nep-hea New Economics Papers
on Health Economics
Issue of 2021‒09‒06
nineteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Consumption, Income, and Well-Being of Single Mother Headed Families 25 Years After Welfare Reform By Jeehoon Han; Bruce D. Meyer; James X. Sullivan
  2. Intensive and Extensive Margin Labor Supply Responses to Kinks in Disability Insurance Programs By Myhre, Andreas
  3. The Value of Statistical Life: A Meta-analysis of Meta-analyses By H. Spencer Banzhaf
  4. The implications of self-reported body weight and height for measurement error in BMI By Davillas, Apostolos; Jones, Andrew M.
  5. Adverse Working Conditions and Immigrants' Physical Health and Depression Outcomes. A Longitudinal Study in Greece By Drydakis, Nick
  6. Working Towards a Sustainable, Healthy Market for Vaccines: a Comprehensive Framework to Support Policy Dialogue and Decision-Making By Rodes Sanchez, M.; Rachev, B.; Spencer, J.; Sharma, I.; Tantri, A.; Towse, A.; Mitrovich, R.; Steuten, L.
  7. Ranking the burden of disease attributed to known risk factors By Lorenzo Lionello; Emilie Counil; Emmanuel Henry
  8. A Tutorial on Time-Dependent Cohort State-Transition Models in R using a Cost-Effectiveness Analysis Example By Fernando Alarid-Escudero; Eline M. Krijkamp; Eva A. Enns; Alan Yang; M. G. Myriam Hunink; Petros Pechlivanoglou; Hawre Jalal
  9. Testing Fractional doses of COVID-19 Vaccines By Witold Więcek; Amrita Ahuja; Esha Chaudhuri; Michael Kremer; Alexandre Simoes Gomes; Christopher Snyder; Alex Tabarrok; Brandon Joel Tan
  10. Modeling the Social Economy of Pandemics in China: An Input-Output Approach By Khan, Haider; Szymanski-Burgos, Adam
  11. Residential land price fluctuations caused by behavioral changes on work-from-home based on COVID-19 By Katafuchi, Yuya
  12. Traveling and Eating Out during the COVID-19 Pandemic: The Go To Campaign Policies in Japan By Toshihiro Okubo
  13. Infection-Resistant Offices - Analyses of the Impacts of the Pandemic on Office Buildings and their Market By Thomas Vogl
  14. The Virus, Vaccination, and Voting By Jeffrey A. Frankel; Randy Kotti
  15. Severity of the COVID-19 Pandemic in India By Katsushi S. Imai; Nidhi Kaicker; Raghav Gaiha
  16. Long-Term Air Pollution Exposure and COVID-19 Mortality in Latin America By Jorge A Bonilla; Alejandro Lopez-Feldman, Paula Pereda, Nathaly M. Rivera, J. Cristobal Ruiz-Tagle
  17. Did COVID-19 Affect the Division of Labor within the Household? Evidence from Two Waves of the Pandemic in Italy By Daniela Del Boca; Noemi Oggero; Paola Profeta; Maria Cristina Rossi
  18. Using Household Rosters from Survey Data to Estimate All-cause Mortality during COVID in India By Anup Malani; Sabareesh Ramachandran
  19. Telework in the spread of COVID-19 By Toshihiro Okubo

  1. By: Jeehoon Han; Bruce D. Meyer; James X. Sullivan
    Abstract: We investigate how material well-being has changed over time for single mother headed families—the primary group affected by welfare reform and other policy changes of the 1990s. We focus on consumption as well as other indicators including components of consumption, measures of housing quality, and health insurance coverage. The results provide strong evidence that the material circumstances of single mothers improved in the decades following welfare reform. The consumption of the most disadvantaged single mother headed families—those with low consumption or low education—rose noticeably over time and at a faster rate than for those in comparison groups.
    JEL: D12 D31 I31 I32 I38
    Date: 2021–08
  2. By: Myhre, Andreas
    Abstract: While kinks are prevalent in tax and transfer systems, the fiscal revenue and behavioral responses are not fully understood. In disability insurance (DI) programs, for instance, kinks help balance the moral hazard effects from the induced entry with the provision of work incentives for recipients who regain their ability to work. Using quasi-random variation in kink points in the benefit schedule for Norwegian DI recipients, I identify intensive and extensive margin earnings responses to the implicit tax on earnings as DI benefits are phased out above the kink. To identify the intensive margin responses, I implement a non-parametric bunching design that does not require functional form assumptions or deciding an excluded region around the kink. Responses correspond to an earnings elasticity with respect to the implicit net-of-tax rate of about 0.18. Using a regression discontinuity design, I further show that the kink in the benefit schedule induces significant responses at the extensive margin. I use the estimated earnings responses to evaluate how the benefit offset affects program costs, and find that relaxing the benefit offset reduces public expenditures only if program entry is very inelastic. My findings speak to recent policy-proposals aiming to improve work incentives of DI recipients.
    Keywords: labor supply, disability insurance, policy evaluation, bunching
    JEL: H53 H55 I38 J21
    Date: 2021–06–09
  3. By: H. Spencer Banzhaf
    Abstract: The Value of Statistical Life (VSL) is arguably the most important number in benefit-cost analyses of environmental, health, and transportation policies. However, agencies have used a wide range of VSL values. One reason may be the embarrassment of riches when it comes to VSL studies. While meta-analysis is a standard way to synthesize information across studies, we now have multiple competing meta-analyses and reviews. Thus, to analysts, picking one such meta-analysis may feel as hard as picking a single "best study." This paper responds by taking the meta-analysis another step, estimating a meta-analysis (or mixture distribution) of six meta-analyses. The baseline model yields a central VSL of $7.0m, with a 90% confidence interval of $2.4m to $11.2m. The provided code allows users to easily change subjective weights on the studies, add new studies, or change adjustments for income, inflation, and latency.
    JEL: I12 I18 J17 J31 K32 Q51
    Date: 2021–08
  4. By: Davillas, Apostolos; Jones, Andrew M.
    Abstract: We designed an experiment to explore the extent of measurement error in body mass index (BMI), when based on self-reported body weight and height. We find that there is a systematic age gradient in the reporting error in BMI, while there is limited evidence of systematic associations with gender, education and income. This is reassuring evidence for the use of self-reported BMI in studies that use it as an outcome, for example, to analyse socioeconomic gradients in obesity. However, our results suggest a complex structure of non-classical measurement error in BMI, depending on both individuals' and within-household peers' true BMI. This may bias studies that use BMI based on self-reported data as a regressor. Common methods to mitigate reporting error in BMI using predictions from corrective equations do not fully eliminate reporting heterogeneity associated with individual and withinhousehold true BMI. Overall, the presence of non-classical error in BMI highlights the importance of collecting measured body weight and height data in large social science datasets.
    Keywords: BMI,Experiment,Measurement error,Reporting bias
    JEL: I10 C18 C50
    Date: 2021
  5. By: Drydakis, Nick
    Abstract: Τhe study examines whether adverse working conditions for immigrants in Greece bear an association with deteriorated physical health and increased levels of depression during 2018 and 2019. Findings indicate that workers with no written contract of employment, receiving hourly wages lower than the national hourly minimum wages, and experiencing insults and/or threats in their present job experience worse physical health and increased levels of depression. The study found that the inexistence of workplace contracts, underpayment, and verbal abuse in the workplace may coexist. An increased risk of underpayment and verbal abuse reveals itself when workers do not have a contract of employment and vice versa. Immigrant workers without a job contract might experience a high degree of workplace precariousness and exclusion from health benefits and insurance. Immigrant workers receiving a wage lower than the corresponding minimum potentially do not secure a living income, resulting in unmet needs and low investments in health. Workplace abuse might correspond with vulnerability related to humiliating treatment. These conditions can negatively impact workers' physical health and foster depression. Policies should promote written employment contracts and ensure a mechanism for workers to register violations of fair practices.
    Keywords: Adverse Working Conditions,Physical Health,Depression,Immigrants,Refugees, Minimum Wages,Written Contracts of Employment,Threats in job,Workplace precariousness
    JEL: J81 O15 E24 I14
    Date: 2021
  6. By: Rodes Sanchez, M.; Rachev, B.; Spencer, J.; Sharma, I.; Tantri, A.; Towse, A.; Mitrovich, R.; Steuten, L.
    Abstract: By placing a strain on health care systems and the global economy, the COVID-19 pandemic clearly shows the need to more comprehensively understand both supply- and demand-side aspects of a "healthy" vaccines market that can meet public health demand over time and across dynamic events. The goal of a healthy vaccines market, as defined for this study, is to support sustainable innovation and equitable access to address public health needs. Current frameworks that describe the global vaccines market, however, focus primarily on demand-side activities in low- and lower-middle income countries. Further, they do not fully reflect the interconnectedness of national and regional vaccine markets that comprise the global vaccines ecosystem. They do not account for spill-over effects of market-shaping activities (e.g. demand forecasting and procurement) across markets and across time. This motivated the development of a more comprehensive Healthy Vaccines Market Framework (HVMF), based on literature review and expert interviews, and applied this to the COVID-19 pandemic as a case study analysis. The HVMF shows how the characteristics of a healthy vaccine market hinge on supply- and demand-side activities and policies that cut across multiple markets. It helps illustrate how challenges in the global vaccines market may be rooted in multiple factors across a market and how market-shaping interventions aimed at addressing a single challenge in a single market can strengthen or undermine the overall health of the global vaccines market in the short- and long-term. Another critical component of the HVMF is that it draws attention to the diverse set of stakeholders actively engaged in market-shaping activities at the national, regional, and global levels. Given such a complex set of dynamics, it is critical that all actors shaping the global vaccines market understand the broader implications and interconnectedness of individual supply- and demand-side activities and how they shape the global marketplace collectively. In working towards a sustainable, healthy market for vaccines, the HVMF can serve as a comprehensive framework to support policy dialogue and decision-making.
    Keywords: Economics of Innovation
    JEL: I1
    Date: 2021–09–01
  7. By: Lorenzo Lionello; Emilie Counil; Emmanuel Henry
    Abstract: The Global Burden of Disease’s (GBD) comparative risk assessment analysis (CRA) is a quantitative estimation of the contribution of known risk factors to the injuries and sequelae enumerated by the study each year. The CRA was introduced in 2002 and has a complex methodology that builds on the epidemiologic concept of attributable risk, or population attributable fractions (PAFs). This work, second of two volumes on the GBD’s evolution, is focused on explaining and tracing the methodological choices of its risk assessment component, with a specific focus on environmental and occupational risk factors. We explore the estimates provided by the Institute of Health Metrics and Evaluation (IHME) and understand how they were calculated. Then, we assess some of the most pressing critiques, and conclude by reflecting on its influence, methodological choices, and future outlook as the IHME sets itself a leading institution in health estimates. This work is part of a broader research analyzing the role of population health metrics, in particular PAFs, on the definition of public health problems and influencing their agendas. The research relies on a literature review (nonstructured) of published studies and commentaries. It follows a chronological development of the CRA estimates since their first publication in 2002 to the version released in 2019.
    Keywords: Global Burden of Disease, Institute of Health Metrics and Evaluations (IHME), Comparative Risk Assessment, risk factors, occupational health, environmental health, health metrics, epidemiology, public health, Gates Foundation, SANTE PUBLIQUE / PUBLIC HEALTH, ENVIRONNEMENT / ENVIRONMENT, PROFESSION / OCCUPATIONS, FACTEUR DE RISQUE / RISK FACTOR, SANTE / HEALTH, COMPARAISON INTERNATIONALE / INTERNATIONAL COMPARISON, ACCIDENT DU TRAVAIL / OCCUPATIONAL ACCIDENTS
    Date: 2021
  8. By: Fernando Alarid-Escudero; Eline M. Krijkamp; Eva A. Enns; Alan Yang; M. G. Myriam Hunink; Petros Pechlivanoglou; Hawre Jalal
    Abstract: This tutorial shows how to implement time-dependent cohort state-transition models (cSTMs) to conduct cost-effectiveness analyses (CEA) in R, where transition probabilities and rewards vary by time. We account for two types of time dependency: time since the start of the simulation (simulation-time dependency) and time spent in a health state (state residence dependency). We illustrate how to conduct a CEA of multiple strategies based on a time-dependent cSTM using a previously published cSTM, including probabilistic sensitivity analyses. We also demonstrate how to compute various epidemiological outcomes of interest from the outputs generated from the cSTM, such as survival probability and disease prevalence. We present both the mathematical notation and the R code to execute the calculations. This tutorial builds upon an introductory tutorial that introduces time-independent cSTMs using a CEA example in R. We provide an up-to-date public code repository for broader implementation.
    Date: 2021–08
  9. By: Witold Więcek; Amrita Ahuja; Esha Chaudhuri; Michael Kremer; Alexandre Simoes Gomes; Christopher Snyder; Alex Tabarrok; Brandon Joel Tan
    Abstract: Millions of people are being vaccinated against SARS-CoV-2 every day, but the virus is also mutating and spreading fast. Vaccine production is increasing, but supply still constrains vaccinations worldwide. Using lower doses of vaccines could dramatically accelerate vaccination. Available evidence on efficacy is not dispositive but suggests half- or even quarter-doses of some vaccines could be almost as effective as currently-used doses. Even if fractional doses are less effective than standard doses, an epidemiological model suggests they could significantly reduce total infections and deaths. The social value of testing dwarfs the costs. However, firms do not internalize the full social value, a market failure that could be addressed with public funding. Governments could support either experimental or observational evaluations of fractional dosing.
    JEL: F62 F68 I1 I15 I18 I31 I38
    Date: 2021–08
  10. By: Khan, Haider; Szymanski-Burgos, Adam
    Abstract: COVID-19 impacts have exacerbated socioeconomic inequalities and the threat of hunger and absolute poverty for vulnerable populations globally. China, as the most important Southern engine of growth, is a complex case. In taking countervailing measures for economic recovery and public health protection, the Chinese case is interesting for several reasons. First, from a public health perspective, what was distinctive about the Chinese policy and what have been the consequences so far? Second, what economic policy measures have led to a V-shaped recovery? Finally, what is the further prognosis for the Chinese Economy for the next few years? Our analysis highlights the salience of considering development and the economic and social shocks of pandemics from a Socially Embedded Intersectional Approach (SEICA) perspective. Using an economy-wide modelling methodology, we are able to draw conclusions that may be relevant for the case of other economies in various stages of development, particularly those with sharply uneven development patterns and large rural populations.
    Keywords: Input-output; China; Development; Covid-19; Socially Embedded Intersectional Approach
    JEL: A10 O2 P0 R15
    Date: 2021–08
  11. By: Katafuchi, Yuya
    Abstract: This study analyzes how the behavioral changes associated with novel coronavirus disease (COVID-19) have affected residential land prices. Under previous pandemics (e.g., Spanish flu and SARS), avoidance of real estate transactions accompanied by going-out behavior and contraction of the real economy have caused a decrease in residential land prices. On the other hand, under the COVID-19 pandemic, it has been reported that residential land prices were stable or increasing due to behavioral changes such as the promotion of work-from-home (WFH). In order to confirm this phenomenon, this study first constructs a yearly panel dataset of Japan with the average published land price at the prefectural level as the dependent variable and treatment variables based on policy interventions for COVID-19, or WFH implementation. Second, this study uses the dataset to examine the relationship between land prices and changes in these conditions before and after the pandemic using the difference-in-difference method. The results of the above empirical analysis suggest that residential land prices were higher in prefectures where policy interventions related to COVID-19 were more robust than in other prefectures and where WFH was promoted more. This result supports the upward trend in residential land prices during the COVID-19 pandemic in the prefectures where policy interventions on COVID-19, including requests for WFH, are more implemented and where WFH is more prevalent.
    Keywords: COVID-19, Land price, Work-from-home, Telework
    JEL: I12 I15 I18 R21 R30
    Date: 2021–08–22
  12. By: Toshihiro Okubo (Faculty of Economics Keio University)
    Abstract: The coronavirus disease (COVID-19) pandemic plunged many sectors of the economy into contraction, particularly the travel, hotel accommodation, and eating/drinking industries. In Japan, some demand-inducing policies targeting such industries were implemented, known as the Go To Travel and Go To Eat campaigns. Using a unique individual-level survey, we investigate what factors make people respond to these campaign policies. We find that certain socioeconomics factors as well as noneconomic factors matter. In particular, risk attitudes, time preferences, and personal traits (e.g., extraversion) as measured by the Big 5 categories crucially affect whether people traveled or dined out in response to these campaigns despite the spread of COVID-19.
    Keywords: Covid-19, demand inducing policies, Go-To campaign, risk, Big 5, Japan
    JEL: H12 H20 H84
    Date: 2021–08–21
  13. By: Thomas Vogl
    Abstract: Time and again, after crises in the course of history, stricter building regulations occurred and not only had a sustained impact on the occupants but also the operator and the builders. For example, after the fire of 1942 in the Coconut Grove nightclub in Boston, outward-swinging doors and emergency exit signs were implemented and became the international standard. Unbreakable glass and concrete core constructions resulted from the experience of 9/11. The corona pandemic, which has been spreading since the end of 2019, presented unforeseen challenges and uncertainties, not least for institutional investors of office properties or Corporate Real Estate Managers. The home office, which was previously often negative, had to be implemented rapidly on an unprecedented scale and led to very low occupancy rates in office buildings. Companies ran into cash flow problems and government assistance was necessary to cover the rental costs for unused workspaces. Despite positive developments for a vaccine, experts predict a permanent upheaval in the design and planning of workplace demands. This analysis of the latest literature is focusing on the physical and organizational provisions being debated in terms of infection-resistant work environments and the associated impacts on the real estate office market are deducted. As it's now well-established that COVID-19 transmission commonly occurs in closed spaces by particles containing the virus, the demands for stricter hygiene measures and effective heating, ventilation, and air-conditioning (HVAC) system could pave the way for a new type of office with a hospital-like character. The predicted increase of remote working concepts ensures (social) distancing, but increases the need for digitalization and leads to low occupancy rates and therefore reduced demand for office spaces. Alongside these aspects, physical implementations in existing office buildings like high-walled booths, wide corridors, one-way traffic, and air inlet systems could influence construction costs and office fit-outs. The line of discussion will focus on the predicted solutions for infection-resistant offices and the impact on the real estate office market which are associated with their implementations.
    Keywords: Costs; Office; Pandemic; Workplace
    JEL: R3
    Date: 2021–01–01
  14. By: Jeffrey A. Frankel; Randy Kotti
    Abstract: Vaccination rates have a statistically significant downward effect on the Covid-19 death rate across US counties, as of August 12, 2021. Controlling for poverty rates, age, and temperature lowers the magnitude of the estimate a little. Using the Biden-Trump vote in the 2020 election as an instrument for vaccination rates raises the magnitude of the estimate. Presumably it corrects for a positive effect of observed local Covid deaths on the decision to get vaccinated. Overall, the estimated beneficial effect holds up and has risen over time.
    JEL: I1
    Date: 2021–08
  15. By: Katsushi S. Imai; Nidhi Kaicker; Raghav Gaiha
    Abstract: This is one of the first econometric analyses of severity of COVID-19 pandemic in India measured using two related but distinct measures of mortality up to 31 October 2020 based on the Cumulative Severity Ratio (CSR). The CSR measures the additional pressure on our fragile and ill-equipped healthcare system, while its first difference helps monitor the progression of fatalities. These measures are supplemented by a measure of infection cases. Another important contribution of this analysis is the use of rigorous econometric methodologies drawing upon random effects models and Tobit models for the weekly panel of 32 states/union territories. Although the rationales vary, they yield a large core of robust results. The specifications are rich and comprehensive despite heavy data constraints. The factors associated with the CSR and infection cases include income, gender, multi-morbidity, urbanisation, lockdown and unlock phases, weather including temperature and rainfall, and the retail price of wheat. Given the paucity of rigorous econometric analyses, our study yields policy insights of considerable significance.
    JEL: C23 I18 N35 O10
    Date: 2020–12
  16. By: Jorge A Bonilla; Alejandro Lopez-Feldman, Paula Pereda, Nathaly M. Rivera, J. Cristobal Ruiz-Tagle
    Abstract: Ambient air pollution is a major problem in many countries of the developing world. This study examines the relationship between long-term exposure to air pollution and COVID-19-related deaths in four countries of Latin America that have been highly affected by the pandemic: Brazil, Chile, Colombia, and Mexico. Relying on historical satellite-based measures of fine particulate matter concentrations and official vital statistics, our results suggest that an increase in long-term exposure of 1 μg/m3 of fine particles is associated with a 2.7 percent increase in the COVID-19 mortality rate. This relationship is found primarily in municipalities of metropolitan areas, where urban air pollution sources dominate, and air quality guidelines are usually exceeded. Our findings support the call for strengthening environmental policies that improve air quality in the region, as well as allocating more health care capacity and resources to those areas most affected by air pollution.
    Keywords: COVID-19; SARS-CoV-2; coronavirus; air pollution; particulate matter; Latin
    JEL: I18 Q52 Q53 O13
    Date: 2021–08–30
  17. By: Daniela Del Boca (University of Turin and Collegio Carlo Alberto); Noemi Oggero; Paola Profeta; Maria Cristina Rossi
    Abstract: The COVID-19 pandemic has had a dramatic impact on families’ lives, with parents all over the world struggling to meet the increased demands of housework, childcare and home-schooling. Much of the additional burden has been shouldered by women, particularly in countries with a traditionally uneven division of household labor. Yet the dramatic increase in remote work from home since the pandemic also has the potential to increase paternal involvement in family life and thus to redress persistent domestic gender role inequalities. This effect depends on the working arrangements of each partner, whether working remotely, working at their usual workplace or ceasing work altogether. We examine the role of working arrangements during the pandemic on the traditional division of household labor in Italy using survey data from interviews with a representative sample of working women conducted during the two waves of COVID-19 (April and November 2020). Our data show that the gender gap in household care related activities was widest during the first wave of the pandemic, and although it was less pronounced during the second wave, it was still higher than pre-COVID-19. The time spent by women on housework, childcare, and assisting their children with distance learning did not depend on their partners’ working arrangements. Conversely, men spent fewer hours helping with the housework and distance learning when their partners were at home. It is interesting, however, that although men who worked remotely or not at all did devote more time to domestic chores and child care, the increased time they spent at home did not seem to lead to a reallocation of couples’ roles in housework and child care. Finally, we find that working arrangements are linked to women’s feelings of uncertainty, with heterogeneous effects by level of education.
    Keywords: COVID-19, work arrangements, housework, childcare, distance learning
    JEL: J13 J16 J21
    Date: 2021–08
  18. By: Anup Malani; Sabareesh Ramachandran
    Abstract: Official statistics on deaths in India during the COVID pandemic are either incomplete or are reported with a delay. To overcome this shortcoming, we estimate excess deaths in India using the household roster from a large panel data set, the Consumer Pyramids Household Survey, which reports attrition from death. We address the problem that the exact timing of death is not reported in two ways, via a moving average and differencing monthly deaths. We estimate roughly 4.5 million (95% CI: 2.8M to 6.2M) excess deaths over 16 months during the pandemic in India. While we cannot demonstrate causality between COVID and excess deaths, the pattern of excess deaths is consistent with COVID-associated mortality. Excess deaths peaked roughly during the two COVID waves in India; the age structure of excess deaths is right skewed relative to baseline, consistent with COVID infection fatality rates; and excess deaths are positively correlated with reported infections. Finally, we find that the incidence of excess deaths was disproportionately among the highest tercile of income-earners and was negatively associated with district-level mobility.
    JEL: C80 I10 I14
    Date: 2021–08
  19. By: Toshihiro Okubo (Faculty of Economics Keio University)
    Abstract: In the spread of coronavirus disease (COVID-19), people have been requested to work from home with information and communication technology (ICT) tools, i.e. telework. This paper investigates which factors (infection of COVID-19, individual characteristics, task characteristics, working environments, and COVID-19 countermeasure policies) are associated with telework use in Japan. Using the unique panel survey on telework, we construct occupational indices for teleworkability and the risk exposure to infection. Our estimation finds that although telework use remains low in Japan, educated, high ICTskilled, younger, and female workers who engage in less teamwork and less routine tasks tend to use telework. Working environments such as the richness of IT communication tools, digitalized offices, flexible-hour working systems, and companywide reform for teleworking can all promote telework use.
    Keywords: telework, Covid-19, teleworkability, tasks, working environments
    JEL: J50
    Date: 2021–08–18

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