nep-hea New Economics Papers
on Health Economics
Issue of 2021‒11‒29
37 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Value of Sick Pay By Adams-Prassl, Abigail; Boneva, Teodora; Golin, Marta; Rauh, Christopher
  2. A Structural Analysis of Vacancy Referrals with Imperfect Monitoring and the Strategic Use of Sickness Absence By Gerard J. van den Berg; Hanno Foerster; Arne Uhlendorff
  3. Insurance without Commitment: Evidence from the ACA Marketplaces By Diamond, Rebecca; Dickstein, Michael J.; McQuade, Timothy; Persson, Petra
  4. The Anatomy of a Hospital System Merger: The Patient Did Not Respond Well to Treatment By Martin Gaynor; Adam Sacarny; Raffaella Sadun; Chad Syverson; Shruthi Venkatesh
  5. The Health Effects of Universal Early Childhood Interventions: Evidence from Sure Start By Sarah Cattan; Gabriella Conti; Christine Farquharson; Rita Ginja; Maud Pecher
  6. Severe Prenatal Shocks and Adolescent Health: Evidence from the Dutch Hunger Winter By Conti, Gabriella; Poupakis, Stavros; Ekamper, Peter; Bijwaard, Govert; Lumey, Lambert H.
  7. Family Spillover Effects of Marginal Diagnoses: The Case of ADHD By Persson, Petra; Qiu, Xinyao; Rossin-Slater, Maya
  8. Earthquakes and Mental Health By Luisito Bertinelli; clotilde Mahé; Eric Strobl
  9. Do Refugees with Better Mental Health Better Integrate? Evidence from the Building a New Life in Australia Longitudinal Survey By Dang, Hai-Anh; Trinh, Trong-Anh; Verme, Paolo
  10. Mental Health, Creativity, and Wealth By Barbara Biasi; Michael S. Dahl; Petra Moser
  11. Office-Based Mental Healthcare and Juvenile Arrests By Monica Deza; Thanh Lu; Johanna Catherine Maclean
  12. Depression and Shopping Behavior By Katherine Meckel; Bradley Shapiro
  13. Modelling the impact of Ovulatory Cycle Knowledge on the number of children and age of women at first birth By Babbar, Karan; Dev, Pritha
  14. Who still dies young in a rich city? Revisiting the case of Oxford By Brimblecombe, Nicola; Dorling, Danny; Green, Mark
  15. Physicians’ incentives to adopt personalised medicine: Experimental evidence By David Bardey; Samuel Kembou; Bruno Ventelou
  16. Low-Acuity Patients Delay High-Acuity Patients in EDs By Luo, Danqi; Bayati, Mohsen; Plambeck, Erica L.; Aratow, Michael
  17. The Effects of Education on Mortality: Evidence Using College Expansions By Jason Fletcher; Hamid Noghanibehambari
  18. Behavioral Bias in Occupational Fatality Risk: Theory, Evidence, and Implications By Perry Singleton
  19. Bad Lighting: Effects of Youth Indoor Tanning Prohibitions By Christopher S. Carpenter; Brandyn F. Churchill; Michelle M. Marcus
  20. Stunting, double orphanhood and unequal access to public services in democratic South Africa By Grace Bridgman; Dieter von Fintel
  21. U.S. Healthcare: A Story of Rising Market Power, Barriers to Entry, and Supply Constraints By Miss Anke Weber; Mr. Mico Mrkaic; Ms. Li Lin
  22. Economic crisis and stillbirth ratios: evidence from Southern Europe By Tsimbos, Cleon; Verropoulou, Georgia; Petropoulou, Dimitra
  23. Water Treatment and Child Mortality: Evidence from Kenya By Johannes Haushofer; Michael Kremer; Ricardo Maertens; Brandon Joel Tan
  24. Harmful Norms: Can Social Convention Theory Explain the Persistence of Female Genital Cutting in Africa? By Congdon Fors, Heather; Isaksson, Ann-Sofie; Lindskog, Annika
  25. Remote Working and Mental Health during the First Wave of COVID-19 Pandemic By Bertoni, Marco; Cavapozzi, Danilo; Pasini, Giacomo; Pavese, Caterina
  26. Improving Women's Mental Health during a Pandemic By Vlassopoulos, Michael; Siddique, Abu; Rahman, Tabassum; Pakrashi, Debayan; Islam, Asad; Ahmed, Firoz
  27. Location inference on social media data for agile monitoring of public health crises: An application to opioid use and abuse during the Covid-19 pandemic By Angela E. Kilby; Charlie Denhart
  28. The COVID-19 Pandemic, Well-Being, and Transitions to Post-secondary Education By Sandner, Malte; Patzina, Alexander; Anger, Silke; Bernhard, Sarah; Dietrich, Hans
  29. Measuring the Epidemiological Impact of a False Negative : Evidence from a Natural Experiment By Fetzer, Thiemo
  30. A Simple Model of Social Distancing and Vaccination By Christopher Avery
  31. Which Beliefs? Behavior-Predictive Beliefs are Inconsistent with Information-Based Beliefs: Evidence from COVID-19 By Ori Heffetz; Guy Ishai
  32. Mask Mandates Save Lives By Mr. Niels-Jakob H Hansen; Rui C. Mano
  33. Schools under mandatory testing can mitigate the spread of SARS-CoV-2 By Isphoring, Ingo E.; Diederichs, Marc; van Ewijk, Reyn; Pestel, Nico
  34. Recoveries After Pandemics: The Role of Policies and Structural Features By Mrs. Swarnali A Hannan; Juan Pablo Cuesta Aguirre
  35. Estimating the Effects of Regulating University Face-to-Face Lectures on the Spread of COVID-19: Evidence from Japan By Michinao Okachi; Haewon Youn
  36. Could the United States benefit from a lockdown? A cost-benefit analysis By Anna Scherbina
  37. Defying the Odds: Remittances During the COVID-19 Pandemic By Mr. Kangni R Kpodar; Mr. Saad N Quayyum; Vigninou Gammadigbe; Mr. Montfort Mlachila

  1. By: Adams-Prassl, Abigail (University of Oxford); Boneva, Teodora (University of Bonn); Golin, Marta (University of Oxford); Rauh, Christopher (University of Cambridge)
    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: 2021–10
  2. By: Gerard J. van den Berg (University of Groningen); Hanno Foerster (Boston College); Arne Uhlendorff (CNRS)
    Abstract: This paper provides a structural analysis of the role of job vacancy referrals (VRs) by Employment Agencies in the job search behavior of unemployed individuals, incorporating in- stitutional features of the monitoring of search behavior by the agencies. Notably, rejections of VRs may lead to sanctions (temporary benefits reductions) while workers may report sick to avoid those. We estimate models using German administrative data from social security records linked with caseworker recorded data on VRs, sick reporting and sanctions. The anal- ysis highlights the influence of aspects of the health care system on unemployment durations. We estimate that for around 25% of unemployed workers, removing the channel that enables strategic sick reporting reduces the mean unemployment duration by 8 days.
    Keywords: unemployment, wage, unemployment insurance, monitoring, moral hazard, struc- tural estimation, counterfactual policy evaluation, unemployment duration
    JEL: J64 J65 C51 C54
    Date: 2021–08–17
  3. By: Diamond, Rebecca (Stanford U); Dickstein, Michael J. (New York U); McQuade, Timothy (Stanford U); Persson, Petra (Stanford U)
    Abstract: We study the dynamics of participation and health care consumption in the Affordable Care Act's health insurance marketplaces. Unlike other health insurance contexts, we find individuals commonly drop coverage midyear--roughly 30% of enrollees exit within nine months of sign-up. While covered, dropouts spend more on health care than in the months before sign-up or after exit. We model the consequences of drop-out on equilibrium premiums and consumer welfare. While dropouts generate a type of adverse selection, the welfare effect from their participation is ambiguous and depends on the relative costs per month of part-year vs. full-year enrollees. In our empirical setting, we find that imposing a penalty that incentivizes participation for at least 3.5 months would lower premium levels and improve overall consumer welfare.
    Date: 2020–12
  4. By: Martin Gaynor; Adam Sacarny; Raffaella Sadun; Chad Syverson; Shruthi Venkatesh
    Abstract: There is an ongoing merger wave in the US hospital industry, but it remains an open question how hospital mergers change, or fail to change, hospital behavior, performance, and outcomes. In this research, we open the “black box” of practices within hospitals in the context of a mega-merger between two large for-profit chains. Benchmarking the effects of the merger against the acquirer’s stated aims, we show that they achieved some of their goals: they harmonized their electronic medical records and sent managers to target hospitals; after the acquisition, managerial processes were similar across hospitals in the merged chain. However, these interventions failed to drive detectable gains in profitability or patient outcomes. Our findings demonstrate the importance of hospital organizations and internal processes for merger research and policy in health care and the economy more generally.
    JEL: D22 I11 M12
    Date: 2021–11
  5. By: Sarah Cattan (Institute for Fiscal Studies); Gabriella Conti (University College London); Christine Farquharson (Institute for Fiscal Studies); Rita Ginja (University of Bergen); Maud Pecher (Institute for Fiscal Studies)
    Abstract: We evaluate the short- and medium-term heath impacts of Sure Start, a large-scale and universal early childhood program in England. We exploit the rollout of the program and implement a difference-in-difference approach, combining data on the exact location and opening date of Sure Start centers with administrative data on the universe of admissions to public-sector hospitals. Exposure to an additional Sure Start center per thousand age-eligible children increases hospitalization by 10% at age 1 (around 6,700 hospitalizations per year), but reduces them by 8-9% across ages 11 to 15 (around 13,150 hospitalizations per year). These findings show that early childhood programs that are less intensive than small-scale ‘model programs’ can deliver significant health benefits, even in contexts with universal healthcare. Impacts are driven by hospitalizations for preventable conditions and are concentrated in disadvantaged areas, suggesting that enriching early childhood environments might be a successful strategy to reduce inequalities in health.
    Keywords: health, difference-in-difference
    JEL: I10 I14 I18
    Date: 2021–11
  6. By: Conti, Gabriella (University College London); Poupakis, Stavros (University College London); Ekamper, Peter; Bijwaard, Govert (NIDI - Netherlands Interdisciplinary Demographic Institute); Lumey, Lambert H. (Columbia University)
    Abstract: This paper investigates impacts, mechanisms and selection effects of prenatal exposure to multiple shocks, by exploiting the unique natural experiment of the Dutch Hunger Winter. At the end of World War II, a famine occurred abruptly in the Western Netherlands (November 1944 - May 1945), pushing the previously and subsequently well-nourished Dutch population to the brink of starvation. We link high-quality military recruits data with objective health measurements for the cohorts born in the years surrounding WWII with newly digitised historical records on calories and nutrient composition of the war rations, daily temperature, and warfare deaths. Using difference-in-differences and triple differences research designs, we show that the cohorts exposed to the Dutch Hunger Winter since early gestation have a higher Body Mass Index and an increased probability of being overweight at age 18, and that this effect is partly accounted for by warfare exposure and a reduction in energy-adjusted protein intake. Moreover, we account for selective mortality using a copula-based approach and newly-digitised data on survival rates, and find evidence of both selection and scarring effects. These results emphasise the complexity of the mechanisms at play in studying the consequences of early conditions.
    Keywords: health, fetal origins hypothesis, famine, prenatal exposure
    JEL: I10 J13
    Date: 2021–10
  7. By: Persson, Petra (Stanford University and Research Institute for Industrial Economics, Stockholm); Qiu, Xinyao (Stanford University); Rossin-Slater, Maya (Stanford University School of Medicine and IZA)
    Abstract: The health care system commonly relies on information about family medical history in the allocation of screenings and in diagnostic processes. At the same time, an emerging literature documents that treatment for “marginally diagnosed†patients often has minimal impacts. This paper shows that reliance on information about relatives’ health can perpetuate marginal diagnoses across family members, thereby raising caseloads and health care costs, but without improving patient well-being. We study Attention Deficit Hyperactivity Disorder (ADHD), the most common childhood mental health condition, and document that the younger siblings and cousins of marginally diagnosed children are also more likely to be diagnosed with and treated for ADHD. Moreover, we find that the younger relatives of marginally diagnosed children have no better adult human capital and economic outcomes than the younger relatives of those who are less likely to be diagnosed. Our analysis points to a simple adjustment to physician protocol that can mitigate these marginal diagnosis spillovers.
    JEL: I14 I18 J13
    Date: 2021–01
  8. By: Luisito Bertinelli (Department of Economics and Management, Université du Luxembourg); clotilde Mahé (Universidad de los Andes in Columbia); Eric Strobl (University of Bern)
    Abstract: Earthquakes may seriously deteriorate mental health by generating fear and stress as a result of economic and human losses. However, mental health has also been found to improve as a result of greater social cohesion in affected communities after the event. We examine the short-run effects of earthquakes on a wide set of mental health outcomes in Ecuador. To this end, we combine hospital admissions, death records, and survey data with precise measures of local seismic activity to exploit the plausibly random spatial and temporal nature of earthquake intensity. We find that damaging earthquakes decrease the propensity to be admitted, the number of days of hospitalisation for mental and behavioural disorders, and deaths due to suicide. Estimates from nationally-representative surveys provide suggestive evidence of increased life satisfaction, trust, and religious observance, and thus provide a possible explanation for the fall in admissions and suicides after an earthquake.
    Keywords: Earthquake, Mental health, Ecuador.
    JEL: I15 Q54 O54
    Date: 2021
  9. By: Dang, Hai-Anh (World Bank); Trinh, Trong-Anh (World Bank); Verme, Paolo (World Bank)
    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: 2021–10
  10. By: Barbara Biasi; Michael S. Dahl; Petra Moser
    Abstract: Focusing on bipolar disorder (BD), we investigate the link between mental health, creativity, and wealth. Analyzing population data for Denmark, we find that people with BD are more likely to be musicians, but less likely to hold other creative jobs than the population. Healthy siblings of people with BD, however, are consistently more likely to work in creative jobs. We also show people in the top decile of parental wealth are seven times as likely to work in creative professions compared with the bottom decile. Yet, wealth differences only explain a small portion of the link between BD and creativity.
    JEL: I12 I14 J24 O31
    Date: 2021–10
  11. By: Monica Deza; Thanh Lu; Johanna Catherine Maclean
    Abstract: We estimate the effect of local access to office-based mental healthcare on juvenile arrest outcomes. We leverage variation in the number of mental healthcare offices within a county over the period 1999 to 2016 in a two-way fixed-effects model. Office-based treatment is the most common modality of mental healthcare received by juveniles. We find that ten additional office-based mental healthcare providers in a county leads a decrease of 2.3% to 2.6% in the per capita costs to society of juvenile arrest. Findings are similar for arrest rates although often less precise, which suggests that accounting for social costs is empirically important. Crime imposes substantial costs on society and individuals, and interventions during early life can have more pronounced effects than those received at later stages, therefore our results imply increased juvenile access to mental healthcare may have an unintended benefit for the current and future generations.
    JEL: I1 I12 J13
    Date: 2021–11
  12. By: Katherine Meckel; Bradley Shapiro
    Abstract: Using a large survey panel that connects household shopping behavior with individual health information, this paper documents correlations between self reported depression and the size and composition of shopping baskets. First, we find that roughly 16% of individuals report suffering from depression and over 30% of households have at least one member who reports suffering from depression. Households with a member suffering from depression exhibit striking differences in shopping behavior: they spend less overall, visit grocery stores less and convenience stores more frequently and spend a smaller share of their baskets on fresh produce and alcohol but a larger share on tobacco. They spend similar shares on unhealthy foods like cakes, candy, and salty snacks. These cross-sectional correlations hold within counties, suggesting that they are not driven by region specific demographics or preferences that are incidentally correlated with depression status. They also hold when considering only single-member households. However, we rule out large differences in shopping behavior within households as they change depression status. Further, using the take-up of antidepressants as an event, we document little change in shopping in response to treatment. With our results, we discuss takeaways for the economic impact of depression and for decision modeling.
    JEL: I1 I10 I12 M31
    Date: 2021–11
  13. By: Babbar, Karan; Dev, Pritha
    Abstract: This study tries to bridge the gap by establishing the causal impact of ovulatory cycle knowledge (OCK) on the number of children and months to the first birth. We have analysed the data of 459957 women aged 15 to 34 using the Indian Demographic Health Survey. Our results establish a causal link and show that OCK is significantly and negatively associated with the number of children and months to the first birth. Governments and policymakers should focus on interventions targeting behavioural change to improve the OCK, especially for girls from disadvantaged socio-economic backgrounds.
    Date: 2021–11–18
  14. By: Brimblecombe, Nicola; Dorling, Danny; Green, Mark
    Abstract: There are substantial inequalities in mortality and life expectancy in England, strongly linked to levels of deprivation. Mortality rates among those who are homeless are particularly high. Using the city of Oxford (UK) as a case study, we investigate ward-level premature standardised mortality ratios for several three-year and five-year periods between 2002 and 2016, and explore the extent to which the mortality of people who become homeless contributed to any rise or fall in geographical inequalities during this period. Age–sex standardised mortality ratios (SMRs) for people aged under 65 years old, with and without deaths among the homeless population, were calculated using Office for National Statistics Death Registration data for England and Wales 2002−2016. Individuals who were homeless or vulnerably housed were identified using records supplied by a local Oxford homeless charity. We found that in an increasingly wealthy, and healthy, city there were persistent ward-level inequalities in mortality, which the city-wide decrease in premature mortality over the period masked. Premature deaths among homeless people in Oxford became an increasingly important contributor to the overall geographical inequalities in health in this city. In the ward with the highest SMR, deaths among the homeless population accounted for 73% of all premature deaths of residents over the whole period; in 2014–2016 this proportion rose to 88%. Homelessness among men (the vast majority of the known homeless population) in this gentrifying English city rose to become the key explanation of geographical mortality patterns in deaths before age 65 across the entire city, particularly after 2011. Oxford reflects a broader pattern now found in many places across England of increasing homeless deaths, widening geographical inequalities in life expectancy, and sharp increases in all-age SMRs. The answer to the question, “Who dies young in a rich, and in fact an even richer, place?” is – increasingly – the homeless.
    Keywords: health-geography; inequality; mortality; homeless; Oxford
    JEL: N0
    Date: 2020–06–01
  15. By: David Bardey (TSE - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - Université Fédérale Toulouse Midi-Pyrénées - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, CEDE - Los Andes University); Samuel Kembou (UNIL - University of Lausanne); Bruno Ventelou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)
    Abstract: We study physicians' incentives to use personalised medicine techniques, replicating the physician's trade-offs under the option of personalised medicine information. In a laboratory experiment conducted in two French Universities, prospective physicians played a real-effort game. We vary both the information structure (free access versus paid access to personalised medicine information) and the payment scheme (pay-for-performance (P4P), capitation (CAP) and fee-for-service (FFS)), implementing a within-subject design. Our results are threefold: (i) Compared to FFS and CAP, the P4P scheme strongly and positively impacts the decision to adopt personalised medicine. (ii) Although expected to dominate the other schemes, P4P is not always efficient in transforming free access to personalised medicine into higher quality of care. (iii) When it has to be paid for and after controlling for self-selection, personalised medicine is positively associated with quality, suggesting that subjects tend to make better use of information that comes at a cost. We find this effect to be stronger for males than for females prospective physicians. Quantification of our results however suggests that this positive impact is not strong enough to justify generalising the payment for personalised medicine access. Finally, we develop a theoretical model that includes in its set-up a commitment device component, which is the mechanism that we inferred from the data of the experiment. Our model replicates the principal results of the experiment, reinforcing the interpretation that the higher quality provided by subjects who bought personalised medicine can be interpreted as a commitment device effect.
    Keywords: Pay-for-performance,Fee-forservice,Capitation,Personalised medicine,Laboratory experiment,Prospective physicians
    Date: 2021–11
  16. By: Luo, Danqi (Stanford U); Bayati, Mohsen (Stanford U); Plambeck, Erica L. (Stanford U); Aratow, Michael (San Mateo Medical Center)
    Abstract: This paper provides evidence that the arrival of an additional low-acuity patient substantially increases the wait time to start of treatment for high-acuity patients, contradicting the long-standing prior conclusion in the medical literature that the effect is "negligible." Whereas the medical literature underestimates the effect by neglecting how delay propagates in a queuing system, this paper develops and validates a new estimation method based on queuing theory, machine learning and causal inference. Wait time information displayed to low-acuity patients provides a quasi-randomized instrumental variable. This paper shows that a low-acuity patient increases wait times for high-acuity patients through: pre-triage delay; delay of lab tests ordered for high-acuity patients; and transition delay when an ED interrupts treatment of a low-acuity patient in order to treat a high-acuity patient. Hence high-acuity patients' wait times could be reduced by: reducing the standard deviation or mean of those transition delays, particularly in bed-changeover; providing vertical or "fast track" treatment for more low-acuity patients, especially ESI 3 patients; standardizing providers' test-ordering for low-acuity patients; and designing wait time information systems to divert (especially when the ED is highly congested) low-acuity patients that do not need ED treatment.
    Date: 2021
  17. By: Jason Fletcher; Hamid Noghanibehambari
    Abstract: This paper explores the long-run health benefits of education for longevity. Using mortality data from the Social Security Administration (1988-2005) linked to geographic locations in the 1940-census data, we exploit changes in college availability across cohorts in local areas. We estimate an intent to treat effect of exposure to an additional 4-year college around age 17 of increasing longevity by 0.13 months; treatment on the treated calculations suggest increases in longevity between 1-1.6 years. Some further analyses suggest the results are not driven by pre-tends, endogenous migration, and other time-varying local confounders. This paper adds to the literature on the health and social benefits of education.
    JEL: I1 I23 I26
    Date: 2021–10
  18. By: Perry Singleton (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244)
    Abstract: Behavioral bias in occupational fatality risk is introduced to the theoretical framework of hedonic wages, yielding an endogenous risk ceiling that increases social welfare. Empirically, bias is most evident among workers with no high school diploma, who do not report relatively greater exposure to death in high fatality rate occupations. These findings suggest that extant population estimates of value of statistical life are biased downwards and should be factored by at least 1.35. Under reasonable assumptions, simulations suggest an optimal risk ceiling between 73.0 to 85.9 percentile of the population distribution of occupational fatality risk.
    Keywords: Compensating Wage Differentials, Value of Statistical Life, Workplace Safety, Occupational Safety
    JEL: J31 J81
    Date: 2021–11
  19. By: Christopher S. Carpenter; Brandyn F. Churchill; Michelle M. Marcus
    Abstract: Indoor tanning beds (ITBs) emit UV light at high intensity and have been classified as carcinogenic to humans by the World Health Organization since 2009. We are the first to study the role of state laws prohibiting youths from indoor tanning using a difference-in-differences research design. We find that youth ITB prohibitions reduced population search intensity for tanning-related information. Among white teen girls, ITB prohibitions reduced self-reported indoor tanning and increased sun protective behaviors. We also find that youth ITB prohibitions significantly reduced the size of the indoor tanning market by increasing tanning salon closures and reducing tanning salon sales.
    JEL: I1
    Date: 2021–10
  20. By: Grace Bridgman (Department of Economics, Stellenbosch University); Dieter von Fintel (Department of Economics, Stellenbosch University)
    Abstract: Orphans who lack household or community support face significant socio-economic disadvantages. In particular, they are at greater risk of malnutrition and stunting in developing countries. Children who have no living parents, also called double orphans, are most likely to require support from extended families or public institutions. This paper explores how WASH infrastructure, and public health and social services relate to stunting. It is one of the first studies to analyse these factors with a specific focus on double orphans, who tend to live in under-serviced areas with high stunting rates and poor access to public resources. We collate a cross sectional spatial dataset with local child stunting rates from 2013, rates of double orphanhood, private household resources, and public services from 2011 for South Africa, a country where the HIV/AIDS pandemic has led to high rates of double orphanhood. We estimate spatial econometric models that account for unobserved regional shocks and measurement bias, but which do not address other biases. Our results show that high stunting rates, particularly in areas with high proportions of double orphans, overlap strongly with poor provision of WASH and the availability of household resources. By contrast, other softer services accessed outside the home, such as access to health, social welfare and early childhood development facilities are not correlated with stunting in the same way. WASH is more strongly related to reduced stunting when infrastructure covers larger geographic areas and with the combined use of services from adjacent areas. This occurs because of economies of scale in provision and preventing transmission of disease across regions. Policy makers can explore the option to reduce stunting by expanding geographic networks of WASH service delivery into under-serviced areas where double orphans tend to locate.
    Keywords: Stunting, double orphanhood, spatial inequality, WASH infrastructure, service delivery, spatial econometrics, South Africa
    JEL: I14 J13 H4 R1
    Date: 2021
  21. By: Miss Anke Weber; Mr. Mico Mrkaic; Ms. Li Lin
    Abstract: Healthcare in the United States is the most expensive in the world, with real per capita spending growth averaging 4 percent since 1980. This paper examines the role of market power of U.S. healthcare providers and pharmaceutical companies. It finds that markups (the ability to charge prices above marginal costs) for publicly listed firms in the U.S. healthcare sector have almost doubled since the early 1980s and that they explain up to a quarter of average annual real per capita healthcare spending growth. The paper also finds evidence that the Affordable Care Act and Medicaid expansion were successful in raising coverage and expanding care, but may have had the undesirable side-effect of leading to labor cost increases: Hourly wages for healthcare practitioners are estimated to have increased by 2 to 3 percent more in Medicaid expansion states over a five-year period, which could be an indication that the supply of medical services is relatively inelastic, even over a long time horizon, to the boost to demand created by the Medicaid expansion. These findings suggest that promoting more competition in healthcare markets and reducing barriers to entry can help contain healthcare costs.
    Keywords: Medicaid expansion; sector markup; healthcare cost; healthcare in the United States; healthcare provider; Wages; Employment; Insurance companies; Insurance; Labor costs; Global
    Date: 2021–07–06
  22. By: Tsimbos, Cleon; Verropoulou, Georgia; Petropoulou, Dimitra
    Abstract: In this paper we assess the impact of the recent European recession on stillbirth indices over the course of the 2000s and 2010s; the analysis focuses on four Southern European countries (Greece, Italy, Spain, Portugal), which were seriously affected by the sovereign debt crisis from around 2008 to 2017. We use national vital statistics and established economic indicators for the period 2000-2017; stillbirth ratios (stillbirths per 1000 livebirths) are the chosen response variable. For the purpose of the study, we employ correlation analysis and fit regression models. The overall impact of economic indicators on the stillbirth indices is sizeable and statistically robust. We find that a healthy economy is associated with low and declining levels of stillbirth measures. In contrast, economic recession appears to have an adverse effect (Greece, Italy and Spain), or an unclear impact (Portugal), on the stillbirth outcome. This study provides evidence of the adverse effect of the European sovereign debt crisis and ensuing period of austerity on a scarcely explored aspect of health.
    Keywords: stillbirths; economic crisis; Southern Europe
    JEL: N0
    Date: 2021–11–18
  23. By: Johannes Haushofer; Michael Kremer; Ricardo Maertens; Brandon Joel Tan
    Abstract: Each year, around 500,000 children under 5 die from diarrhea, making it the third-leading cause of death in this age group. More than 80 percent of these deaths are attributable to unsafe drinking water. Drinking water can be made safe through dilute chlorine solution, but take-up of this technology has been low. Previous work has shown that free community-wide provision of dilute chlorine solution through “dispensers” – reservoirs of chlorine solution at water sources that make chlorination easy and free – increases take-up of chlorination. However, it has remained unclear whether this increase also translates into reduced mortality. Here we show that four years of community-wide provision of dilute chlorine solution in rural Kenya reduces all-cause under-5 mortality by 1.4 percentage points (95% CI: 0.3 pp, 2.5 pp), a 63% reduction relative to control. We estimate that at USD 25 per DALY averted, free provision of chlorine solution is twenty times more cost-effective than the WHO “highly cost-effective” threshold.
    JEL: I15 O1
    Date: 2021–11
  24. By: Congdon Fors, Heather (University of Gothenburg, Department of Economics); Isaksson, Ann-Sofie (Research Institute of Industrial Economics (IFN)); Lindskog, Annika (University of Gothenburg, Department of Economics)
    Abstract: This paper investigates the explanatory power of social convention theory for explaining the persistence of female genital cutting (FGC) in a broad sample of African countries. While influential in policy circles, the idea that FGC is best described as a bad equilibrium in a social coordination game has recently been challenged by quantitative evidence from selected countries. These studies have pointed towards the importance of private preferences. We use novel approaches to test whether FGC is social interdependent when decisions also depend on private preferences. We test implications of the simple fact that according to social convention theory mothers will sometimes cut their daughters even if they do not support the practice. The substantial regional variation in FGC practices warrants investigation in a broad sample. Empirical results drawing on Demographic and Health Survey data from 34 surveys performed between 1992-2018 in 11 African countries suggest that cutting behavior is indeed often socially interdependent, and hence that it can be understood as a social convention. Our findings indicate that even if social convention theory does not provide the full picture, it should not be dismissed. Accordingly, interventions that acknowledge the social interdependence of cutting behavior are likely to be more successful than interventions that do not.
    Keywords: Female genital cutting; Social convention theory; Norms; Africa
    JEL: D71 D91 I15 O55
    Date: 2021–11–15
  25. By: Bertoni, Marco (University of Padova); Cavapozzi, Danilo (Università Ca’ Foscari di Venezia); Pasini, Giacomo (Ca' Foscari University of Venice); Pavese, Caterina (University of Padua)
    Abstract: We use longitudinal data from the SHARE survey to estimate the causal effect of remote working during the COVID-19 pandemic on mental health of senior Europeans. We face endogeneity concerns both for the probability of being employed during the pandemic and for the choice of different work arrangements conditional on employment. Our research design overcomes these issues by exploiting variation in the technical feasibility of remote working across occupations and in the legal restrictions to in-presence work across sectors. We estimate heterogeneous effects of remote working on mental health: we find negative effects for respondents with children at home and for those living in countries with low restrictions or low excess death rates due to the pandemic. On the other hand, the effect is positive for men and for respondents with no co-residing children.
    Keywords: mental health, remote working, COVID-19, SHARE
    JEL: I10 J22 J24 J81
    Date: 2021–10
  26. By: Vlassopoulos, Michael (University of Southampton); Siddique, Abu (Technical University of Munich); Rahman, Tabassum (University of Newcastle, Australia); Pakrashi, Debayan (Indian Institute of Technology Kanpur); Islam, Asad (Monash University); Ahmed, Firoz (Khulna University, Bangladesh)
    Abstract: In low-income settings, women are vulnerable to the psychological distress caused by the social and economic impact of large-scale shocks (e.g., pandemics, natural disasters, political). This paper evaluates a randomized over-the-phone counseling intervention aimed at mitigating the mental health impact of COVID-19 on a sample of 2,402 women across 357 villages in Bangladesh. We find that the provision of mental support to participating women improves their mental health ten months post-intervention, leading to reductions of 20.4% in the prevalence of moderate and severe stress and 32.8% in depression, relative to women in the control group. We also find positive impacts on economic outcomes: household food security and time invested in homeschooling of children, suggesting that improvement in mental health is an important step toward better economic well-being for these women. Finally, we also observe impacts on various other outcomes, including preventive health behavior associated with COVID-19 and vaccination take-up. Our results suggest that this type of low-cost intervention can be effective in providing rapid psychological support to vulnerable groups in times of crises.
    Keywords: mental health, COVID-19, food security, telecounseling, randomized experiment, parental investment, rural Bangladesh
    JEL: I10 I12 I18 I31 O12
    Date: 2021–10
  27. By: Angela E. Kilby; Charlie Denhart
    Abstract: The Covid-19 pandemic has intersected with the opioid epidemic to create a unique public health crisis, with the health and economic consequences of the virus and associated lockdowns compounding pre-existing social and economic stressors associated with rising opioid and heroin use and abuse. In order to better understand these interlocking crises, we use social media data to extract qualitative and quantitative insights on the experiences of opioid users during the Covid-19 pandemic. In particular, we use an unsupervised learning approach to create a rich geolocated data source for public health surveillance and analysis. To do this we first infer the location of 26,000 Reddit users that participate in opiate-related sub-communities (subreddits) by combining named entity recognition, geocoding, density-based clustering, and heuristic methods. Our strategy achieves 63 percent accuracy at state-level location inference on a manually-annotated reference dataset. We then leverage the geospatial nature of our user cohort to answer policy-relevant questions about the impact of varying state-level policy approaches that balance economic versus health concerns during Covid-19. We find that state government strategies that prioritized economic reopening over curtailing the spread of the virus created a markedly different environment and outcomes for opioid users. Our results demonstrate that geospatial social media data can be used for agile monitoring of complex public health crises.
    Date: 2021–11
  28. By: Sandner, Malte (Institute for Employment Research (IAB), Nuremberg); Patzina, Alexander (Institute for Employment Research (IAB), Nuremberg); Anger, Silke (Institute for Employment Research (IAB), Nuremberg); Bernhard, Sarah (Institute for Employment Research (IAB), Nuremberg); Dietrich, Hans (Institute for Employment Research (IAB), Nuremberg)
    Abstract: This study examines the immediate and intermediate effects of the COVID-19 pandemic on the well-being of two high school graduation cohorts (2020 and 2021). We also investigate how changes in well-being at the transition to post-secondary education affect educational plans and outcomes. Our unique panel data contain prospective survey information on three dimensions of well- being: mental health problems, self-rated health, and life satisfaction for 3,697 students. Data is collected several months before (fall 2019), shortly before and soon after (spring 2020), and several months after (fall/winter 2020/21) the outbreak of the COVID-19 pandemic. Applying difference-in-differences designs, random effect growth curve models, and linear regression models, we find that school closures had a positive immediate effect on students' wellbeing. Over the course of the pandemic, however, well-being strongly declined, mainly concentrated among the 2021 graduation cohort. Finally, we show that a strong decline in mental health is associated with changes in educational and career plans and transition outcomes. As adverse life experiences in adolescence are likely to accumulate over the life course, this study is the first to exhibit potential long-lasting negative effects of the COVID-19 pandemic on education and careers of young individuals.
    Keywords: COVID-19, high school graduates, mental and physical well-being, life satisfaction, school-to-work transition
    JEL: I21 I18 J24
    Date: 2021–10
  29. By: Fetzer, Thiemo (University of Warwick, CAGE, CESifo and CEPR)
    Abstract: Reliable COVID-19 testing remains a central pillar to manage the pandemic. Yet, the accuracy and reliability of tests and test equipment has regularly been brought into question. Both false-positive and false-negative test results convey costs. Yet, false negatives are likely more problematic due to the risk of onward transmission and the failure to break infection chains as a result. This paper studies the epidemiological impact of a false negative in the context of a high vaccine uptake country. Between 2 September and 12 October an estimated 43,000 PCR tests in the UK may have produced a false negative test result with individuals infected being told that they tested negative. These instances were particularly pronounced in the South West of England. Using a synthetic control method approach concentrating on the 13 most affected regions, this paper estimates that every false negative COVID-19 case is likely to have caused between 0.6 to 1.6 additional infections in the subsequent weeks
    Keywords: False Negative ; Natural Experiment ; Test Error ; Health ; Coronavirus JEL Classification: I31 ; Z18
    Date: 2021
  30. By: Christopher Avery
    Abstract: This paper analyzes a simple model of infectious disease where the incentives for individuals to reduce risks through endogenous social distancing take straightforward cost-benefit form. Since disease is transmitted through social interactions, the threat of spread of infection poses a collective action problem. Policy interventions such as lockdowns, testing, and mask-wearing serve, in part, as substitutes for social distancing. Provision of a vaccination is the only intervention that unambiguously reduces both the peak infection level and the herd immunity level of infection. Adoption of vaccination remains limited in a decentralized equilibrium, with resulting reproductive rate of disease Rt > 1 at the conclusion of vaccination. Vaccine mandates yield increases in vaccination rates and corresponding reductions in future infection rates but do not increase expected payoffs to individuals.
    JEL: D0 I10 I18
    Date: 2021–11
  31. By: Ori Heffetz; Guy Ishai
    Abstract: We investigate the relationship between (a) official information on COVID-19 infection and death case counts; (b) beliefs about such case counts, at present and in the future; (c) beliefs about average infection chance—in principle, directly calculable from (b); and (d) self-reported health-protective behavior. We elicit (b), (c), and (d) with a daily online survey in the US from March to August 2020 (N ≈ 13,900). We have three main findings: (1) beliefs elicited as infection case counts are closely related to present and future official case-count information; however (2) beliefs elicited as risk perceptions—i.e., the chance to get infected—are inconsistent with those case-count beliefs, even when mathematically, they should be identical; notably, (3) it is the latter—the risk perceptions—that are significantly better predictors of reported behavior than the former. Together, these findings suggest that researchers and policymakers, who increasingly engage in direct elicitation and communication of numeric measures of uncertainty, may get very different outcomes, depending on which measures they use. We discuss potential implications for public communication of health-risk information.
    JEL: D83 D84 D91 I12
    Date: 2021–11
  32. By: Mr. Niels-Jakob H Hansen; Rui C. Mano
    Abstract: We quantify the effect of mask mandates in the United States. Our regression discontinuity design exploits county-level variation in COVID-19 cases, hospital admissions, and deaths across the border between states with and without mandates. We find a significant and substantial effect—mask mandates reduced new weekly COVID-19 cases, hospital admissions, and deaths by 55, 11 and 0.7 per 100,000 inhabitants on average. Crucially, we find that the effect of mask mandates depends on the attitudes toward mask wearing at the county level, with larger effects in counties more positively inclined towards mask wearing. Our results imply that mandates saved 87,000 lives through December 19, 2020, while a nationwide mandate could have saved 58,000 additional lives. These large effects suggest that mask mandates are a crucial tool to counter pandemics, particularly if accepted widely by the population. Our results are thus also relevant for countries who will not be able to immunize large swaths of their population in the short term.
    Keywords: COVID-19, public health measures, face masks, regression discontinuity.; mask mandate; discontinuity design; nationwide mandate; mask border; mask wearing; COVID-19; Global
    Date: 2021–08–06
  33. By: Isphoring, Ingo E.; Diederichs, Marc; van Ewijk, Reyn; Pestel, Nico (ROA / Labour market and training, RS: GSBE other - not theme-related research)
    Abstract: We use event-study models based on staggered summer vacations in Germany to estimate the effect of school re-openings after the summer of 2021 on the spread of SARS-CoV-2. Estimations are based on daily counts of confirmed coronavirus infections across all 401 German counties. Our results are consistent with mandatory testing contributing to containment of cases by uncovering otherwise undetected (asymptomatic) cases. Case numbers in school-aged children spike in the first week after the summer breaks but then turn not significantly different from zero. Case numbers in prime-aged age groups gradually decrease after school re-openings, arguably as a result of detected clusters through the school testing. The age group 60+ remains unaffected by the school re-openings. We conclude that the combination of mandatory testing and compulsory school attendance can provide an unbiased and near-complete surveillance of the pandemic. Thus, under certain conditions open schools can play a role in containing the spread of the virus. The trade-off between reducing contacts and losing an important monitoring device has to be taken seriously when re-considering school closures as a nonpharmaceutical intervention under the current circumstances.
    JEL: I12 I18 I28
    Date: 2021–11–23
  34. By: Mrs. Swarnali A Hannan; Juan Pablo Cuesta Aguirre
    Abstract: To shed light on the possible scarring effects from Covid-19, this paper studies the economic effects of five past pandemics using local projections on a sample of fifty-five countries over 1990-2019. The findings reveal that pandemics have detrimental medium-term effects on output, unemployment, poverty, and inequality. However, policies can go a long way toward alleviating suffering and fostering an inclusive recovery. The adverse output effects are limited for countries that provided relatively greater fiscal support. The increases in unemployment, poverty, and inequality are likewise lower for countries with relatively greater fiscal support and relatively stronger initial conditions (as defined by higher formality, family benefits, and health spending per capita).
    Keywords: pandemics, output, unemployment, poverty, inequality, fiscal support, informality, social expenditure, health expenditure.; increases in unemployment; copyright page; potential GDP; group four; expenditure group; COVID-19; Income inequality; Health care spending; Maternity and childcare benefit spending; Global
    Date: 2021–07–09
  35. By: Michinao Okachi; Haewon Youn
    Abstract: Universities are the only institutions that are still conducting most lectures through online during the prolonged COVID-19 pandemic. This study quantifies the effect of university lecture styles on the containment of spreading the novel coronavirus. Using the multiple event study model, we find that the cumulative increase in university students' infections from online only lecture style or long breaks to the combination of face-to-face and online lecture style is 5.2 per 10,000 students. Meanwhile, the opposite lecture style change reports the decline of 2.3 per 10,000 students. Other lecture style changes between almost online and these two lecture styles have relatively smaller effects. These results are robust to other models and omitting outliers.
    Date: 2021–11–16
  36. By: Anna Scherbina (American Enterprise Institute)
    Abstract: Although COVID-19 vaccines are finally available, the rate at which they are administered is slow, and in the meantime the pandemic continues to claim about as many lives every day as the 9/11 tragedy. I estimate that with the promised rate of vaccinations, if no additional nonpharmaceutical interventions are implemented, 406 thousand additional lives will be lost and the future cost of the pandemic will reach $2.4 trillion, or 11% of GDP. Using a cost-benefit analysis, I assess whether it is optimal for the United States to follow the lead of many European countries and introduce a nation-wide lockdown. I find that a lockdown would be indeed optimal and, depending on the assumptions, it should last between two and four weeks and will generate a net benefit of up to $1.2 trillion.
    Keywords: Coronavirus, Gross Domestic Product (GDP), US Economy, US Labor Market, Vaccines
    JEL: A
    Date: 2021–01
  37. By: Mr. Kangni R Kpodar; Mr. Saad N Quayyum; Vigninou Gammadigbe; Mr. Montfort Mlachila
    Abstract: This paper provides an early assessment of the dynamics and drivers of remittances during the COVID-19 pandemic, using a newly compiled monthly remittance dataset for a sample of 52 countries, of which 16 countries with bilateral remittance data. The paper documents a strong resilience in remittance flows, notwithstanding an unprecedent global recession triggered by the pandemic. Using the local projection approach to estimate the impulse response functions of remittance flows during Jan 2020-Dec 2020, the paper provides evidence that: (i) remittances responded positively to COVID-19 infection rates in migrant home countries, underscoring its role as an important automatic stabilizer; (ii) stricter containment measures have the unintended consequence of dampening remittances; and (iii) a shift from informal to formal remittance channels due to travel restrictions appears to have also played a role in the surge in formal remittances. Lastly, the size of the fiscal stimulus in host countries is positively associated with remittances as the fiscal response cushions the economic impact of the pandemic.
    Keywords: Remittances, COVID-19, Shocks; impulse response function; infection rate; home economy; remittance flow; corridor data; Remittances; COVID-19; Fiscal stimulus; Migration; Inward remittances; Global
    Date: 2021–07–16

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