates and OUD rates separately for Medicaid enrollees and non-Medicaid enrollees, the progress in treating OUD patients with MAT seems to have been much greater for the Medicaid population. In terms of raw numbers, the largest single-year gain in the number of patients receiving MAT occurred in 2014, the year when the ACA and Medicaid expansion went into effect. Among the first-time enrollees of 2014 who received MAT, over 80 percent were Medicaid enrollees, and those individuals accounted for more than one-third of the overall increase in MAT patients from the previous year. The analysis also suggests that expanded uptake of MAT may have contributed to the decline in opioid-related mortality in Rhode Island that occurred between 2016 and 2018, although more recent (preliminary) evidence suggests that Rhode Island as well as the rest of the country saw a resurgence in opioid-related mortality in 2020.
    Keywords: medication-assisted treatment; opioid use disorder; Rhode Island; all-payer claims database; buprenorphine; methadone; Affordable Care Act; Medicaid
    Date: 2021–03–17
  7. By: Baktash, Mehrzad B. (University of Trier); Heywood, John S. (University of Wisconsin, Milwaukee); Jirjahn, Uwe (University of Trier)
    Abstract: We study the link between performance pay and alcohol use in Germany, a country with mandated health insurance. Previous research from the US argues that alcohol use as a form of "self-medication" may be a natural response to the stress and uncertainty of performance pay when many workers do not have access to health insurance. We find that the likelihood of consuming each of four types of alcohol (beer, wine, spirits, and mixed drinks) is higher for those receiving performance pay even controlling for a long list of economic, social and personality characteristics and in sensible IV estimates. We also show that the total number of types of alcohol consumed is larger for those receiving performance pay. We conclude that even in the face of mandated health insurance, the link found in the US persists in Germany.
    Keywords: performance pay, alcohol, stress
    JEL: I12 J33
    Date: 2021–03
  8. By: Marit Hinnosaar
    Abstract: The paper estimates the causal impact of retirement on the healthiness of food purchases. The identification strategy uses early and full retirement ages as instruments for retirement. Using household-level scanner data, I find that retirement increases fruit and vegetable purchases and overall healthiness of food purchases. I also find indirect evidence that retirement increases the time spent on shopping and food preparation: it increases shopping frequency and shifts purchases to fresh and unprepared food products. This suggests that time constraints might play a role in limiting healthy food consumption.
    Keywords: Health behaviors, retirement, consumer behavior, dietary choice
    JEL: I12 L66 D12
    Date: 2020
  9. By: Sana Tabassum (Indian Institute of Management Kozhikode); Ashok Thomas (Indian Institute of Management Kozhikode)
    Abstract: This paper investigates the impact of health shocks on wealth using four waves of data from English longitudinal Study of Ageing (ELSA). We investigate short, medium and long term impact of existing and new health conditions on the wealth of the elderly. The results reveal that onset of new health events lead to wealth depletion during the period in which they occur and the impact disappears over time. The impact of existing health conditions in maximum in short and medium term and declines in the long run.
    Keywords: Health shocks, Wealth analysis
    Date: 2020–03
  10. By: Guinnane, Timothy; Streb, Jochen
    Abstract: Economists have long argued that introducing social insurance will reduce fertility. The hypothesis relies on standard models: if children are desirable in part because they provide security in case of disability or old age, then State programs that provide insurance against these events should induce couples to substitute away from children in the allocation of wealth. We test this claim using the introduction of social insurance in Germany in the period 1881-1910. Bismarck's social-insurance scheme had three pillars: health insurance, workplace accident insurance, and an old age pension. Earlier studies typically focus on the pension alone; we consider all three pillars. We find that Bismarck's social insurance system affected fertility overall only via its effects on the incentive to marry. The old age insurance by itself tended to reduce marriages, but the health and accident-insurance components had the opposite effect. For people exposed to all three pillars of social insurance, the two effects cancelled each other and the aggregate effect on fertility was muted.
    Keywords: Social insurance,pensions,fertility transition,marriage,Bismarck,Prussia
    JEL: H55 I13 J11 N13 N33 N43
    Date: 2021
  11. By: Carine Milcent (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)
    Abstract: We explore the competition impact on patient management in healthcare (length of stay and technical procedure's probability to be performed) by difference-indifference , exploiting time variations in the intensity of local competition caused by the French pro-competition reform (2004-2008). Models are estimated with hospital fixed effects to take into account hospital unobserved heterogeneity. We use an exhaustive dataset of in-hospital patients over 35 admitted for a heart attack. We consider the period before the reform from 2001 to 2003 and a period after the reform from 2009 to 2011. Before the reform, there were two types of reimbursement systems. Hospitals from private sector, were paid by fee-for-service. Hospitals from public sector were paid by global budget. They had no current activity's link, and a weak competition incentive. After the DRG-based payment reform, all hospitals compete with each other to attract patients. We find the reform a sizeable positive competition effect on high-technical procedure for the private sector as well as a negative competition effect on the length of stay for public hospitals. However, the overall local competition effect of the reform explained a very marginal part of the explanatory power of the model. Actually, this period is characterised by two contradictory components: a competition effect of the reform and in-patients who are more concentrated. Results suggest that if competition impacted management patient's change, it is through a global competition included in a global trend much more than a local competitive aspect of the reform.
    Keywords: Competition,Hospital ownership,Policy evaluation,Length of stay,High-tech procedure,Difference-in-difference,Measure of market structure,Heart attack competition
    Date: 2021–03
  12. By: Giorgia Menta (University of Luxembourg [Luxembourg]); Anthony Lepinteur (University of Luxembourg [Luxembourg]); Andrew Clark (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Simone Ghislandi (Bocconi University [Milan, Italy]); Conchita Ambrosio (University of Luxembourg [Luxembourg])
    Abstract: We here address the causal relationship between maternal depression and child human capital using UK cohort data. We exploit the conditionally-exogenous variation in mothers' genomes in an instrumental-variable approach, and describe the conditions under which mother's genetic variants can be used as valid instruments. An additional episode of maternal depression between the child's birth up to age nine reduces both their cognitive and non-cognitive skills by 20 to 45% of a SD throughout adolescence. Our results are robust to a battery of sensitivity tests addressing, among others, concerns about pleiotropy and the maternal transmission of genes to her child.
    Keywords: Mendelian Randomisation,Maternal Depression,Human Capital,Instrumental Variables,ALSPAC
    Date: 2021–02
  13. By: Yohan Renard (Université Paris-Dauphine, PSL Research University, CNRS, IRD, LEDa, DIAL)
    Abstract: Despite recent progress, about 295,000 women in the World still die each year from pregnancy-related causes, and about 4.1 million children die before reaching the age of one. 99% of these deaths occur in developing countries. In 2006 the Zambian government removed user fees in public and mission health facilities in 54 out of 72 districts, and then extended this policy to rural parts of unaffected districts in 2007. I exploit the staggered implementation of the policy to assess its impact on maternal health care utilization and child health outcomes. Using a difference-in-differences estimation strategy, I find a 43% increase in the probability to give birth in a medical facility following the removal and a 36% increase in the probability of being assisted by a skilled birth attendant during childbirth. These positive effects decrease with household’s distance from the nearest health facility. In terms of child health, chronic malnutrition decreased by 8% and the abolition of user fees reduced newborn mortality risk only for those living close to a health facility providing essential emergency obstetric care and child health services.
    Keywords: Free health care, Childbirth conditions, Child health, User fees, Zambia, Difference-in-differences
    JEL: I12 I18 J13 O12 O15
    Date: 2021–02
  14. By: Stroka, Magdalena A.
    Abstract: There is widespread concern about the consequences of the undersupply of outpatient care for the utilization of inpatient care. lt is common knowledge in the media that urban areas aften are characterized by an oversupply of health care providers, while rural areas suffer from shortage. As such, the undersupply of outpatient medical care in rural areas can lead to higher utilization of inpatient care due to both substitution effects and the possible disastrous health consequences if medical care is not received frequently or quickly enough. On the basis of administrative data from the largest sickness fund in Germany, this study analyzes the relationship between the district density of general as well as medical practitioner and the individual number of hospitalizations. We find evidence for a significant negative association between the share of general and medical practitioners in the population and the utilization of inpatient health care services, measured in the amount of yearly hospitalizations.
    Keywords: Hospital utilization,general proctitioner,medical practitioner,shirking regions,medical undersupply,fixed-effects,administrative data
    JEL: I10
    Date: 2021
  15. By: Yarine Fawaz (CEMFI, Centro de Estudios Monetarios y Financieros); Pedro Mira (CEMFI, Centro de Estudios Monetarios y Financieros)
    Abstract: We provide a comprehensive picture of the health effects of social isolation using longitudinal data over 21 European countries (SHARE) and seven waves (14 years) : first by looking at how social isolation at baseline impacts mortality at follow-up using Cox duration models, then looking at the dynamics of the health effects of social isolation, i.e. how social isolation at baseline affects functional, physical, mental and cognitive health at each future wave, when controlling for all these facets of health at baseline along with an extensive set of other covariates, in a standard linear regression framework. Our results suggest social isolation leads to worse health along all the dimensions we observe, and this effect is persistent. Being socially isolated at baseline is associated with a 20 to 30% increase in the mortality hazard, in line with other studies. Allowing for heterogeneity across countries, we find a remarkably strong association (up to a 45% increase) in Eastern countries. This association is not just picking up a correlation of social isolation with concurrent loneliness, health behaviors or health care utilization.
    Keywords: Social isolation, loneliness, health, mortality, SHARE.
    JEL: I10 C41
    Date: 2020–06
  16. By: Charles F. Manski
    Abstract: Vaccination against infectious disease may be beneficial to reduce illness in vaccinated persons and disease transmission across the population. The welfare-economic practice of specifying a social welfare function and considering a planner who seeks to optimize welfare provides a constructive framework to evaluate vaccination policy. This paper characterizes choice of vaccination policy as a planning problem that aims to minimize the social cost of illness and vaccination. Manski (2010, 2017) studied vaccination as a problem of planning under uncertainty, assuming that a planner can choose any vaccination rate or that the planner has only two options: mandate or decentralize vaccination. The analysis focused on uncertainty regarding the effect of vaccination on disease transmission. Here I weaken the assumptions to recognize multiple uncertainties relevant to evaluation of policy for vaccination against COVID-19. These include uncertainty not only about the effect of vaccination on disease transmission, but also about the fraction of susceptible persons in the population, the effectiveness of vaccination in reducing illness and infectiousness, and the health risks associated with vaccination. The paper considers planning under ambiguity using the minimax and minimax-regret criteria, as well as planning using a subjective probability distribution on unknown quantities. It develops algorithms that may be applied flexibly to determine policy choices with specified degrees and types of uncertainty.
    JEL: D81 H75 I18
    Date: 2021–02
  17. By: Elena Bassoli (Department of Economics, University Of Venice Cà Foscari); Agar Brugiavini (Department of Economics, University Of Venice Cà Foscari; Institute For Fiscal Studies); Irene Ferrari (Department of Economics, University Of Venice Cà Foscari; Netspar)
    Abstract: This paper focuses on the changes in care provision at the time of the COVID-19 outbreak by exploiting variation in lockdown policies across Europe. We use the SHARE-COVID-19 survey, which involves about 50000 respondents of age 50 and over in 26 countries, to investigate how the stringency of the policy measures have affected care provision. Our study is based on the linkage of the SHARE-COVID-19 data with an individual specific “stringency index” which measures the intensity of the restriction policies and the degree of individual’s exposure. We find that older individuals, low-income individuals and people affected by limitations in everyday life faced a higher probability of receiving help because of the lockdown policies. Women and people in the age group 50-65 were more likely to provide help/care, but we also uncover a complex interaction with the labour market condition of caregivers. Lockdown policies hit hard individuals who were already receiving care as they experienced a form of rationing, both due to higher financial costs and travelling restrictions. Since these individuals are already among the most fragile in society, our evidence raises concern and calls for a re-design of the welfare system.
    Keywords: Care provision, caregiving, caregiver, COVID-19, SHARE data, SHARE-COVID-19 questionnaire, lockdown policies
    JEL: D1 I14 I18 J14 J16
    Date: 2021
  18. By: Carine Milcent (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Saad Zbiri (UVSQ - Université de Versailles Saint-Quentin-en-Yvelines)
    Abstract: BACKGROUND: Prior to the COVID-19 pandemic, teleconsultation were seldom used in France. The sanitary crisis has brought with it a great need for the use of teleconsultation and other interventions using digital technology. OBJECTIVE: Indentify how has French teleconsultation for obstetrics and gynecology care services been used prior and during this sanitary crisis. METHODS: We first described the global picture of the teleconsultation context prior to the sanitary crisis and then during the first quarantine and lockdown measures. We set up three aspects, namely: 1-use of teleconsultation as regards to providers' ability; 2- use of teleconsultation as regards to technology features; 3- use of teleconsultation for which type of healthcare. Second, we studied the determinant factors of teleconsultation use and those of provider's satisfaction with teleconsultation practice. RESULTS: We show the central role of training, the importance of some main digital technology benefits including improving public health, responding to patient's request and facilitating healthcare access, as well as the importance of some main digital technology drawbacks including lack of convenience and lack of veracity (truthfulness). CONCLUSIONS: Our results guide the regulator on the suppliers' motivation and needs for teleconsultation adoption. They highlight the conditions for an efficient use of teleconsultation.
    Keywords: Technology features,Training,Obstetrics and gynecology,Teleconsultation
    Date: 2021–03
  19. By: Emilia Barili (University of Genoa); Veronica Grembi (University of Milan); Anna Rosso (University of Milan)
    Abstract: Relying on a survey of more than 4,000 female respondents, we investigate the main determinants of women's mental distress during the first wave of the COVID-19 pandemic in Italy. We focus on two groups of variables to capture both the health and the economic emergency: present concerns and future expectations. Our results show that the main predictors of mental health are future expectations, such as the fear of losing a job, which is more relevant than concerns related to the spread of the virus. Younger women (less than 35), those lacking a high school degree, and those working in education or in remote work with school-aged children are in most distress. Using a panel fixed effects model that includes respondents to a re-call run in February 2021, we show that there was no adjustment to the new normal. Finally, using data on gender norms, we show that where the role of women is conceived in a more traditional way, the level of mental distress as driven by future employment is lower, suggesting that women's expectations for their role in society do play a relevant role in self-assessed well-being.
    Keywords: Mental health, COVID-19, Expectations, Gender Stereotypes
    JEL: I1 I12 J16
    Date: 2021–03–19
  20. By: Katharina Muhlhoff (Universidad Carlos III de Madrid)
    Abstract: Without safe and effective vaccination the current coronavirus pandemic will not get under control. Moreover, economic history suggests that even with vaccination, success is uncertain. To make this point, the present paper studies smallpox - an aggressive viral disease like Covid19 - as a model for future coronavirus immunization. Setting out from the formal basis of mathematical epidemiology and the theory of economic externalities, it finds that (i) vaccination externalities are non-monotonous in the burden of disease, that (ii) public interventions need to be tailored to the specific stages of the externality and (iii) that concrete implementation matters as much as formal institutions. To derive practical implications from these results, I retrace the prevention policies of two German states, Baden and Wurttemberg, which provide an intriguing natural experiment: Both featured similar socio-economic characteristics, both were initially ridden by smallpox and both passed mandatory vaccination laws at roughly the same time. But whereas laws hardly differed, one state - Baden - performed better in terms of epidemiological outcomes (smallpox prevalence and mortality), in cost efficiency and in measures of compliance. The main reasons for this success were the rapid implementation of mass vaccination, central coordination of vaccine supply, supervision and positive incentives for medical professionals. The bottom line of the historical case is therefore that governments which invest early in the infrastructural and personnel needs of a mass-vaccination system are likely rewarded by high popular acceptance and low disease prevalence.
    Keywords: Health Externalities, Vaccination, Smallpox, Vaccine Resistance, Government Regulation, Historical Public Health Institutions
    JEL: I12 I18 I38 N33 N43
    Date: 2021–02
  21. By: Paul Brandily (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Clément Brébion (CBS - Copenhagen Business School [Copenhagen]); Simon Briole (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, J-PAL Europe - Abdul Latif Jameel Poverty Action Lab - Europe); Laura Khoury (Norwegian School of Economics and Business Administration - Norwegian School of Economics and Business Administration)
    Abstract: While a burgeoning literature has documented the unequal distribution of COVID-19 confirmed cases,there is still little evidence on the causal effect of the epidemic on mortality inequalities. In this pa-per, we exploit exhaustive municipality-level data in France, one of the most severely hit country in the world, to identify a persistent negative relationship between income and excess mortality withinurban areas. Over the year 2020, the poorest municipalities experienced a 42% higher increase inexcess mortality. Our analyses further reveal that the policy responses to the epidemic - including thelockdowns - play no role in this heterogeneous impact. Last, we show that both labour-market expo-sure and housing conditions are major determinants of the direct effect of the epidemic on mortalityinequalities, but that their respective role depends on the state of the epidemic and the lockdown policy
    Keywords: COVID-19,poverty,inequality,mortality,labor market,housing conditions
    Date: 2021–02
  22. By: Andrew Atkeson
    Abstract: I present a behavioral epidemiological model of the evolution of the COVID epidemic in the United States and the United Kingdom over the past 12 months. The model includes the introduction of a new, more contagious variant in the UK in early fall and the US in mid December. The model is behavioral in that activity, and thus transmission, responds endogenously to the daily death rate. I show that with only seasonal variation in the transmission rate and pandemic fatigue modeled as a one-time reduction in the semi-elasticity of the transmission rate to the daily death rate late in the year, the model can reproduce the evolution of daily and cumulative COVID deaths in the both countries from Feb 15, 2020 to the present remarkably well. I find that most of the end-of-year surge in deaths in both the US and the UK was generated by pandemic fatigue and not the new variant of the virus. I then generate fore- casts for the evolution of the epidemic over the next two years with continuing seasonality, pandemic fatigue, and spread of the new variant.
    JEL: C0 I0
    Date: 2021–02
  23. By: Bar-On, Yinon (Weizmann Institute of Science); Baron, Tatiana (Ben Gurion University); Cornfeld, Ofer; Milo, Ron (Weizmann Institute of Science); Yashiv, Eran (Tel Aviv University)
    Abstract: Research in Economics on COVID-19 posits an economy subject to disease dynamics, which are often seriously misspecified in terms of speed and scale. Using a social planner problem, we show that such misspecifications lead to misguided policy. Erroneously characterizing a relatively slow-moving disease engenders dramatically higher death tolls and excessive output loss relative to the correct benchmark. We delineate the latter, employing epidemiological evidence on the timescales of COVID-19 transmission and clinical progression. The resulting sound model is simple, transparent, and novel in Economics.
    Keywords: optimal policy, public health, GDP loss, COVID-19, disease dynamics and scale, misspecification
    JEL: E61 E65 H12 J17
    Date: 2021–03
  24. By: Gutin, Gregory; Hirano, Tomohiro; Hwang, Sung-Ha; Neary, Philip R; Toda, Alexis Akira
    Abstract: How does social distancing affect the reach of an epidemic in social networks? We present Monte Carlo simulation results of a susceptible-infected-removed with social distancing model. The key feature of the model is that individuals are limited in the number of acquaintances that they can interact with, thereby constraining disease transmission to an infectious subnetwork of the original social network. While increased social distancing typically reduces the spread of an infectious disease, the magnitude varies greatly depending on the topology of the network, indicating the need for policies that are network dependent. Our results also reveal the importance of coordinating policies at the 'global' level. In particular, the public health benefits from social distancing to a group (e.g. a country) may be completely undone if that group maintains connections with outside groups that are not following suit.
    Keywords: BA scale-free networks, Infectious subnetwork, SIRwSD model, Social distancing, WS small-world networks, q-bio.PE, physics.soc-ph, Fluids & Plasmas, Applied Economics
    Date: 2021–03–03
  25. By: Ewen Gallic (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); Michel Lubrano (School of Economics, Jiangxi University of Finance and Economics, 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); Pierre Michel (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)
    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
    Date: 2021–02–18
  26. By: Digialleonardo, Luca; Mare, Mauro; Motroni, Antonello; Porcelli, Francesco
    Abstract: This paper provides an empirical analysis of the relationship between the strength of family ties and the spread of Sars-CoV-2. The dataset is constructed for a cross-section of 63 countries combining different data sources, to cover seven dimensions: the spread of the virus, family ties, trust and religion, policies implemented to stop the outbreak, status of the economy, geography, demography. We observe a robust positive relationship between family ties and the contagion rate across the world; in particular, the attitude of parents towards the wellbeing for their children is the main force that drives the positive correlation with the contagion. Instead, the respect toward parents (the variable love-parents) seems to be a component of the family ties which negatively correlates with the diffusion of Sars-CoV-2, leading to the final quadratic relationship between the overall family ties strength and the spread of the virus. Moreover, as expected, we find a significant negative correlation between religion and trust and the number of infected people. As conclusive evidence, we observe that the death rate, as well as the recovery rate, are not affected by the strength of family ties and other social capital variables. What matters, in this case, are structural variables like GPD, number of hospital beds per capita, life expectance, median age and geographical location.
    Keywords: Keywords: Family Ties, Social Capital, Sars-CoV-2, Pandemic JEL classification: A13, I12, I18
    JEL: A12 I12 I18 Z12
    Date: 2021–03
  27. By: Pierluigi Conzo; Andrea Gallice; Juan S. Morales; Margaret Samahita; Laura K. Taylor
    Abstract: We investigate the effect of social media endorsements (likes, retweets, shares) on individuals’ policy preferences. In two online controlled experiments (N=1,384), we exposed participants to non-neutral policy messages about the COVID-19 pandemic (emphasizing either public health or economic activity as a policy priority) while varying the level of endorsements of these messages. Our experimental treatment significantly shifted the policy views of active social media users by about 0.12 standard deviations. The treatment effect for these users is heterogeneous depending on their pre-existing views. Specifically, message endorsements reinforce pre-existing attitudes, thereby increasing opinion polarization. The effect appears concentrated on a minority of individuals who correctly answered a factual manipulation check regarding the endorsement metrics. This evidence suggests that though only a fraction of individuals pay conscious attention to these metrics, they may be easily influenced by these social cues.
    Keywords: social media, social conformity, political polarization, COVID-19.
    JEL: D83 L82 L86 O33
    Date: 2021
  28. By: Mohammad Reza Farzanegan
    Abstract: This paper evaluates whether the level of public corruption influences COVID-19 case fatality rates. Using cross-section data, including 64 countries and multiple regression techniques, we find that the level of corruption is positively and significantly associated with COVID-19 human costs. These results are robust to control of other possible explanatory factors.
    Keywords: Covid-19, case fatality rates, pandemic, corruption, trust, cross-country regression
    JEL: I15 I18 D73 E02 H51
    Date: 2021
  29. By: Christelle Baunez (INT - Institut de Neurosciences de la Timone - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique); Mickaël Degoulet (INT - Institut de Neurosciences de la Timone - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique); Stéphane Luchini (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); Patrick A. Pintus (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); Miriam Teschl (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)
    Abstract: Even though much has been learned about the new pathogen SARS-CoV-2 since the beginning of the COVID-19 pandemic, a lot of uncertainty remains. In this paper we argue that what is important to know under uncertainty is whether harm accelerates and whether health policies achieve deceleration of harm. For this, we need to see cases in relation to diagnostic effort and not to look at indicators based on cases only, such as a number of widely used epidemiological indicators, including the reproduction number, do. To do so overlooks a crucial dimension, namely the fact that the best we can know about cases will depend on some welldefined strategy of diagnostic effort, such as testing in the case of COVID-19. We will present a newly developed indicator to observe harm, the acceleration index, which is essentially an elasticity of cases in relation to tests. We will discuss what efficiency of testing means and propose that the corresponding health policy goal should be to find ever fewer cases with an ever-greater diagnostic effort. Easy and low-threshold testing will also be a means to give back people's sovereignty to lead their life in an "open" as opposed to "locked-down" society.
    Keywords: uncertainty,acceleration index,anti-fragility,reproduction factor,test strategy,sovereignty
    Date: 2021–02–20
  30. By: Michael P. Cameron (University of Waikato); Barbara Fogarty-Perry (Otago Polytechnic); Gemma Piercy (University of Waikato)
    Abstract: The coronavirus pandemic and associated lockdowns have had broad impacts across societies globally. In particularly, the move to online learning for students in higher education has been disruptive and challenging. We report on the New Zealand arm of an international survey of higher education students (n = 147), investigating students’ experiences of online teaching and the impacts of lockdown. Using quantitative and qualitative data from the survey, we find that students coped reasonably well with the disruption to their studies, and were generally satisfied with how their lecturers and institutions responded to the unanticipated lockdowns. However, many students felt that their studies were negatively impacted, and in particular, vulnerable groups such as students with low financial resources, were most severely impacted. Moreover, students reported a range of negative emotions during lockdown that suggest mental health impacts may be a concern. Our results suggest that clear communication from authorities, reducing the uncertainty for students, and ensuring that vulnerable groups are appropriately supported, may be the best avenues to reduced negative impacts on students during future significant disruptions to study, whether pandemic-related or otherwise.
    Keywords: COVID-19; higher education; New Zealand
    JEL: I20 I31
    Date: 2021–03–10
  31. By: Busemeyer, Marius R.
    Abstract: The persistent challenge posed by the coronavirus crisis raises questions concerning the efficiency and fairness of the German healthcare system. Based on new representative survey data, this paper examines what Germans think of the system’s general strength and fairness. Whereas trust in the system’s ability to avoid the unequal treatment of different groups of the population is high, people are more skeptical when it comes to its strength and efficiency. Political preferences play a role here, with supporters of the right-wing populist Alternative for Germany (AfD) much more skeptical than those supporting the center-right Christian Democrats (CDU/CSU) and the Green Party. Trust in the healthcare system and political trust, especially in the truthfulness of the federal government’s information policy, are closely linked. Information policy, therefore, plays a crucial role when it comes to securing public trust in the healthcare system.
    Date: 2020

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