nep-hea New Economics Papers
on Health Economics
Issue of 2021‒09‒13
thirty-two papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Value of Sick Pay By Adams-Prassl, A.; Boneva, T.; Golin, M.; Rauh, C.
  2. School Health Programs: Education, Health, and Welfare Dependency of Young Adults By Signe Abrahamsen; Rita Ginja; Julie Riise
  3. Extending alcohol retailers opening hours: Evidence from Sweden By Daniel Avdic; Stephanie von Hinke
  4. Am I My Brother's Barkeeper? Sibling Spillovers in Alcohol Consumption at the Minimum Legal Drinking Age By Schnorr, Geoffrey; Lee, Eunju
  5. The causal effects of employment on mental health and criminality for disabled workers By Remco van Eijkel; Sander Gerritsen; Klarita Sadiraj; Maroesjka Versantvoort
  6. Intended and Unintended Effects of E-cigarette Taxes on Youth Tobacco Use By Rahi Abouk; Charles J. Courtemanche; Dhaval M. Dave; Bo Feng; Abigail S. Friedman; Johanna Catherine Maclean; Michael F. Pesko; Joseph J. Sabia; Samuel Safford
  7. Prices and market power in mental health care: Evidence from a major policy change in the Netherlands By Rudy Douven; Chiara Brouns; Ron Kemp
  8. Early-life Famine Exposure, Hunger Recall and Later-life Health By Zichen Deng; Maarten Lindeboom
  9. Communication Barriers and Infant Health: Intergenerational Effects of Randomly Allocating Refugees Across Language Regions By Daniel Auer; Johannes S. Kunz
  10. The Impact of Healthcare IT on Clinical Quality, Productivity and Workers By Ari Bronsoler; Joseph J. Doyle Jr.; John Van Reenen
  11. Health Literacy Improvement and Use of Digital Health Services in Aged People: A Systematic Literature Review By Zolbin, Maedeh Ghorbanian; Nikou, Shahrokh
  12. The Right to Health and the Health Effects of Denials By Bhalotra, Sonia R.; Fernandez Sierra, Manuel
  13. A Structural Microsimulation Model for Demand-Side Cost-Sharing in Healthcare By Minke Remmerswaal; Jan Boone
  14. The Intergenerational Transmission of Mental and Physical Health in the United Kingdom By Panka Bencsik; Timothy J. Halliday; Bhashkar Mazumder
  15. Socioeconomic Health Inequalities: Differences Between and Within Individuals By Parra-Mujica, F.; Robson, M.; Cookson, R.
  16. Consequences of Greater Gambling Accessibility By Samia Badji; Nicole Black; David W. Johnston
  17. When financials get tough, life gets rough? Problematic debts and ill health By Anne-Fleur Roos; Maaike Diepstraten; Rudy Douven
  18. Paid Childcare Leave, Fertility, and Female Labor Supply in South Korea By Kyeongkuk Kim; Sang-Hyop Lee; Timothy J. Halliday
  19. Medical Expenditures over the Life Cycle: Persistent Risks and Insurance By FUKAI Taiyo; ICHIMURA Hidehiko; KITAO Sagiri; MIKOSHIBA Minamo
  21. Deviations From Standard Family Histories and Subjective Wellbeing at Older Ages By Bruno Arpino; Jordi GumÃ; Albert JuliÃ
  22. Evaluating Wildfire Exposure: Using Wellbeing Data to Estimate and Value the Impacts of Wildfire By Johnston, David; Onder, Yasin Kursat; Rahman, Habibur; Ulubasoglu, Mehmet
  23. Markups and Fixed Costs in Generic and Off-Patent Pharmaceutical Markets By Sharat Ganapati; Rebecca McKibbin
  24. The economics of patient safety Part IV: Safety in the workplace: Occupational safety as the bedrock of resilient health systems By Katherine de Bienassis; Luke Slawomirski; Nicolaas S. Klazinga
  25. Non-routine Tasks and ICT tools in Telework By Toshihiro Okubo
  26. Role of Professionalism in Response to the COVID-19 Pandemic: Does a Public Health or Medical Background Help? By Li, Xun; Lai, Weizheng; Wan, Qianqian; Chen, Xi
  27. Have Girls Been Left behind during the COVID-19 Pandemic? Gender Differences in Pandemic Effects on Children's Mental Wellbeing By Mendolia, Silvia; Suziedelyte, Agne; Zhu, Anna
  28. Addressing the Impact of Border Enforcement Measures on the Self-Reported Health of Migrants Aiming to Enter Japan During the COVID-19 Epidemic. By Wels, Jacques
  29. Inequality in Mortality between Black and White Americans by Age, Place, and Cause, and in Comparison to Europe, 1990-2018 By Hannes Schwandt; Janet Currie; Marlies Bär; James Banks; Paola Bertoli; Aline Bütikofer; Sarah Cattan; Beatrice Zong-Ying Chao; Claudia Costa; Libertad Gonzalez; Veronica Grembi; Kristiina Huttunen; René Karadakic; Lucy Kraftman; Sonya Krutikova; Stefano Lombardi; Peter Redler; Carlos Riumallo-Herl; Ana Rodríguez-González; Kjell Salvanes; Paula Santana; Josselin Thuilliez; Eddy van Doorslaer; Tom Van Ourti; Joachim Winter; Bram Wouterse; Amelie Wuppermann
  30. Telecommunications networks and public health responses during the COVID-19 pandemic: Evidence from a large national network operator in Canada By Rowsell, Joe; Hertanto, Anthony; Mathur, Anand
  31. Reducing public transit compounds social vulnerabilities during COVID-19 By Kar, Armita; Carrel, Andre L.; Miller, Harvey J.; Le, Huyen T. K.
  32. COVID-19, Vaccination, and Consumer Behavior (Japanese) By MORIKAWA Masayuki

  1. By: Adams-Prassl, A.; Boneva, T.; Golin, M.; Rauh, C.
    Abstract: Not all countries provide universal access to publicly funded paid sick pay. Amongst countries that do, compensation rates can be low and coverage incomplete. This leaves a significant role for employer-provided paid sick pay in many countries. In this paper, we study who has access to employer-provided sick pay, how access to sick pay relates to labor supply when sick, and how much it is valued by workers for themselves and others. We find that workers in jobs with high contact to others are particularly unlikely to have employer provided sick pay, as are economically insecure workers who are least able to afford unpaid time off work. We find that workers without sick pay are more likely to work when experiencing cold-like symptoms and are less willing to expose themselves to health risks at work during the pandemic. Using vignettes, we reveal that large shares of workers have a very high, but even more have a very low willingness to sacrifice earnings for access to sick pay. Together our findings highlight the unequal distribution of access to sick pay and the potentially strong negative externalities of not providing it publicly. The pandemic may have made these issues more salient as perceived probabilities of having to self-isolate are positively related to support for publicly provided sick pay. Finally, we find that providing information on the health externality of paid sick leave increases support for the public provision of sick pay, suggesting that there might be a public under-provision because individuals do not factor in the externalities.
    Keywords: Inequality, sick pay, sick leave, externalities, public finance, Covid-19, pandemic, coronavirus, market failure, vignette, information treatment
    JEL: J22 J32 J81
    Date: 2021–09–06
  2. By: Signe Abrahamsen (University of Bergen); Rita Ginja (University of Bergen); Julie Riise (University of Bergen)
    Abstract: This paper provides new evidence that preventive health care services delivered at schools and provided at a relatively low cost have positive and lasting impacts. We use variation from a 1999-reform in Norway that induced substantial differences in the availability of health professionals across municipalities and cohorts. In municipalities with one fewer school nurse per 1,000 school-age children before the reform there was an increase in the availability of nurses of 35% from the pre- to the post-reform period, attributed to the policy change. The reform reduced teenage pregnancies and increased college attendance for girls. It also reduced the take-up of welfare benefits by ages 26 and 30 and increased the planned use of primary and specialist health care services at ages 25-35, without impacts on emergency room admissions. The reform also improved the health of newborns of affected new mothers and reduced the likelihood of miscarriages.
    Keywords: school health services, teenage pregnancy, welfare dependence, utilization of health services, health status
    JEL: H75 I10 I12 I28 I30 I38
    Date: 2021–09
  3. By: Daniel Avdic (Monash University); Stephanie von Hinke (University of Bristol)
    Abstract: Excessive alcohol use is associated with a wide range of adverse outcomes that inflict large societal costs. This paper investigates the impacts of increases in regulated opening hours of Swedish alcohol retailers on alcohol purchases, health and crime outcomes by relating changes in these outcomes in municipalities that increased their retail opening hours to those in municipalities whose opening hours remained unchanged. We show that extended opening hours led to statistically and economically significant increases in alcohol purchases by around two percent per weekly opening hour, but find no corresponding increases in adverse outcomes related to the consumption of alcohol. We study potential mechanisms, such as consumption spillovers and on and off-premise substitution, and we discuss policy implications of our findings.
    Keywords: alcohol policy, alcohol availability, health effects , crime
    JEL: I12 I15
    Date: 2021–09
  4. By: Schnorr, Geoffrey; Lee, Eunju
    Abstract: We use data on sibling pairs near the minimum legal drinking age to provide causal estimates of peer effects in alcohol consumption. Following prior work on other outcomes, we exploit the discontinuous increase in alcohol consumption of the older sibling at the legal drinking age in a regression discontinuity design. Our preferred point estimates imply that the number of binge drinking days reported by the younger sibling decreases by 27% of the mean at the cutoff. While our estimates are somewhat imprecise, we are consistently able to rule out positive estimates from the existing literature. Our research design provides estimates which are interpretable as the causal effect of the peer's alcohol consumption. This is in contrast to most prior work which instead identifies the causal effect of exposure to the peer. We explain how this distinction matters for policy.
    Date: 2021–09–01
  5. By: Remco van Eijkel (CPB Netherlands Bureau for Economic Policy Analysis); Sander Gerritsen (Ministry of Economic Affairs and Climate Policy); Klarita Sadiraj (SCP, The Netherlands Institute for Social Research); Maroesjka Versantvoort (SCP, The Netherlands Institute for Social Research)
    Abstract: In this paper, we study to what extent employment generates spillover effects on other life domains for persons with a work disability. We find that that paid work reduces the probability of using mental health care by 7 percentage points, engaging in criminal activity by 3 percentage points and using non-medical home care by 8 percentage points. Relative to the baseline prevalence in our sample of disabled persons, these effects range between 30 and 60 percent. Increasing labor participation of disabled workers thus generates beneficial effects on other important life domains like health and social behavior. This not only benefits disabled workers in the form of a higher quality of life and lower out-of-pocket payments on health care, but also society as a whole in the form of lower public expenditures on health care and crime. Our paper therefore contributes to a better understanding of the full benefits of activation policies targeted at disabled people.
    JEL: J68 H75 I18
    Date: 2021–07
  6. By: Rahi Abouk; Charles J. Courtemanche; Dhaval M. Dave; Bo Feng; Abigail S. Friedman; Johanna Catherine Maclean; Michael F. Pesko; Joseph J. Sabia; Samuel Safford
    Abstract: Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has prompted aggressive regulation by state and local governments. Between 2010 and 2019, ten states and two large counties adopted ENDS taxes. Applying a continuous treatment difference-in-differences approach to data from two large national datasets (Monitoring the Future and the Youth Risk Behavior Surveillance System), this study explores the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth e-cigarette consumption, with estimated e-cigarette tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax elasticities, suggesting economic substitution between cigarettes and e-cigarettes for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may more than fully offset any public health gains.
    JEL: H2 I1 I18
    Date: 2021–09
  7. By: Rudy Douven (CPB Netherlands Bureau for Economic Policy Analysis); Chiara Brouns (Menzis); Ron Kemp (ACM, EUR)
    Abstract: In the Dutch health care system of managed competition, insurers and mental health providers negotiate on prices for mental health services. Contract prices are capped by a regulator who sets a maximum price for each mental health service. In 2013, the majority of the contract prices equaled these maximum prices. We study price setting after a major policy change in 2014. In 2014, mental health care providers had to negotiate prices with each individual health insurer separately, instead of with all insurers collectively as in 2013. Moreover, after a cost-price revision, the regulator increased in 2014 maximum prices by about 10%. Insurers and mental health providers reacted to this policy change by setting most contract prices below the new maximum prices. We find that in 2014 mental health providers with more market power, i.e. a higher willingness to pay measure, contracted significantly higher prices. Some insurers negotiated significantly lower prices than other insurers but these differences are unrelated to an insurers’ market share.
    JEL: I11 I18 L11
    Date: 2020–05
  8. By: Zichen Deng (Norwegian School of Economics); Maarten Lindeboom (Vrije Universiteit Amsterdam)
    Abstract: We use newly collected individual-level hunger recall information from the China Family Panel Survey to estimate the causal effect of undernourishment on later-life health. We develop a Two-Sample Instrumental Variable (TSIV) estimator that can deal with heterogeneous samples. We find a non-linear relationship between mortality rates, a commonly used famine indicator, and the individual hunger experience. The nonlinearity in famine exposure may explain the variation in the famine’s effect on later life health found in previous studies. We also find that exposure to famine-induced hunger early in life leads to worse health among females fifty years later. This effect is much larger than the reduced-form effect found in previous studies. For males, we find no impact.
    Keywords: famine, hunger, developmental origins, two-sample instrumental varia
    JEL: I12 J11 C21 C26
    Date: 2021–09
  9. By: Daniel Auer (University of Mannheim); Johannes S. Kunz (Monash University)
    Abstract: This paper investigates the intergenerational effect of communication barriers on child health at birth using a natural experiment in Switzerland. We leverage the fact that refugees arriving in Switzerland originate from places that have large shares of French (or Italian) speakers for historical reasons and upon arrival are by law randomly allocated across states that are dominated by different languages but subject to the same jurisdiction. Our findings based on administrative records of all refugee arrivals and birth events between 2010 and 2017 show that children born to mothers who were exogenously allocated to an environment that matched their linguistic heritage are on average 72 gram heavier (or 2.2%) than those that were allocated to an unfamiliar language environment. The differences are driven by growth rather than gestation and manifest in a 2.9 percentage point difference in low birth weight incidence. We find substantial dose-response relationships in terms of language exposure in both, the origin country and the destination region. Moreover, French (Italian) exposed refugees only benefit from French-(Italian-) speaking destinations, but not vice versa. Contrasting the language match with co-ethnic networks, we find that high quality networks are acting as a substitute rather than a complement.
    Keywords: Infant health, language proficiency, refugee allocation , networks
    JEL: F22 I12 J13 J24 J61 J62
    Date: 2021–09
  10. By: Ari Bronsoler; Joseph J. Doyle Jr.; John Van Reenen
    Abstract: Adoption of health information and communication technologies (“HICT”) has surged over the past two decades. We survey the medical and economic literature on HICT adoption and its impact on clinical outcomes, productivity and labor. We find that HICT improves clinical outcomes and lowers healthcare costs, but (i) the effects are modest so far, (ii) it takes time for these effects to materialize, and (iii) there is much variation in the impact. More evidence on the causal effects of HICT on productivity is needed to guide further adoption. There is little econometric work directly investigating the impact of HICT on labor, but what there is suggests no substantial negative effects on employment and earnings. Overall, while healthcare is “exceptional” in many ways, we are struck by the similarities to the wider findings on ICT and productivity stressing the importance of complementary factors (e.g. management and skills) in determining HICT impacts.
    JEL: I12 I18 J21 J24 O14
    Date: 2021–09
  11. By: Zolbin, Maedeh Ghorbanian; Nikou, Shahrokh
    Abstract: The low level of health literacy skills often found in elderly people has been associated with a significant risk of poor access to health services and poor health status and makes it more likely that they will be prevented from obtaining and understanding the basic health information and services needed to make appropriate health decisions. Therefore, empowering the older population with health literacy skills could enable them to benefit from the use of various digital health sources, such as telemedicine, webpages, or other digital platforms, to improve their health quality and enable them to live independently for longer. The purpose of this paper is to perform a systematic review to analyse and evaluate studies that explored the relationship between health literacy skills and the use of digital health platforms in the context of elderly people. To do so, four main databases - Medline, Scopus, Web of Science, and PubMed -were searched based on the following inclusion criteria: (i) no geographical limitation, (ii) written in English, (iii) participants were aged ≥ 65 years, and (iv) studies were published between 2000 and 2020. By applying the inclusion and exclusion criteria for further analysis, the final dataset comprised 32 articles, which were analysed using the Preferred Reporting Items for Systematic Reviews (PRISMA) model. The results show that four different intervention methods could be used to increase elderlies' health literacy skills in the case of using digital health services. Besides, before implementing any training sessions, barriers of learning shall be identified and tackled.
    Keywords: Aging,Digital health service,E-health literacy,Elderly people,Health literacy,Intervention,Senior population,Systematic literature review
    Date: 2021
  12. By: Bhalotra, Sonia R. (University of Warwick); Fernandez Sierra, Manuel (Universidad de los Andes)
    Abstract: We estimate the health costs of supply-side barriers to accessing medical care. The setting is Colombia, where citizens have a constitutional right to health care, but insurance companies that manage delivery impose restrictions on access. We use administrative data on judicial claims for health as a proxy for unmet demand. We validate this using the register recording all health service utilization, estimating that a one standard deviation increase in judicial claims is associated with pervasive decreases in utilization rates of between 0.25 and 0.71 standard deviations, including in medical consultations, procedures, hospitalizations and emergency care. These restrictions on access manifest in population health outcomes. We estimate that a one standard deviation increase in judicial claims increases the all-cause mortality rate by between 0.10 and 0.23 standard deviations. Increases in mortality are pervasive across causes, with the largest increase in deaths from certain cancers. They are also pervasive across the age and sex distribution but larger among individuals over the age of fifty and (weakly) among women and the low-income population.
    Keywords: health care, health insurance, mortality, right-to-health, litigation, universal-health-coverage, Colombia
    JEL: I11 I13 I18 K4
    Date: 2021–08
  13. By: Minke Remmerswaal (CPB Netherlands Bureau for Economic Policy Analysis); Jan Boone (CPB Netherlands Bureau for Economic Policy Analysis)
    Abstract: Demand-side cost-sharing schemes reduce moral hazard in healthcare at the expense of out-of-pocket risk and equity. With a structural microsimulation model, we show that shifting the starting point of the deductible away from zero to 400 euros for all insured individuals, leads to an average 4 percent reduction in healthcare expenditure and 47 percent lower out-of-pocket payments. We use administrative healthcare expenditure data and focus on the price elastic part of the Dutch population to analyze the differences between the cost-sharing schemes. The model is estimated with a Bayesian mixture model to capture distributions of healthcare expenditure with which we predict the effects of cost-sharing schemes that are not present in our data.
    JEL: I11 I13 I14
    Date: 2020–07
  14. By: Panka Bencsik (University of Chicago); Timothy J. Halliday (University of Hawai‘i); Bhashkar Mazumder (Federal Reserve Bank of Chicago)
    Abstract: We estimate intergenerational health persistence in the United Kingdom using Quality Adjusted Life Years (QALY), a broad measure of health derived from the SF-12 Survey. We estimate that both the rank-rank slope and the intergenerational health association (IHA) are 0.21. We use components of the SF-12 to create mental and physical health indices and find that mental health is at least as persistent across generations as physical health. Importantly, parents’ mental health is much more strongly associated with children's health than parents’ physical health indicating that mental health might be a more important transmission channel. Finally, we construct an overall measure of welfare that combines income and health, and estimate a rank-rank association of 0.31. This is considerably lower than a comparable estimate of 0.43 for the US, suggesting greater mobility of overall welfare in the UK than the US.
    Keywords: intergenerational health mobility; mental health; physical health; United Kingdom
    JEL: F14 F16 J31
    Date: 2021–02
  15. By: Parra-Mujica, F.; Robson, M.; Cookson, R.
    Abstract: Research on socioeconomic health inequalities has primarily relied on univariate markers of socioeconomic status (SES), measured at one point in time. Using data from the UKHLS dataset (2009{2020), we build an age-conditional multidimensional SES index for the adult population in the UK. By using a "within-between" model we disentangle the relationship between health outcomes and: i) between-individual differences in SES, and ii) within-individual variations of SES across time. Results show that both are positive and highly significant predictors of physical and mental health. However, we find that these relationships are not linear and that within and between effects interact. While higher levels of SES are always associated with an increase in physical health, for mental health, after some point (SES = 0.613), higher average SES is associated with a score decrease. For an individual with the lowest average SES rank we observe a large and significant effect of a within-individual increase in SES on mental health (8.91) and physical health (1.82), however, this within-effect diminishes for those individuals with higher average SES. Individuals with high expected mobility are also found to have significantly better health scores, particularly for mental health.
    Keywords: health inequality; socioeconomic status; social gradient; Mundlak;
    JEL: I14 C23 D63
    Date: 2021–09
  16. By: Samia Badji (Monash University); Nicole Black (Monash University); David W. Johnston (Monash University)
    Abstract: Greater accessibility to gambling venues may increase gambling rates, and therefore enhance welfare through the additional enjoyment from gambling and the related socialising. However, it may also lead to problematic gambling, financial hardship and psychological distress. We provide new evidence on the potential benefits and harms of greater geographic accessibility to suburban gambling venues containing electronic gaming (slot) machines. Our setting is Australia, the world leader in per capita gambling expenditure. Our approach combines geolocations of gambling venues with longitudinal survey data on gambling behaviours and economic, health and social outcomes. We find that people residing in close proximity to gambling venues are more likely to gamble, less likely to be happy, and are more likely to suffer from financial hardship and mental health problems. We find no significant impacts on socialising, general health, relationship dissatisfaction, or crime victimisation. These findings have implications for the regulation of gambling venues.
    Keywords: gambling, harms, mental health, financial hardship
    JEL: D10 H70 I10 I30
    Date: 2021–09
  17. By: Anne-Fleur Roos (CPB Netherlands Bureau for Economic Policy Analysis); Maaike Diepstraten (CPB Netherlands Bureau for Economic Policy Analysis); Rudy Douven (CPB Netherlands Bureau for Economic Policy Analysis)
    Abstract: It is often suggested that problematic debts antecede health problems. In this paper, we investigate whether individuals obtaining problematic debts are more likely to use mental healthcare or social guidance and/or financial help, and whether they have higher mental healthcare costs. We use nationwide individual-level panel data from the Netherlands for the years 2011-2015. We employ a difference-in-differences approach with individual fixed effects and find that obtaining problematic debt is strongly associated with ill (mental) health. We find that average mental healthcare expenditures increased with approximately 200 euro in 2014 and 2015 for individuals who experienced problematic debts in 2013. The effect corresponds to an increase of 30% of individual mental healthcare expenditures because of problematic debts. Furthermore, the use of mental healthcare increased with 7% and the use of social guidance and/or financial assistance increased with 40% after getting into problematic debt. We therefore conclude that policies that prevent people from getting into debt may generate positive external effects by saving on expenditures on healthcare or social guidance and/or financial assistance. It is often suggested that problematic debts antecede health problems. In this paper, we investigate whether individuals obtaining problematic debts are more likely to use mental healthcare or social guidance and/or financial help, and whether they have higher mental healthcare costs. We use nationwide individual-level panel data from the Netherlands for the years 2011-2015. We employ a difference-in-differences approach with individual fixed effects and find that obtaining problematic debt is strongly associated with ill (mental) health. We find that average mental healthcare expenditures increased with approximately 200 euro in 2014 and 2015 for individuals who experienced problematic debts in 2013. The effect corresponds to an increase of 30% of individual mental healthcare expenditures because of problematic debts. Furthermore, the use of mental healthcare increased with 7% and the use of social guidance and/or financial assistance increased with 40% after getting into problematic debt. We therefore conclude that policies that prevent people from getting into debt may generate positive external effects by saving on expenditures on healthcare or social guidance and/or financial assistance.
    JEL: I14 D14
    Date: 2021–08
  18. By: Kyeongkuk Kim (Ministry of Finance, South Korea); Sang-Hyop Lee (University of Hawaii at Manoa); Timothy J. Halliday (University of Hawai‘i)
    Abstract: We consider the effects of a paid childcare leave subsidy on maternal behavior in South Korea. We employ both difference-in-difference and regression kink techniques. The subsidies had very large behavioral effects. Regression kink estimates indicate that an extra dollar of the monthly subsidy (on annual basis) increased conceptions by 0.06-0.08 percentage points. Difference-in-difference estimates indicate that paid leave subsidies also increased permanent working arrangements by ten percentage points for lower earning women and four percentage points for higher earning women. In a country with the lowest total fertility rate in the world and that often performs middling in rankings of gender inequality, we conclude that paid childcare leave for working women confers positive benefits.
    Keywords: intergenerational health mobility; mental health; physical health; United Kingdom
    JEL: J18 J13
    Date: 2021–08
  19. By: FUKAI Taiyo; ICHIMURA Hidehiko; KITAO Sagiri; MIKOSHIBA Minamo
    Abstract: This paper analyzes individuals' medical expenditure risks over the life-cycle and roles of the national health insurance system using nationwide administrative data of health insurance claims (NDB) in Japan. Health shocks are highly persistent and estimated distribution of lifetime medical expenditures varies greatly with the assumed order of persistence. We build a structural life-cycle model for males and females, and single and married households with different labor productivity and assets, and quantify economic and welfare effects of medical expenditure risks and the insurance system. The national health insurance characterized by age-dependent copay rates and progressive out-of-pocket ceilings protects households from expenditure risks well, and has significant effects on their life-cycle savings. Responses to health insurance reform are highly heterogeneous. In response to lower benefits, high-income households turn to self-insurance and increase savings, while low-income households reduce savings and consumption and many of them become recipients of welfare transfers. Welfare effects of such a reform also vary across households and low-income and unhealthy households fare worse than the average. We also show that effects of health insurance reform depend on the generosity of other welfare programs and differ across households.
    Date: 2021–08
  20. By: Bolin, Kristian (Department of Economics, School of Business, Economics and Law, Göteborg University); Lood, Qarin (Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, Centre for Ageing and Health – AgeCap, University of Gothenburg, Gothenburg, Sweden)
    Abstract: The time of retirement is analyzed in a theoretical framework taking capability and health into account. Capability if formalized as a stock characteristic which determines the attained amounts of a composite good which yields utility. The model is purposely simple and comprises one choice variable – the time of retirement. The core assumption is that inherited capability influences the rate of evolvement of health, and vice versa, and that the rates of change of the stocks differ between the pre- and post-retirement periods. The optimal retirement timing decision is characterized and the effects of the model’s exogenous variables on this decision are examined. We derive refutable comparative statistics results with respect to the model’s exogenous variables, and, for example, show – for a specified version of the model – how the timing of retirement depends on the inherited amounts of capability and health.
    Keywords: Capability; Health; Retirement
    JEL: I10 I30
    Date: 2021–09
  21. By: Bruno Arpino (Dipartimento di Statistica, Informatica, Applicazioni "G. Parenti", Università di Firenze); Jordi Gumà (Department of Political and Social Sciences, Pompeu Fabra University); Albert Julià (Department of Sociology, University of Barcelona)
    Abstract: Life course research emphasizes that health and wellbeing at older ages are influenced by experiences occurred in the previous stages of life. Several studies have focused on fertility and partnership histories and health at older ages, but fewer have examined subjective wellbeing (SWB), especially using a holistic approach. Another strand of the literature demonstrated that non-standard family behaviors negatively influence SWB. We contribute to these strands of the literature by examining the association between non-standardness of family histories and SWB at older ages. We argue that individuals who experienced non-standard trajectories have been exposed to social sanctions throughout their life course which could exert negative long-term influence on their SWB. We apply sequence analysis and optimal matching on retrospective data from the seventh wave of the Survey of Health Ageing and Retirement in Europe (SHARE) to calculate the degree of non-standardness of family histories between age 15 and 49. Subseuently, we estimate linear regression models to assess the association between non-standardness of family histories and older people's SWB. Our results show a negative association between non-standardness of family histories and SWB, which is stronger for lower educated individuals and in Southern European countries.
    Keywords: Fertility histories; Partnership histories; subjective wellbeing; older people; SHARE.
    Date: 2021–09
  22. By: Johnston, David; Onder, Yasin Kursat; Rahman, Habibur; Ulubasoglu, Mehmet
    Abstract: This paper estimates and quantifies the wellbeing effects of the 2009 Black Saturday Bushfires, the deadliest wildfire event in Australia's known history. Using subjective wellbeing data from a nationally representative longitudinal study and adopting an individual fixed-effects approach, our results identify a significant reduction in life satisfaction for individuals residing in close proximity of the wildfires. The negative wellbeing effect is valued at A$52,300 per annum; corresponding to 80% of the average annual income of a full-time employed adult. The satisfaction domain most negatively affected is how safe the person feels, and the group most affected are people with low social support. A delayed adverse mental health effect is also identified.
    Keywords: Wildfires, georeferencing, life satisfaction
    JEL: I18 I31 Q54
    Date: 2021–09–08
  23. By: Sharat Ganapati; Rebecca McKibbin
    Abstract: There is wide dispersion in pharmaceutical prices across countries with comparable quality standards. Under monopoly, off-patent and generic drug prices are at least four times higher in the United States than in comparable English-speaking high income countries. With five or more competitors, off-patent drug prices are similar or lower. Our analysis shows that differential US markups are largely driven by the market power of drug suppliers and not due to wholesale intermediaries or pharmacies. Furthermore, we show that the traditional mechanism of reducing market power – free entry – is limited because implied entry costs are substantially higher in the US.
    JEL: F14 I11 L44 L65
    Date: 2021–09
  24. By: Katherine de Bienassis (OECD); Luke Slawomirski (OECD); Nicolaas S. Klazinga (OECD)
    Abstract: Health care settings are inherently hazardous places, with very unpredictable and complex working environments. These hazards and risks not only result in a range of injuries and ill-health among workers but also jeopardise the safety of patients. The COVID-19 crisis has amplified the importance of ensuring that the health care that is provided is safe—for patients and health workers alike. A sufficient, and capable, workforce, is the foundation of resilient systems. Policy makers need to focus now on how to build and support an appropriate workforce to respond to future shocks. This includes health workers beyond the hospital—including those in community, long-term, and primary care. The safety of both patients and health workers should be protected through appropriate mechanisms to ensure the safety of protective equipment and sufficient supplies, appropriate staffing levels, training and support at the workplace. These governance mechanisms are even more relevant when policy makers face trade-offs between health, safety and economic concerns.
    JEL: I12 I18
    Date: 2021–09–10
  25. By: Toshihiro Okubo (Faculty of Economics Keio University)
    Abstract: Telework has spread during the pandemic of coronavirus disease (COVID-19). Using a unique individual-level survey in Japan, we investigate how telework has changed the way people live and work and what impediments hamper telework use. As a result, we find that telework allows workers to spend more time on leisure and their families. Compared to routine task workers, non-routine (abstract) task workers are more suited to telework. However, once engaged in telework, non-routine task workers have fewer opportunities to communicate with coworkers, which is a serious impediment that tends to hamper work performance and compromise mental health.
    Keywords: telework, COVID-19, survey, non-routine tasks, impediments, efficiency
    JEL: J20 J24
    Date: 2021–08–31
  26. By: Li, Xun (Wuhan University); Lai, Weizheng (University of Maryland); Wan, Qianqian (Wuhan University); Chen, Xi (Yale University)
    Abstract: In response to the outbreak of coronavirus disease 2019 (COVID-19), there have been substantial variations in policy response and performance for disease control and prevention within and across nations. It remains unclear to what extent these variations may be explained by bureaucrats' professionalism, as measured by their educational background or work experience in public health or medicine. To investigate the effects of officials' professionalism on their response to and performance in fighting the COVID-19 pandemic, we collect information from the résumés of government and Party officials in 294 Chinese cities, and integrate this information with other data sources, including weather conditions, city characteristics, COVID-19-related policy measures, and health outcomes. We show that, on average, cities whose top officials had public health or medical backgrounds (PHMBG) had significantly lower infection rates than cities whose top officials lacked such backgrounds. We test the mechanisms of these effects and find that cities whose officials had PHMBG implemented community closure more rapidly than those lacked such backgrounds. Our findings highlight the importance of professionalism in combating the pandemic.
    Keywords: COVID-19, professionalism, public health background, medical background, policy response
    JEL: I18 H12 H75 P41
    Date: 2021–09
  27. By: Mendolia, Silvia (University of Wollongong); Suziedelyte, Agne (University of London); Zhu, Anna (RMIT University)
    Abstract: Using data from the UK, we show that girls have been affected more than boys by the COVID-19 pandemic in terms of their mental wellbeing. These gender differences are more pronounced in lower-income families. Our results are consistent with previous findings of larger pandemic effects on mental health of women.
    Keywords: COVID-19, pandemic, mental health, children
    JEL: I10 I31 J13
    Date: 2021–08
  28. By: Wels, Jacques
    Abstract: Following the spread of COVID-19 in early 2020, Japan has implemented border enforcement measures to ban most foreigners, including tourists, workers and students from entering Japan for the time being, except for special humanitarian circumstances. For about a year, many migrants have been unable to enter Japan and had to postpone their plans. Using an online questionnaire (N=478), this study aimed to assess the impact of border enforcement measures on migrants’ health and wellbeing. Results indicate that border enforcement measures have generated insecurities, both from a financial and personal point of view. These have had strong negative effects on physical health and, to a greater extent, on sleep quality, level of stress and quality of life. The article demonstrates that insecurity is key for understanding Japanese border policies and, consequently, migrants’ health as it shapes a spectrum between the insiders and the outsiders that is determined by factors that take little account of individuals’ situation and that the state of exception reveals a gradient that is independent from the epidemic situation. It concludes with five points to be discussed further to protect migrants’ heath in case of travel ban: allow a fair treatment of migrants, developing international remote work possibilities, discussing the portability of the costs related to border enforcement measures, allow non-married couples to reunite and give a greater visibility to international migrants.
    Date: 2021–09–01
  29. By: Hannes Schwandt; Janet Currie; Marlies Bär; James Banks; Paola Bertoli; Aline Bütikofer; Sarah Cattan; Beatrice Zong-Ying Chao; Claudia Costa; Libertad Gonzalez; Veronica Grembi; Kristiina Huttunen; René Karadakic; Lucy Kraftman; Sonya Krutikova; Stefano Lombardi; Peter Redler; Carlos Riumallo-Herl; Ana Rodríguez-González; Kjell Salvanes; Paula Santana; Josselin Thuilliez; Eddy van Doorslaer; Tom Van Ourti; Joachim Winter; Bram Wouterse; Amelie Wuppermann
    Abstract: Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990-2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in rich and poor U.S. areas and with reference to six European countries. Inequalities in life expectancy are starker in the U.S. than in Europe. In 1990 White Americans and Europeans in rich areas had similar overall life expectancy, while life expectancy for White Americans in poor areas was lower. But since then even rich White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%. Black life expectancy increased more than White life expectancy in all U.S. areas, but improvements in poorer areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black mortality reductions included: Cancer, homicide, HIV, and causes originating in the fetal or infant period. Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990-2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both rich and poor areas.
    JEL: E21 I1 J1
    Date: 2021–09
  30. By: Rowsell, Joe; Hertanto, Anthony; Mathur, Anand
    Abstract: The COVID-19 pandemic has demonstrated the fundamental importance of telecommunications networks. This paper utilizes data from a large North American network operator to examine the role of telecom networks in enabling public health and economic responses to the pandemic. During the pandemic, data usage grew significantly, with growth in wireline data use outstripping growth in wireless data use, 53% to 27%, between March and December 2020. Yet, even at pre-pandemic levels, data use is growing exponentially, doubling every 1.3 years between 2017 and 2020. This paper also considers three examples of public health and economic responses enabled by telecom networks: staying at home, adopting telemedicine, and teleworking. First, based on de-identified data on customer movement and location, this paper estimates that compliance with stay-at-home orders was about 20% lower in the 2nd wave than during the 1st wave, despite much cases counts, suggesting that Canadians suffered from isolation fatigue. Across Canada's six largest cities, controlling for population and GDP per capita, a 1% decrease in compliance is associated with an additional 700 COVID-19 infections. Second, based on data on two telemedicine apps, this paper highlights the potential for the rapid adoption of telemedicine. At the start of the pandemic, adoption of these apps doubled and then was sustained throughout 2020, with usage patterns reflecting digital divides in age and gender. Third, Canada's teleworking rate changed in lockstep with COVID-19 cases, even while the unemployment rate remained constant, suggesting that employers are adopting teleworking as a flexible way to adapt to evolving public health conditions and restrictions without resorting to layoffs. When viewed against this backdrop, telecommunication policy can support public health and social outcomes, in addition to economic outcomes.
    Date: 2021
  31. By: Kar, Armita; Carrel, Andre L.; Miller, Harvey J.; Le, Huyen T. K. (The Ohio State University)
    Abstract: The COVID-19 pandemic has severely impacted public transit services through a combination of plummeting ridership during the lockdown and subsequent budget cuts. This study investigates the equity impacts of reductions in accessibility due to public transit service cuts during COVID-19 and their association with urban sprawl. We evaluated accessibility to essential services such as grocery stores and both urgent and non-urgent health care across 22 cities across the United States in three phases during 2020: pre-lockdown, lockdown, and post-lockdown. We estimated the spatio-temporal coverage of transit service during the peak and off-peak periods in each phase. We found stark disparities in food and health care access for various socio-economic groups. Economically disadvantaged and suburban neighborhoods were more likely to lose food and health care access by public transit during COVID-19. In particular, transit service cuts worsened accessibility for population groups with multiple social vulnerabilities, such as low-income workers with zero vehicle ownership, poor households living in urban neighborhoods, and non-white populations residing in suburban neighborhoods. Moreover, our study suggests that sprawled cities experienced greater losses in access to food and health care during COVID-19 than compact cities, highlighting the influence of urban form on the functionality of transit services during crises.
    Date: 2021–09–02
  32. By: MORIKAWA Masayuki
    Abstract: With the continued spread of COVID-19, vaccination represents one avenue towards a recovery in household consumption. However, there is high uncertainty regarding the effectiveness of vaccination in terms of restoring economic activity. This paper, based on an original survey for individuals in July 2021, presents some evidence on the relationship between vaccination and consumer behavior. According to the results, first, a large number of respondents intend to increase their consumption after the end of the pandemic, but not so many respondents will increase their consumption after finishing their vaccination. Second, female, high-income earners, and those who used last year's GoTo campaign tend to exhibit somewhat higher intention to increase consumption after vaccination. No clear association with health status or subjective risk of infection has been detected.
    Date: 2021–08

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