nep-hea New Economics Papers
on Health Economics
Issue of 2021‒05‒10
forty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Employment Contracts and Stress: Experimental Evidence By Allan, Julia L.; Andelic, Nicole; Bender, Keith A.; Powell, Daniel; Stoffel, Sandro; Theodossiou, Ioannis
  2. The Effects of Unemployment on Health, Hospitalizations, and Mortality - Evidence from Administrative Data By Vodopivec, Matija; Laporsek, Suzana; Stare, Janez; Vodopivec, Milan
  3. Voice at Work By Harju, Jarkko; Jäger, Simon; Schoefer, Benjamin
  4. Death on the Job: The Great Recession and Work-Related Traffic Fatalities By French, Michael; Gumus, Gulcin
  5. In Sickness and in Health: Job Displacement and Health Spillovers in Couples By Gathmann, Christina; Huttunen, Kristiina; Jenström, Laura; Sääksvuori, Lauri; Stitzing, Robin
  6. Promotions and Productivity: The Role of Meritocracy and Pay Progression in the Public Sector By Deserranno, Erika; León-Ciliotta, Gianmarco
  7. Dementia and Disadvantage in the United States and England By Arapakis, Karolos; Brunner, Eric; French, Eric Baird; McCauley, Jeremy
  8. Women's Education, Fertility and Children's Health during a Gender Equalization Process: Evidence from a Child Labor Reform in Spain By Bellés-Obrero, Cristina; Cabrales, Antonio; Jimenez-Martin, Sergi; Vall-Castello, Judit
  9. Family Spillover Effects of Marginal Diagnoses: The Case of ADHD By Persson, Petra; Qui, Xinyao; Rossin-Slater, Maya
  10. Predicting Divertible Medicaid Emergency Department Costs By Hastings, Justine S.; Howison, Mark
  11. Complexities of Health and Acceptance of Electronic Health Records for the Austrian Elderly Population By Nicole Halmdienst; Gerald J. Pruckner; Rudolf Winter-Ebmer
  12. Increasing price transparency in the Dutch health care market does not affect provider choice By Husiatynski, Maciej; Klein, Tobias; Mikkers, Misja
  13. Attitudes, Preferences and Usage Behavior of the Population Regarding Social Media Pages of Hospitals - Results of a Quantitative Survey in the DACH Region (Germany, Austria, Switzerland) By Beier, Michael; Früh, Sebastian
  14. Engaging in cognitively stimulating activities and change in cognitive function: a cross-country analysis using SHARE By Andrea Cegolon; Andrew Jenkins
  15. Breaking Bad: How Health Shocks Prompt Crime By Andersen, Steffen; Parise, Gianpaolo; Peijnenburg, Kim
  16. Technological unemployment and income inequality: a stock-flow consistent agent-based approach By Luiza Nassif Pires; Laura Carvalho, Eduardo Rawet
  17. Contacts, Altruism and Competing Externalities By Toxvaerd, Flavio
  18. Effects of Mandatory Military Service on Wages and Other Socioeconomic Outcomes By Puhani, Patrick A.; Sterrenberg, Margret K.
  19. Mental Health Effects of Same-Sex Marriage Legalization By Chen, Shuai; van Ours, Jan C.
  20. Algorithm is Experiment: Machine Learning, Market Design, and Policy Eligibility Rules By Yusuke Narita; Kohei Yata
  21. A nonparametric instrumental approach to endogeneity in competing risks models By Jad Beyhum; Jean-Pierre Florens; Ingrid Van Keilegom
  22. Material resources and well-being — Evidence from an Ethiopian housing lottery By Andersen, Asbjørn G.; Kotsadam, Andreas; Somville, Vincent
  23. Selection and Behavioral Responses of Health Insurance Subsidies in the Long Run: Evidence from a Field Experiment in Ghana By Patrick Opoku Asuming; Hyuncheol Bryant Kim; Armand Sim
  24. A Macroeconomic Model of Healthcare Saturation, Inequality & the Output-Pandemia Tradeoff By Mendoza, Enrique G; Rojas, Eugenio; Tesar, Linda; Zhang, Jing
  25. Global health care infrastructure and Africa in times of Covid-19: insights for sustainable development and future pandemics By Diop, Samba; Asongu, Simplice
  26. Unequal Mortality during the Spanish Flu By Basco, Sergi; Domenech, Jordi; Rosés, Joan R.
  27. Income gradient of pharmaceutical panic buying at the outbreak of the COVID-19 pandemic By Péter Elek; Anikó Bíró; Petra Fadgyas-Freyler
  28. The Backward Art of Slowing the Spread? Congregation Efficiencies during COVID-19 By Casey B. Mulligan
  29. Relationship among state reopening policies, health outcomes and economic recovery through first wave of the COVID-19 pandemic in the U.S By Alexandre K. Ligo; Emerson Mahoney; Jeffrey Cegan; Benjamin D. Trump; Andrew S. Jin; Maksim Kitsak; Jesse Keenan; Igor Linkov
  30. Normalizing Community Mask-Wearing: A Cluster Randomized Trial in Bangladesh By Jason Abaluck; Laura H Kwong; Ashley Styczynski; Ashraful Haque; Md. Alamgir Kabir; Ellen Bates-Jefferys; Emily Crawford; Jade Benjamin-Chung; Salim Benhachmi; Shabib Raihan; Shadman Rahman; Neeti Zaman; Peter J. Winch; Md. Maqsud Hossain; Hasan Mahmud Reza; Stephen P. Luby; Ahmed Mushfiq Mobarak
  31. Addressing the COVID-19 Pandemic: Comparing Alternative Value Frameworks By Bloom, David; Ferranna, Maddalena; Sevilla, JP
  32. On the socio-economic impact of pandemics in Africa: Lessons learned from COVID-19, Trypanosomiasis, HIV, Yellow Fever and Cholera By Kohnert, Dirk
  33. Lessons for the Age of Consequences:COVID-19 and the Macroeconomy By Servaas Storm
  34. The Covid-19 pandemic: theoretical and practical perspectives on children, women and sex trafficking By Asongu, Simplice; Usman, Usman
  35. Epidemics in modern economies By Heinrich, Torsten
  36. Democracy and COVID-19 Outcomes By Bilgin, Mehmet Huseyin; Doker, Asli Cansin; Karabulut, Gokhan; Zimmermann, Klaus F
  37. The welfare cost of vaccine misallocation, delays and nationalism By Gollier, Christian
  38. Apart but Connected: Online Tutoring and Student Outcomes during the COVID-19 Pandemic By Carlana, Michela; La Ferrara, Eliana
  39. Modeling optimal quarantines with waning immunity By Goenka, Aditya; Liu, Lin; Nguyen, Manh-Hung
  40. When to Lock, Not Whom: Managing Epidemics Using Time-Based Restrictions By Bar-On, Yinon; Baron, Tatiana; Cornfeld, Ofer; Milo, Ron; Yashiv, Eran
  41. "Too shocked to search" The COVID-19 shutdowns' impact on the search for apprenticeships By Daniel Goller; Stefan C. Wolter

  1. By: Allan, Julia L.; Andelic, Nicole; Bender, Keith A.; Powell, Daniel; Stoffel, Sandro; Theodossiou, Ioannis
    Abstract: A growing literature has found a link between performance-related pay (PRP) and poor health, but the causal direction of the relationship is not known. To address this gap, the current paper utilises a crossover experimental design to randomly allocate subjects into a work task paid either by performance or a fixed payment. Stress is measured through self-reporting and salivary cortisol. The study finds that PRP subjects had significantly higher cortisol levels and self-rated stress than those receiving fixed pay, ceteris paribus. By circumventing issues of self-report and self-selection, these results provide novel evidence for the detrimental effect PRP may have on health.
    Keywords: performance-related pay,stress,experiment,cortisol
    JEL: J33 I0 C91
    Date: 2021
  2. By: Vodopivec, Matija (University of Primorska); Laporsek, Suzana (University of Primorska); Stare, Janez (University of Ljubljana); Vodopivec, Milan (University of Primorska)
    Abstract: Linking health to the employment history of the whole Slovenia's workforce, this paper employs three innovative features. First, it utilizes a novel "double proof" approach of addressing the reverse causality that tracks only healthy individuals, making sure that any unemployment spell that individual may undergo precedes the occurrence of a disease, and relies on mass-layoffs to provide an additional layer of exogeneity to unemployment. Second, it is one of the first papers using data on drug prescriptions to infer information about the health status of individuals and link it labor market outcomes. And third, it treats the health effects of unemployment as part of a dose-response relationship, with the share of time spent in unemployment (as opposed to other labor market states) reflecting the "unemployment dose". The paper finds that, in comparison to employed persons with permanent contracts, persons experiencing unemployment face increased hazard of all three studied groups of diseases - cardiovascular diseases, diabetes, and mental disorders - as well as of hospitalizations caused by these diseases, with the effects stretching over a 15-year horizon. Moreover, the results also show that unemployment significantly increases the probability of death due to cardiovascular diseases and mental disorders, as well as death of any cause.
    Keywords: unemployment, health, hospitalization, mortality, cardiovascular diseases, diabetes, mental disorders, prescriptions, duration analysis
    JEL: J64 I12 C23
    Date: 2021–04
  3. By: Harju, Jarkko; Jäger, Simon; Schoefer, Benjamin
    Abstract: How does boosting worker voice affect worker separations, job quality, wages, and firm performance? We study the 1991 introduction of a right to worker voice in Finland. The law granted workers in firms with at least 150 employees the right to elect representatives to company boards. The size-dependent introduction permits a difference-in-differences design. In contrast to exit-voice theory, we find no effects on voluntary job separations as a revealed-preference measure of job quality. We can also rule out small increases in the labor share or rent sharing, with some evidence for small pay premia increases, in particular at the bottom of the wage distribution. We detect a small reduction in involuntary separations, zero effects on worker health, and a moderate increase in survey-based subjective job quality. Regarding firm performance, we find, if anything, small positive effects on survival, productivity, and capital intensity. An additional 2008 introduction of shop-floor representation in smaller firms had similar, limited effects. Interviews and surveys indicate that worker representation facilitates information sharing and cooperation rather than shifting power or rents to labor.
    Date: 2021–03
  4. By: French, Michael (University of Miami); Gumus, Gulcin (Florida Atlantic University)
    Abstract: In light of recent discussions about shifting employees from traditional workplaces to virtual employment, we are motivated by the question of whether this phenomenon will end up saving lives even in the absence of an infectious disease outbreak. Motor vehicle incidents are the leading cause of work-related fatalities in the US, killing more than 1,200 workers each year, which make up about a quarter of all work-related deaths. Not only are motor vehicle crashes the top killer at work, but economic expansions can further increase occupational and traffic deaths as they both tend to be procyclical. In this paper, we examine the effects of business cycles on traffic fatalities in the US with a special focus on work-related deaths. Specifically, we implement a longitudinal design across all 50 states by compiling quarterly data for 2004-2012 and consider macroeconomic fluctuations around the Great Recession. Our findings show that traffic deaths during prosperous times are not solely due to an increase in risky behaviors such as drunk driving, but directly related to work. Given the highly preventable nature of traffic crashes, policy makers, public health advocates, and employers can develop effective strategies, including remote work arrangements, to improve both occupational and traffic safety.
    Keywords: traffic fatalities, occupational health, business cycles, unemployment, Great Recession
    JEL: E32 I12 I18
    Date: 2021–04
  5. By: Gathmann, Christina; Huttunen, Kristiina; Jenström, Laura; Sääksvuori, Lauri; Stitzing, Robin
    Abstract: Using administrative labor market data matched to mortality and patient records, we document that male job displacement increases mortality for both men and his partner. For every 10,000 displaced men, there are 110 additional deaths. Of those, 60% accrue to the displaced worker but 40% are due to excess spousal mortality. We further document a stunning gender asymmetry: while male job displacement generates persistent health effects, no such dire consequences are observed after a woman's job loss. We explore four explanations for this pattern: risk sharing through spousal labor supply; earnings losses and public insurance; widowhood; and family structure.
    Date: 2021–02
  6. By: Deserranno, Erika; León-Ciliotta, Gianmarco
    Abstract: We study promotion incentives in the public sector by means of a field experiment with the Ministry of Health in Sierra Leone. The experiment creates exogenous variation in meritocracy by linking promotions to performance and variation in perceived pay progression among the lowest tier of health workers. We find that meritocratic promotions lead to higher productivity, and more so when workers expect a steep pay increase. However, when promotions are not meritocratic, increasing the pay gradient reduces productivity through negative morale effects. The findings highlight the importance of taking into account the interactions between different tools of personnel policy.
    Keywords: Meritocracy; Pay Progression; promotions; Worker productivity
    JEL: D73 J31 M51 M52
    Date: 2021–02
  7. By: Arapakis, Karolos; Brunner, Eric; French, Eric Baird; McCauley, Jeremy
    Abstract: We compare dementia prevalence and how it varies by socioeconomic status (SES) across the United States and England. We compare between country differences in age-gender standardized dementia prevalence, across the SES gradient. Dementia prevalence was estimated in each country using an algorithm based on an identical battery of demographic, cognitive, and functional measures. Dementia prevalence is higher among the disadvantaged in both countries, with the United States being more unequal according to four measures of SES. Once past health factors and education were controlled for, most of the within country inequalities disappeared; however, the cross-country difference in prevalence for those in lowest income decile remained disproportionately high. This provides evidence that disadvantage in the United States is a disproportionately high risk factor for dementia.
    Keywords: dementia; disadvantage; socioeconomic gradient
    JEL: I14 I32
    Date: 2021–03
  8. By: Bellés-Obrero, Cristina; Cabrales, Antonio; Jimenez-Martin, Sergi; Vall-Castello, Judit
    Abstract: We study the effect of women's education on fertility and children's health during a period of gender equalization and women's greater access to economic opportunities. In 1980, Spain raised the minimum working age from 14 to 16, while compulsory education age remained at 14. This reform changed the within-cohort incentives to remain in the educational system. Using a difference-in-differences approach, we find that the reform delayed fertility but did not impact completed fertility of affected women. We also show that the reform was detrimental for the health of the children's of affected mothers at delivery. We document two channels for this negative effect: the postponement in the entrance of motherhood and the deterioration of women's health habits (such as smoking and drinking). This last channel is a direct effect of the gender equalization process. However, in the medium run, these more educated mothers are able to reverse the negative health shocks at birth through maternal vigilance and investment in their children's health habits.
    Keywords: Education; Fertility; gender equalization; Infant health
    JEL: I12 I25 J13 J81
    Date: 2021–02
  9. By: Persson, Petra; Qui, Xinyao; Rossin-Slater, Maya
    Abstract: The health care system commonly relies on information about family medical history in the allocation of screenings and in diagnostic processes. At the same time, an emerging literature documents that treatment for ``marginally diagnosed'' patients often has minimal impacts. This paper shows that reliance on information about relatives' health can perpetuate marginal diagnoses across family members, thereby raising caseloads and health care costs, but without improving patient well-being. We study Attention Deficit Hyperactivity Disorder (ADHD), the most common childhood mental health condition, and document that the younger siblings and cousins of marginally diagnosed children are also more likely to be diagnosed with and treated for ADHD. Moreover, we find that the younger relatives of marginally diagnosed children have no better adult human capital and economic outcomes than the younger relatives of those who are less likely to be diagnosed. Our analysis points to a simple adjustment to physician protocol that can mitigate these marginal diagnosis spillovers.
    Keywords: ADHD; family spillovers; marginal diagnosis; mental health; targeting
    JEL: I14 I18 J13
    Date: 2021–01
  10. By: Hastings, Justine S.; Howison, Mark
    Abstract: Lowering health care costs is a policy priority for public health insurance programs. Policies that divert Emergency Department (ED) care to less costly, more effective health services are a promising avenue for cost savings. Using comprehensive, anonymized administrative data from the State of Rhode Island, which includes Medicaid and other social insurance programs, we demonstrate how government can identify and conduct efficient outreach to Medicaid recipients at risk of becoming high-cost ED users for potentially divertible care. The top predictors from our models include age, Medicaid enrollment and eligibility factors, and prior medical procedures. Our predictive models capture more future divertible spending than existing methods for identifying ED “super-utilizers” based on multiple prior ED visits. By using comprehensive administrative data that includes all of the state’s social insurance programs, we can also establish connections between predicted high-cost ED users and existing case management in non-Medicaid programs. Policymakers could use these models to improve their identification of divertible spending and reduce the need for de novo outreach and case management programs.
    Date: 2021–04–26
  11. By: Nicole Halmdienst; Gerald J. Pruckner; Rudolf Winter-Ebmer
    Abstract: We examine the personal health situation and how the complexities thereof affect the elderly Austrians' willingness to accept electronic health records (EHR). Using data from the sixth wave of the SHARE survey in Austria, we find the complexity of individual health problems and the social integration of individuals in uencing the acceptance of EHR. The more the diagnoses of a patient, the more the medication she has to take, and the more often the treatment of a person in hospital, the higher is the acceptance of EHR. Having a chronic illness has a positive effect on EHR acceptance, whereas a pessimistic attitude and lack of joy in life, as indicators of depressive mood, have a negative impact. The results are mainly driven by females and younger patients aged between 50 and 70. People with poor social connection express lower acceptance of EHR.
    Keywords: Electronic health records, health status, social connectedness, SHARE survey.
    JEL: I11 I12 I18
    Date: 2021–04
  12. By: Husiatynski, Maciej; Klein, Tobias; Mikkers, Misja
    Abstract: Price transparency is often viewed as an effective way to encourage price shopping and thereby lower health care expenditure. Using individual claims data for 6 frequent, non-emergency dermatological procedures, we estimate the short-run effect of unexpected publication of prices by a major Dutch health insurer on spending and provider choice. Visits to the price transparency website surged, but spending, the likelihood to visit a new provider, distance traveled, and type of provider visited remained unaffected.
    Keywords: healthcare demand; Price Transparency; provider choice
    JEL: I11 I13
    Date: 2021–03
  13. By: Beier, Michael; Früh, Sebastian
    Abstract: This research report describes attitudes, preferences and usage behavior of the population regarding social media pages of hospitals. For this purpose, the results of a quantitative survey (N=1,547) in the DACH region (Germany, Austria, Switzerland) are presented and explained.
    Keywords: social media,hospitals,digital health,preferences,usage behavior,Facebook,Twitter,Instagram,LinkedIn,XING,YouTube
    Date: 2021
  14. By: Andrea Cegolon (Department of Political Science, Communication and International Relations, University of Macerata, and PhD candidate, University College London); Andrew Jenkins (Social Research Institute, University College London)
    Abstract: We examine the relationship between different types of cognitively stimulating activities (CSAs) and cognitive function in a sample of community-dwelling Europeans aged 50 and older. The data were drawn from the fourth, fifth and sixth waves of the Survey on Health, Ageing and Retirement in Europe (SHARE). The cognitive activities analysed were: educational and training courses; reading books, newspapers and magazines; word or number games (such as crossword puzzles or Sudoku); and playing chess or cards. The cognitive function outcomes under investigation were memory and verbal fluency. Our longitudinal analysis of changes in cognitive abilities show that CSAs can constitute a potential source for the delay or reduction of cognitive decline, even after a short period - only 4 years - of engagement in such activities and regardless of one’s age.
    Keywords: ageing, cognitive decline, memory, verbal fluency, cognitively stimulating activities
    JEL: J14 J26 I12 I21
    Date: 2021–04–01
  15. By: Andersen, Steffen; Parise, Gianpaolo; Peijnenburg, Kim
    Abstract: We explore the impact of health shocks on criminal behavior. Exploiting variations in the timing of cancer diagnoses, we find that health shocks elicit an increase in the probability of committing crime by 13%. This response is economically significant at both the extensive (first-time criminals) and intensive margin (reoffenders). We uncover evidence for two channels explaining our findings. First, diagnosed individuals seek illegal revenues to compensate for the loss of earnings on the legal labor market. Second, cancer patients face lower expected cost of punishment through a lower survival probability. We do not find evidence that changes in preferences explain our findings. The documented pattern is stronger for individuals who lack insurance through preexisting wealth, home equity, or marriage. Welfare programs that alleviate the economic repercussions of health shocks are effective at mitigating the ensuing negative externality on society.
    Keywords: Economics of crime; event study; Health shocks; Human Capital
    Date: 2021–03
  16. By: Luiza Nassif Pires; Laura Carvalho, Eduardo Rawet
    Abstract: The paper presents empirical evidence from Brazil on the bidirectional relationship between inequality and the COVID-19 crisis: racial, regional and income inequalities have both aggravated the pandemic and been exacerbated by it. The paper provides a measure of social risk factors to COVID-19, which is positively associated with the number of Covid-19 cases across Brazilian states. This is complemented by a discussion of the country's inequalities in access to healthcare and in the incidence of comorbidities, which elucidates observed disparities in the need of a ventilator and in the number of deaths by COVID-19. Finally, our empirical analysis suggests that the substantive fiscal effort in the country and particularly the implementation of the cash relief program Auxílio Emergencial neutralized the short-term increase in wage disparities but has been insufficient to neutralize the cost of multi-dimensional structural inequalities on Brazil’s death tolls.
    Keywords: inequality; Covid-19 in Brazil; social vulnerability; health disparities; intersectionality
    JEL: I14 J15 D31
    Date: 2020–12–31
  17. By: Toxvaerd, Flavio
    Abstract: This paper considers voluntary transmissive contacts between partially altruistic individuals in the presence of asymptomatic infection. Two different types of externalities from contacts are considered, infection externalities and socioeconomic externalities. When contacts are incidental, then externalities work through disease propagation. When contacts are essential, both infection and socioeconomic externalities are present. It is shown that for incidental contacts, equilibrium involves suboptimally high exposure whereas for essential contacts, equilibrium exposure is suboptimally low. An increase in altruism may thus increase or decrease disease transmission, depending on the type of contact under consideration. The analysis implies that policy to manage the epidemic should differentiate between different types of tranmissive activities.
    Keywords: altruism; disease control; Epidemics; infection externalities; socioeconomic externalities
    JEL: D83 I12
    Date: 2021–03
  18. By: Puhani, Patrick A.; Sterrenberg, Margret K.
    Abstract: In this paper, we estimate the effects of mandatory military service by exploiting the post-cold war decrease in the need for soldiers causing a substantial number of potential conscripts not to be drafted into the German military. Specifically, using previously unavailable information on degree of fitness in the military's medical exam as a control variable, we test for the effects of mandatory military service on wages; employment; marriage/partnership status; and satisfaction with work, financial situation, health, family life, friends, and life in general. We find almost no statistically significant effects of this 6 to 9 month career interruption for young German men, with the exception of hourly wage, which shows a negative point estimate of -15 percent with a large confidence interval of between -30 and -0.2 percent. This interval estimate is consistent with previous findings for the United States, Denmark, and the Netherlands.
    Keywords: career breaks,conscription,wages,employment,life satisfaction,natural experiment
    JEL: J12 J24 J47
    Date: 2021
  19. By: Chen, Shuai; van Ours, Jan C.
    Abstract: Sexual minorities have had worse than average mental health, which may have to do with actual or perceived discrimination. Same-sex marriage legalization (SSML) is a typical anti-discrimination policy removing marital restrictions for sexual minorities. We study how this legislation affected mental health of sexual minorities in the Netherlands. Conducting a difference-in-differences analysis, we compare changes in mental health following the legalization between sexual minorities and heterosexuals. We fi nd that SSML improved mental health of both married and non-married sexual minorities, which implies that marriage is not the only channel. Examinations of alternative mechanisms combined with literature suggest that the legislation may also take effect by improving societal tolerance as well as stabilizing partnerships and enriching the choice basket of partnership forms for sexual minorities.
    Keywords: mental health; Same-sex marriage; Sexual minorities
    JEL: I12 I18 J12 J15 K36
    Date: 2021–01
  20. By: Yusuke Narita (Massachusetts Institute of Technology); Kohei Yata (Yale University)
    Abstract: Algorithms produce a growing portion of decisions and recommendations both in policy and business. Such algorithmic decisions are natural experiments (conditionally quasi-randomly assigned instruments) since the algorithms make decisions based only on observable input variables. We use this observation to develop a treatment-effect estimator for a class of stochastic and deterministic algorithms. Our estimator is shown to be consistent and asymptotically normal for well-defined causal effects. A key special case of our estimator is a high-dimensional regression discontinuity design. The proofs use tools from differential geometry and geometric measure theory, which may be of independent interest. The practical performance of our method is first demonstrated in a high-dimensional simulation resembling decision-making by machine learning algorithms. Our estimator has smaller mean squared errors compared to alternative estimators. We finally apply our estimator to evaluate the effect of Coronavirus Aid, Relief, and Economic Security (CARES) Act, where more than $10 billion worth of relief funding is allocated to hospitals via an algorithmic rule. The estimates suggest that the relief funding has little effects on COVID- 19-related hospital activity levels. Naive OLS and IV estimates exhibit substantial selection bias.
    Keywords: natural experiment, treatment effects, geometric measure theory, COVID-19
    JEL: D70 C90 H51
    Date: 2021–04
  21. By: Jad Beyhum; Jean-Pierre Florens; Ingrid Van Keilegom
    Abstract: This paper discusses endogenous treatment models with duration outcomes, competing risks and random right censoring. The endogeneity issue is solved using a discrete instrumental variable. We show that the competing risks model generates a non-parametric quantile instrumental regression problem. The cause-specific cumulative incidence, the cause-specific hazard and the subdistribution hazard can be recovered from the regression function. A distinguishing feature of the model is that censoring and competing risks prevent identification at some quantiles. We characterize the set of quantiles for which exact identification is possible and give partial identification results for other quantiles. We outline an estimation procedure and discuss its properties. The finite sample performance of the estimator is evaluated through simulations. We apply the proposed method to the Health Insurance Plan of Greater New York experiment.
    Date: 2021–05
  22. By: Andersen, Asbjørn G. (Ragnar Frisch Centre for Economic Research); Kotsadam, Andreas (Ragnar Frisch Centre for Economic Research); Somville, Vincent (Dept. of Economics, Norwegian School of Economics and Business Administration)
    Abstract: Do better material conditions improve well-being and mental health? Or does any positive relationship merely reflect that psychological well-being promotes economic success? We supply new responses to these questions by comparing winners and losers from a large Ethiopian housing lottery in a preregistered analysis. Winners gain access to better housing, experience a substantial increase in wealth, and report higher levels of overall life satisfaction and lower levels of financial distress. However, we find no effects of winning on psychological distress, suggesting that depression and anxiety involve other causal determinants and are less sensitive to economic conditions than life satisfaction is.
    Keywords: Housing lottery; Mental health
    JEL: I00
    Date: 2021–04–26
  23. By: Patrick Opoku Asuming; Hyuncheol Bryant Kim; Armand Sim
    Abstract: We conduct a randomized experiment that varies one-time health insurance subsidy amounts (partial and full) in Ghana to study the impacts of subsidies on insurance enrollment and health care utilization. We find that both partial and full subsidies promote insurance enrollment in the long run, even after the subsidies expired. Although the long run enrollment rate and selective enrollment do not differ by subsidy level, long run health care utilization increased only for the partial subsidy group. We show that this can plausibly be explained by stronger learning-through-experience behavior in the partial than in the full subsidy group.
    Date: 2021–05
  24. By: Mendoza, Enrique G; Rojas, Eugenio; Tesar, Linda; Zhang, Jing
    Abstract: COVID-19 became a global health emergency when it threatened the catastrophic collapse of health systems as demand for health goods and services and their relative prices surged. Governments responded with lockdowns and increases in transfers. Empirical evidence shows that lockdowns and healthcare saturation contribute to explain the cross-country variation in GDP drops even after controlling for COVID-19 cases and mortality. We explain this output-pandemia tradeoff as resulting from a shock to subsistence health demand that is larger at higher capital utilization in a model with entrepreneurs and workers. The health system moves closer to saturation as the gap between supply and subsistence narrows, which worsens consumption and income inequality. An externality distorts utilization, because firms do not internalize that lower utilization relaxes healthcare saturation. The optimal policy response includes lockdowns and transfers to workers. Quantitatively, strict lockdowns and large transfer hikes can be optimal and yield sizable welfare gains because they prevent a sharp rise in inequality. Welfare and output costs vary in response to small parameter changes or deviations from optimal policies. Weak lockdowns coupled with weak transfers programs are the worst alternative and yet are in line with what several emerging and least developed countries have implemented.
    Keywords: COVID; Fiscal policy; pandemia
    JEL: E25 E65 I1
    Date: 2021–02
  25. By: Diop, Samba; Asongu, Simplice
    Abstract: This exploratory study aims to assess Africa’s lagging position in global heath in relation to some health care infrastructure before critically examining the situation of Africa in the light of pressing Covid-19 healthcare infrastructural needs in terms of number of hospital beds, intensive care units (ICU) beds and ventilators per 100 000 people. A comparative analysis is provided to showcase which regions are leading in the health facilities in the world in general and Africa in particular as well as countries that are lagging in the attendant healthcare facilities. Analytical insights are provided to illustrate that the Covid-19 pandemic has revealed how Africa cannot reach most Sustainable Development Goals (SDGs), especially SDG-3 on health and wellbeing. Moreover, corresponding inferences suggest that the continent is unprepared for future pandemics in terms of health facilities.
    Keywords: Novel coronavirus, Socio-economic effects; Africa
    JEL: E10 E12 E20 E23 I10 I18
    Date: 2020–06
  26. By: Basco, Sergi; Domenech, Jordi; Rosés, Joan R.
    Abstract: The outburst of deaths and cases of Covid-19 around the world has renewed the interest to understand the mortality effects of pandemics across regions, occupations, age and gender. The Spanish Flu is the closest pandemic to Covid-19. Mortality rates in Spain were among the largest in today's developed countries. Our research documents a substantial heterogeneity on mortality rates across occupations. The highest mortality was on low-income workers. We also record a rural mortality penalty that reversed the historical urban penalty temporally. The higher capacity of certain social groups to isolate themselves from social contact could explain these mortality differentials. However, adjusting mortality evidence by these two factors, there were still large mortality inter-provincial differences for the same occupation and location, suggesting the existence of a regional component in rates of flu contagion possibly related to climatic differences.
    Keywords: Health inequality; Pandemics; Socio-Economic Mortality Differences; Urban Penalty
    JEL: I14 J1 N34
    Date: 2021–02
  27. By: Péter Elek (Health and Population Lendület Research Group, Centre for Economic and Regional Studies, 1097 Budapest, Tóth Kálmán u. 4., Hungary and Institute of Economics, Corvinus University of Budapest); Anikó Bíró (Health and Population Lendület Research Group, Centre for Economic and Regional Studies); Petra Fadgyas-Freyler (National Health Insurance Fund Administration)
    Abstract: We analyse the timing, magnitude and income dependence of pharmaceutical panic buying around the outbreak of the COVID-19 pandemic in Hungary. We use district-level monthly and daily administrative data on detailed categories of pharmaceutical purchases, merge them to income statistics and estimate multilevel panel models. Our main results are as follows. First, the days of therapy (DOT) of pharmaceutical purchases increased by more than 30% in March 2020, when major lockdown measures were announced. This pattern holds for almost all categories of pharmaceuticals. Second, shortly after the panic reactions, the aggregate amount of pharmaceutical purchases returned to their pre-shock levels, however, the frequency of pharmacy visits decreased. Third, the panic buying reaction was significantly stronger in richer geographical areas, where – according to the daily data – people also reacted earlier to the pandemic-related news. Overall, the results suggest that panic buying of pharmaceuticals can have dtrimental effects on vulnerable populations.We combine macro-level data on high-stakes testing with survey data on more than 300,000 students aged 10-16 years in 31 European countries, from three waves (2002, 2006 and 2010) of the Health Behaviour in School-aged Children (HBSC) study. With variation in high-stakes testing across countries, years and grade levels, we use a quasi-experimental difference-in-differences (DD) design for identification of causal effects. We find that high-stakes testing increases self-reported school-related stress by almost 10 % of a standard deviation. This is primarily driven by a strong effect for girls, meaning that high-stakes testing increases the gender gap in school-related stress. The results are robust to a range of sensitivity analyses.
    Keywords: COVID-19, inequality, panic buying, pharmaceutical demand
    JEL: I12 I14
    Date: 2021–03
  28. By: Casey B. Mulligan
    Abstract: Were workers more likely to be infected by COVID-19 in their workplace, or outside it? While both economic models of the pandemic and public health policy recommendations often presume that the workplace is less safe, this paper seeks an answer both in micro data and economic theory. The available data from schools, hospitals, nursing homes, food processing plants, hair stylists, and airlines show employers adopting mitigation protocols in the spring of 2020. Coincident with the adoption, infection rates in workplaces typically dropped from well above household rates to well below. When this occurs, the sign of the disease externality from participating in large organizations changes from negative to positive, even while individuals continue to have an incentive to avoid large organizations due to the prevention costs they impose on members. Rational cooperative prevention sometimes results in infectious-disease patterns that are opposite of predictions from classical epidemiology.
    JEL: D22 D71 H23 I18 L25
    Date: 2021–04
  29. By: Alexandre K. Ligo; Emerson Mahoney; Jeffrey Cegan; Benjamin D. Trump; Andrew S. Jin; Maksim Kitsak; Jesse Keenan; Igor Linkov
    Abstract: State governments in the U.S. have been facing difficult decisions involving tradeoffs between economic and health-related outcomes during the COVID-19 pandemic. Despite evidence of the effectiveness of government-mandated restrictions mitigating the spread of contagion, these orders are stigmatized due to undesirable economic consequences. This tradeoff resulted in state governments employing mandates at widely different ways. We compare the different policies states implemented during periods of restriction ("lockdown") and reopening with indicators of COVID-19 spread and consumer card spending at each state during the first "wave" of the pandemic in the U.S. between March and August 2020. We find that while some states enacted reopening decisions when the incidence rate of COVID-19 was minimal or sustained in its relative decline, other states relaxed socioeconomic restrictions near their highest incidence and prevalence rates experienced so far. Nevertheless, all states experienced similar trends in consumer card spending recovery, which was strongly correlated with reopening policies following the lockdowns and relatively independent from COVID-19 incidence rates at the time. Our findings suggest that consumer card spending patterns can be attributed to government mandates rather than COVID-19 incidence in the states. This result highlights the important role of state policies in minimizing health impacts while promoting economic recovery and helps planning effective interventions in subsequent waves and immunization efforts.
    Date: 2021–05
  30. By: Jason Abaluck; Laura H Kwong; Ashley Styczynski; Ashraful Haque; Md. Alamgir Kabir; Ellen Bates-Jefferys; Emily Crawford; Jade Benjamin-Chung; Salim Benhachmi; Shabib Raihan; Shadman Rahman; Neeti Zaman; Peter J. Winch; Md. Maqsud Hossain; Hasan Mahmud Reza; Stephen P. Luby; Ahmed Mushfiq Mobarak
    Abstract: A randomized-trial of community-level mask promotion in rural Bangladesh during COVID-19 shows that the intervention tripled mask usage and is a cost-effective means of promoting public health.
    JEL: I12 I14 I15
    Date: 2021–04
  31. By: Bloom, David; Ferranna, Maddalena; Sevilla, JP
    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.
    Keywords: benefit-cost analysis; control policies; COVID-19; lockdown; prioritarianism; Utilitarianism; vaccine allocation
    JEL: D6 I1 I3
    Date: 2021–03
  32. By: Kohnert, Dirk
    Abstract: Throughout history, nothing has killed more human beings than infectious diseases. Although, death rates from pandemics dropped globally by about 0.8 % per year, all the way through the 20th century, the number of new infectious diseases like Sars, HIV and Covid-19 increased by nearly fourfold over the past century. In Africa, there were reported a total of 4,522,489 confirmed COVID-19 cases and 119,816 death, as of 23 April 2021. The pandemic impacted seriously on the economic and social sectors in almost all African countries. It is threatening to push up to 58 m people into extreme poverty. However, apart from the African poor, the Covid pandemic also affects the growing African middle class, i.e. about 170 million out of Africa’s 1.3 billion people currently classified as middle class. Nearly eight million of may be thrust into poverty because of the coronavirus and its economic aftermath. This setback will be felt for decades to come. Moreover, in recent African History also other infectouse diseases like the 1896–1906 Congo Basin Trypanosomiasis with a death-toll of over 500.000 as well as the 1900–1920 Uganda African trypanosomiasis epidemic with 200,000–300,000 death had tremendous negative impact on Africa’s societies and economies. Actually, other pandemics, like Yellow Fever, Cholera, Meningitis and Measles – not to mention Malaria - contributed to long-lasting economic downturns and seriously affect the social wellbeing for decades.
    Keywords: COVID-19, Corona pandemic, pandemics, Africa, socio-economic impact, migration, poverty, violence, ethics in epidemics, ethics dumping, African Studies, Post-Colonialism,
    JEL: D63 D74 E24 E26 F15 F22 F35 F52 F54 H12 H51 I14 I15 J46 N37 N97 O17 O55 Z1
    Date: 2021–05–04
  33. By: Servaas Storm (Delft University of Technology)
    Abstract: Based on comparative empirical evidence for 22 major OECD countries, I argue that country differences in cumulative mortality impacts of SARS-CoV-2 are largely caused by: (1) weaknesses in public health competence by country; (2) pre-existing country-wise variations in structural socio-economic and public health vulnerabilities; and (3) the presence of fiscal constraints. The paper argues that these pre-existing conditions, all favorable to the coronavirus, have been created, and amplified, by four decades of neoliberal macroeconomic policies – in particular by (a) the deadly emphasis on fiscal austerity (which diminished public health capacities, damaged public health and deepened inequalities and vulnerabilities); (b) the obsessive belief of macroeconomists in a trade-off between 'efficiency' and 'equity', which is mostly used to erroneously justify rampant inequality; (c) the complicit endorsement by mainstream macro of the unchecked power over monetary and fiscal policy-making of global finance and the rentier class; and (d) the unhealthy aversion of mainstream macro (and MMT) to raising taxes, which deceives the public about the necessity to raise taxes to counter the excessive liquidity preference of the rentiers and to realign the interests of finance and of the real economy. The paper concludes by outlining a few lessons for a saner macroeconomics.
    Keywords: COVID-19; public health emergency; recession; relief spending; fiscal austerity; social determinants of health; economic inequality; excess liquidity; 'disconnect' between the financial and the real worlds
    JEL: E00 E24 E50 E64 G20
    Date: 2021–03–08
  34. By: Asongu, Simplice; Usman, Usman
    Abstract: We provide theoretical and practical perspectives on children, women, and sex trafficking during the Covid-19 pandemic. Process tracing is employed as a primary research instrument. It is an analytical technique used for either theory-building or theory-testing purposes that is employed to elucidate causation and change as well as to develop and evaluate extant theories in social sciences. We illustrate that a policy is needed that will strengthen the capacity of existing structures in the fight against the underlying trafficking so that these attendant structures are efficiently used to stop the trafficking and avoid the corresponding threats to public health safety.
    Keywords: Coronavirus, pandemic, human trafficking, girls and women, feminism
    JEL: I00 O1
    Date: 2020–01
  35. By: Heinrich, Torsten
    Abstract: How are economies in a modern age impacted by epidemics? In what ways is economic life disrupted? How can pandemics be modeled? What can be done to mitigate and manage the danger? Does the threat of pandemics increase or decrease in the modern world? The Covid-19 pandemic has demonstrated the importance of these questions and the potential of complex systems science to provide answers. This article offers a broad overview of the history of pandemics, of established facts, and of models of infection diffusion, mitigation strategies, and economic impact. The example of the Covid-19 pandemic is used to illustrate the theoretical aspects, but the article also includes considerations concerning other historic epidemics and the danger of more infectious and less controllable outbreaks in the future.
    Keywords: epidemics and economics; public health; complex systems; SIR models; Agent-based models; mean-field models; Covid-19
    JEL: C63 I10 N30
    Date: 2021–04–30
  36. By: Bilgin, Mehmet Huseyin; Doker, Asli Cansin; Karabulut, Gokhan; Zimmermann, Klaus F
    Abstract: More democratic countries are often expected to fail at providing a fast, strong, and effective response when facing a crisis such as COVID-19. This could result in higher infections and more negative health effects, but hard evidence to prove this claim is missing for the new disease. Studying the association with five different democracy measures, this study shows that while the infection rates of the disease do indeed appear to be higher for more democratic countries so far, their observed case fatality rates are lower. There is also a negative association between case fatality rates and government attempts to censor media. However, such censorship relates positively to the infection rate.
    Keywords: Coronavirus; COVID-19; democracy; lockdown; Media Censoring; Pandemic
    JEL: C30 D72 I19 P16
    Date: 2021–01
  37. By: Gollier, Christian
    Abstract: I calibrate an eco-epidemiological age-structured SIR model of the B.1.1.7 covid variant on the eve of the vaccination campaign in France, under a stop-and-go lockdown policy. Three-quarters of the welfare benefit of the vaccine can be achieved with a speed of 100,000 full vaccination per day. A 1-week delay in the vaccination campaign raises the death toll by approximately 2,500, and it reduces wealth by 8 billion euros. Because of the large heterogeneity of the rates of hospitalization and mortality across age classes, it is critically important for the number of lives saved and for the economy to vaccinate older people first. Any departure from this policy has a welfare cost. Prioritizing the allocation of vaccines to the most vulnerable people save 70k seniors, but it also increases the death toll of younger people by 14k. Vaccine nationalism is modeled by assuming two identical Frances, one with a vaccine production capacity and the other without it. If the production country vaccinates its entire population before exporting to the other, the global death toll would be increased by 20\%. I also measure the welfare impact of the strong French anti-vax movement, and of the prohibition of an immunity passport.
    Keywords: anti-vaxxer; COVID; covid immunity passport; Pandemic; Vaccine
    Date: 2021–03
  38. By: Carlana, Michela; La Ferrara, Eliana
    Abstract: In response to the COVID-19 outbreak, the governments of most countries ordered the closure of schools, potentially exacerbating existing learning gaps. This paper evaluates the effectiveness of an intervention implemented in Italian middle schools that provides free individual tutoring online to disadvantaged students during lock-down. Tutors are university students who volunteer for 3 to 6 hours per week. They were randomly assigned to middle school students, from a list of potential beneficiaries compiled by school principals. Using original survey data collected from students, parents, teachers and tutors, we find that the program substantially increased students' academic performance (by 0.26 SD on average) and that it significantly improved their socio-emotional skills, aspirations, and psychological well-being. Effects are stronger for children from lower socioeconomic status and, in the case of psychological well-being, for immigrant children.
    JEL: I21 I24
    Date: 2021–02
  39. By: Goenka, Aditya; Liu, Lin; Nguyen, Manh-Hung
    Abstract: This paper studies continuing optimal quarantines (can also be interpreted as lockdowns or self-isolation) in the long run if a disease (Covid-19) is endemic and immunity can fail, i.e. the disease has SIRS dynamics. We model how the disease related mortality aects optimal choices in a dynamic general equilibrium neoclassical growth framework. An extended welfare function that incorporates loss from mortality is used. Without welfare loss from mortality, in the long run even if there is continuing mortality, it is not optimal to impose a quarantine. We characterize the optimal decision of quarantines and how the disease endemic steady state changes with eectiveness of quarantine, productivity of working from home, rate of mortality from the disease, and failure of immunity. We also give the suciency conditions for economic models with SIRS dynamics - a class of models which are non-convex and have endogenous discounting so that no existing results are applicable.
    JEL: E13 E22 D15 D50 D63 I10 I15 I18 O41 C61
    Date: 2021–05–04
  40. By: Bar-On, Yinon; Baron, Tatiana; Cornfeld, Ofer; Milo, Ron; Yashiv, Eran
    Abstract: We present normative and positive analyses of policy tools to manage epidemics, both current and any future ones. Against the background of serious misspecification of COVID19 dynamics in Economics research, at odds with the evidence, we present a constructive alternative with a sound model. This may guide researchers and place the analysis in Economics on solid footing. We introduce novel NPI tools for the management of epidemics. Rather than using prevalent policies based on population restrictions, these place time at the center of the analysis: time restrictions, relation to timescales of virus transmission, and optimal timing of interventions. Key findings are that the new tools significantly improve social welfare, substantially lessening the trade-offs involved; optimally-derived timings of interventions suppress the disease while maintaining reasonable economic activity; and outcomes are superior to the actual experience of New York State and Florida in the course of 2020.
    Keywords: normative analysis; NPI; positive analysis; public health policy; roles of time
    JEL: E23 E61 E65 I12 I18
    Date: 2021–03
  41. By: Daniel Goller; Stefan C. Wolter
    Abstract: This study is, to the best of our knowledge, the first analysis of apprenticeship supply that allows us to analyse the effects of the shutdowns triggered by the COVID-19 pandemic before, during and after these shutdowns by means of daily searches for vacant apprenticeships. Analysing over 10 million search queries on the national administrative platform for apprenticeship offers from February 2020 until April 2021 we find a sharp reduction of up to 40% in the daily number of search queries associated to the first shutdown in March 2020, followed by some catch-up effect thereafter. Although we find a strong relationship between the intensity of the politically imposed restrictions due to the COVID-19 pandemic and daily search queries, this relationship weakens over time as the pandemic progresses. Finally, we find a large heterogeneity of effects, but all regions and occupational groups studied show a statistically significant negative effect of the measures on the search intensity for apprenticeships.
    Keywords: COVID-19, Switzerland, stringency index, apprenticeship
    JEL: I20 J22
    Date: 2021–05

This nep-hea issue is ©2021 by Nicolas R. Ziebarth. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.