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on Health Economics |
| By: | Silvia Angerer; Daniela Glätzle-Rützler; Christian Waibel |
| Abstract: | Credence goods markets are characterized by asymmetric information concerning the needed and/or provided quality between experts and consumers. The functioning of the market heavily relies on trust on the side of the consumer as well as trustworthiness on the side of the expert. However, a great amount of empirical and experimental papers document for a range of different credence goods markets the existence of over-, undertreatment, and overcharging. In this paper, we study two determinants of trust and trustworthiness in experimental credence goods markets, namely the effect of a health frame (versus a neutral frame) as well as the identity of the expert (being either a standard student subject or a prospective physician). Our results reveal that the identity in combination with a health frame has a significant impact on the level of trust shown by a higher willingness of consumers (patients) to enter the market. Trustworthiness, as measured by the provision and charging behavior of experts, however, is not significantly influenced by the health care framing, nor by the subject pool. |
| Keywords: | Health care economics, trust, fraud, framing effects, experts, credence goods, undertreatment, overcharging, laboratory experiment |
| JEL: | C91 D82 I11 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:inn:wpaper:2021-13&r=all |
| By: | Onur Altindag; Jane Greve; Erdal Tekin |
| Abstract: | We evaluate the impact of a nationwide public health intervention on deaths from sudden infant death syndrome (SIDS), using population data from Denmark in a regression discontinuity research design. The information campaign–implemented primarily through a universal nurse home visiting program–reduced infant mortality by 17.6 percent and saved between 11.5-14.5 lives over 10,000 births. The estimated effect sizes are 11-14 times larger among low birthweight and preterm infants relative to the overall population. Improvement in infant mortality is concentrated among those with lower socio-economic status and with limited access to health information, thereby reducing health inequities at birth in Denmark. |
| JEL: | I12 I18 I24 |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28621&r=all |
| By: | Partha Deb; Anjelica Gangaram |
| Abstract: | In this paper, we examine the impact of school shootings on the human health and capital outcomes of middle and high school student survivors as adults in their twenties and early thirties. Our data on school shooting events is from a recent, comprehensive database of school shootings compiled by the Center for Homeland Defense and Security. The analytic dataset contains incidents from 1994-2005 in conjunction with Behavioral Risk Factors Surveillance System survey data from 2003-2012 on respondents 23 to 32 years of age. We find substantial evidence that, relative to their unexposed peers, school shooting survivors experience declines in health and well-being, engage in more risky behaviors, and have worse education and labor market outcomes. The effects among those exposed in the more recent past, 6-12 years prior to the survey, are consistent with those of the full sample. The significance of effects dissipates among those exposed earlier, 13-18 years prior to the survey. |
| JEL: | I12 I18 I21 J21 |
| Date: | 2021–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28634&r=all |
| By: | Prashant Bharadwaj; Manudeep Bhuller; Katrine V. Løken; Mirjam Wentzel |
| Abstract: | We use data on all middle and high school-aged children who survived a mass shooting incident on July 22, 2011 in Utøya, Norway, to understand how such events affect survivors, their families, and their peers. Using a difference-in-differences design to compare survivors to a matched control group, we find that in the short run children who survive have substantially lower GPA (nearly 0.5 SD), increased health visits, and more mental health diagnoses (nearly 400% increase). In the medium run, survivors have fewer years of schooling completed and lower labor force participation. Parents and siblings of survivors are also impacted, experiencing substantial increases in doctor visits and mental health diagnoses. However, there appear to be limited impacts on school-aged peers of survivors. While this event affected the entire country, we show that survivors and their families bear significant costs despite robust social safety nets and universal access to healthcare. |
| JEL: | I0 |
| Date: | 2021–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28642&r=all |
| By: | Paul Goldsmith-Pinkham; Maxim Pinkovskiy; Jacob Wallace |
| Abstract: | We use a five percent sample of Americans' credit bureau data, combined with a regression discontinuity approach, to estimate the effect of universal health insurance at age 65-when most Americans become eligible for Medicare-at the national, state, and local level. We find a 30 percent reduction in debt collections-and a two-thirds reduction in the geographic variation in collections-with limited effects on other financial outcomes. The areas that experienced larger reductions in collections debt at age 65 were concentrated in the Southern United States, and had higher shares of black residents, people with disabilities, and for-profit hospitals. |
| Date: | 2021–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2102.02142&r=all |
| By: | Adrianna L. McIntyre; Mark Shepard; Myles Wagner |
| Abstract: | There is growing interest in market design using default rules and other choice architecture principles to steer consumers toward desirable outcomes. Using data from Massachusetts’ health insurance exchange, we study an "automatic retention" policy intended to prevent coverage interruptions among low-income enrollees. Rather than disenroll people who lapse in paying premiums, the policy automatically switches them to an available free plan until they actively cancel or lose eligibility. We find that automatic retention has a sizable impact, switching 14% of consumers annually and differentially retaining healthy, low-cost individuals. The results illustrate the power of defaults to shape insurance coverage outcomes. |
| JEL: | D90 I13 I18 |
| Date: | 2021–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28630&r=all |
| By: | Amanda E. Kowalski |
| Abstract: | Decades of evidence reveal a complicated relationship between mammograms and mortality. Mammograms may detect deadly cancers early, but they may also lead to the diagnosis and potentially fatal treatment of cancers that would never progress to cause symptoms. I provide a brief history of the evidence on mammograms and mortality, focusing on evidence from clinical trials, and I discuss how this evidence informs mammography guidelines. I then explore the evolution of all-cause mortality relative to breast cancer mortality within an influential clinical trial. I conclude with some responses to the evolving evidence. |
| JEL: | I1 |
| Date: | 2021–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28648&r=all |
| By: | Daysal, N. Meltem (University of Copenhagen); Elder, Todd E. (Michigan State University); Hellerstein, Judith K. (University of Maryland); Imberman, Scott A. (Michigan State University); Orsini, Chiara (London School of Economics) |
| Abstract: | We use rich administrative data from Denmark to assess medical theories that autism spectrum disorder (ASD) is a heritable condition transmitted through underlying parental skills. Positing that occupational choices reflect skills, we create two separate occupation-based skill measures and find that these measures are associated with ASD incidence among children, especially through the father's side. We also assess the empirical relevance of assortative mating based on skill, concluding that intertemporal changes in assortative mating explain little of the increase in ASD diagnoses in recent decades. |
| Keywords: | parental skills, autism |
| JEL: | I1 J1 |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14227&r=all |
| By: | Laudicella, Mauro (University of Southern Denmark, DaCHE - Danish Centre for Health Economics); Li Donni, Paolo (University of Palermo, Department of Economics, Business and Statistics) |
| Abstract: | This paper develops an extension of the class of finite mixture models for longitudinal count data to the bivariate case by using a trivariate reduction technique and a hidden Markov chain approach. The model allows for disentangling unobservable time-varying heterogeneity from the dynamic effect of utilisation of primary and secondary care and measuring their potential substitution effect. Three points of supports adequately describe the distribution of the latent states suggesting the existence of three profiles of low, medium and high users who shows persistency in their behaviour, but not permanence as some switch to their neighbour's profile. |
| Keywords: | mixture distributions; hidden Markov models; panel data; primary care; secondary care; Denmark healthcare. |
| JEL: | C33 D12 I11 I18 |
| Date: | 2021–03–25 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:sduhec:2021_001&r=all |
| By: | D. Mark Anderson; Daniel I. Rees |
| Abstract: | Thirty-six states have legalized medical marijuana and 14 states have legalized the use of marijuana for recreational purposes. In this paper, we review the literature on the public health consequences of legalizing marijuana, focusing on studies that have appeared in economics journals as well as leading public policy, public health, and medical journals. Among the outcomes considered are: youth marijuana use, alcohol consumption, the abuse of prescription opioids, traffic fatalities, and crime. For some of these outcomes, there is a near consensus in the literature regarding the effects of medical marijuana laws (MMLs). As an example, leveraging geographic and temporal variation in MMLs, researchers have produced little credible evidence to suggest that legalization promotes marijuana use among teenagers. Likewise, there is convincing evidence that young adults consume less alcohol when medical marijuana is legalized. For other public health outcomes such as mortality involving prescription opioids, the effect of legalizing medical marijuana has proven more difficult to gauge and, as a consequence, we are less comfortable drawing firm conclusions. Finally, it is not yet clear how legalizing marijuana for recreational purposes will affect these and other important public health outcomes. We will be able to draw stronger conclusions when more post-treatment data are collected in states that have recently legalized recreational marijuana. |
| JEL: | I1 I12 I18 K42 |
| Date: | 2021–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28647&r=all |
| By: | Nuñez, Roy |
| Abstract: | Obesity is a problem that affects not only developing countries, but also middle-income countries. Using anthropometric and socioeconomic information, I analyzed the relationship between obesity and employment and wages in Peru, a country that has shown rapid economic growth in the last decade. The results show that an increase in the body mass index (BMI) has a negative relationship with the probability of women working (-0.3 percentage points, on average), particularly among married women and those living in urban areas. In the case of men, no statistically significant relationship is observed. Regarding monthly wages, an increase in BMI is associated with a 0.8% reduction in women's wages (US$ 2.3, on average). This effect is seen in the upper part of the wages distribution and among those who are in the BMI obesity range. In the case of men, the effect is positive and significant (additional US$ 4.5, on average) in most of the subgroups analyzed. These results are similar to those observed in the international literature. |
| Keywords: | obesity; labor market; Peru |
| JEL: | I12 I15 J21 J30 |
| Date: | 2020–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:105621&r=all |
| By: | Hollingsworth, Alex; Konisky, David; Zirogiannis, Nikos |
| Abstract: | Excess emissions are air pollution releases that exceed permitted levels and occur during facility start-ups, shutdowns, or malfunctions. While they are violations of the federal Clean Air Act, states have historically granted violating facilities automatic exemptions; limiting enforcement and weakening existing regulation. Recent efforts to harmonize state and federal rules have ignited debate surrounding optimal excess emissions regulation. Using Texas data from 2002-2017, we show robust evidence on the costs of excess emissions. We find that excess emissions increase harmful nearby pollution and elderly mortality, and are responsible for an average of 35 annual deaths in Texas alone. Using excess emissions as an instrument for ozone concentrations, we find that a 10% increase in monthly average ozone increases elderly mortality by 3.9%, driven by increased deaths in the oldest age groups. |
| Date: | 2021–04–05 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:gc73x&r=all |
| By: | Marisa Miraldo (Imperial College Business School,); Carol Propper (Imperial College Business School); Christiern Rose (School of Economics, University of Queensland, Brisbane, Australia) |
| Abstract: | This paper provides new identification results for panel data models with contextual and endogenous peer effects. Contextual effects operate through individuals’ time-invariant unobserved heterogeneity. Identification hinges on a conditional mean restriction requiring exogenous mobility of individuals between groups over time. Some networks governing peer interactions preclude identification. For these cases we propose additional conditional variance restrictions. We conduct a Monte-Carlo experiment to evaluate the performance of our method and apply it to surgeon-hospital-year data to study take-up of minimally invasive surgery. A standard deviation increase in the average time-invariant unobserved heterogeneity of other surgeons in the same hospital leads to a 0.12 standard deviation increase in take-up. The effect is equally due to endogenous and contextual effects. |
| Keywords: | Peer effects, panel data, networks, identification, innovation, healthcare |
| Date: | 2020–12–03 |
| URL: | http://d.repec.org/n?u=RePEc:qld:uq2004:639&r=all |
| By: | Anindya Ghose; Xitong Guo; Beibei Li; Yuanyuan Dang |
| Abstract: | With today's technological advancements, mobile phones and wearable devices have become extensions of an increasingly diffused and smart digital infrastructure. In this paper, we examine mobile health (mHealth) platforms and their health and economic impacts on the outcomes of chronic disease patients. To do so, we partnered with a major mHealth firm that provides one of the largest mobile health app platforms in Asia specializing in diabetes care. We designed and implemented a randomized field experiment based on detailed patient health activities (e.g., steps, exercises, sleep, food intake) and blood glucose values from 1,070 diabetes patients over several months. Our main findings show that the adoption of the mHealth app leads to an improvement in both short term metrics (such as reduction in patients' blood glucose and glycated hemoglobin levels) and longer-term metrics (such as hospital visits, and medical expenses). Patients who adopted the mHealth app undertook higher levels of exercise, consumed healthier food with lower calories, walked more steps and slept for longer times on a daily basis. A comparison of mobile vs. PC enabled version of the same app demonstrates that the mobile has a stronger effect than PCs in helping patients make behavioral modifications with respect to diet, exercise and life style, which ultimately leads to an improvement in their healthcare outcomes. We also compared outcomes when the platform facilitates personalized health reminders to patients vs. generic reminders. We found that personalized mobile message with patient-specific guidance can have an inadvertent effect on patient app engagement, life style changes, and health improvement. Overall, our findings indicate the potential value of mHealth technologies, as well as the importance of mHealth platform design in achieving better healthcare outcomes. |
| Date: | 2021–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2102.05506&r=all |
| By: | Tushar Bharati (Business School, The University of Western Australia; Research Center in Business, Economics and Resources, HCMC Open University; Faculty of Banking, Finance and Business Administration, Quy Nhon University); Samuel Rapeport (Business School, the University of Western Australia; Research Centre in Business, Economics and Resources, Ho Chi Minh City Open University; Faculty of Finance, Banking and Business Administration, Quy Nhon University) |
| Abstract: | We exploit spatial and temporal variation in sunlight radiation across Australia to document the relationship between in utero sunlight exposure and later-life asthma. We find that respondents who experienced above-average levels of sunlight in the nine months prior to their birth are 4.7 percentage points less likely to have been diagnosed with asthma. Next, we turn to the puzzle that despite being one of the sunniest countries, Australia has one of the highest rates of asthma prevalence. The explanation appears to be the Australians’ rising propensity to avoid the sun. A comparison of contemporaneous sunlight and the time Australians spend outdoors shows that younger generations are actively avoiding the sun. Using data on the year of establishment and financial standing of the Cancer Councils in different states, we show that SunSmart awareness campaigns about the harmful effects of sun exposure have triggered this behaviour, and may be unintentionally contributing to the rising rates of asthma in Australia. |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:uwa:wpaper:21-04&r=all |
| By: | Eliana Barrenho (Paris and Imperial College Business School.); Eric Gautier (Toulouse School of Economics); Marisa Miraldo (Imperial College Business School,); Carol Propper (Imperial College Business School); Christiern Rose (School of Economics, University of Queensland, Brisbane, Australia) |
| Abstract: | We examine the effect of a physician network on medical innovation using novel matched patient-physician-hospital panel data. The data include every relevant physician and all patients in the English NHS for 15 years and physicians’ workplace histories for more than 20. The dynamic network arising from physician mobility between hospitals over time allows us to separate unobserved physician and hospital heterogeneity from the effect of the network. We build on standard peer-effects models by adding cumulative peer behaviour and allow for particularly influential physicians (‘key players’), whose identities we estimate. We find positive effects of peer innovation take-up, number of peers, and proximity in the network to both pioneers of the innovation and key players. Counterfactual estimates suggest that early intervention targeting young, connected physicians with early take-up can significantly increase aggregate take-up. |
| Keywords: | Innovation, medical practice, networks, peer-effects |
| Date: | 2020–12–03 |
| URL: | http://d.repec.org/n?u=RePEc:qld:uq2004:638&r=all |
| By: | Dauth, Christine (Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany]) |
| Abstract: | Among health care systems with both public and private elements (such as in the US and Germany), an important question is whether the type of health insurance exerts an impact on workers' careers. We exploit the unique German case of a two-tier health care system to analyze whether opting out of public statutory health insurance and into private health insurance affects the specific health and employment outcomes of employed workers over a period of nine years. We exploit administrative registers and apply a fuzzy regression discontinuity design. We do not find any evidence that the type of health insurance affects employed workers' outcomes in the medium or long run. This suggests that even though private health insurance entails more comfortable healthcare conditions, public health insurance does not come with heavy health impairments or detrimental employment outcomes." (Author's abstract, IAB-Doku) ((en)) |
| JEL: | I13 J21 J30 |
| Date: | 2021–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:iab:iabdpa:202103&r=all |
| By: | Alberto Sardi; Alessandro Rizzi; Enrico Sorano; Anna Guerrieri |
| Abstract: | The current world challenges include issues such as infectious disease pandemics, environmental health risks, food safety, and crime prevention. Through this article, a special emphasis is given to one of the main challenges in the healthcare sector during the COVID-19 pandemic, the cyber risk. Since the beginning of the Covid-19 pandemic, the World Health Organization has detected a dramatic increase in the number of cyber-attacks. For instance, in Italy the COVID-19 emergency has heavily affected cybersecurity; from January to April 2020, the total of attacks, accidents, and violations of privacy to the detriment of companies and individuals has doubled. Using a systematic and rigorous approach, this paper aims to analyze the literature on the cyber risk in the healthcare sector to understand the real knowledge on this topic. The findings highlight the poor attention of the scientific community on this topic, except in the United States. The literature lacks research contributions to support cyber risk management in subject areas such as Business, Management and Accounting; Social Science; and Mathematics. This research outlines the need to empirically investigate the cyber risk, giving a practical solution to health facilities. Keywords: cyber risk; cyber-attack; cybersecurity; computer security; COVID-19; coronavirus;information technology risk; risk management; risk assessment; health facilities; healthcare sector;systematic literature review; insurance |
| Date: | 2021–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2102.04093&r=all |
| By: | Hossain, Md. Mobarak |
| Abstract: | This paper performs a systematic review on whether there is a relationship between health insurance and self-employment. There are three types of findings available regarding this issue in the entrepreneurship literature. First, health insurance clearly plays a vital role when individuals choose to become self-employed. Second, there is some evidence of the effect of health insurance on entrepreneurial choices for some individuals with some demographic characteristics, like married women, students, people with disabilities, etc. Third, the evidence of relationship between health insurance and entrepreneurial choices is anecdotal. |
| Keywords: | health insurance, entrepreneurship, self-employment |
| JEL: | I11 I13 J48 |
| Date: | 2021–01–28 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:105634&r=all |
| By: | Haris Aziz; Florian Brandl |
| Abstract: | As the COVID-19 pandemic shows no clear signs of subsiding, fair and efficient rationing of healthcare resources has emerged as an important issue that has been discussed by medical experts, policy-makers, and the general public. We consider a healthcare rationing problem where medical units are to be allocated to patients. Each unit is reserved for one of several categories and the patients have different priorities for the categories. We present an allocation rule that respects the priorities, complies with the eligibility requirements, allocates the largest feasible number of units, and does not incentivize agents to hide that they qualify through a category. Moreover, the rule is polynomial-time computable. To the best of our knowledge, it is the first known rule with the aforementioned properties. |
| Date: | 2021–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2102.04384&r=all |
| By: | Makoto Niwa; Yasushi Hara; Yusuke Matsuo; Hodaka Narita; Lim Yeongjoo; Shintaro Sengoku; Kota Kodama |
| Abstract: | During the global spread of COVID-19, Japan has been among the top countries to maintain a relatively low number of infections, despite implementing limited institutional interventions. Using a Tokyo Metropolitan dataset, this study investigated how these limited intervention policies have affected public health and economic conditions in the COVID-19 context. A causal loop analysis suggested that there were risks to prematurely terminating such interventions. On the basis of this result and subsequent quantitative modelling, we found that the short-term effectiveness of a short-term pre-emptive stay-at-home request caused a resurgence in the number of positive cases, whereas an additional request provided a limited negative add-on effect for economic measures (e.g. the number of electronic word-of-mouth (eWOM) communications and restaurant visits). These findings suggest the superiority of a mild and continuous intervention as a long-term countermeasure under epidemic pressures when compared to strong intermittent interventions. |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2103.14298&r=all |
| By: | Emmanuelle Lavaine (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); Marion Davin (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) |
| Abstract: | This paper combines a theoretical and an empirical approach to address how health at birth affects child development? Using a simple theoretical model in which parents invest in their children, we identify the mechanisms through which better health at birth can improve child development. We also emphasise how parental socioeconomic status can shape the effects of health at birth. We perform an empirical analysis on a French cohort of children born in 2011, using a unique dataset ELFE. We identify the effect of birth weight and gestational age on child development at one year. The results indicate that only gestational age positively affects early development. We find no empirical evidence for the existence of a severity effect, according to which the adverse effects of poor health at birth are higher for children in low-income families or with poorly educated mothers. |
| Keywords: | Early Child Development,Health at birth,Parental investment |
| Date: | 2021–04–02 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-03189147&r=all |
| By: | Tóth, Csaba G. |
| Abstract: | The excess mortality indicator is able to capture how an epidemic affects a country’s mortality processes, taking into account direct and indirect, as well as possible effects in different directions. From the point of view of mortality processes in Hungary, the main feature of the first months of 2020 was that seasonal flu claimed fewer victims than in previous years, for this reason we examined last year’s excess mortality for the period between weeks 12 and 52 related to the coronavirus epidemic using a stochastic mathematical model. According to our calculations, excess mortality related to the coronavirus epidemic in Hungary was 13,700 people in 2020, which means a 14% excess in the period under review. Eighty-six percent of those who died were over the age of 65, 10 percent were between the ages of 50 and 64, and the proportion of those aged 49 or younger was 4 percent. In almost all age groups, the excess mortality rate was nearly twice as high for men as for women. According to our calculations, excess mortality was roughly one and a half times the number of victims claimed by the epidemic in 2020 according to official statistics, and we also found a significant difference between the time course of the two indicators. |
| Keywords: | Excess mortality, Covid-19, mortality, Demography, Flu, Hungary |
| JEL: | C10 I10 J10 J19 |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:106948&r=all |
| By: | Bertocchi, Graziella (University of Modena and Reggio Emilia); Dimico, Arcangelo (Queen's University Belfast) |
| Abstract: | The mounting evidence on the demographics of COVID-19 fatalities points to an overrepresentation of minorities and an underrepresentation of women. Using individual-level, race-disaggregated, and georeferenced death data collected by the Cook County Medical Examiner, we jointly investigate the racial and gendered impact of COVID-19, its timing, and its determinants. Through an event study approach we establish that Blacks individuals are affected earlier and more harshly and that the effect is driven by Black women. Rather than comorbidity or aging, the Black female bias is associated with poverty and channeled by occupational segregation in the health care and transportation sectors and by commuting on public transport. Living arrangements and lack of health insurance are instead found uninfluential. The Black female bias is spatially concentrated in neighborhoods that were subject to historical redlining. |
| Keywords: | COVID-19, deaths, race, gender, occupations, transport, redlining, Cook County, Chicago |
| JEL: | I14 J15 J16 J21 R38 |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14238&r=all |
| By: | Claudius Gros; Daniel Gros |
| Abstract: | We derive an analytic expression describing how health costs and death counts of the Covid-19 pandemic change over time as vaccination proceeds. Meanwhile, the disease may continue to spreads exponentially unless checked by Non Pharmacological Interventions (NPI). The key factors are that the mortality risk from a Covid-19 infection increases exponentially with age and that the sizes of age cohorts decrease linearly at the top of the population pyramid. Taking these factors into account, we derive an expression for a critical threshold, which determines the minimal speed a vaccination campaign needs to have in order to be able to keep fatalities from rising. Younger countries with fast vaccination campaigns find it substantially easier to reach this threshold than countries with aged population and slower vaccination. We find that for EU countries it will take some time to reach this threshold, given that the new, now dominant, mutations, have a significantly higher infection rate. We also find that protecting the over 60 years old, which constitute one quarter of the EU population, would reduce the loss of live by 95 percent. |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2103.15544&r=all |
| By: | Kahanec, Martin (Central European University); Lafférs, Lukáš (Matej Bel University); Schmidpeter, Bernhard (University of Linz) |
| Abstract: | More than 100 million people have been infected and 2.5 million people have died of COVID-19 globally as of February 2021. Mass antigen testing could help to mitigate the pandemic and allow the economy to re-open. We investigate the effects of mass antigen testing on the pandemic, using data from a uniquely designed nation-wide testing implemented in Slovakia in Autumn 2020. After the first round, only districts above an ex-ante unknown prevalence threshold were re-tested. Comparing districts above and below the threshold using a quasi-experimental design, we find that repeated mass antigen testing reduced infections by about 25-30% and decreased R0 by 0.3 two weeks after the re-testing; the effects on incidence peaked around that time and all effects gradually dissipated afterward. These results suggest that mass testing could be an effective tool in curbing the spread of COVID-19, but for lasting effects regular retesting would be necessary. |
| Keywords: | COVID-19, COVID-19 policies, antigen testing, mass testing, non-pharmaceutical interventions |
| JEL: | D04 I18 J22 |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14228&r=all |
| By: | Casey B. Mulligan |
| Abstract: | The health costs of in-person schooling during the pandemic, if any, fall primarily on the families of students, largely due to the fact that students significantly outnumber teachers. Data from North Carolina, Wisconsin, Australia, England, and Israel covering almost 80 million person-days in school help assess the magnitude of the fatality risks of in-person schooling (with mitigation protocols), accounting for the age and living arrangements of students and teachers. The risks of in-person schooling to teachers are comparable to the risks of commuting by automobile. Valued at a VSL of $10 million, the average daily fatality cost ranges from $0.01 for an unvaccinated young teacher living alone to as much as $29 for an elderly and unvaccinated teacher living with an elderly and unvaccinated spouse. COVID-19 risk avoidance may also be more amenable to Bayesian updating and selective protection than automobile fatalities are. The results suggest that economic behaviors can sometimes invert epidemiological patterns when it comes to the spread of infectious diseases in human populations. |
| JEL: | I18 I21 J45 J51 L33 L51 |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28619&r=all |
| By: | Maddalena Ferranna; JP Sevilla; David E. Bloom |
| Abstract: | The COVID-19 pandemic has forced countries to make difficult ethical choices, e.g., how to balance public health and socioeconomic activity and whom to prioritize in allocating vaccines or other scarce medical resources. We discuss the implications of benefit-cost analysis, utilitarianism, and prioritarianism in evaluating COVID-19-related policies. The relative regressivity of COVID-19 burdens and control policy costs determines whether increased sensitivity to distribution supports more or less aggressive control policies. Utilitarianism and prioritarianism, in that order, increasingly favor income redistribution mechanisms compared with benefit-cost analysis. The concern for the worse-off implies that prioritarianism is more likely than utilitarianism or benefit-cost analysis to target young and socioeconomically disadvantaged individuals in the allocation of scarce vaccine doses. |
| JEL: | D6 I1 I3 |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28601&r=all |
| 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 |
| URL: | http://d.repec.org/n?u=RePEc:pke:wpaper:pkwp2101&r=all |
| By: | Andreas Hornstein |
| Abstract: | I incorporate quarantine, contact tracing, and random testing in the basic SEIR model of infectious disease diffusion. A version of the model that is calibrated to known characteristics of the spread of COVID-19 is used to estimate the transmission rate of COVID-19 in the United States in 2020. The transmission rate is then decomposed into a part that reflects observable changes in employment and social contacts and a residual component that reflects disease properties and all other factors that affect the spread of the disease. I then construct counterfactuals for an alternative employment path that avoids the sharp employment decline in the second quarter of 2020 but also results in higher cumulative deaths due to a higher contact rate. For the simulations, a modest permanent increase of quarantine effectiveness counteracts the increase in deaths, and the introduction of contact tracing and random testing further reduces deaths, although at a diminishing rate. Using a conservative assumption on the statistical value of life, the value of improved health outcomes from the alternative policies far outweighs the economic gains in terms of increased output and the potential fiscal costs of these policies. |
| Keywords: | Quarantine; Testing |
| Date: | 2021–03–31 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedrwp:90651&r=all |
| By: | Dipoppa Dipoppa (Stanford University); Guy Grossman (University of Pennsylvania); Stephanie Zonszein (University of Pennsylvania) |
| Abstract: | Covid-19 caused a significant health and economic crisis, a condition identified as conducive to stigmatization and hateful behavior against minority groups. It is however unclear whether the threat of infection triggers violence in addition to stigmatization, and whether a violent reaction can happen at the onset of an unexpected economic shock before social hierarchies can be disrupted. Using a novel database of hate crimes across Italy, we show that (i) hate crimes against Asians increased substantially at the pandemic onset, and that (ii) the increase was concentrated in cities with higher expected unemployment, but not higher mortality. We then examine individual, local and national mobilization as mechanisms. We find that (iii) local far-right institutions motivate hate crimes, while we find no support for the role of individual prejudice and national discourse. Our study identifies new conditions triggering hateful behavior, advancing our understanding of factors hindering migrant integration. |
| Keywords: | Italy; Hate Crimes; Intergroup violence; Prejudice; Economic crisis |
| JEL: | D74 D91 G01 P46 |
| Date: | 2021–02 |
| URL: | http://d.repec.org/n?u=RePEc:pri:esocpu:23&r=all |
| By: | Vulpe, Simona - Nicoleta; Rughinis, Cosima |
| Abstract: | Background: Despite lacking scientific support, vaccine hesitancy is widespread. While “vaccine damage” as a scientific fact is statistically highly uncommon, emerging social and technological forces have converted “probable vaccine damage” into an alternative fact, thus making it a widely shared intersubjective reality. Methods: Using the Eurobarometer 91.2 survey on a statistically representative EU27-UK sample interviewed in March 2019, we documented perceptions of vaccine risks and identified three belief configurations regarding vaccine effectiveness, safety, and usefulness, through exploratory cluster analysis. Results: The public beliefs in vaccine risks are frequent. Approximatively one-tenth of the EU27-UK population consider that vaccines are not rigorously tested before authorization, one-third believe that vaccines can overload or weaken the immune system and that they can cause the disease against which they protect, and almost one-half believe that vaccines can cause serious side effects. We identified three belief configurations: the skeptical, the confident, and the trade-off clusters. The skeptical type (approx. 11% of EU27-UK respondents) is defined by the belief that vaccines are rather ineffective, affected by risks of probable vaccine damage, not well-tested, and useless; the confident type (approx. 59%) is defined by beliefs that vaccines are effective, safe, well-tested, and useful; and the trade-off type (approx. 29%) combines beliefs that vaccines are effective, well-tested and useful, with beliefs of probable vaccine damage. The vaccine-confident and the trade-off types profess having similar vaccination histories, indicating the significant role of other factors besides beliefs in inducing behavior. Conclusions: The high proportion of varying public beliefs in vaccine risks and the presence of a trade-off type of vaccination assessment indicate the social normality of beliefs in probable vaccine damage. Probable vaccine damage presently exists as an alternative fact in the public imagination, perceptively available for wide segments of the public, including those who trust medical science. |
| Keywords: | Vaccine hesitancy; vaccine damage; typology; Eurobarometer; belief configurations |
| JEL: | I12 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:105647&r=all |
| By: | Roberto Chang; Humberto Martínez; Andrés Velasco |
| Abstract: | The advent of a pandemic is an exogenous shock, but the dynamics of contagion are very much endogenous --and depend on choices that individuals make in response to incentives. In such an episode, economic policy can make a difference not just by alleviating economic losses but also via incentives that affect the trajectory of the pandemic itself. We develop this idea in a dynamic equilibrium model of an economy subject to a pandemic. Just as in conventional SIR models, infection rates depend on how much time people spend at home versus working outside the home. But in our model, whether to go out to work is a decision made by individuals who trade off higher pay from working outside the home today versus a higher risk of infection and expected future economic and health-related losses. As a result, pandemic dynamics depend on factors that have no relevance in conventional models. In particular, expectations and forward-looking behavior are crucial and can result in multiplicity of equilibria with different levels of economic activity, infection, and deaths. The analysis yields novel policy lessons. For example, incentives embedded in a fiscal package resembling the U.S. CARES Act can result in two waves of infection. |
| JEL: | E6 F4 H3 I3 |
| Date: | 2021–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:28636&r=all |
| By: | Jonah Tobin (Williams College); Oliver Hall (Williams College); Jacob Lazris (Williams College); David Zimmerman (Williams College) |
| Abstract: | This paper presents empirical evidence on factors influencing choices made by members of the Annapolis Group of Liberal Arts colleges regarding whether to operate primarily in person, primarily online or some flexible alternative during the COVID-19 pandemic of 2020. Binary and multinomial choice model estimates suggest that conditional upon the prevailing level of COVID-19 in their county, financially distressed colleges were about 20 percentage points more likely to opt for primarily in-person operations than less financially distressed colleges. These choices highlight an important potential tradeoff between public health and financial concerns present in the higher education sector. |
| Keywords: | COVID-19, college reopenings, financial stress, public health |
| JEL: | I2 I23 |
| Date: | 2021–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:wil:wileco:2021-06&r=all |
| By: | Ajzenman, Nicolas (São Paulo School of Economics-FGV); Cavalcanti, Tiago (University of Cambridge); Da Mata, Daniel (São Paulo School of Economics-FGV) |
| Abstract: | This paper investigates if the anti-scientific rhetoric of modern populists can induce followers to engage in risky behavior. We gather electoral information, in-person card transactions, and geo-localized mobile phone data for approximately 60 million devices in Brazil. After the president publicly dismissed the risks of the COVID-19 pandemic and challenged scientific community recommendations, social distancing in pro-government localities declined. Consistently, general in-person transactions increased immediately, while expenses in pharmacies and cases grew with a six-day lag. Results are driven by localities with higher media penetration levels, active Twitter accounts, and a larger proportion of Evangelical Christians, a critical electoral group. |
| Keywords: | populism, persuasion, leadership, risky behavior, health, COVID-19 |
| JEL: | D1 D72 I12 I31 |
| Date: | 2021–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14229&r=all |