nep-hea New Economics Papers
on Health Economics
Issue of 2021‒08‒23
27 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Industrial Organization of Health Care Markets By Benjamin R. Handel; Kate Ho
  2. Unobserved Heterogeneity, State Dependence, and Health Plan Choices By Ariel Pakes; Jack R. Porter; Mark Shepard; Sophie Calder-Wang
  3. Wealth and Insurance Choices: Evidence from US Households By Michael J. Gropper; Camelia M. Kuhnen
  4. Attention Please! Health Plan Choice and (In-)Attention By Tamara Bischof; Michael Gerfin; Tobias Mueller
  5. The Economic Costs of Child Maltreatment in UK By Conti, Gabriella; Pizzo, Elena; Morris, Stephen; Melnychuk, Mariya
  6. Career Effects of Mental Health By Barbara Biasi; Michael S. Dahl; Petra Moser
  7. The Opioid Safety Initiative and Veteran Suicides By Joshua C. Tibbitts; Benjamin W. Cowan
  8. Inequality in Life and Death By Martin S. Eichenbaum; Sergio Rebelo; Mathias Trabandt
  9. The measurement of health inequalities: does status matter? By Costa-Font, Joan; Cowell, Frank
  10. Regulated Revenues and Hospital Behavior: Evidence from a Medicare Overhaul By Tal Gross; Adam Sacarny; Maggie Shi; David Silver
  11. Understanding the Puzzle of Primary Health Care Use :Evidence from India By Kumar Sur, Pramod
  12. On the Short-Term Impact of Pollution: The Effect of PM 2.5 on Emergency Room Visits By Dardati, Evangelina; de Elejalde, Ramiro; Giolito, Eugenio
  13. Impacts of Double-Fortified Salt on Anemia and Cognition: Four-Year Follow-up Evidence from a School-Based Nutrition Intervention in India By von Grafenstein, Liza; Kumar, Abhijeet; Kumar, Santosh; Vollmer, Sebastian
  14. End-of-life planning depends on socio-economic and racial background: evidence from the US Health and Retirement Study (HRS) By Orlovic, Martina; Warraich, Haider; Wolf, Douglas; Mossialos, Elias
  15. No Free Launch: At-Risk Entry by Generic Drug Firms By Keith M. Drake; Robert He; Thomas McGuire; Alice K. Ndikumana
  16. The Effect of Heavy Smoking on Early Retirement: An Instrumental Variable Approach By Gaggero, A.; Ajnakina, O.; Hackett, R.A
  17. Uber and Alcohol-Related Traffic Fatalities By Michael L. Anderson; Lucas W. Davis
  18. Effects of Welfare Reform on Household Food Insecurity Across Generations By Hope Corman; Dhaval M. Dave; Nancy Reichman; Ofira Schwartz-Soicher
  19. The impact of Covid-19 vaccination for mental health By Chaudhuri, K; Howley, P.
  20. How Does Exposure to Covid-19 Influence Health and Income Inequality Aversion? By Miqdad Asaria; Joan Costa-i-Font; Frank Cowell
  21. Women's Well-Being During a Pandemic and its Containment By Natalie Bau; Gaurav Khanna; Corinne Low; Manisha Shah; Sreyashi Sharmin; Alessandra Voena
  22. Mortality in Germany during the Covid-19 pandemic By Alois Pichler; Dana Uhlig
  23. The long shadow of an infection: COVID-19 and performance at work By Fischer, Kai; Reade, J. James; Schmal, W. Benedikt
  24. Why is the Vaccination Rate Low in India? By Kumar Sur, Pramod
  25. Native Americans’ Experience of Chronic Distress in the USA By David G. Blanchflower; Donna Feir
  26. Disentangling Covid-19, Economic Mobility, and Containment Policy Shocks By Annika Camehl; Malte Rieth
  27. The Impact of Covid-19 on Older Workers' Employment and Social Security Spillovers By Gopi Shah Goda; Emilie Jackson; Lauren Hersch Nicholas; Sarah See Stith

  1. By: Benjamin R. Handel; Kate Ho
    Abstract: In this paper we outline the tools that have been developed to model and analyze competition and regulation in health care markets, and describe particular papers that apply them to policy-relevant questions. We focus particularly on the I.O. models and empirical methods and analyses that researchers have formulated to address policy-relevant questions, although we also provide an overview of the institutional facts and findings that inform them. We divide the chapter into two broad sections: (i) papers considering competition and price-setting among insurers and providers and (ii) papers focused specifically on insurance and market design. The former set of papers is largely concerned with models of oligopolistic competition; it is often focused on the US commercial insurance market where prices are market-determined rather than being set administratively. The latter focuses on insurance market design with an emphasis on issues raised by asymmetric information, leading to adverse selection and moral hazard. In addition, we discuss the literature on consumer choice frictions in this market and the significant implications of those frictions for I.O. questions.
    JEL: I11 L13 L2
    Date: 2021–08
  2. By: Ariel Pakes; Jack R. Porter; Mark Shepard; Sophie Calder-Wang
    Abstract: We provide a new method to analyze discrete choice models with state dependence and individual-by-product fixed effects and use it to analyze consumer choices in a policy-relevant environment (a subsidized health insurance exchange). Moment inequalities are used to infer state dependence from consumers’ switching choices in response to changes in product attributes. We infer much smaller switching costs on the health insurance exchange than is inferred from standard logit and/or random effects methods. A counterfactual policy evaluation illustrates that the policy implications of this difference can be substantive.
    JEL: C13 D12 I11 L60 M31
    Date: 2021–07
  3. By: Michael J. Gropper; Camelia M. Kuhnen
    Abstract: Theoretically, wealthier people should buy less insurance, and should self-insure through saving instead, as insurance entails monitoring costs. Here, we use administrative data for 63,000 individuals and, contrary to theory, find that the wealthier have better life and property insurance coverage. Wealth-related differences in background risk, legal risk, liquidity constraints, financial literacy, and pricing explain only a small fraction of the positive wealth-insurance correlation. This puzzling correlation persists in individual fixed-effects models estimated using 2,500,000 person-month observations. The fact that the less wealthy have less coverage, though intuitively they benefit more from insurance, might increase financial health disparities among households.
    JEL: D14 G22 G51 G52
    Date: 2021–07
  4. By: Tamara Bischof; Michael Gerfin; Tobias Mueller
    Abstract: We study the role of inattention as a key source of inertia in health plan choices. Our structural model shows that more than 90% of the elderly in Switzerland are inattentive and thus stick to their previous plan. We estimate sizeable switching costs even conditional on attention explaining part of the observed choice persistence. Inattention leads to overspending and generates considerable welfare losses for most consumers. A policy simulation shows that eliminating financially dominated plans from the choice set yields welfare gains for two thirds of individuals.
    Keywords: health plan choice, inertia, attention, switching costs, managed competition, elderly
    JEL: D12 G22 I13 D90 J14
    Date: 2021–08
  5. By: Conti, Gabriella (University College London); Pizzo, Elena (University College London); Morris, Stephen (University of Cambridge); Melnychuk, Mariya (University College London)
    Abstract: Child maltreatment is a major public health problem with significant consequences for individual victims and for society. In this paper we quantify for the first time the economic costs of fatal and non-fatal child maltreatment in the UK in relation to several short-, medium- and long-term outcomes ranging from physical and mental health problems, to labour market outcomes and welfare use. We combine novel regression analysis of rich data from the National Child Development Study and the English Longitudinal Study of Ageing with secondary evidence to produce an incidence-based estimate of the lifetime costs of child maltreatment from a societal perspective. The discounted average lifetime incidence cost of non-fatal child maltreatment by a primary caregiver is estimated at £89,390 (95% uncertainty interval £44,896 to £145,508); the largest contributors to this are costs from social care, short-term health and long-term labour market outcomes. The discounted lifetime cost per death from child maltreatment is estimated at £940,758, comprising health care and lost productivity costs. Our estimates provide the first comprehensive benchmark to quantify the costs of child maltreatment in the UK and the benefits of interventions aimed at reducing or preventing it.
    Keywords: child maltreatment, incidence-based approach, lifetime costs, health care costs, productivity losses, sensitivity analysis
    JEL: I18 J17 D61
    Date: 2021–07
  6. By: Barbara Biasi; Michael S. Dahl; Petra Moser
    Abstract: This paper investigates the career effects of mental health, focusing on depression, schizophrenia, and bipolar disorder (BD). Individual-level registry data from Denmark show that these disorders carry large earnings penalties, ranging from 34 percent for depression and 38 percent for BD to 74 percent for schizophrenia. To investigate the causal effects of mental health on a person’s career, we exploit the approval of lithium as a maintenance treatment for BD in 1976. Baseline estimates compare career outcomes for people with and without access in their 20s, the typical age of onset for BD. These estimates show that access to treatment eliminates one third of the earnings penalty associated with BD and greatly reduces the risks of low or no earnings. Importantly, access to treatment closes more than half of the disability risk associated with BD.
    JEL: I12 J23 J24 O31
    Date: 2021–07
  7. By: Joshua C. Tibbitts; Benjamin W. Cowan
    Abstract: We investigate the relationship between opioid diverting policy and suicides among the veteran population. The opioid epidemic of the past two decades has had devastating health consequences among U.S. veterans and military personnel. In 2013, the Veterans Health Administration (VA) implemented the Opioid Safety Initiative (OSI) with the goal of discouraging prescription opioid dependence among VA patients. Between 2012 and 2017, prescription opioids dispensed by the VA fell 41% (VA, 2018). Because this involved the aggressive curtailing of opioid prescriptions for many VA patients, OSI may have had a detrimental effect on veterans’ mental health leading to suicide in extreme cases. In addition, because rural veterans have much higher rates of VA enrollment, more prescription opioid use and abuse, and lower rates of substance abuse and mental health treatment utilization, we expect any effect of OSI on veteran suicides to be concentrated in rural areas. We find that OSI raised the veteran suicide rate relative to the non-veteran (“civilian”) rate with rural veterans suffering the lion’s share of the increase. We estimate that OSI raised the rural veteran suicide rate by a little over one-third between 2013 and 2018.
    JEL: I12 I18
    Date: 2021–08
  8. By: Martin S. Eichenbaum; Sergio Rebelo; Mathias Trabandt
    Abstract: We argue that the Covid epidemic disproportionately affected the economic well-being and health of poor people. To disentangle the forces that generated this outcome, we construct a model that is consistent with the heterogeneous impact of the Covid recession on low- and high-income people. According to our model, two thirds of the inequality in Covid deaths reflect pre-existing inequality in comorbidity rates and access to quality health care. The remaining third, stems from the fact that low-income people work in occupations where the risk of infection is high. Our model also implies that the rise in income inequality generated by the Covid epidemic reflects the nature of the goods that low-income people produce. Finally, we assess the health-income trade-offs associated with fiscal transfers to the poor and mandatory containment policies.
    JEL: E1 H0 I1
    Date: 2021–07
  9. By: Costa-Font, Joan; Cowell, Frank
    Abstract: Approaches to measuring health inequalities are often problematic because they use methods that are inappropriate for categorical data. In this paper we focus on “pure” or univariate health inequality (rather than income-related or bivariate health inequality) and use a concept of individual status that allows a consistent treatment of such data. We take alternative versions of the status concept and apply methods for treating categorical data to examine self-assessed health inequality for the countries included in the World Health Survey. We also use regression analysis on the apparent determinants of these health inequality estimates. We show that the status concept that is used will affect health-inequality rankings across countries and the way health inequality is related to countries’ median health, income, demographics and governance.
    Keywords: health inequality; categorical data; entropy measures; health surveys; upward status; downward status; Springer deal
    JEL: D63 H23 I18
    Date: 2021–07–30
  10. By: Tal Gross; Adam Sacarny; Maggie Shi; David Silver
    Abstract: We study a 2008 policy reform in which Medicare revised its hospital payment system to better reflect patients’ severity of illness. We construct a simulated instrument that predicts a hospital’s policy-induced change in reimbursement using pre-reform patients and post-reform rules. The reform led to large persistent changes in Medicare payment rates across hospitals. Hospitals that faced larger gains in Medicare reimbursement increased the volume of Medicare patients they treated. The estimates imply a volume elasticity of approximately unity. To accommodate greater volume, hospitals increased nurse employment, but also lowered length of stay, with ambiguous effects on quality.
    JEL: I18
    Date: 2021–07
  11. By: Kumar Sur, Pramod
    Abstract: Can a domestic policy implemented by the government in the past help explain the puzzling practice of health care usage today? I study this question in the context of India, where households' use of primary health care services presents a paradox. A significant fraction of Indian households uses fee-charging private health care services even though most providers have no formal medical qualifications. The private share of health care use is even higher in markets where qualified doctors offer free care through public clinics. Combining contemporary household-level data with archival records, I examine the aggressive family planning program implemented during the emergency rule in the 1970s and explore whether the coercion, disinformation, and carelessness involved in implementing the program could partly explain the puzzle. Exploiting the timing of the emergency rule, state-level variation in the number of sterilizations, and an instrumental variable approach, I show that the states heavily affected by the sterilization policy have a lower level of public health care usage today. I demonstrate the mechanism for this practice by showing that the states heavily affected by forced sterilizations have a lower level of confidence in government hospitals and doctors and a higher level of confidence in private hospitals and doctors in providing good treatment.
    Keywords: Health care market, health care usage, confidence in institutions, sterilization, persistence, India, I11, N35, I12, J13
    Date: 2021–08
  12. By: Dardati, Evangelina (Centro de Estudios Públicos); de Elejalde, Ramiro (Universidad Alberto Hurtado); Giolito, Eugenio (Universidad Alberto Hurtado)
    Abstract: In this paper, we study the effect of fine particulate matter (PM 2.5) exposure on Emergency Room (ER) visits in Chile. Our identification strategy exploits daily PM 2.5 variation within a hospital-month-year combination. Unlike previous papers, our data allow us to study the impact of high levels of pollution while controlling for avoidance behavior. We find that a one standard deviation increase in PM 2.5 increases respiratory ER visits by 1.4 percent. This effect is positive for all age groups but is stronger for children (less than five years old) and the elderly (more than 65 years old). Moreover, we find that the effects are stronger in geographical areas in which the share of emissions from residential wood burning is more than 75 percent. Finally, our results are robust to instrumenting pollution using wind direction and speed and to controlling for other pollutants.
    Keywords: air pollution, PM 2.5, emergency room visits
    JEL: I12 I18 Q51 Q53
    Date: 2021–07
  13. By: von Grafenstein, Liza (University of Göttingen); Kumar, Abhijeet (University of Göttingen); Kumar, Santosh (Sam Houston State University); Vollmer, Sebastian (University of Goettingen)
    Abstract: Long-term follow-up of early childhood health interventions is important for human capital accumulation. We provide experimental evidence on child health and human capital outcomes from the longer-term follow-up of a school-based nutrition intervention in India. Using panel data, we examine the effectiveness of the use of iron and iodine fortified salt in school lunches to reduce anemia among school children. After four years of treatment, treated children, on average, have higher hemoglobin levels and a lower likelihood of anemia relative to the control group. Interestingly, the intervention did not have any impact on cognitive and educational outcomes.
    Keywords: anemia, children, double-fortified salt, cognition, mid-day meal, India
    JEL: C93 I15 I18 O12
    Date: 2021–08
  14. By: Orlovic, Martina; Warraich, Haider; Wolf, Douglas; Mossialos, Elias
    Abstract: Context: Americans express a strong preference for participating in decisions regarding their medical care, yet they are often unable to participate in decision-making regarding their end-of-life care. Objective: To examine determinants of end-of-life planning; including, the effect of an individual's ageing and dying process, health status and socio-economic and racial/ethnic background. Methods: US observational cohort study, using data from the Health and Retirement Study (1992 – 2014) including 37,494 individuals. Random-effects logistic regression analysis was used to examine the relationship between the presence of a living will and a range of individual time-varying characteristics, including time to death, and several time-invariant characteristics. Results: End-of-life planning depends on several patient characteristics and circumstances, with socio-economic and racial/ethnic background having the largest effects. The probability of having a living will rises sharply late in life, as we would expect, and is further modified by the patient's proximity to death. The dying process, exerts a stronger influence on end-of-life planning than does the aging. Conclusions: Understanding differences that increase end-of-life planning is important to incentivize patients’ participation. Advance planning should be encouraged and accessible to people of all ages as it is inevitable for the provision of patient-centered and cost-effective care.
    Keywords: advance care planning; end-of-life; end-of-life planning; living will
    JEL: N0
    Date: 2021–05–28
  15. By: Keith M. Drake; Robert He; Thomas McGuire; Alice K. Ndikumana
    Abstract: After receiving FDA approval, a generic drug manufacturer can launch “at risk” before conclusion of any patent infringement litigation, but it risks paying damages if it loses. The generic can eliminate the risk by waiting to launch until the appeals process is complete but waiting has downsides too. We develop a model that implies that, after the generic has won a district court decision, at-risk entry is generally profitable and will occur quickly unless the cost of waiting for the appeal is very low. We examine generic drug applications that have received FDA approval with “first-filer” status (which precludes later filing generics from entering before the first filer). In our data, the generic and brand usually settled prior to the conclusion of litigation. For the remainder, drugs that received FDA approval prior to a favorable district court decision were always launched at risk. Generics without FDA approval before a favorable district court decision launched upon approval unless the approval was close in time to the appeal decision or it had forfeited the first filer exclusivity (indicating a low cost of waiting). We also consider implications of at-risk entry for social welfare, arguing that at-risk entry is analogous to a “buy out” of the patent with favorable welfare implications in both the short run (consumer prices) and long run (efficient incentives for R&D).
    JEL: D22 I11 I18 O32
    Date: 2021–08
  16. By: Gaggero, A.; Ajnakina, O.; Hackett, R.A
    Abstract: The extent to which heavy smoking and early retirement are causally related remains to be determined. To overcome the endogeneity of heavy smoking behaviour, we employ a novel approach by exploiting Mendelian Randomisation and use genetic predisposition to heavy smoking, as measured with a polygenic risk score (PGS), as an instrumental variable. A total of 3578 participants from the English Longitudinal Study of Ageing (mean age 64.41 years) had data on smoking behaviour, employment and a heavy smoking PGS. Heavy smoking was indexed as smoking at least 20 cigarettes a day. Early retirement was classified as retiring before state pension age. Our results show that being a heavy smoker increases significantly the probability of early retirement. Results were robust to a battery of robustness checks and a falsification test. Overall, our findings support a causal pathway from heavy smoking to early retirement.
    Keywords: smoking; early retirement; polygenic risk scores; instrumental variable; mendelian randomisation
    Date: 2021–08
  17. By: Michael L. Anderson; Lucas W. Davis
    Abstract: Previous studies of the effect of ridesharing on traffic fatalities have yielded inconsistent, often contradictory conclusions. In this paper we revisit this question using proprietary data from Uber measuring monthly rideshare activity at the Census tract level. Most previous studies are based on publicly-available information about Uber entry dates into US cities, but we show that an indicator variable for whether Uber is available is a poor measure of rideshare activity — for example, it explains less than 3% of the tract-level variation in ridesharing, reflecting the enormous amount of variation both within and across cities. Using entry we find inconsistent and statistically insignificant estimates. However, when we use the more detailed proprietary data, we find a robust negative impact of ridesharing on traffic fatalities. Impacts concentrate during nights and weekends and are robust across a range of alternative specifications. Overall, our results imply that ridesharing has decreased US alcohol-related traffic fatalities by 6.1% and reduced total US traffic fatalities by 4.0%. Based on conventional estimates of the value of statistical life the annual life-saving benefits range from $2.3 to $5.4 billion. Back-of-the-envelope calculations suggest that these benefits may be of similar magnitude to producer surplus captured by Uber shareholders or consumer surplus captured by Uber riders.
    JEL: I12 I18 R41 R49
    Date: 2021–07
  18. By: Hope Corman; Dhaval M. Dave; Nancy Reichman; Ofira Schwartz-Soicher
    Abstract: This study estimated the effects of welfare reform in the 1990s, which permanently restructured and contracted the cash assistance system in the U.S., on food insecurity—a fundamental form of hardship—of the next generation of households. An implicit goal underlying welfare reform was the disruption of an assumed intergenerational transmission of disadvantage; however, little is known about the effects of welfare reform on the well-being of the next generation. Using intergenerational data from the Panel Study of Income Dynamics and a variation on a difference-in-differences framework, this study exploits 3 sources of variation in childhood exposure to welfare reform: (1) risk of exposure across birth cohorts; (2) variation of exposure within cohorts because different states implemented welfare reform in different years; and (3) variation between individuals with the same exposure who were more likely and less likely to rely on welfare. We found that exposure to welfare reform led to decreases in food insecurity of the next generation of households, by about 10% for a 5-year increase in exposure, with stronger effects for women, individuals exposed for longer durations during childhood, individuals exposed in early childhood (0-5 years), and individuals whose mothers had a high school education (versus less).
    JEL: H53 I14 I3 I38
    Date: 2021–07
  19. By: Chaudhuri, K; Howley, P.
    Abstract: We examine the impact of vaccination against Covid-19 for mental health. Our estimates suggest that vaccination leads to a significant and substantive improvement in the mental health of those most at risk of hospitalisation and death from Covid-19. Our proposed explanation is that in the absence of vaccination, anxiety about contracting COVID-19 has a deleterious impact on the mental health of this cohort. On the other hand, our findings suggest that vaccination does not materially impact the mental health of those least at risk from Covid-19, namely younger cohorts. The lack of any significant impact for this cohort may explain vaccine hesitancy amongst young people. For this group, a lack of uptake may be principally due to a lack of perceived benefits for their own wellbeing as opposed to vaccine hesitancy.
    Keywords: covid-19; mental well-being; vaccination; propensity score matching;
    JEL: I12 I31
    Date: 2021–08
  20. By: Miqdad Asaria; Joan Costa-i-Font; Frank Cowell
    Abstract: We study the determinants of individual aversion to health and income inequality in three European countries and the effects of exposure to COVID-19 including the effect employment, income and health shocks using representative samples of the population in each country. Comparing levels of health- and income-inequality aversion in the UK between the years 2016 and 2020 we find a significant increase in inequality aversion in both income and health domains. Inequality aversion is higher in the income domain than in the health domain and inequality aversion in both income and health domains is increasing in age and education and decreasing in income and risk appetite. However, people directly exposed to major health shocks during the COVID-19 pandemic generally exhibited lower levels of aversion to both income and health inequality. But for those at high risk of COVID-19 mortality who experienced major health shocks during the pandemic, inequality aversion was significantly higher than for those of similar individuals experiencing a health shock prior to the pandemic.
    Keywords: inequality aversion, income, health, Covid-19, attitudes to inequality, employment shocks, health shocks, difference in differences
    JEL: I18 I30 I38
    Date: 2021
  21. By: Natalie Bau; Gaurav Khanna; Corinne Low; Manisha Shah; Sreyashi Sharmin; Alessandra Voena
    Abstract: The COVID-19 pandemic brought the dual crises of disease and the containment policies designed to mitigate it. Yet, there is little evidence on the impacts of these policies on women, who are likely to be especially vulnerable, in lower-income countries. We conduct a large phone survey and leverage India's geographically-varying containment policies to estimate the association between both the pandemic and its containment policies, and measures of women's well-being, including mental health and food security. On aggregate, the pandemic resulted in dramatic income losses, increases in food insecurity, and declines in female mental health. While potentially crucial to stem the spread of COVID-19 cases, we find that greater prevalence of containment policies is associated with increased food insecurity, particularly for women, and with reduced female mental health. Average containment levels are associated with a 39-40% increase in the likelihood of sadness, depression, and hopelessness among women and with an increase in the likelihood that women feel more worried by 45% of the variable mean. Particularly vulnerable groups of women, those with daughters and those living in female-headed households, experience larger declines in mental health.
    JEL: I14 I15 J16 O12 O38
    Date: 2021–08
  22. By: Alois Pichler; Dana Uhlig
    Abstract: The Covid-19 pandemic still causes severe impacts on society and the economy. This paper studies excess mortality during the pandemic years 2020 and 2021 in Germany empirically with a special focus on the life insurer's perspective. Our conclusions are based on official counts of German governmental offices on the living and deaths of the entire population. Conclusions, relevant for actuaries and specific insurance business lines, including portfolios of pension, life, and health insurance contracts, are provided.
    Date: 2021–06
  23. By: Fischer, Kai; Reade, J. James; Schmal, W. Benedikt
    Abstract: The COVID-19 pandemic has caused economic shock waves across the globe. Much research addresses direct health implications of an infection, but to date little is known about how this shapes lasting economic effects. This paper estimates the workplace productivity effects of COVID-19 by studying performance of soccer players after an infection. We construct a dataset that encompasses all traceable infections in the elite leagues of Germany and Italy. Relying on a staggered difference-in-differences design, we identify negative short- and longer-run performance effects. Relative to their preinfection outcomes, infected players' performance temporarily drops by more than 6%. Over half a year later, it is still around 5% lower. The negative effects appear to have notable spillovers on team performance. We argue that our results could have important implications for labor markets and public health in general. Countries and firms with more infections might face economic disadvantages that exceed the temporary pandemic shock due to potentially long-lasting reductions in productivity.
    Keywords: Labor Performance,Economic Costs of COVID-19,Public Health
    JEL: I18 J24 J44
    Date: 2021
  24. By: Kumar Sur, Pramod
    Abstract: Why does the vaccination rate remain low, even in countries where long-established immunization programs exist, and vaccines are provided for free? We study this lower vaccination paradox in the context of India—which contributes to the largest pool of under-vaccinated children in the world and about one-third of all vaccine-preventable deaths globally. We explore the importance of historical events shaping current vaccination practices. Combining historical records with survey datasets, we examine the Indian government’s forced sterilization policy implemented in 1976-77 and find that greater exposure to forced sterilization has had a large negative effect on the current vaccination completion rate. We explore the mechanism for this practice and find that institutional delivery and antenatal care are low in states where policy exposure was high. Finally, we examine the consequence of lower vaccination, suggesting that child mortality is currently high in states with greater sterilization exposure. Together, the evidence suggests that government policies implemented in the past could have persistent impacts on adverse demand for healthseeking behavior, even if the burden is exceedingly high.
    Keywords: Vaccination, immunization, family planning, forced sterilization, institutional delivery, antenatal care, child mortality, persistence, N01, I12, I18, O53, J13, Z1
    Date: 2021–08
  25. By: David G. Blanchflower; Donna Feir
    Abstract: Four million Native Americans who identify as single race live in the USA. Another three million identify as Native American in combination with another race. Yet they are rarely the focus of detailed research. We provide the first evidence that levels of consistently poor mental health, or chronic distress, among Native peoples were greater in every year between 1993 and 2020 than among White or Black Americans. We find this to be present among those over the age of thirty but less so for the young. Over time we demonstrate there has been a rise in chronic distress among Native Americans and multi-race individuals. However, chronic distress seems to be lowest among Native peoples living in the seven states with the largest Native American populations of Alaska, Arizona, Montana, New Mexico, North Dakota, South Dakota and Oklahoma. In our judgment these facts are important and not widely known. This stands in stark contrast to the enormous scholarly and media interest in declining physiological well-being among White Americans.
    JEL: I14 J15 J71
    Date: 2021–08
  26. By: Annika Camehl; Malte Rieth
    Abstract: We study the dynamic impact of Covid-19, economic mobility, and containment policy shocks. We use Bayesian panel structural vector autoregressions with daily data for 44 countries, identified through sign and zero restrictions. Incidence and mobility shocks raise cases and deaths significantly for two months. Restrictive policy shocks lower mobility immediately, cases after one week, and deaths after three weeks. Non-pharmaceutical interventions explain half of the variation in mobility, cases, and deaths worldwide. These flattened the pandemic curve, while deepening the global mobility recession. The policy tradeoff is 1 p.p. less mobility per day for 9% fewer deaths after two months.
    Keywords: Epidemics, general equilibrium, non-pharmaceutical interventions, structural vector autoregressions, coronavirus, Bayesian analysis, panel data
    JEL: C32 E32 I18
    Date: 2021
  27. By: Gopi Shah Goda; Emilie Jackson; Lauren Hersch Nicholas; Sarah See Stith
    Abstract: The COVID-19 pandemic and associated mitigation strategies exacted a large economic toll on large portions of the United States population. For older and disabled workers, the effects could be more persistent and fiscally costly than the impacts experienced by young, healthy workers due to the spillovers onto Social Security. We use Current Population Survey, Social Security administrative data on applications for retirement and disability benefits, and Google Trends data to assess the impact of COVID-19 on older adults age 50-70. We find that employment for this group dropped substantially more than would have been predicted prior to the pandemic: employment for 50-61 year olds was 5.7 pp (8.3 percent) lower, while employment for 62-70-year- olds was 3.9 pp (10.7 percent) lower. For people aged 50-61, unemployment and labor force exits due to reasons other than disability and retirement represented 63 and 30 percent of the employment decline, respectively. For those aged 62-70, the two largest components of the reduction were unemployment (50 percent) and retirement-driven labor force exits (30 percent). We find evidence of declines in reporting a labor force exit due to disability (4-5 percent), applications for disability insurance (15 percent), and Google search intensity for disability (7 percent). Retirement benefit claiming remains largely unchanged overall, though we find evidence that applicants substituted towards filing for benefits via the internet. We explore potential mechanisms and find evidence for both supply- and demand-side explanations.
    JEL: H53 H55 J22 J23 J26
    Date: 2021–07

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