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on Health Economics |
| By: | Bhalotra, Sonia (University of Warwick); Clots-Figueras, Irma (University of Kent); Iyer, Lakshmi (University of Notre Dame) |
| Abstract: | Debates around abortion typically invoke religion and politics but there is no causal evidence of the impact of politician religion on abortion. Leveraging quasi-random variation in politician religion generated by close elections in India and controlling for the party affiliation of politicians, we find lower rates of sex-selective abortion in districts won by Muslim state legislators, consistent with a higher reported aversion to abortion among Muslims compared to Hindus. The competing hypothesis that this reflects weaker son preference among Muslims is undermined by stated preference data and by demonstrating that fertility and girl-biased infant mortality increase in Muslim-won districts. |
| Keywords: | religion, politician identity, abortion, sex-selection, India, gender JEL Classification: I15, J13, O15, P16 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:cge:wacage:582&r= |
| By: | Gabriella Conti (University College London); Stavros Poupakis (University College London); Peter Ekamper (Netherlands Interdisciplinary Demographic Institute); Govert Bijwaard (Netherlands Interdisciplinary Demographic Institute); L. H. Lumey (Columbia University Medical Center) |
| 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: | fetal origins hypothesis, famine, prenatal exposure |
| JEL: | I10 J13 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2021-056&r= |
| By: | Charles F. Manski |
| Abstract: | Until recently, there has been a consensus that clinicians should condition patient risk assessments on all observed patient covariates with predictive power. The broad idea is that knowing more about patients enables more accurate predictions of their health risks and, hence, better clinical decisions. This consensus has recently unraveled with respect to a specific covariate, namely race. There have been increasing calls for race-free risk assessment, arguing that using race to predict patient outcomes contributes to racial disparities and inequities in health care. Writers calling for race-free risk assessment have not studied how it would affect the quality of clinical decisions. Considering the matter from the patient-centered perspective of medical economics yields a disturbing conclusion: Race-free risk assessment would harm patients of all races. |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2112.01639&r= |
| By: | Paolo Brunori (London School of Economics , International Inequality Institute & University of Bari); Apostolos Davillas (University of East Anglia, Norwich Medical School); Andrew Jones (University of York); Giovanna Scarchilli (University of Trento & University of Modena and Reggio Emilia) |
| Abstract: | We measure unfair health inequality in the UK using a novel data-driven empirical approach. We explain health variability as the result of circumstances beyond individual control and health-related behaviours. We do this using model-based recursive partitioning, a supervised machine learning algorithm. Unlike usual tree-based algorithms, model-based recursive partitioning does identify social groups with different expected levels of health but also unveils the heterogeneity of the relationship linking behaviors and health outcomes across groups. The empirical application is conducted using the UK Household Longitudinal Study. We show that unfair inequality is a substantial fraction of the total explained health variability. This finding holds no matter which exact definition of fairness is adopted: using both the fairness gap and direct unfairness measures, each evaluated at different reference values for circumstances or effort. |
| Keywords: | Health inequality, machine learning, UK Household Longitudinal Study |
| JEL: | I14 D63 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:inq:inqwps:ecineq2021-596&r= |
| By: | Jean-Felix Brouillette; Charles I. Jones; Peter J. Klenow |
| Abstract: | We construct a measure of consumption-equivalent welfare for Black and White Americans. Our statistic incorporates life expectancy, consumption, leisure, and inequality, with mortality rates playing a key role quantitatively. According to our estimates, welfare for Black Americans was 43% of that for White Americans in 1984 and rose to 60% by 2019. Going back further in time (albeit with more limited data), the gap was even larger, with Black welfare equal to just 28% of White welfare in 1940. On the one hand, there has been remarkable progress for Black Americans: the level of their consumption-equivalent welfare increased by a factor of 28 between 1940 and 2019, when aggregate consumption per person rose a more modest 5-fold. On the other hand, despite this remarkable progress, the welfare gap in 2019 remains disconcertingly large. Mortality from COVID-19 has temporarily reversed a decade of progress, lowering Black welfare by 17% while reducing White welfare by 10%. |
| JEL: | I31 J15 O40 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29539&r= |
| By: | Martin Halla; Christopher Kah (Department of Economic Theory, Policy and History, University of Innsbruck); Rupert Sausgruber |
| Abstract: | To test for ethnic discrimination in access to outpatient health care services, we carry out an email-correspondence study in Germany. We approach 3,224 physician offices in the 79 largest cities in Germany with fictitious appointment requests and randomized patients’ characteristics. We find that patients’ ethnicity, as signaled by distinct Turkish versus German names, does not affect whether they receive an appointment or wait time. In contrast, patients with private insurance are 31 percent more likely to receive an appointment. Holding a private insurance also increases the likelihood of receiving a response and reduces the wait time. This suggests that physicians use leeway to prioritize privately insured patients to enhance their earnings, but they do not discriminate persons of Turkish origin based on taste. Still, their behavior creates means-based barriers for economically disadvantaged groups |
| Keywords: | Discrimination, immigrants, ethnicity, health care markets, health insurance, inequality, correspondence experiment, field experiment |
| JEL: | I11 J15 I14 I18 H51 C93 |
| Date: | 2021–11 |
| URL: | http://d.repec.org/n?u=RePEc:jku:econwp:2021-15&r= |
| By: | Marcus Dillender; Lu G. Jinks; Anthony T. Lo Sasso |
| Abstract: | High health care prices contribute to the United States spending more on health care than any other country, but policies that reduce health care payments have the potential to lead to health care access issues if providers reduce their supply in response to reimbursement rate reductions. In this paper, we examine the impact of reimbursement rates on health care supply by studying a policy that reduced reimbursement rates by 30% in one of the highest-reimbursing workers' compensation insurance systems in the nation. Despite the large decrease in reimbursement rates, we find no evidence that the policy affected the amount of health care that injured workers receive or recoveries after injuries. Our estimates suggest that the policy reduced annual workers' compensation medical costs by over $400 million and indicate that providers may be operating on the inelastic portion of the supply curve for care paid for by high-reimbursing payers. |
| JEL: | H75 I11 J22 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29564&r= |
| By: | Finkelstein, Amy (MIT); Persson, Petra (Stanford University); Polyakova, Maria (Stanford University); Shapiro, Jesse M. (Brown University) |
| Abstract: | We use population administrative data from Sweden to study adherence to 63 medication-related guidelines. We compare the adherence of patients without personal access to medical expertise to the adherence of those with access, namely doctors and their close relatives. We estimate that, among observably similar patients, access to expertise is associated with 3.8 percentage points lower adherence, relative to a baseline adherence rate of 54.4 percent among those without access. This association is larger for recommendations with a weaker clinical motivation. Our findings suggest an important role in non-adherence for factors other than those, such as ignorance, complexity, or failures of patient-provider communication, that would be expected to diminish with access to expertise. |
| Keywords: | Information; Medical decision-making; Experts |
| JEL: | D83 I12 I18 |
| Date: | 2021–12–13 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:iuiwop:1421&r= |
| By: | Marika Cabral; Marcus Dillender |
| Abstract: | While a growing body of evidence documents large gender disparities in health care and related social insurance programs, little is known about what drives these disparities. We leverage administrative data and random assignment of doctors to patients inherent within the workers’ compensation insurance claim dispute resolution process to study the impact of gender match between doctors and patients on medical evaluations and subsequent social insurance benefits received. Compared to differences among their male patient counterparts, female patients randomly assigned a female doctor rather than a male doctor are 5.0% more likely to be evaluated as disabled and receive 8.5% more subsequent cash benefits on average. There is no analogous gender-match effect for male patients. The magnitude of these effects implies that having female doctors evaluate patients entirely offsets the observed gender gap in the likelihood of being evaluated as disabled when male doctors evaluate patients. We explore mechanisms through further analysis of the administrative data and complementary survey evidence. In addition, we present broader evidence on gender gaps in workers' compensation insurance and gender homophily in patients' selections of doctors in settings where patients have choice. Combining this evidence, we conduct policy counterfactuals illustrating how policies increasing gender diversity among doctors or increasing gender homophily in patient-doctor matches may impact gender gaps in evaluated disability. Our findings indicate that policies increasing the share of female patients evaluated by female doctors may substantially shrink gender gaps in medical evaluations and associated outcomes. |
| JEL: | I11 I14 J16 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29541&r= |
| By: | Anup Malani (University of Chicago); Phoebe Holtzman; Kosuke Imai (Harvard University); Cynthia Kinnan (Tufts University); Morgen Miller (University of Chicago); Shailender Swaminathan (Sai University); Alessandra Voena (The University of Chicago); Bartosz Woda (University of Chicago); Gabriella Conti (University College London) |
| Abstract: | We report on a large randomized controlled trial of hospital insurance for above-poverty-line Indian households. Households were assigned to free insurance, sale of insurance, sale plus cash transfer, or control. To estimate spillovers, the fraction of households offered insurance varied across villages. The opportunity to purchase insurance led to 59.91% uptake and access to free insurance to 78.71% uptake. Access increased insurance utilization. Positive spillover effects on utilization suggest learning from peers. Many beneficiaries were unable to use insurance, demonstrating hurdles to expanding access via insurance. Across a range of health measures, we estimate no significant impacts on health. |
| Keywords: | randomized control trials, hospital insurance, India, peer effects, Spillover effects |
| JEL: | I13 C93 I14 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2021-055&r= |
| By: | Engy Ziedan; Robert Kaestner |
| Abstract: | In this article, we provide a comprehensive, empirical assessment of the hypothesis that the Hospital Readmissions Reduction Program (HRRP) affected hospital readmissions. In doing so, we provide evidence as to the validity of prior empirical approaches used to evaluate the HRRP and we present results from a previously unused approach to study this research question—a regression-kink design. Results of our analysis document that the empirical approaches used in most prior research assessing the efficacy of the HRRP often lack internal validity. Therefore, results from these studies may not be informative about the causal consequences of the HRRP. Results from our regression-kink analysis, which we validate, suggest that the HRRP had little effect on hospital readmissions. This finding contrasts with the results of most prior studies, which report that the HRRP significantly reduced readmissions. Our finding is consistent with conceptual considerations related to the assumptions underlying HRRP penalty; in particular, the difficulty of identifying preventable readmissions, the highly imperfect risk adjustment that affects the penalty determination and the absence of proven tools to reduce readmissions. |
| JEL: | I11 I18 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29545&r= |
| By: | Marc Fleurbaey (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Marie-Louise Leroux (ESG-UQAM - UQAM - Université du Québec à Montréal = University of Québec in Montréal); Pierre Pestieau (Université de Liège); Gregory Ponthiere (UCL - Université Catholique de Louvain = Catholic University of Louvain); Stéphane Zuber (PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - EHESS - École des hautes études en sciences sociales - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | While little agreement exists regarding the taxation of bequests in general, there is a widely held view that accidental bequests should be subjected to a confiscatory tax. We reexamine the optimal taxation of accidental bequests by introducing a concern for compensating individuals for a premature death. Assuming that individuals care about what they leave to their offspring, we show that, whereas the 100 % tax view holds under the utilitarian criterion, the ex post egalitarian criterion (giving priority to the worst-off ex post) implies subsidizing accidental bequests so as to compensate the short-lived. In a second-best setting, compensating the short-lived justifies taxing total bequests at a rate increasing with the age of the deceased. Finally, when the model is extended to an intergenerational setting, accidental bequests cannot be used as a redistributive tool anymore, so that ex post egalitarianism rejoins the 100 % tax view. |
| Keywords: | mortality,accidental bequests,optimal taxation,compensation,OLG models |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:hal:pseptp:halshs-03454842&r= |
| By: | Fukushima, Nanna (Stockholm University) |
| Abstract: | This paper estimates the effects of the 1956 UK Clean Air Act on infant mortality. Using novel data, I exploit the seasonality in demand for coal to analyze the effects of a staggered expansion of a ban on local smoke emission. The findings show that the policy eliminated the seasonal difference in air quality as well as infant mortality. According to my instrumental variables estimates, the reduction in air pollution between 1957 and 1973 can account for 70 % of the observed decline in infant mortality during the same period. The results are relevant to explain the fast decline in post-war infant mortality in developed countries and understand the effect of pollution on infant mortality in many developing countries. |
| Keywords: | Health economics, Child mortality, Air pollution, Air pollution control JEL Classification: I12, J13, N540, Q51, Q53, Q58 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:cge:wacage:587&r= |
| By: | Dora Costa |
| Abstract: | Whether and how a paternal health shock cascades across multiple generations to affect descendant health is understudied even though a link between ancestral living conditions and descendant health may constitute an important source of differences in the stock of health capital across families and thus across ethnic, racial and social groups. I study how a paternal health shock affects grandchildren's longevity in a unique setting where the ancestral stressor is the grandfather's ex-POW status in the US Civil War (1861-5) and the children are born after the war. Ancestral stress is associated with longevity after age 45 of male-line grandsons but not of granddaughters or female-line grandchildren. I rule out transmission through socioeconomic channels and direct cultural transmission from grandfather to grandson. An epigenetic explanation is consistent with observed male-line transmission at epigenetically sensitive ancestral ages and mediation by own late gestational conditions. Consistent with epigenetic reprogramming depending on the in-utero environment, the association between the veteran's ex-POW status and that of his male-line descendants declines across generations. |
| JEL: | I14 I19 N31 N32 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29553&r= |
| By: | Rainer Franz Kotschy |
| Abstract: | This paper investigates whether and to what extent long-run trends in population health affected income inequality in the United States over the period 1960-2000. To isolate exogenous variation in health over time, the analysis exploits the sharp decline in cardiovascular disease mortality across states that originated from medical advances in the treatment and prevention of these diseases after 1960. The results demonstrate that health improvements contributed to rising income inequality through mechanisms related to education. |
| Keywords: | population health, aging, Gini coefficient, skill-biased technical change |
| JEL: | I14 I24 J11 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_9429&r= |
| By: | Selina Gangl |
| Abstract: | This paper examines the effect of two different soda taxes on consumption behaviour and health of school-aged children in Europe: Hungary imposed a Public Health Product Tax (PHPT) on several unhealthy products in 2011. France introduced solely a soda tax, containing sugar or artificial sweeteners, in 2012. In order to exploit spatial variation, I use a semi-parametric Difference-in-Differences (DID) approach. Since the policies differ in Hungary and France, I analyse the effects separately by using a neighbouring country without a soda tax as a control group. The results suggest a counter-intuitive positive effect of the tax on soda consumption in Hungary. The reason for this finding could be the substitution of other unhealthy beverages, which are taxed at a higher rate, by sodas. The effect of the soda tax in France is as expected negative, but insignificant which might be caused by a low tax rate. The body mass index (BMI) is not affected by the tax in any country. Consequently, policy makers should think carefully about the design and the tax rate before implementing a soda tax. |
| Date: | 2021–11 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2111.14521&r= |
| By: | Quitterie Roquebert; Marianne Tenand |
| Abstract: | This paper provides a comprehensive analysis of informal care receipt by the French individuals aged 60 or older. The literature has focused on the community, leaving informal care in residential care settings in the shadow. We leverage data from a representative survey (CARE) conducted in 2015-2016 on both community-dwelling individuals and nursing home residents. Focusing on the 60+ with activity restrictions, we show that 76% of nursing home residents receive help with the activities of daily living from relatives, against 55% in the community. The number of hours conditional on receipt is yet 3.5 times higher in the community. Informal care represents 180 million hours per month and a value equivalent to 1.5% of GDP, care in the community representing 95% of the total. We investigate the determinants of informal care receipt. Using an Oaxaca-type approach, we disentangle between two mechanisms explaining differences observed across settings, namely the differences in population composition (endowments) and the differences in the association of individual characteristics with informal care (coefficients). They are found to have a similar contribution at the extensive margin. Our results imply that private costs make up for the majority (80%) of the costs associated with long-term care provision once informal care is taken into account. They also highlight that informal care is extremely common for nursing home residents. Existing evidence on the determinants of informal care receipt in the community has however limited relevance to understand informal care behaviors in nursing homes. |
| Keywords: | informal care, long-term care, ageing, valuation, decomposition. |
| JEL: | D10 I10 J14 I18 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:ulp:sbbeta:2021-51&r= |
| By: | Izhak, Olena; Saxell, Tanja; Takalo, Tuomas |
| Abstract: | The debate on whether COVID-19 vaccine patents are slowing down the pace of vaccination and the recovery from the crisis has brought the optimal design of pharmaceutical patent policy to the fore. In this paper we evaluate patent policy in the US pharmaceutical industry. We estimate the effect of patent length and scope on generic entry prior to the expiration of new drug patents using two quasi-experimental approaches: one based on changes in patent laws and another on the allocation of patent applications to examiners. We find that extending effective patent length increases generic entry whereas broadening protection reduces it. To assess the welfare effects of patent policy, we match these empirical results with a model of new drug development, generic entry, and patent length and scope. Optimal policy calls for shorter but broader pharmaceutical patents. |
| JEL: | I18 K20 L13 O34 O31 |
| Date: | 2021–12–29 |
| URL: | http://d.repec.org/n?u=RePEc:bof:bofrdp:2021_016&r= |
| By: | Nakamura, Ryota; Albanese, Andrea; Coombes, Emma; Suhrcke, Marc |
| Abstract: | This study investigates the impact of economic incentives on travel-related physical activity, leveraging the London Congestion Charge's disincentivising of sedentary travel modes via increasing the cost of private car use within Central London. The scheme imposes charges on most types of cars entering, exiting and operating within the Central London area, while individuals living inside the charging zone are eligible for a 90% reduction in congestion charges. Geographical location information provides the full-digit postcode data necessary to precisely identify the eligibility for the discount of participants in the London Travel Demand Survey for the period 2005-2011. Using a boundary regression-discontinuity design reveals a statistically significant but small impact on active commuting (i.e. cycling and walking) around the border of the charging zone. The effect is larger for lower-income households and car owners. The findings are robust against multiple specifications and validation tests. |
| Keywords: | economic incentive,health behaviour,London Congestion Charge,geographical information system,regression-discontinuity |
| JEL: | D04 I12 R48 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1006&r= |
| By: | Baktash, Mehrzad B. (University of Trier); Heywood, John S. (University of Wisconsin, Milwaukee); Jirjahn, Uwe (University of Trier) |
| Abstract: | While performance pay can benefit firms and workers by increasing productivity and wages, it has also been associated with a deterioration of worker health. The transmission mechanisms for this deterioration remain in doubt. We examine the hypothesis that increased stress is one transmission mechanism. Using unique survey data from the German Socio-Economic Panel, we find performance pay consistently and importantly associates with greater stress even controlling for a long list of economic, social and personality characteristics. It also holds in instrumental variable estimations accounting for the potential endogeneity of performance pay. Moreover, we show that risk tolerance moderates the relationship between performance pay and stress. The risk tolerant receiving performance pay suffer less stress than the risk averse. |
| Keywords: | performance pay, worker health, stress, risk tolerance |
| JEL: | J33 I31 J32 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14939&r= |
| By: | Zied Chaieb (Quantlabs - Quanteam); Djibril Gueye (Quantlabs - Quanteam) |
| Abstract: | Mortality surface is a function of age and year with the main characteristic of being increasing with respect to ages from a given age. One of the major challenges of its construction is to take this last specificity into account. In this paper, we propose to use constrained Kriging for such a construction. Our approach is based on the finite dimensional approximation of the Gaussian process. We first show the ability of Kriging to construct mortality surfaces and then compare its performance against classical Kriging models with trend functions such as those used in [LRZ18]. Our empirical study based on mortality data from three countries (France, Italy and Germany) showed the need to add a constraint of convexity in age and illustrated through an RMSE criterion that Kriging constraint provided better results in terms of out-of-sample forcasting. |
| Date: | 2021–11–29 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-03454856&r= |
| By: | Amarasekara, Chandranath; Venuganan, Poongothai |
| Abstract: | Since its independence, Sri Lanka has been lauded by researchers and policymakers for its human capital outcomes and has consistently been ahead of its regional peers. On the other hand, Vietnam continued to struggle with conflicts and other economic bottlenecks which hindered the development of its human capital base, particularly until the initiation of the Doi Moi reform process in the mid 1980s. Accordingly, a comparative assessment is undertaken of the significantly different human capital development journeys of Vietnam and Sri Lanka to understand the course of progress that both countries have experienced especially in the last three decades. Such an assessment paves way to identify developmental lessons that policymakers of both countries can draw upon to further augment their human capital which will be pivotal to achieve sustainable and inclusive growth amid the short-run challenge of the COVID-19 pandemic and the medium-run challenge of the ‘middle-income trap.’ |
| Keywords: | Comparative Studies, Human Capital, Health, Education, Poverty, COVID-19 Response |
| JEL: | I1 I15 I18 I2 I24 I25 I28 I3 I31 I38 O1 O15 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:111204&r= |
| By: | Mrs. Swarnali A Hannan; David Bartolini; Juan Pablo Cuesta Aguirre |
| Abstract: | Poverty in Mexico was high before the COVID-19 pandemic and has been exacerbated by the pandemic, with significant variation across states. Education losses from the pandemic are likely to be large and worsen pre-existing disparities; unless mitigated soon, they could contribute to heightened scarring over the medium term. Using state-level and cross-country comparisons, this paper reviews key social programs as well as priorities in education and health. It finds that higher spending and improved design of social programs (e.g., better targeting) would reduce socioeconomic gaps, mitigate scarring risks, and foster inclusive growth. |
| Keywords: | social programs, health, education, sustainable development goals; scarring effect; losses from the pandemic; pre-existing disparity; government program; scarring risk; COVID-19; Income; Caribbean |
| Date: | 2021–10–18 |
| URL: | http://d.repec.org/n?u=RePEc:imf:imfwpa:2021/244&r= |
| By: | Kim, Jun Hyung; Wang, Shaoda |
| Abstract: | While it is well known that there are systematic birth order effects on life cycle outcomes, there is less consensus about underlying channels and mechanisms of birth order effects. We find negative birth order effects among Chinese adolescents, favoring earlier-born children within household in academic achievement and cognitive skill measures. We highlight harsh parenting as a novel channel of birth order effects, in which earlier-born children are less likely to be physically punished by their parents. Focusing on son preference as a potential mechanism generating birth order effects, our tests show limited support for the existence of son preference among Chinese siblings. These findings are in contrast to positive birth order effects and strong evidence of son preference among earlier generations of Chinese siblings reported in the literature, suggesting weakened role of son preference within families in contemporary China. |
| Keywords: | birth order effect,parenting style,academic achievement,cognitive skill,son preference |
| JEL: | I20 J10 J13 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1007&r= |
| By: | Li, Xun; Lai, Weizheng; Wan, Qianqian; Chen, Xi |
| 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 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1002&r= |
| By: | Gueguen, Guillaume; Senik, Claudia |
| Abstract: | Using the UK household longitudinal survey, we uncover a positive effect of work from home on life satisfaction, which is driven by partnered people and those without children at home. Concerning mental health, there is no average effect of telework, except for those living in rural areas, but this hides a dynamic evolution, as mental health initially deteriorates in the first months of telework, but improves after a period of adaptation, especially the feeling of being useful, of being a worthy person, and of being able to concentrate. |
| Keywords: | Telework, Life Satisfaction, Mental Health, Covid-19 |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:cpm:docweb:2201&r= |
| By: | Giulietti, Corrado; Vlassopoulos, Michael; Zenou, Yves |
| Abstract: | In this study, we investigate whether COVID-19 deaths that occurred before vaccination rollouts impact subsequent vaccination take-up. We use data on local vaccination rates and COVID-19-related deaths from England measured at high geographic granularity. We find that vaccination take-up as of November 2021 is positively associated with pre-vaccine COVID-19-related deaths, controlling for demographic, economic, and health-related characteristics of the localities, while including geographic fixed effects. In addition, the share of ethnic minorities in a locality is negatively associated with vaccination rates, and localities with a larger share of ethnic minorities increase their vaccination rates if they are exposed to more COVID-related-deaths. Further evidence on vaccination intention at the individual level from a representative sample corroborates these patterns. Overall, our evidence suggests that social proximity to victims of the disease triggers a desire to take protective measures against it. |
| Keywords: | Vaccination hesitancy,COVID-19,Social interactions,Information,Behavior change |
| JEL: | H51 I12 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:999&r= |
| 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 |
| URL: | http://d.repec.org/n?u=RePEc:cge:wacage:596&r= |
| By: | Mario Lackner; Uwe Sunde; Rudolf Winter-Ebmer |
| Abstract: | The unprecedented consequences of the Covid-19 pandemic have raised concerns about intensified social unrest, but evidence for such a link and the underlying channels is still lacking. We use a unique combination of nationally representative survey data, event data on social unrest, and data on Covid-19 fatalities and unemployment at a weekly resolution to investigate the forces behind social unrest in the context of the strains on public health and the economy due to the pandemic in the USA. The results show that pandemic-related unemployment and Covid-19 fatalities intensified negative emotional stress and led to a deterioration of economic confidence among individuals. The prevalence of negative emotional stress, particularly in economically strained and politically polarized environments, was, in turn, associated with intensified social unrest as measured by political protests. No such link is found for economic perceptions. |
| Keywords: | economic shocks | Covid-19 | civil unrest | political polarization |
| Date: | 2021–11 |
| URL: | http://d.repec.org/n?u=RePEc:jku:econwp:2021-16&r= |
| By: | Corsi, Marcella; Ilkkaracan, Ipek |
| Abstract: | The Covid-19 pandemic has triggered simultaneously a global health crisis and a global economic crisis which have further deepened existing inequalities along several dimensions, including gender. Increasing gender inequalities in paid and unpaid work has been a primary outcome of the pandemic and the associated economic crisis. Given the disproportionate gender division of labor, women were foremost in bearing the brunt of the increased demands on unpaid care work under the lockdown conditions. At the same time, women were also overrepresented in informal employment and service sectors hard-hit by the pandemic resulting in more severe job loss for female workers overall. In many labor markets, women constituted the majority of so-called essential workers, who were protected from job loss yet exposed to increased health risks and prolonged work hours under distressed work conditions. The increasing demand for household production and the unpaid work burden contributed to weakening women's labor market attachment resulting in higher declines in female labor force participation than male. The increased prevalence of teleworking under the pandemic has the potential to provide improved work-life balance conditions, yet at the risk of widening the gender inequalities in the labor market. While these outcomes point to the threat that Covid-19 poses at rolling back the gains achieved in gender equality, the experiences under the pandemic conditions have also contributed to increased awareness around the Globe of the importance of caring labor and care workers, establishing a solid basis for advocacy of gender equal care policies. |
| Keywords: | COVID-19,gender,paid and unpaid work,work-life balance,telework |
| JEL: | B54 J08 J01 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1012&r= |
| By: | Alexander Karaivanov; Dongwoo Kim; Shih En Lu; Hitoshi Shigeoka |
| Abstract: | We evaluate the impact of government mandated proof of vaccination requirements for access to public venues and non-essential businesses on COVID-19 vaccine uptake. We find that the announcement of a mandate is associated with a rapid and significant surge in new vaccinations (more than 60\% increase in weekly first doses) using the variation in the timing of these measures across Canadian provinces in a difference-in-differences approach. Time-series analysis for each province and for France, Italy and Germany corroborates this finding, and we estimate cumulative gains of up to 5 percentage points in provincial vaccination rates and 790,000 or more first doses for Canada as a whole as of October 31, 2021 (5 to 13 weeks after the provincial mandate announcements). We also find large vaccination gains in France (3 to 5 mln first doses), Italy (around 6 mln) and Germany (around 3.5 mln) 11 to 16 weeks after the proof of vaccination mandate announcements. |
| JEL: | C23 I12 I18 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29563&r= |
| By: | Bagues, Manuel (University of Warwick, CEPR, IZA and J-Pal); Dimitrova, Velichka (University of Warwick) |
| Abstract: | We quantify the impact of COVID-19 vaccination on psychological well-being using information from a large-scale panel survey representative of the UK population. Exploiting exogenous variation in the timing of vaccinations, we find that vaccination increases psychological well-being by 0.12 standard deviation, compensating for around one half of the overall decrease caused by the pandemic. This effect persists for at least two months, and it is associated with a decrease in the perceived likelihood of contracting COVID-19 and higher engagement in social activities. The improvement is 1.5 times larger for mentally distressed individuals, supporting the prioritization of this group in vaccination roll-outs. |
| Keywords: | Psychological well-being, COVID-19, vaccination JEL Classification: I18, I31 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:cge:wacage:594&r= |
| By: | De Donder, Philippe; Llavador, Humberto; Penczynski, Stefan; Roemer, John E.; Vélez, Roberto |
| Abstract: | Whether or not to vaccinate one's child is a decision that a parent may approach in several ways. The vaccination game, in which parents must choose whether to vaccinate a child against a disease, is one with positive externalities (herd immunity). In some societies, not vaccinating is an increasingly prevalent behavior, due to deleterious side effects that parents believe may accompany vaccination. The standard game-theoretic approach assumes that parents make decisions according to the Nash behavioral protocol, which is individualistic and non-cooperative. Because of the positive externality that each child’s vaccination generates for others, the Nash equilibrium suffers from a free-rider problem. However, in more solidaristic societies, parents may behave cooperatively –they may optimize according to the Kantian protocol, in which the equilibrium is efficient. We test, on a sample of six countries, whether childhood vaccination behavior conforms better to the individualistic or cooperative protocol. In order to do so, we conduct surveys of parents in these countries, to ascertain the distribution of beliefs concerning the subjective probability and severity of deleterious side effects of vaccination. We show that in all the countries of our sample the Kant model dominates the Nash model. We conjecture that, due to the free-rider problem inherent in the Nash equilibrium, a social norm has evolved, quite generally, inducing parents to vaccinate with higher probability than they would in the non-cooperative solution. Kantian equilibrium offers one precise version of such a social norm. |
| Keywords: | Kantian equilibrium ; Nash equilibrium ; vaccination ; social norm |
| JEL: | C72 D62 D63 I12 |
| Date: | 2021–12–20 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:126272&r= |
| By: | Sonia Bhalotra; Emilia Brito; Damian Clarke; Pilar Larroulet; Francisco J. Pino |
| Abstract: | We leverage staggered implementation of lockdown across Chile's 346 municipalities, identifying dynamic impacts on domestic violence. Using administrative data, we find lockdown imposition increases indicators of distress related to domestic violence, while decreasing domestic violence reports to the police. We identify male job loss as a mechanism driving distress, and female job loss as driving decreased reporting. Stimulus payments to poor households act on both margins, their impacts partially differentiated by lockdown status. |
| Keywords: | Domestic violence, Social protection, COVID-19, Lockdown, Public health, Welfare impact |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:unu:wpaper:wp-2021-189&r= |
| By: | Upton, Joanna; Tennant, Elizabeth; Fiorella, Kathryn J.; Barrett, Christopher B. |
| Abstract: | Resilience offers a useful lens for studying how human well-being and the systems on which it depends can absorb and recover from a range of shocks and stressors, including events such as the COVID-19 pandemic. Looking beyond the direct effects of observable shocks and individual or household resilience capacities to the meso-level mechanisms that shape impacts on communities, households, and individuals can both guide our understanding of COVID-19 impacts and help leverage findings from the pandemic context to better understand resilience to other food systems shocks, past, present, and future. We develop a conceptual framework for the multiple paths through which observed, exogenous shocks interact with systemic, endogenous mechanisms to influence the resilience of household well-being and supporting food systems. We illustrate this framework with reference to the COVID-19 pandemic and policy responses as they unfolded in three rural study areas in Malawi, Madagascar, and Kenya. Consistent with this framework, we find multiple pathways through which the pandemic shock affected household food security and resilience. Our findings highlight that in some settings, at some points in the multi-stressor trajectory of a shock, the more serious, direct effects – in this case, severe illness and mortality from SARS-CoV-2 – may impact far fewer people than do the substantive, indirect impacts that arise as behaviors, markets, and policies adjust to the shock. These adjustments are necessarily correlated and elicit varied household coping responses. We illustrate the degree to which, from the point of view of rural food systems and households, COVID-19 is a new shock but its massive, broad-reaching impacts manifest through familiar stressors and uncertainties that frequently burden poor rural populations in much of the lowand middle-income world |
| Keywords: | Community/Rural/Urban Development |
| Date: | 2021–11–30 |
| URL: | http://d.repec.org/n?u=RePEc:ags:cudawp:316613&r= |
| By: | Haelermans, Carla (ROA / Education and transition to work, RS: GSBE Studio Europa Maastricht, RS: GSBE Theme Learning and Work); Jacobs, Madelon (ROA / Education and transition to work, RS: GSBE other - not theme-related research); van Vugt, Lynn (ROA / Health, skills and inequality, RS: GSBE Theme Learning and Work); Aarts, Bas (RS: GSBE other - not theme-related research, ROA / Human capital in the region); Abbink, Henry (RS: GSBE other - not theme-related research, ROA / Labour market and training); Smeets, Chayenne; van der Velden, Rolf (ROA / Education and transition to work, RS: GSBE Theme Learning and Work); van Wetten, Sanne (RS: GSBE other - not theme-related research, ROA / Education and transition to work) |
| Abstract: | After more than a year of COVID-19 crisis and the school closures that followed all around the world, the concerns about lower learning growth and exacerbated inequalities are larger than ever. In this paper, we use unique data to analyse how one full year of COVID-19 crisis in Dutch primary education has affected learning growth and pre-existing inequalities. We draw on a dataset that includes around 330,000 Dutch primary school students from about 1,600 schools, with standardized test scores for reading, spelling and mathematics, as well as rich (family) background information of the students. The results show a lower learning growth over a full year for all three domains, varying from 0.06 standard deviations for spelling to 0.12 for maths and 0.17 standard deviations for reading. Furthermore, we find that the lower learning growth is (much) larger for vulnerable students with a low socioeconomic background. This implies that pre-existing inequalities between students from different backgrounds have increased. These results are quite alarming and suggest that distance learning could not compensate for classroom teaching, although it prevented some damage that would have occurred if students had not enjoyed any formal education at all. |
| JEL: | I24 I20 I21 C90 |
| Date: | 2021–12–16 |
| URL: | http://d.repec.org/n?u=RePEc:unm:umagsb:2021021&r= |
| By: | Haelermans, Carla (ROA / Education and transition to work, RS: GSBE Studio Europa Maastricht, RS: GSBE Theme Learning and Work); Korthals, Roxanne; Jacobs, Madelon (ROA / Education and transition to work, RS: GSBE other - not theme-related research); de Leeuw, Suzanne (RS: GSBE other - not theme-related research, ROA / Education and transition to work); Vermeulen, Stan (ROA / Education and transition to work, RS: GSBE Theme Learning and Work); van Vugt, Lynn (ROA / Health, skills and inequality, RS: GSBE Theme Learning and Work); Aarts, Bas (RS: GSBE other - not theme-related research, ROA / Human capital in the region); Breuer, Tijana (ROA / Labour market and training, RS: GSBE other - not theme-related research); van der Velden, Rolf (ROA / Education and transition to work, RS: GSBE Theme Learning and Work); van Wetten, Sanne (RS: GSBE other - not theme-related research, ROA / Education and transition to work); de Wolf, Inge (ROA / Labour market and training, RS: GSBE other - not theme-related research) |
| Abstract: | The COVID-19-pandemic forced many countries to close schools abruptly in the spring of 2020. These school closures and the subsequent period of distance learning has led to concerns about increasing inequality in education, as children from lower-educated and poorer families have less access to (additional) resources at home. This study analyzes differences in declines in learning gains in primary education in the Netherlands for reading, spelling and math, using rich data on standardized test scores and register data on student and parental background for almost 300,000 unique students. The results show large inequalities in the learning loss based on parental education and parental income, on top of already existing inequalities. The results call for a national focus on interventions specifically targeting vulnerable students. |
| JEL: | I24 I20 I21 C90 |
| Date: | 2021–12–16 |
| URL: | http://d.repec.org/n?u=RePEc:unm:umagsb:2021022&r= |