nep-hea New Economics Papers
on Health Economics
Issue of 2021‒10‒11
fourteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Causal Effects of Place on Health and Longevity By Tatyana Deryugina; David Molitor
  2. Competition, quality and integrated health care By Kurt R. Brekke; Luigi Siciliani; Odd Rune Straume
  3. Exposure to Cigarette Taxes as a Teenager and the Persistence of Smoking into Adulthood By Andrew I. Friedson; Moyan Li; Katherine Meckel; Daniel I. Rees; Daniel W. Sacks
  4. Minimum Wages and Teenage Childbearing: New Estimates Using a Dynamic Difference-in-Differences Approach By Daniel I. Rees; Joseph J. Sabia; Rebecca Margolit
  5. SNAP Work Requirement and Food Insecurity By Das, Debasmita
  6. Local Economic Growth and Infant Mortality By Andreas Kammerlander; Günther G. Schulze
  7. The Local Fiscal Multiplier of Intergovernmental Grants: Evidence from Federal Medicaid Assistance to States By Seth Giertz; Anil Kumar
  8. Do Refugees with Better Mental Health Better Integrate? Evidence from the Building a New Life in Australia Longitudinal Survey By Dang, Hai-Anh H.; Trinh, Trong-Anh; Verme, Paolo
  9. Mortality Rates by College Degree Before and During COVID-19 By Anne Case; Angus Deaton
  10. Mask Mandates and COVID-19 Related Symptoms in the US By Nguyen, My
  11. COVID-19 and pro-sociality: How do donors respond to local pandemic severity, increased salience, and media coverage? By Adena, Maja; Harke, Julian
  12. Sex workers’ everyday security in the Netherlands and the impact of COVID-19 By Cubides Kovacsics, M.I.; Santos, W.; Siegmann, K.A.
  13. Identifying Early Adopters of COVID-19 Vaccines in Latin America By Alejandro Arrieta; Ariadna García-Prado; Juan Pablo Sarmiento; Carmen Paz Castro
  14. The Pandemic Retirement Surge Increased Retirement Inequality By Owen Davis; Bridget Fisher; Teresa Ghilarducci; Siavash Radpour

  1. By: Tatyana Deryugina; David Molitor
    Abstract: Life expectancy varies substantially across local regions within a country, raising conjectures that place of residence affects health. However, population sorting and other confounders make it difficult to disentangle the effects of place on health from other geographic differences in life expectancy. Recent studies have overcome such challenges to demonstrate that place of residence substantially influences health and mortality. Whether policies that encourage people to move to places that are better for their health or that improve areas that are detrimental to health are desirable depends on the mechanisms behind place effects, yet these mechanisms remain poorly understood.
    JEL: H75 I1 R1
    Date: 2021–10
  2. By: Kurt R. Brekke (Department of Economics, Norwegian School of Economics (NHH)); Luigi Siciliani (Department of Economics and Related Studies, University of York, Heslington); Odd Rune Straume (Department of Economics/NIPE, University of Minho)
    Abstract: Integration of health care services has been promoted in several countries to improve the quality and coordination of care. We investigate the effects of such integration in a model where providers compete on quality to attract patients under regulated prices. We identify circumstances under which integration either increases or reduces the quality of services provided. In the absence of synergies related to costs or benefits, integration generally leads to increases in quality for some services and reductions for others. The corresponding effect on health benefits depends largely on whether integration leads to quality dispersion or convergence across services.
    Keywords: Integrated care, quality, competition, health care.
    JEL: I11 L12 L13
    Date: 2021
  3. By: Andrew I. Friedson; Moyan Li; Katherine Meckel; Daniel I. Rees; Daniel W. Sacks
    Abstract: Are teenage and adult smoking causally related? Recent anti-tobacco policy is predicated on the assumption that preventing teenagers from smoking will ensure that fewer adults smoke, but direct evidence in support of this assumption is scant. Using data from three nationally representative sources and cigarette taxes experienced as a teenager as an instrument, we document a strong, positive relationship between teenage and adult smoking: specifically, deterring 10 teenagers from smoking through raising cigarette taxes roughly translates into 5 or 6 fewer eventual adult smokers. We conclude that efforts to reduce teenage smoking can have important, long-lasting consequences on smoking participation and, presumably, health.
    JEL: H2 I1 I12
    Date: 2021–10
  4. By: Daniel I. Rees; Joseph J. Sabia; Rebecca Margolit
    Abstract: The minimum wage is increasingly viewed as an important tool for improving public health outcomes, including reducing childbearing among teenagers. Taken at face value, recently reported estimates suggest that raising the federal minimum wage to $15 per hour could reduce the number of teenage births by 35,000 per year. Using an event study framework that accounts for dynamic and heterogeneous treatment effects, we find little evidence that minimum wages are causally related to teenage childbearing. Moreover, the estimated effects of minimum wages on teenage sexual behaviors, including contraception use, abstinence, and number of partners are consistently small and statistically insignificant.
    JEL: J13 J18
    Date: 2021–10
  5. By: Das, Debasmita
    Abstract: In this paper, I examine the effect of Supplemental Nutrition Assistance Program(SNAP) work requirement reinstatement on food insecurity outcomes of able-bodied adults without dependents (ABAWDs). The policy restricts SNAP benefits of ABAWDs to 3 months in a 36 months period if they are not working or participating in any work program for at least 20 hours a week. In the aftermath of the 2008 recession, the American Recovery and Reinvestment Act of 2009 waived work requirements nationwide, and many states reimplemented the work rule at different times beginning in 2011. I employ a difference-in-differences approach utilizing this cross-state variation in the reimplementation of the policy. Using rich information on food affordability and food intake behavior from the Food Security Supplement of the Current Population Survey (CPS-FSS), I find that promoting work for food assistance improved the overall food security status of ABAWDs by reducing disruptions in food intake, anxiety over food affordability and dependency on emergency food receipt. Subsample analyses indicate that effects are stronger for never married and less educated ABAWDs.
    Keywords: Food assistance; SNAP; Food Security; Work Requirement
    JEL: D12 I12 I38
    Date: 2019–11–10
  6. By: Andreas Kammerlander; Günther G. Schulze
    Abstract: We show, for the first time, a causal effect of local economic growth on infant mortality. We use geo-referenced data for non-migrating mothers from 46 developing countries and 128 DHS survey rounds and combine it with nighttime luminosity data at a granular level. Using mother fixed effects we show that an increase in local economic activity significantly reduces the probability that the same mother loses a further child before its first birthday.
    Keywords: local economic growth, child mortality, nighttime lights
    JEL: I15 O18
    Date: 2021
  7. By: Seth Giertz; Anil Kumar
    Abstract: Advocates of Medicaid expansion argue that federal Medicaid assistance to states fosters economic activity, generating positive local multiplier effects. Furthermore, during economic downturns, Congress regularly tweaks federal match rates for state Medicaid spending – including during the COVID-19 public health emergency – in order to assist states. Despite heavy reliance on Medicaid funding formulas, identifying the economic effect of these federal transfers has proved challenging. This is because federal Medicaid assistance (to states) is endogenous, since funding levels are correlated with unobserved factors driving state economic activity. To address this concern, we construct an instrument based on a slope discontinuity in the federal matching rate for state Medicaid spending. Using state-level panel data from 1990 to 2013, we find that federal Medicaid assistance does stimulate economic activity, but the implied cost per job created is quite high and the multiplier is well below 1. Despite modest economic effects over the entire sample period, we find that federal Medicaid assistance provided powerful fiscal stimulus to states after the Great Recession when the implied multiplier shot up to 1.5.
    Keywords: Fiscal Multiplier; Fiscal Stimulus; Medicaid Matching Grants
    JEL: C31 E62 I38 H31
    Date: 2021–09–24
  8. By: Dang, Hai-Anh H.; Trinh, Trong-Anh; Verme, Paolo
    Abstract: Hardly any evidence currently exists on the causal effects of mental illness on refugee labor market outcomes. We offer the first study on this topic in the context of Australia, one of the host countries with the largest number of refugees per capita in the world. Analyzing the Building a New Life in Australia longitudinal survey, we exploit the variations in traumatic experiences of refugees interacted with time as an instrument for refugee mental health. We find that worse mental health, as measured by a one standard deviation increase in the Kessler mental health score, reduces the probability of employment by 14.1% and labor income by 26.8%. We also find some evidence of adverse impacts of refugees' mental illness on their children's mental health and education performance. These effects appear more pronounced for refugees that newly arrive or are without social networks, but they may be ameliorated with government support. Our findings suggest that policies that target refugees' mental health may offer a new channel to improve their labor market outcomes.
    Keywords: refugees,mental health,labor outcomes,instrumental variable,BNLA longitudinal survey,Australia
    JEL: I15 J15 J21 J61 O15
    Date: 2021
  9. By: Anne Case; Angus Deaton
    Abstract: It is now established that mortality and excess mortality from COVID-19 differed across racial and ethnic groups in 2020. Less is known about educational differences in mortality during the pandemic. We examine mortality rates by BA status within sex, age, and race/ethnic groups comparing 2020 with 2019. Mortality rates have increasingly differed by BA status in the US in recent years and there are good reasons to expect the gap to have widened further during the pandemic. Using publicly available provisional data from the National Center for Health Statistics we find that mortality rates increased in 2020 over 2019 for those with and without a BA, irrespective of age, sex, or race/ethnicity. Although mortality rates increased by more for those without a BA, the ratio of mortality rates for those with and without a BA changed surprisingly little from 2019 to 2020. Among 60 groups (sex by race/ethnicity by age) that are available in the data, the ratio of mortality rates of those without a BA to those with a BA fell for more than half of the groups. Our results suggest that differences in the risk of infection were less important in structuring mortality by education than differences in the risk of death conditional on infection.
    JEL: I1 I21 I24 J1
    Date: 2021–10
  10. By: Nguyen, My
    Abstract: This study investigates the extent to which the Public Mask Mandate, a policy that requires the use of face masks in public, can protect people from developing COVID-19 symptoms during the initial stage of the pandemic. By exploiting the differential timing of the mask mandate implementation across the United States, we show that mandating masks in public significantly lowers the incidence of developing all COVID-19 symptoms by 0.29 percentage points. Taking the mandate-unaffected individuals who display all symptoms as the benchmark, our estimate implies an average reduction by 290%. The finding provides suggestive evidence for the health benefits of wearing masks in public in the initial stage of the COVID-19 pandemic. The study also highlights the relevance of public mask wearing for the ongoing pandemic where the vaccination rate is precarious and access to vaccines is still limited in many countries.
    Keywords: COVID-19; coronavirus symptoms; mask mandates; face masks
    JEL: I12 I18
    Date: 2020
  11. By: Adena, Maja; Harke, Julian
    Abstract: Has the COVID-19 pandemic affected pro-sociality among individuals? After the onset of the pandemic, many charitable appeals were updated to include a reference to COVID-19. Did donors increase their giving in response to such changes? In order to answer these questions, we conducted a real-donation online experiment with more than 4,200 participants from 149 local areas in England and over 21 weeks. First, we varied the fundraising appeal to either include or exclude a reference to COVID-19. We found that including the reference to COVID-19 in the appeal increased donations. Second, in a natural experiment-like approach, we studied how the relative local severity of the pandemic and media coverage about local COVID-19 severity affected giving in our experiment. We found that both higher local severity and more related articles increased giving of participants in the respective areas. This holds for different specifications, including specifications with location fixed effects, time fixed effects, a broad set of individual characteristics to account for a potentially changing composition of the sample over time and to account for health- and work-related experiences with and expectations regarding the pandemic. While negative experiences with COVID-19 correlate negatively with giving, both approaches led us to conclude that the pure effect of increased salience of the pandemic on pro-sociality is positive. Despite the shift in public attention toward the domestic fight against the pandemic and away from developing countries' challenges, we found that preferences did not shift toward giving more to a national project and less to developing countries.
    Keywords: COVID-19,charitable giving,online experiments,natural experiments
    JEL: C93 D64 D12
    Date: 2021
  12. By: Cubides Kovacsics, M.I.; Santos, W.; Siegmann, K.A.
    Abstract: The COVID-19 pandemic has laid bare and exacerbates the existing insecurities of sex workers, a highly stigmatised, often criminalised and economically precarious group of workers. In the Netherlands, sex workers continue to experience different forms of violence despite the occupation’s legalisation, making it a ‘profession in limbo’. This paper therefore seeks to formulate answers to the questions: What are sex workers’ everyday experiences of (in)security? And: How has the COVID-19 pandemic influenced these? Given sex workers’ historical exclusion from policy formulation, we engage with these questions through collaborative research based on semi-structured interviews with sex workers in The Hague. Our analysis reveals a stark mismatch between the insecurities that sex workers’ experience and the concerns enshrined in the regulatory environment. While the municipality’s regulation of the sex industry focuses on sexually transmitted infections (STIs), occupational safety and health issues that sex workers experience also include psychological problems, insufficient hygiene in the workplace and the risk of violent clients. Besides, income insecurity is a key concern for sex workers. The decline in legal workspaces during the past two decades has not translated into higher service rates. Net earnings are further reduced when window operators pass on the risks of illness or damage to sex workers. Furthermore, operators act as powerful gatekeepers of access to remunerative employment. Here, sex workers identify gender-based discrimination with resulting more severe employment and income insecurities for transwomen and male sex workers. This legal liminality is enabled not only by the opaque legal status of sex work in the Netherlands, but also by the gendering of official regulation. Our study mirrors research from the Netherlands and beyond that documents sex workers’ widespread exclusion from COVID-19 support packages. Over and beyond this, we find that immigration status intersects with and mediates these exclusionary processes. We conclude that, firstly, to effectively address the insecurities that sex workers experience and fear, regulation needs to shift from its current criminal law and public health focus to a labour approach. Secondly, over and above such decriminalization, policies and civil society actors alike need to address the gender and sexual hierarchies that underpin sex worker stigma as well as migrants’ discrimination which have come out as powerful mediators of sex workers’ insecurities.
    Keywords: Biopolitics, collaborative research, gender, insecurities, intersectionality, labour approach, legal liminality, the Netherlands, sex work
    Date: 2021–09–29
  13. By: Alejandro Arrieta (Department of Health Policy and Management, Florida International University); Ariadna García-Prado (Department of Economics, Universidad Publica de Navarra, Spain); Juan Pablo Sarmiento (Extreme Events Institute, Florida International University); Carmen Paz Castro (Department of Geography, Universidad de Chile, Chile)
    Abstract: COVID-19 vaccine hesitancy is currently one of the main obstacles to worldwide herd immunity and socioeconomic recovery. Because vaccine coverage can vary between and within countries, it is important to identify sources of variation so that policies can be tailored to different population groups. In this paper, we analyze the results from a survey designed and implemented in order to identify early adopters and laggers in six big cities of Latin America. We find that trust in government and science, accurate knowledge about the value of vaccination and vaccine effects, perceived risk of getting sick, and being a student increase the odds to get vaccinated. We also identify potential laggers as women and populations between 20 and 35 years old who are not students. We discuss specific strategies to promote vaccination among these populations groups as well as more general strategies designed to gain trust. These findings are specific to the context of Latin America insofar as the underlying factors associated with the choice to be vaccinated vary significantly by location and in relation to individual-level factors.
    Keywords: Coronavirus, COVID-19, Vaccines, Latin America
    JEL: I12 C13
    Date: 2021–09
  14. By: Owen Davis; Bridget Fisher; Teresa Ghilarducci; Siavash Radpour (Schwartz Center for Economic Policy Analysis (SCEPA))
    Abstract: An examination of the status of older workers in June of 2021 reveals three highlights: 1.) Retirement Boom: At least 1.7 million more older workers than expected retired due to the pandemic recession. (2.) Retirement Inequality: At earlier ages, vulnerable older workers retired sooner, while more privileged workers delayed retirement. The share of retired workers among adults aged 55-64 rose 5% for those without a college education but fell 4% for those with a college degree.(3.) Racial Inequality: Black workers without a college degree experienced the highest increase in the share who are retired before age 65. This rate rose 1.5 percentage points, from 16.4% to 17.9%, between 2019 and 2021.
    Keywords: older workers, recession, COVID-19, coronavirus, downward mobility, poverty, unemployment, wages, involuntary retirement, retirement, 401k, Medicare, Older Workers Bureau, racial disparities, disparities, inequality
    JEL: E24 J30 J38 J60 J88 J58
    Date: 2021–06

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