nep-hea New Economics Papers
on Health Economics
Issue of 2021‒08‒16
37 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Lasting Effects of Early Childhood Education on Promoting the Skills and Social Mobility of Disadvantaged African Americans By García, Jorge Luis; Heckman, James J.; Ronda, Victor
  2. Health Endowments, Schooling Allocation in the Family, and Longevity: Evidence from US Twins By Savelyev, Peter A.; Ward, Benjamin C.; Krueger, Robert F.; McGue, Matt
  3. The Long-Term Effects of Hospital Deliveries By Fischer, Martin; Karlsson, Martin; Prodromidis, Nikolaos
  4. The effect of nutritional status on historical infectious disease morbidity: evidence from the London Foundling Hospital, 1892-1919 By Schneider, Eric B.
  5. Inertia, Market Power, and Adverse Selection in Health Insurance: Evidence from the ACA Exchanges By Evan Saltzman; Ashley Swanson; Daniel Polsky
  6. Plugging Gaps in Payment Systems: Evidence from the Take-Up of New Medicare Billing Codes By Jeffrey P. Clemens; Jonathan M. Leganza; Alex Masucci
  7. Do Urgent Care Centers Reduce Medicare Spending? By Janet Currie; Anastasia Karpova; Dan Zeltzer
  8. The effect of Long-Term Care (LTC) benefits on healthcare use By Manuel Serrano-Alarcón; Helena Hernández-Pizarro; Guillem López i Casasnovas; Catia Nicodemo
  9. The Heterogeneous Value of a Statistical Life: Evidence from U.S. Army Reenlistment Decisions By Kyle Greenberg; Michael Greenstone; Stephen P. Ryan; Michael Yankovich
  10. Subjective Life Expectancies, Time Preference Heterogeneity, and Wealth Inequality By Richard Foltyn; Jonna Olsson
  11. Getting Warmer: Fuel Poverty, Objective and Subjective Health and Well-Being By Davillas, Apostolos; Burlinson, Andrew; Liu, Hui-Hsuan
  12. Welfare Effects of Time Reallocation: Would Ending Daylight Saving Time Affect Wellbeing? By Costa-Font, Joan; Flèche, Sarah; Pagan, Ricardo
  13. Return-to-Work Policies' Clawback Regime and Labor Supply in Disability Insurance Programs By Zaresani, Arezou; Olivo-Villabrille, Miguel
  14. Retirement and health outcomes in a meta-analytical framework By Filomena, Mattia; Picchio, Matteo
  15. Health, Retirement and Economic Shocks By Martinez-Jimenez, Mario; Hollingsworth, Bruce; Zucchelli, Eugenio
  16. Why Are Pollution Damages Lower in Developed Countries? Insights from High-Income, High-Particulate Matter Hong Kong By Jonathan Colmer; Dajun Lin; Siying Liu; Jay Shimshack
  17. Racial Disparities in the Health Effects from Air Pollution: Evidence from Ports By Kenneth Gillingham; Pei Huang
  18. Economic Consequences of Hospital Closures By Diane E. Alexander; Michael R. Richards
  19. Physician Effects in Antibiotic Prescribing: Evidence from Physician Exits By Shan Huang; Hannes Ullrich
  20. Optimal Epidemic Control in Equilibrium with Imperfect Testing and Enforcement By Tom Phelan; Alexis Toda
  21. Intangible Assets, Corporate Taxes and the Relocation of Pharmaceutical Establishments: The case of Puerto Rico By Zadia M. Feliciano; Meng-Ting Chen
  22. Recreational Marijuana Laws and the Use of Opioids: Evidence from NSDUH Microdata By Mir M. Ali; Chandler B. McClellan; Ryan Mutter; Daniel I. Rees
  23. Nighttime Light Intensity and Child Health Outcomes in Bangladesh By Mohammad Rafiqul Islam; Masud Alam; Munshi Naser \.Ibne Afzal
  24. Cultural Norms and Women's Health: Implications of the Practice of Menstrual Restrictions in Nepal By Kumar, Rahul; Maity, Bipasha
  25. The Die is Cast - Factors Influencing Mortality during the COVID-19 Pandemic By Jenny Bethaeuser; Jennifer Muschol
  26. Productivity in UK healthcare during and after the Covid-19 pandemic By Diane Coyle; Kaya Dreesbeimdieck; Annabel Manley
  27. Biden, COVID and Mental Health in America By David G. Blanchflower; Alex Bryson
  28. Unequal Burdens: Racial Differences in ICU Stress during the Third Wave of COVID-19 By Ruchi Avtar; Rajashri Chakrabarti; Maxim L. Pinkovskiy
  29. Well-being Analysis Favours a Virus-Elimination Strategy for COVID-19 By John F. Helliwell; Max B. Norton; Shun Wang; Lara B. Aknin; Haifang Huang
  30. Doctors' and Nurses' Social Media Ads Reduced Holiday Travel and COVID-19 Infections: A Cluster Randomized Controlled Trial By Emily Breza; Fatima Cody Stanford; Marcella Alsan; Burak Alsan; Abhijit Banerjee; Arun G. Chandrasekhar; Sarah Eichmeyer; Traci Glushko; Paul Goldsmith-Pinkham; Kelly Holland; Emily Hoppe; Mohit Karnani; Sarah Liegl; Tristan Loisel; Lucy Ogbu-Nwobodo; Benjamin A. Olken; Carlos Torres; Pierre-Luc Vautrey; Erica Warner; Susan Wootton; Esther Duflo
  31. The Effects of the COVID-19 Pandemic on the Mental Health and Subjective Well-Being of Workers: An Event Study Based on High-Frequency Panel Data By Schmidtke, Julia; Hetschko, Clemens; Schöb, Ronnie; Stephan, Gesine; Eid, Michael; Lawes, Mario
  32. Psychische Gesundheit im zweiten Covid-19 Lockdown in Deutschland By Theresa Entringer; Hannes Kröger
  33. A rational-choice model of Covid-19 transmission with endogenous quarantining and two-sided prevention By Bhattacharya, Joydeep; Chakraborty, Shankha; Yu, Xiumei
  34. Direct and Spillover Effects from Staggered Adoption of Health Policies: Evidence from COVID-19 Stay-at-Home Orders By Vadim Elenev; Luis E. Quintero; Alessandro Rebucci; Emilia Simeonova
  35. Tendances de la mortalité et de l’état nutritionnel au Niger By Michel Garenne
  36. Linking Covid-19 epidemic and emerging market OAS: Evidence using dynamic copulas and Pareto distributions By Imdade Chitou; Gilles Dufrénot; Julien Esposito
  37. Drivers of COVID-19 outcomes: Evidence from a heterogeneous SAR panel-data model By Kit Baum; Miguel Henry

  1. By: García, Jorge Luis (Clemson University); Heckman, James J. (University of Chicago); Ronda, Victor (Aarhus University)
    Abstract: This paper demonstrates multiple beneficial impacts of a program promoting inter-generational mobility for disadvantaged African-American children and their children. The program improves outcomes of the first-generation treatment group across the life cycle, which translates into better family environments for the second generation leading to positive intergenerational gains. There are long-lasting beneficial program effects on cognition through age 54, contradicting claims of fadeout that have dominated popular discussions of early childhood programs. Children of the first-generation treatment group have higher levels of education and employment, lower levels of criminal activity, and better health than children of the first-generation control group.
    Keywords: early childhood education, intergenerational mobility, racial inequality, social mobility
    JEL: J13 I28 C93 H43
    Date: 2021–07
  2. By: Savelyev, Peter A. (College of William and Mary); Ward, Benjamin C. (University of Georgia); Krueger, Robert F. (University of Minnesota); McGue, Matt (University of Minnesota)
    Abstract: We analyze data from the Minnesota Twin Registry (MTR), combined with the Socioeconomic Survey of Twins (SST), and new mortality data, and contribute to two bodies of literature. First, we demonstrate a beneficial causal effect of education on health and longevity in contrast to other twin-based studies of the US population, which show little or no effect of education on health. Second, we present evidence that parents compensate for differences in their children's health endowments through education, but find no evidence that parents reinforce differences in skill endowments. We argue that there is a bias towards detecting reinforcement both in this paper and in the literature. Despite this bias, we still find statistical evidence of compensating behavior. We account for observed and unobserved confounding factors, sample selection bias, and measurement error in education.
    Keywords: health, education, intrafamily resource allocation, skill endowment, health endowment, longevity, twin study, Minnesota Twin Registry
    JEL: I12 I14 I24 J13 J24
    Date: 2021–07
  3. By: Fischer, Martin (IFN - Research Institute of Industrial Economics); Karlsson, Martin (University of Duisburg-Essen); Prodromidis, Nikolaos (University of Duisburg-Essen)
    Abstract: This paper analyzes the long-term effects on mortality and socio-economic outcomes from institutional delivery. We exploit two Swedish interventions that affected the costs of hospital deliveries and the supply of maternity wards during the 1926–46 period. Using exogenous variation in the supply of maternity wards to instrument the likelihood of institutional delivery, we find that delivery in hospital has substantial effects on later-life outcomes such as education and mortality. We argue that a decrease in child morbidity due to better treatment of complications is a likely mechanism. This interpretation is corroborated by evidence from primary school performance, showing a large reduction in the probability of low performance. In contrast to an immediate and large take-up in hospital deliveries as response to an increase in the supply, we find no increase in hospital births from the abolishment of fees – but some degree of displacement of high-SES parents.
    Keywords: institutional delivery, diffusion of innovations, difference-in-discontinuities
    JEL: I18 I13 N34
    Date: 2021–07
  4. By: Schneider, Eric B.
    Abstract: There is a complex inter-relationship between nutrition and morbidity in human health. Many diseases reduce nutritional status, but on the other hand, having low nutritional status is also known to make individuals more susceptible to certain diseases and to more serious illness. Modern evidence on these relationships, determined after the introduction of antibiotics and vaccines, may not be applicable to historical settings before these medical technologies were available. This paper uses a historical cohort study based on records from the London Foundling Hospital to determine the causal effect of nutritional status of children, proxied by weight- and height-for-age Z-scores, on the odds of contracting five infectious diseases of childhood (measles, mumps, rubella, chicken pox and whooping cough) and on sickness duration from these diseases. I identify a causal effect by exploiting the randomisation of environmental conditions as foundling children were removed from their original homes, then fostered with families in counties nearby London and later returned to the Foundling Hospital’s main site in London. I find no effect of nutritional status on the odds of contracting the five diseases, but I do find a historically important and statistically significant effect of nutritional status on sickness duration for measles and mumps. These findings have three implications. First, historical incidence of these diseases was unrelated to nutritional status, meaning that poor nutritional status during famines or during the Colombian Exchange did not affect the spread of epidemics. However, undernutrition in these events may have exacerbated measles severity. Second, improving nutritional status in the past 150 years would have reduced the severity of measles and mumps infections but not affect the decline in whooping cough mortality. Finally, selective culling effects from measles would be larger than those from whooping cough since whooping cough severity was not correlated with underlying nutritional status.
    Keywords: morbidity; nutritional status; infectious diseases; health transition
    JEL: N01 N30
    Date: 2021–07
  5. By: Evan Saltzman; Ashley Swanson; Daniel Polsky
    Abstract: We study how inertia interacts with market power and adverse selection in managed competition health insurance markets. We use consumer-level data to estimate a model of the California ACA exchange, in which four firms dominate the market and risk adjustment is in place to manage selection. We estimate high inertia costs, equal to 44% of average premiums. Although eliminating inertia exacerbates adverse selection, it significantly reduces market power such that average premiums decrease 13.2% and annual per-capita welfare increases $902. These effects are substantially smaller in settings without market power and/or risk adjustment. Moreover, converting the ACA's premium-linked subsidies to vouchers mitigates the impact of inertia by reducing market power, whereas reducing high consumer churn in the ACA exchanges increases the impact of inertia by enhancing market power. The impact of inertia is not sensitive to provider network generosity, despite greater consumer attachment to plans with more differentiated provider networks.
    JEL: G22 I11 I13 L1
    Date: 2021–07
  6. By: Jeffrey P. Clemens; Jonathan M. Leganza; Alex Masucci
    Abstract: Over the last decade, the U.S. Medicare program has added new billing codes to enhance the financial rewards for Chronic Care Management and Transitional Care Management. We show that the take-up of these new billing codes is gradual and exhibits substantial variations across markets and physician groups, indicating that frictions to take-up may delay the impacts of payment reforms. We show that patterns of care and billing code substitution and complementarity can be important for assessing the costs and care access impacts of payment reforms. In our particular context, we estimate that the new Transitional Care Management codes had substantial impacts on the overall provision of evaluation and management services, flu vaccinations, and other recommended services, while the new Chronic Care Management codes did not. These patterns of complementarity shape both the costs and benefits of the introduction of these payment reforms, including the effects of the new billing codes on the overall return to specializing in primary care.
    Keywords: health care, health economics, payment systems, procurement
    JEL: H51 H57 I10
    Date: 2021
  7. By: Janet Currie; Anastasia Karpova; Dan Zeltzer
    Abstract: We examine the impact of the opening of a new urgent care center (UCC) on health care costs and the utilization of care among nearby Medicare beneficiaries. We focus on 2006–2016, a period of rapid UCC expansion. We find that total Medicare spending rises when residents of a zip code are first served by a UCC, relative to spending in yet-to-be-served zip codes, while mortality remains flat. We explore mechanisms by looking at categories of spending and by examining utilization. Increases in inpatient visits are the largest contributor to the overall increase in spending, rising by 6.65 percent within six years after UCC entry. The number of emergency room visits that result in a hospital admission also increases by 3.7 percent. In contrast, there is no change in the number of ER visits that do not result in admission to hospital, in visits to physicians outside a UCC, or in imaging and tests. Overall, these results provide little evidence that UCCs replace costly ER visits or that they crowd out visits to patients' regular doctors. Instead, the evidence is consistent with the possibility that UCCs—which are increasingly owned by or contract with hospital systems—induce greater spending on hospital care.
    JEL: I1 I11
    Date: 2021–07
  8. By: Manuel Serrano-Alarcón; Helena Hernández-Pizarro; Guillem López i Casasnovas; Catia Nicodemo
    Abstract: The healthcare systems of most European countries are currently operating under extreme levels of pressure. Part of this pressure is due to a rising demand for healthcare caused by an increase in comorbidities and life expectancies amongst the populations they serve. The implementation of a good system of Long-Term Care (LTC) could reduce this pressure if it promotes preventative habits and treatment adherence, or reduces age-related risks. In this study we aim to understand the role of LTC benefits in reducing healthcare use in primary and secondary care by exploring a detailed administrative database. Results show that a monthly LTC benefit of around 412 euros could reduce avoidable hospitalizations by 60% and also unscheduled "walk-in" patient visits by a half, with the majority relating to social exclusion cases. Furthermore, LTC benefits could promote preventive healthcare, improving access to healthcare services such as cataract surgery. These findings have important policy implications for the organization of the LTC and healthcare systems, suggesting that allocating resources to LTC might not only increase the welfare of LTC beneficiaries, but also help to contain the increasing costs of healthcare.
    Date: 2021–08
  9. By: Kyle Greenberg; Michael Greenstone; Stephen P. Ryan; Michael Yankovich
    Abstract: This paper estimates the value of a statistical life (VSL), or the willingness to trade-off wealth and mortality risk, among 430,000 U.S. Army soldiers choosing whether to reenlist between 2002 and 2010. Using a discrete choice random utility approach and significant variation in retention bonuses and mortality risk, we recover average VSL estimates that range between $500,000 and $900,000, an order of magnitude smaller than U.S. civilian labor market estimates. Additionally, we fulfill Rosen's (1974) vision to recover indifference curves between wealth and non-market goods (e.g., mortality risk) and document substantial heterogeneity in preferences across types. We find that the VSL increases rapidly with mortality risk within type, and that soldiers in combat occupations have much lower VSLs than those in noncombat occupations. We estimate that the quadrupling of mortality risk from the Afghanistan and Iraq wars reduced annual welfare by $2,355 per soldier, roughly 8 percent of pay.
    JEL: J17 J31 J45
    Date: 2021–07
  10. By: Richard Foltyn; Jonna Olsson
    Abstract: This paper explores how heterogeneity in life expectancy, objective (statistical) as well as subjective, affects savings behavior between healthy and unhealthy people. Using data from the Health and Retirement Study, we show that people in poor health not only have shorter actual lifespan, but are also more pessimistic about their remaining time of life. Using a standard overlapping-generations model, we show that differences in life expectancy can explain one third of the differences in accumulated wealth with an important part driven by pessimism among unhealthy people.
    Keywords: Life expectancy, preference heterogeneity, subjective beliefs, life cycle
    JEL: D15 E21 G41 I14
    Date: 2021–07
  11. By: Davillas, Apostolos (University of East Anglia); Burlinson, Andrew (University of East Anglia); Liu, Hui-Hsuan (Royal Veterinary College)
    Abstract: This paper uses data from Understanding Society: the UK Household Longitudinal Study to explore the association between fuel poverty and a set of well-being outcomes: life-satisfaction, self-reported health measures and more objectively measured biomarker data. Over and above the conventional income–fuel cost indicators, we also use more proximal heating deprivation indicators. We create and draw upon a set of composite indicators that concomitantly capture (the lack of) affordability and thermal comfort. Depending on which fuel deprivation indicator is used, we find heterogeneous associations between fuel poverty and our well-being outcomes. Employing combined fuel deprivation indicators, which takes into account the income–fuel cost balance and more proximal perceptions of heating adequacy, reveals the presence of more pronounced associations with life satisfaction and fibrinogen, one of our biological health measures. The presence of these strong associations would have been less pronounced or masked when using separately each of the components of our composite fuel deprivation indicators as well as in the case of self-reported generic measures of physical health. Lifestyle and chronic health conditions plays a limited role in attenuating our results, while material deprivation partially, but not fully, attenuates our associations between fuel deprivation and well-being. These results remain robust when bounding analysis is employed to test the potential confounding role of unobservables. Our analysis suggests that composite fuel deprivation indicators may be useful energy policy instruments for uncovering the underlining mechanism via which fuel poverty may get "under the skin".
    Keywords: fuel poverty, biomarkers, health, well-being
    JEL: I12 I31 I32 Q4
    Date: 2021–08
  12. By: Costa-Font, Joan (London School of Economics); Flèche, Sarah (Aix-Marseille University); Pagan, Ricardo (University of Malaga)
    Abstract: Daylight Saving Time (DST) is currently implemented by more than seventy countries, yet we do not have a clear knowledge of how it affects individuals' welfare. Using a regression discontinuity design combined with a differences-in-differences approach, we find that the Spring DST causes a significant decline in life satisfaction. By inducing a reallocation of time, the transition into DST deteriorates sleep and increases time stress, which in turn affects physical and emotional health. After performing a simple cost-benefit analysis, we find evidence suggestive that ending DST would exert a positive effect on welfare, namely the wellbeing costs associated with DST exceed its benefits.
    Keywords: Daylight Saving Time, wellbeing, health, sleep, time stress
    JEL: I18 K2 I31
    Date: 2021–07
  13. By: Zaresani, Arezou (University of Manitoba); Olivo-Villabrille, Miguel (ARC Centre of Excellence in Population Ageing Research (CEPAR))
    Abstract: Exploiting a quasi-natural experiment and using administrative data, we examine the effects of the return-to-work policies' clawback regime in Disability Insurance (DI) programs on beneficiaries' labor supply decisions, allowing them to collect reduced DI payments while working. We compare two return-to-work policies: one with a single rate clawback regime and another with a progressive clawback regime where a reform further increased its progressiveness. The reform caused an increase in the mean labor supply; beneficiaries who already work, work more, and those who did not work start working. The effects are heterogeneous by beneficiaries characteristics, and the increase is driven mainly by top percentiles of earnings. Findings suggest an essential role for the clawback regime in return-to-work policies and targeted policies to increase the labor supply in DI programs.
    Keywords: disability insurance, clawback rate, return-to-work policy, financial incentives, labor supply
    JEL: D3 H3 I3 J3
    Date: 2021–07
  14. By: Filomena, Mattia; Picchio, Matteo
    Abstract: This paper presents a meta-analysis on the effects of retirement on health. We select academic papers published between 2000 and 2021 studying the impact of retirement on physical and mental health, self-assessed general health, healthcare utilization and mortality. Among 275 observations from 85 articles, 28% (13%) find positive (negative) effects of retirement on health outcomes. Almost 60% of the observations do not provide statistically significant findings. Using meta-regression analysis, we checked for the presence of publication bias after distinguishing among different journal subject areas and, once correcting for it, we find that the average effect of retirement on health outcomes is small and barely significant. We apply model averaging techniques to explore possible sources of heterogeneity and our results suggest that the different estimated effects can be explained by the differences in both health measurements and retirement schemes.
    Keywords: Retirement,health,meta-analysis,meta-regression,publication bias
    JEL: I10 J14 J26
    Date: 2021
  15. By: Martinez-Jimenez, Mario (Lancaster University); Hollingsworth, Bruce (Lancaster University); Zucchelli, Eugenio (Universidad Autónoma de Madrid)
    Abstract: We explore the effects of retirement on both physical and mental ill-health and whether these change in the presence of economic shocks. We employ inverse probability weighting regression adjustment to examine the mechanisms influencing the relationship between retirement and health and a difference-in-differences approach combined with matching to investigate whether the health effects of retirement are affected by the Great Recession. We estimate these models on data drawn from the English Longitudinal Study of Ageing (ELSA) and find that retirement leads to a deterioration in both mental and physical health, however there seems to be considerable effect heterogeneity by gender and occupational status. Our findings also suggest that retiring shortly after the Great Recession appears to improve mental and physical health, although only among individuals working in the most affected regions. Overall, our results indicate that the health effects of retirement might be influenced by the presence of economic shocks.
    Keywords: retirement, health, Great Recession, ELSA
    JEL: J14 J26 I10
    Date: 2021–07
  16. By: Jonathan Colmer; Dajun Lin; Siying Liu; Jay Shimshack
    Abstract: Conventional wisdom suggests that marginal damages from particulate matter pollution are high in less-developed countries because they are highly polluted. Using administrative data on the universe of births and deaths, we explore birthweight and mortality effects of gestational particulate matter exposure in high-pollution yet high-income Hong Kong. The marginal effects of particulates on birthweight are large but we fail to detect an effect on neonatal mortality. We interpret our stark mortality results in a comparative analysis of pollution-mortality relationships across studies. We provide early evidence that marginal mortality damages from pollution are high in less-developed countries because they are less developed, not because they are more polluted.
    JEL: Q53 I15 Q56
    Date: 2021
  17. By: Kenneth Gillingham; Pei Huang
    Abstract: This study examines the uneven effects of air pollution from maritime ports on physical and mental health across racial groups. We exploit quasi-random variation in vessels in port from weather events far out in the ocean to estimate how port traffic influences air pollution and human health. We find that one additional vessel in a port over a year leads to 3.0 hospital visits per thousand Black residents within 25 miles of the port and only 1.0 per thousand for whites. We assess a port-related environmental regulation and show that the policy can help alleviate racial inequalities in health outcomes.
    JEL: D63 I14 Q51 Q53 Q58 R41
    Date: 2021–07
  18. By: Diane E. Alexander; Michael R. Richards
    Abstract: Hospitals anchor much of US health care and receive a third of all medical spending, including various subsidies. Nevertheless, some become insolvent and exit the market. Research has documented subsequent access problems; however, less is understood about broader implications. We examine over 100 rural hospital closures spanning 2005-2017 to quantify the effects on the local economy. We find sharp and persistent reductions in employment, but these localize to health care occupations and are largely driven by areas experiencing complete closures. Aggregate consumer financial health is only modestly affected, and housing markets were already depressed prior to hospital closures.
    JEL: H51 I11 I18 J21
    Date: 2021–07
  19. By: Shan Huang; Hannes Ullrich
    Abstract: Human antibiotic consumption is considered the main driver of antibiotic resistance. Reducing human antibiotic consumption without compromising health care quality poses one of the most important global health policy challenges. A crucial condition for designing effective policies is to identify who drives antibiotic treatment decisions, physicians or patient demand. We measure the causal effect of physician practice style on antibiotic intake and health outcomes exploiting variation in patient-physician relations due to physician exits in general practice in Denmark. We estimate that physician practice style accounts for 53 to 56 percent of between-clinic differences in all antibiotic consumption, and for 74 to 81 percent in the consumption of second-line antibiotic drugs. We find little evidence that low prescribing styles adversely affect health outcomes measured as preventable hospitalizations due to infections. Our findings suggest that policies to curb antibiotic resistance are most effective when aimed at improving physician decision-making, in particular when they target high prescribers. High prescribing practice styles are positively associated with physician age and negatively with staff size and the availability of diagnostic tools, suggesting that improvements in the quality of diagnostic information is an important path to improved decisions.
    Keywords: antibiotic prescribing, practice styles, general practitioners
    JEL: I11 J44 I12
    Date: 2021
  20. By: Tom Phelan; Alexis Toda
    Abstract: We analyze equilibrium behavior and optimal policy within a Susceptible-Infected-Recovered epidemic model augmented with potentially undiagnosed agents who infer their health status and a social planner with imperfect enforcement of social distancing. We define and prove the existence of a perfect Bayesian Markov competitive equilibrium and contrast it with the efficient allocation subject to the same informational constraints. We identify two externalities, static (individual actions affect current risk of infection) and dynamic (individual actions affect future disease prevalence), and study how they are affected by limitations on testing and enforcement. We prove that a planner with imperfect enforcement will always wish to curtail activity, but that its incentives vanish as testing becomes perfect. When a vaccine arrives far into the future, the planner with perfect enforcement may encourage activity before herd immunity. We find that lockdown policies have modest welfare gains, whereas quarantine policies are effective even with imperfect testing.
    Keywords: efficiency; externalities; lockdown; perfect Bayesian equilibrium; quarantine
    JEL: C73 D50 D62 I12
    Date: 2021–08–04
  21. By: Zadia M. Feliciano; Meng-Ting Chen
    Abstract: Puerto Rico operated as a tax haven under U.S. Internal Revenue Code (IRC) Section 936. Firms in the pharmaceutical industry accounted for approximately 50% of tax credits awarded and 20% of employment under the program. The U.S. Congress eliminated the tax exemption program in 2006, creating a natural experiment on the elimination of corporate taxation of intangible assets. We use panel data on establishments from the Quarterly Census of Employment and Wages and a difference in difference methodology to measure the impact of the elimination of IRC Section 936 on pharmaceutical and medical devices using establishments with low, medium and high participation in the program as controls. Survival rates of all manufacturing establishments declined after the phaseout and elimination of the tax exemption program but pharmaceutical and medical devices establishments experienced an additional 6.9% decline. Approximately 50% of the 34% decline in pharmaceutical and medical devices establishments in Puerto Rico from 1995 to 2017 can be attributed to the elimination of IRC Section 936. Employment in pharmaceutical and medical devices establishments, which also declined by 34%, decreased at the same rate as that of other industries. Plant closings accounted for most of the decline in their employment.
    JEL: F21 F23 H25 O14
    Date: 2021–07
  22. By: Mir M. Ali; Chandler B. McClellan; Ryan Mutter; Daniel I. Rees
    Abstract: Recent studies have concluded that state laws legalizing medical marijuana can reduce deaths from opioid overdoses. Using data from the National Survey on Drug Use and Health, a survey uniquely suited to assessing drug misuse, we examine the relationship between recreational marijuana laws (RMLs) and the use of opioids. Standard difference-in-differences (DD) regression estimates indicate that RMLs do not affect the likelihood of misusing prescription pain relievers such as OxyContin, Percocet, and Vicodin. Although DD regression estimates provide evidence that state laws legalizing recreational marijuana can reduce the frequency of misusing prescription pain relievers, event-study estimates are noisy and suggest that any effect on the frequency of misuse is likely transitory.
    JEL: I12
    Date: 2021–07
  23. By: Mohammad Rafiqul Islam; Masud Alam; Munshi Naser \.Ibne Afzal
    Abstract: This study examines the impact of nighttime light intensity on child health outcomes in Bangladesh. We use nighttime light intensity as a proxy measure of urbanization and argue that the higher intensity of nighttime light, the higher is the degree of urbanization, which positively affects child health outcomes. In econometric estimation, we employ a methodology that combines parametric and non-parametric approaches using the Gradient Boosting Machine (GBM), K-Nearest Neighbors (KNN), and Bootstrap Aggregating that originate from machine learning algorithms. Based on our benchmark estimates, findings show that one standard deviation increase of nighttime light intensity is associated with a 1.515 rise of Z-score of weight for age after controlling for several control variables. The maximum increase of weight for height and height for age score range from 5.35 to 7.18 units. To further understand our benchmark estimates, generalized additive models also provide a robust positive relationship between nighttime light intensity and children's health outcomes. Finally, we develop an economic model that supports the empirical findings of this study that the marginal effect of urbanization on children's nutritional outcomes is strictly positive.
    Date: 2021–08
  24. By: Kumar, Rahul; Maity, Bipasha
    Abstract: We study the association between the ritual of menstrual restrictions and maternal health- care access as well as women's subjective well-being. Similar restrictions, also practised around the time of childbirth, are based on the assumption that women are ritually impure during these phases of their lives. Although menstrual taboos and restrictions are common across many de- veloping countries, we use micro-data from Nepal where these rituals are widely prevalent. We use a rich set of controls as well as assess the sensitivity of our results to alternative estimation methods. We find that women who face any menstrual restriction are also more likely to give birth at home and receive assistance only from untrained individuals during childbirth, which increases the risk of maternal mortality. We find that only the strictest menstrual restrictions are associated with a decline in subjective well-being. These findings indicate that menstrual restriction related rituals can have persistent negative implications on women's physical and mental health that is not just limited to the time of menstruation.
    Keywords: menstruation,culture,health,subjective well-being,women,Nepal
    JEL: I14 I15 J16 Z12 Z13
    Date: 2021
  25. By: Jenny Bethaeuser (Justus-Liebig-University Giessen); Jennifer Muschol (Justus-Liebig-University Giessen)
    Abstract: Since the beginning of the year, almost the entire world has been thrown off course by the outbreak of the COVID-19 pandemic, which has caused health, social and economic challenges. In an international comparison it can be seen that the mortality rates vary widely between countries. This study therefore aims to investigate the quality of international healthcare systems and their potential risk factors in order to explore the differences in mortality. After the derivation of suitable variables and the collection of a widespread data set, we were able to detect with six different OLS regressions that the mortality rate significantly decreases with a higher number of hospital beds and increases with a higher proportion of elderly population (p
    Keywords: COVID-19; Coronavirus; Cases; Deaths; Pandemic; Mortality; Healthcare System; Health Economics
    JEL: C12 C13 I1 I15
    Date: 2020
  26. By: Diane Coyle (The Productivity Institute, Bennett Institute for Public Policy, University of Cambridge); Kaya Dreesbeimdieck (University of Cambridge); Annabel Manley (Bennett Institute for Public Policy, University of Cambridge)
    Abstract: Measured health output in the UK has declined sharply during the Covid-19 pandemic, despite the evident increase in some National Health Service (NHS) activities such as critical care, and the new test and trace and vaccination programmes. We identify the measurement methods applied to public services that explain the measured decline, and also explore the likely impact of changes in hospital practices during the pandemic, including increased use of technology, on healthcare productivity. We find that within NHS England the capacity constraints have contributed to substantial falls in non-Covid-19 health care activities, and argue that increased capacity in the social infrastructure of the health service is essential to enable higher productivity in an uncertain environment.
    Keywords: productivity, health care, NHS
    JEL: H51 I10 E01
    Date: 2021–02
  27. By: David G. Blanchflower; Alex Bryson
    Abstract: Using US Census Household Pulse Survey data for the period April 2020 to June 2021 we track the evolution of the mental health of nearly 2.3 million Americans during the COVID pandemic. We find anxiety, depression and worry peaked in November 2020, coinciding with the Presidential election. The taking of prescription drugs for mental health conditions peaked two weeks later in December 2020. Mental health improved subsequently such that by April 2021 it was better than it had been a year previously. The probability of having been diagnosed with COVID did not rise significantly in the first half of 2021 but COVID infection rates were higher among the young than the old. COVID diagnoses were significantly lower in States that had voted for Biden in the Presidential Election. The probability of vaccination rose with age, was considerably higher in Biden states, and rose precipitously over the period among the young and old. Anxiety was higher among people in Biden states, whether they had been diagnosed or not, and whether they were vaccinated or not. The association between anxiety and depression and having had COVID was not significant in Biden or Trump states but being vaccinated was associated with lower anxiety and depression, with the effect being larger in Biden states. Whilst being in paid work was associated with lower anxiety, worry and depression and was associated with higher vaccination rates, it also increased the probability of having had COVID.
    JEL: I1 I3
    Date: 2021–07
  28. By: Ruchi Avtar; Rajashri Chakrabarti; Maxim L. Pinkovskiy
    Abstract: A critical risk during the COVID-19 pandemic has been the possibility of the hospital system becoming overwhelmed. COVID-19 not only has killed nearly 2 percent of people with confirmed infections but causes many more who contract it to develop severe complications that are potentially fatal if not treated in an intensive care unit (ICU). As ICU capacity is based on typical needs for intensive care before the pandemic, a surge of COVID-related ICU patients may leave no room for individuals requiring intensive care for other reasons—such as heart attacks—or may exceed the total ICU capacity to treat even COVID-19 patients. In this post, we investigate the extent to which members of different racial and ethnic groups faced different levels of hospital system stress during the “third wave” of COVID-19 in the winter of 2021, which, as the largest wave to hit the United States, briefly brought intensive care units around the country to the point of being overwhelmed. We find that while Black and Hispanic individuals faced the greatest exposure to overburdened ICUs over the course of the third wave from beginning to end, Asian American and Pacific Islanders (AAPI) went from experiencing more stable ICU capacities than the national average at the beginning of the wave to a nearly overwhelmed ICU system at its peak.
    Keywords: COVID-19; race; ICU; hospital
    JEL: J15 I14
    Date: 2021–08–09
  29. By: John F. Helliwell; Max B. Norton; Shun Wang; Lara B. Aknin; Haifang Huang
    Abstract: A well-being approach requires looking beyond COVID-19 deaths to compare the performance of elimination versus mitigation strategies as measured by other important supports for well-being. What do the data show? Our comparison based on 2020 data shows a virus elimination strategy to be more successful than other options, whether measured in terms of COVID-19 deaths, overall excess deaths, income, unemployment, trust, or mental and physical health. Countries that chose and followed a strategy of reducing community transmission to zero and keeping it there saved lives and better protected income and employment, all without obvious costs to either the social fabric or the mental health of their populations.
    JEL: H12 H51 I14 I18 I31
    Date: 2021–07
  30. By: Emily Breza; Fatima Cody Stanford; Marcella Alsan; Burak Alsan; Abhijit Banerjee; Arun G. Chandrasekhar; Sarah Eichmeyer; Traci Glushko; Paul Goldsmith-Pinkham; Kelly Holland; Emily Hoppe; Mohit Karnani; Sarah Liegl; Tristan Loisel; Lucy Ogbu-Nwobodo; Benjamin A. Olken; Carlos Torres; Pierre-Luc Vautrey; Erica Warner; Susan Wootton; Esther Duflo
    Abstract: During the COVID-19 epidemic, many health professionals started using mass communication on social media to relay critical information and persuade individuals to adopt preventative health behaviors. Our group of clinicians and nurses developed and recorded short video messages to encourage viewers to stay home for the Thanksgiving and Christmas Holidays. We then conducted a two-stage clustered randomized controlled trial in 820 counties (covering 13 States) in the United States of a large-scale Facebook ad campaign disseminating these messages. In the first level of randomization, we randomly divided the counties into two groups: high intensity and low intensity. In the second level, we randomly assigned zip codes to either treatment or control such that 75% of zip codes in high intensity counties received the treatment, while 25% of zip codes in low intensity counties received the treatment. In each treated zip code, we sent the ad to as many Facebook subscribers as possible (11,954,109 users received at least one ad at Thanksgiving and 23,302,290 users received at least one ad at Christmas). The first primary outcome was aggregate holiday travel, measured using mobile phone location data, available at the county level: we find that average distance travelled in high-intensity counties changed by -0.993 percentage points (95% CI -1.616, -0.371, p-value 0.002) the three days before each holiday. The second primary outcome was COVID-19 infection at the zip-code level: COVID-19 infections recorded in the two-week period starting five days post-holiday declined by 3.5 percent (adjusted 95% CI [-6.2 percent, -0.7 percent], p-value 0.013) in intervention zip codes compared to control zip codes.
    JEL: D83 I12
    Date: 2021–07
  31. By: Schmidtke, Julia (Institute for Employment Research (IAB), Nuremberg); Hetschko, Clemens (University of Leeds); Schöb, Ronnie (Free University of Berlin); Stephan, Gesine (Institute for Employment Research (IAB), Nuremberg); Eid, Michael (Freie Universität Berlin); Lawes, Mario (Freie Universität Berlin)
    Abstract: Using individual monthly panel data from December 2018 to December 2020, we estimate the impact of the Covid-19 pandemic and two lockdowns on the mental health and subjective well-being of German workers. Employing an event-study design using individual-specific fixed effects, we find that the first and the second wave of the pandemic reduced workers' mental health substantially. Momentary happiness and life satisfaction also decline in response to Covid-19, but to a smaller extent. We observe adapation in our study outcomes between waves of the pandemic. This applies to a lesser extent to indicators of well-being in certain areas of life, such as satisfaction with the job and with leisure, which are negatively affected, too. Women do not seem to suffer greater well-being losses than men. However, workers in the German short-time work scheme are particularly negatively affected. Our results imply that increased anxiety about the future and restricted personal freedoms are among the drivers of the well-being impact of the pandemic.
    Keywords: Covid-19, life satisfaction, depression, affective well-being, app-based survey data, German Job Search Panel
    JEL: I31 I19
    Date: 2021–08
  32. By: Theresa Entringer; Hannes Kröger
    Abstract: This study compares the level of self-reported mental health and well-being in Germany in the second Covid-19 related lockdown (January/February 2021) with the situation in the first lockdown (March to July 2020). In the second lockdown, satisfaction with health decreased and concerns about health increased compared to the first lockdown. However, both scores remained well above pre-pandemic levels. Further, compared to pre-pandemic levels loneliness remained strongly elevated during the second lockdown, but did not further increase compared to the first lockdown. Depression and anxiety symptoms decreased slightly in the second lockdown compared to the first lockdown and were overall comparable to the levels in 2016. Affective well-being and life satisfaction decreased slightly in the second lockdown compared to the first lockdown and pre-pandemic levels. Especially women, younger people and people with a direct migration background suffered most during the second lockdown: They reported higher loneliness, more depression and anxiety symptoms (or a smaller decrease in the symptoms reported), less affective well-being and a lower life satisfaction. At the same time, socioeconomic factors such as education and income played a smaller role for differences in mental health and well-being than before the pandemic. Die vorliegende Studie vergleicht das Niveau der selbstberichteten psychischen Gesundheit und des Wohlbefindens in Deutschland im zweiten Covid-19 Lockdown (Januar/Februar 2021) mit der Situation im ersten Lockdown (März bis Juli 2020). Im zweiten Lockdown sank die Zufriedenheit mit der Gesundheit und stiegen die Sorgen um die Gesundheit im Vergleich zum ersten Lockdown. Beide Werte blieben aber weiterhin deutlich über dem Vor-Pandemie Niveau. Die Einsamkeit der in Deutschland lebenden Menschen war auch im zweiten Lockdown im Vergleich zum Vor-Pandemie Niveau noch stark erhöht, stieg jedoch im Vergleich zum ersten Lockdown nicht weiter an. Depressions- und Angstsymptome sanken im zweiten Lockdown im Vergleich zum ersten Lockdown wieder leicht und waren damit vergleichbar zum Niveau in 2016. Darüber sanken das affektive Wohlbefinden und die Lebenszufriedenheit im zweiten Lockdown im Vergleich zum ersten Lockdown und dem Vor-Pandemie Niveau leicht. Es zeigt sich, dass insbesondere Frauen, jüngere Menschen und Menschen mit direktem Migrationshintergrund unter dem zweiten Lockdown litten: Sie berichteten eine höhere Einsamkeit, eine höhere Depressions- und Angstsymptomatik (bzw. einen geringeren Rückgang der Symptomatik im Vergleich zum ersten Lockdown), ein geringeres affektives Wohlbefinden und eine geringere Lebenszufriedenheit. Gleichzeitig spielten sozioökonomische Faktoren wie Bildung und Einkommen eine geringere Rolle für Unterschiede in der psychischen Gesundheit und dem Wohlbefinden als vor der Pandemie.
    Date: 2021
  33. By: Bhattacharya, Joydeep; Chakraborty, Shankha; Yu, Xiumei
    Abstract: This paper offers a parsimonious, rational-choice model to study the effect of pre-existing inequalities on the transmission of COVID-19. Agents decide whether to "go out" (or self-quarantine) and, if so, whether to wear protection such as masks. Three elements distinguish the model from existing work. First, non-symptomatic agents do not know if they are infected. Second, some of these agents unknowingly transmit infections. Third, we permit two-sided prevention via the use of non-pharmaceutical interventions: the probability of a person catching the virus from another depends on protection choices made by each. We find that a mean-preserving increase in pre-existing income inequality unambiguously increases the equilibrium proportion of unprotected, socializing agents and may increase or decrease the proportion who self-quarantine. Strikingly, while higher pre-COVID inequality may or may not raise the overall risk of infection, it increases the risk of disease in social interactions.
    Date: 2021–03–01
  34. By: Vadim Elenev; Luis E. Quintero; Alessandro Rebucci; Emilia Simeonova
    Abstract: Local policies can have substantial spillovers both across geographies and markets. Little is known about the impact of public health regulations across administrative borders. We estimate U.S. county level direct and spillover effects of Stay-at-Home-Orders (SHOs) aimed at containing the spread of COVID-19 on mobility and social interaction measures. We propose a modified difference-in-difference regression design, based on contiguous-county triplets. This approach compares treated counties, which adopted the SHO, and neighbors, to the neighbor's neighbors, which we term hinterland, counties. We find that mobility in neighboring counties declined by a third to a half as much as in the treated locations. These spillover effects are concentrated in neighbors that share media markets with treated counties. Using directional mobility data, we decompose the spillover decline in mobility into reductions in external visits coming from the treated county and an even stronger voluntary decline in the neighbor county's own traffic. Together, our results provide strong evidence that SHOs operate through information sharing and illustrate the quantitative importance of voluntary social distancing. The finding that the estimated spillovers are in the same direction as the direct effects casts doubt on the prevailing narrative that a more nationally coordinated policy response would have accomplished a greater reduction in mobility and contacts.
    JEL: H75 I1 I18 R1 R38
    Date: 2021–07
  35. By: Michel Garenne (FERDI - Fondation pour les Etudes et Recherches sur le Développement International, WITS - University of the Witwatersrand [Johannesburg], IRD - Institut de Recherche pour le Développement, UMI RESILIENCES - Unité mixte internationale Résiliences - Centre ivoirien de recherches économiques et sociales (CIRES) - Université de Cocody)
    Abstract: The study presents an analysis of mortality trends and some of its factors in Niger since 1960. The focus is on infant and child mortality (0 to 4 years old) and young adult mortality (15-49 years old). In the absence of vital statistics, various surveys and demographic censuses are used to reconstruct trends and annual variations in mortality, and in particular DHS surveys. Overall, infant mortality declined sharply between 1960 and 2010, but irregularly. After favorable trends in the first years, infant and child mortality stagnated for about twenty years, before dropping rapidly after 1990. The difficult 1970-1989 period was seriously affected by two episodes of drought, during of which mortality increased significantly. In the later period, a few years of drought also saw small increases in mortality. The mortality of young adults is less well known: it also evolved favorably between 1990 and 2010, but no reliable data are available for the drought periods of the 1970's and 1980's. The mortality decline between 1990 and 2010 occurred in absence of any increase in per capita income, but thanks to an improvement in public health and above all thanks to international aid. No demographic data was available in 2021 to measure changes in mortality between 2010 and 2020. Finally, child nutritional status improved somewhat between 1992 and 2020, but with ups and downs. The height of adult women aged 15-49 years did not change over the period, however their Body-Mass-Index (BMI) increased slightly between 1992 and 2010. The study discusses the relationships between demographic parameters and the various political, economic and climatic changes since independence.
    Abstract: L'étude présente une analyse des tendances de la mortalité et de certains de ses facteurs au Niger depuis 1960. L'accent est mis sur la mortalité infanto-juvénile (de 0 à 4 ans) et sur la mortalité des jeunes adultes (de 15 à 49 ans). En l'absence de statistiques d'état civil, les différentes enquêtes et recensements démographiques sont utilisés pour reconstruire les tendances et les variations annuelles de la mortalité, et tout particulièrement les enquêtes DHS. Dans l'ensemble, la mortalité des jeunes enfants a fortement baissé entre 1960 et 2010, mais irrégulièrement. Après une évolution favorable dans les premières années, la mortalité infanto-juvénile a stagné pendant une vingtaine d'années, avant de baisser rapidement après 1990. La période difficile des années 1970-1989 a été sérieusement affectée par deux périodes de sécheresse, au cours desquelles la mortalité a augmenté sensiblement. Certaines années de sécheresse dans la période postérieure ont aussi connu des petites hausses de mortalité. La mortalité des jeunes adultes est moins bien connue : elle a aussi évolué favorablement entre 1990 et 2010, mais on ne dispose pas de données fiables pour les périodes de sécheresse. La baisse de la mortalité des années 1990-2010 s'est produite en l'absence d'une augmentation du revenu par tête, mais grâce à une amélioration de la santé publique et surtout grâce à l'aide internationale. Aucune donnée démographique n'était disponible en 2021 pour mesurer les changements de mortalité entre 2010 et 2020. Enfin l'état nutritionnel des enfants s'est un peu amélioré, mais avec des hauts et des bas entre 1992 et 2020. Si la taille des femmes de 15-49 ans n'a pas changé, leur rapport poids/taille a un peu augmenté entre 1992 et 2010. L'étude discute les relations entre les paramètres démographiques et les différentes évolutions politiques, économiques et climatiques depuis l'indépendance.
    Keywords: Mortalité infanto-juvénile,Mortalité des jeunes adultes,État nutritionnel de l’enfant,État nutritionnel de l’adulte,Sécheresse,Famine,Disette,Disponibilité alimentaire,PIB par tête,Enquête démographique,DHS,Afrique sub-Saharienne,Sahel : Niger
    Date: 2021–06–30
  36. By: Imdade Chitou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université); Gilles Dufrénot (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université, Institut Louis Bachelier); Julien Esposito (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université)
    Abstract: This paper investigates the dependence of the Option-Adjusted Spread (OAS) for several ICE BofA Emerging Markets Corporate Plus Indexes to the outbreaks of the Covid-19 viral pandemics between March 1, 2020, and April 30, 2021. We investigate whether the number of new cases, the reproduction rate, death rate and stringency policies have resulted in an increase/decrease in the spreads. We study the bivariate distributions of epidemiological indicators and spreads to investigate their concordance using dynamic copula analysis and estimate the Kendall rankcorrelation coefficient. We also investigate the effect of the epidemiological variables on the extreme values of the spreads by fitting a tail index derived from a Pareto type I distribution. We highlight the existence of correlations, robust to the type of copulas used (Clayton or Gumbel). Moreover, we show that the epidemiological variables explain well the extreme values of the spreads.
    Keywords: Covid-19,corporate spreads,pandemics,emerging economies
    Date: 2021–07
  37. By: Kit Baum (Boston College; DIW Berlin; CESIS); Miguel Henry (Greylock McKinnon Associates)
    Abstract: In an extension of the standard spatial autoregressive (SAR) model, Aquaro, Bailey and Pesaran (ABP; 2021, introduced a SAR panel model that allows one to produce heterogeneous point estimates for each spatial unit. Their methodology has been implemented as the Stata routine hetsar (Belotti, 2021, Statistical Sofware Components S458926). As the COVID-19 pandemic has evolved in the U.S. since its first outbreak in February 2020 with following resurgences of multiple widespread and severe waves of the pandemic, the level of interactions between geographic units (for example, states and counties) has differed greatly over time in terms of the prevalence of the disease. Applying ABP’s HETSAR model to 2020 and 2021 COVID-19 data outcomes (confirmed case and death rates) at the state level, we extend our previous spatial econometric analysis (Baum and Henry, 2020, Boston College Working Papers in Economics 1009) on socioeconomic and demographic factors influencing the spatial spread of COVID-19 confirmed case and death rates in the U.S.
    Date: 2021–08–07

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