nep-hea New Economics Papers
on Health Economics
Issue of 2022‒01‒24
thirty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Health and Labor Market Impacts of Twin Birth : Evidence from a Swedish IVF Policy Mandate By Bhalotra, Sonia; Clarke, Damian; Mühlrad, Hanna; Palme, Mårten
  2. Long-term health insurance: Theory meets evidence By Atal, Juan Pablo; Fang, Hanming; Karlsson, Martin; Ziebarth, Nicolas R.
  3. Digital Access to Healthcare Services and Healthcare Utilization: A Quasi-Experiment By Antinyan, Armenak; Bellio, Stefania; Bertoni, Marco; Corazzini, Luca; Narne, Elena
  4. Lobbying Physicians: Payments from Industry and Hospital Procurement of Medical Devices By Alon Bergman; Matthew Grennan; Ashley Swanson
  5. Regional medical practice variation in high-cost healthcare services: evidence from diagnostic imaging in Austria By Berger, Michael; Czypionka, Thomas
  6. Biased Survival Expectations and Behaviours: Does Domain Specific Information Matter? By Costa-Font, Joan; Vilaplana-Prieto, Cristina
  7. Discontinuities in the Age-Victimization Profile and the Determinants of Victimization By Bindler, Anna; Hjalmarsson, Randi; Ketel, Nadine; Mitrut, Andreea
  8. Mandated sick pay: Coverage, utilization, and welfare effects By Maclean, Catherine; Pichler, Stefan; Ziebarth, Nicolas R.
  9. Early retirement of employees in demanding jobs: Evidence from a German pension reform By Geyer, Johannes; Lorenz, Svenja; Zwick, Thomas; Bruns, Mona
  10. Uncovering the Roots of Obesity-Based Wage Discrimination: The Role of Job Characteristics By Dolado, Juan J.; Guerra, Airam
  11. Peltzman Revisited: Quantifying 21st Century Opportunity Costs of FDA Regulation By Casey B. Mulligan
  12. Time-consistent mean-variance reinsurance-investment problem with long-range dependent mortality rate By Ling Wang; Mei Choi Chiu; Hoi Ying Wong
  13. Heckman-Selection or Two-Part models for alcohol studies? Depends By Reka Sundaram-Stukel
  14. Examining the Link Between Gentrification, Children’s Egocentric Food Environment, and Obesity By Christopher Rick; Jeehee Han; Spencer Shanholtz; Amy Ellen Schwartz
  15. Facing it: assessing the immediate emotional impacts of calorie labelling using automatic facial coding By Laffan, Kate; Sunstein, Cass; Dolan, Paul
  16. The Predictive Power of Self-Control for Life Outcomes By Cobb-Clark, Deborah A.; Dahmann, Sarah C.; Kamhöfer, Daniel A.; Schildberg-Hörisch, Hannah
  17. Historical Prevalence of Infectious Diseases and Entrepreneurship: the Role of Institutions in 125 Countries By Omang O. Messono; Simplice A. Asongu
  18. Forced Displacement and Human Capital: Evidence from Separated Siblings By Giorgio Chiovelli; Stelios Michalopoulos; Elias Papaioannou; Sandra Sequeira
  19. Similarities and differences in Health Technology Assessment systems and implications for coverage decisions:: evidence from 32 countries By Fontrier, Anna-Maria; Visintin, Erica; Kanavos, Panos
  20. Changing Patterns of Son Preference and Fertility in Pakistan By Javed, Rashid; Mughal, Mazhar
  21. Compiling Granular Population Data Using Geospatial Information By Mitterling, Thomas; Fenz, Katharina; Martinez Jr, Arturo; Bulan, Joseph; Addawe, Mildred; Durante, Ron Lester; Martillan, Marymell
  22. Administrative Border Effects in COVID-19 Related Mortality By Berta, Paolo; Bratti, Massimiliano; Fiorio, Carlo V.; Pisoni, Enrico; Verzillo, Stefano
  23. The Impact of the COVID-19 Vaccine Distribution on Mental Health Outcomes By Virat Agrawal; Jonathan H. Cantor; Neeraj Sood; Christopher M. Whaley
  24. "The Better You Feel, the Harder You Fall": Health Perception Biases and Mental Health among Chinese Adults during the COVID-19 Pandemic By Nie, Peng; Wang, Lu; Dragone, Davide; Lu, Haiyang; Sousa-Poza, Alfonso; Ziebarth, Nicolas R.
  25. Pandemic-Induced Wealth and Health Inequality and Risk Exposure By Konstantinos Angelopoulos; Spyridon Lazarakis; Rebecca Mancy; Max Schroeder
  26. Associational and plausible causal effects of COVID-19 public health policies on economic and mental distress By Reka Sundaram-Stukel; Richard J Davidson
  27. Determinants Of Covid-19 Vaccine Hesitancy And Resistance In Russia By Yana Roshchina; Sergey Roshchin; Ksenia Rozhkova
  28. Using COVID-19 mortality to select among hospital plant capacity models: An exploratory empirical application to Hubei province By Kristiaan Kerstens; Zhiyang Shen
  29. Policewomen's experiences of working during lockdown: results of a survey with officers from England and Wales By Fleming, Jenny; Brown, Jennifer
  30. COVID-19 Government Responses to Labour Market Disruptions and Economic Impacts: The New Zealand Model By Maani, Sholeh A.
  31. COVID-19 Vaccines: A Shot in Arm for the Economy By Mr. Niels-Jakob H Hansen; Rui C. Mano

  1. By: Bhalotra, Sonia (Department of Economics, University of Warwick, CEPR, IEA, IZA, CAGE); Clarke, Damian (Department of Economics, University of Chile and IZA); Mühlrad, Hanna (Institute for Evaluation of Labour Market and Education Policy (IFAU)); Palme, Mårten (Department of Economics, Stockholm University)
    Abstract: IVF allows women to delay birth and pursue careers, but IVF massively increases the risk of twin birth. There is limited evidence of how having twins influences women’s post-birth careers. We investigate this, leveraging a single embryo transfer (SET) mandate implemented in Sweden in 2003, following which the share of twin births showed a precipitous drop of 70%. Linking birth registers to hospitalization and earnings registers, we identify substantial improvements in maternal and child health and women’s earnings following IVF birth, alongside an increase in subsequent fertility. We provide the first comprehensive evaluation of SET, relevant given the secular rise in IVF births and growing concerns over twin birth risk. We contribute new estimates of the child penalty imposed by twin as opposed to singleton birth, relevant to the secular rise in the global twin birth rate.
    Keywords: twins ; IVF ; single embryo transfer ; career costs of children ; child penalty ; gender wage gap ; fertility ; maternal health ; neonatal health ; gender JEL Classification: J13 ; I11 ; I12 ; I38 ; J24
    Date: 2021
  2. By: Atal, Juan Pablo; Fang, Hanming; Karlsson, Martin; Ziebarth, Nicolas R.
    Abstract: To insure policyholders against contemporaneous health expenditure shocks and future reclassification risk, long-term health insurance constitutes an alternative to community-rated short-term contracts with an individual mandate. In this paper, we study the German long-term health insurance (GLTHI) from a life-cycle perspective. The GLTHI is one of the few real-world long-term health insurance markets. We first present and discuss insurer regulation, premium setting, and the main market principles of the GLTHI. Then, using unique claims panel data from 620 thousand policyholders over 7 years, we propose a new method to classify and model health transitions. Feeding the empirical inputs into our theoretical model, we assess the welfare effects of the GLTHI over policyholders' lifecycle. We find that GLTHI achieves a high level of welfare against several benchmarks. Finally, we conduct counterfactual policy simulations to illustrate the welfare consequences of integrating GLTHI into a hybrid insurance system similar to the current system in the United States.
    Keywords: long-term health insurance,individual private health insurance,reclassification risk,intertemporal incentives,ACG scores,health transitions
    JEL: G22 I11 I18
    Date: 2021
  3. By: Antinyan, Armenak (Cardiff University); Bellio, Stefania (Regione Veneto); Bertoni, Marco (University of Padova); Corazzini, Luca (Ca' Foscari University of Venice); Narne, Elena (Regione Veneto)
    Abstract: An Italian region introduced a web portal allowing women to manage online their appointment in the public cervical cancer screening program, besides the standard possibility of doing it via phone. We report quasi-experimental evidence on how access to the portal changes screening behaviour. We find that eligible women do manage their appointment online. The introduction of the portal also reduces attendance of the screening program. Two factors contribute to explain this finding. First, by encouraging women not to take a screening test if they performed an analogous one in the previous three years, the portal reduces overly-frequent screening. Second, the portal induces procrastination in rescheduling the appointment. We also find that, when they cancel their appointment online, women are more likely to share information about their screening episodes in the private health sector, that is useful to schedule future screening appointments.
    Keywords: ICT intervention, cervical cancer, screening uptake, quasi-experiment
    JEL: H51 O33 I12 D91
    Date: 2021–12
  4. By: Alon Bergman; Matthew Grennan; Ashley Swanson
    Abstract: We draw upon newly merged administrative data sets to study the relationship between payments from medical technology firms to physicians and medical device procurement by hospitals. These payments (and the interactions that accompany them) may facilitate the transfer of valuable information to and from physicians. However, they may also influence physicians’ treatment decisions, and in turn hospital device procurement, in favor of paying firms. Payments are pervasive: 87 percent of device sales in our sample occurred at a hospital where a relevant physician received a payment from a device firm. Payments are also highly correlated with spending within a firm-hospital pair: event studies suggest that a large positive increase in payments to a given hospital from a given firm ($438 per physician on average, or 112 percent of the mean) is associated with 27 percent higher expenditures on the paying firm’s devices post-event. Finally, we explore how payments mediate the relationship between expertise and device procurement patterns. Hospitals affiliated with the top Academic Medical Centers (AMCs), which plausibly represent an expert benchmark, purchase a different mix of devices than other hospitals, and payments to hospitals outside the top AMCs are correlated with larger deviations from the procurement patterns of top AMC hospitals.
    JEL: D23 D73 I11 L15
    Date: 2021–12
  5. By: Berger, Michael; Czypionka, Thomas
    Abstract: Magnetic resonance imaging (MRI) is a popular yet cost-intensive diagnostic measure whose strengths compared to other medical imaging technologies have led to increased application. But the benefits of aggressive testing are doubtful. The comparatively high MRI usage in Austria in combination with substantial regional variation has hence become a concern for its policy makers. We use a set of routine healthcare data on outpatient MRI service consumption of Austrian patients between Q3-2015 and Q2-2016 on the district level to investigate the extent of medical practice variation in a two-step statistical analysis combining multivariate regression models and Blinder–Oaxaca decomposition. District-level MRI exam rates per 1.000 inhabitants range from 52.38 to 128.69. Controlling for a set of regional characteristics in a multivariate regression model, we identify payer autonomy in regulating access to MRI scans as the biggest contributor to regional variation. Nevertheless, the statistical decomposition highlights that more than 70% of the regional variation remains unexplained by differences between the observable district characteristics. In the absence of epidemiological explanations, the substantial regional medical practice variation calls the efficiency of resource deployment into question.
    Keywords: blinder–Oaxaca decomposition; health policy; healthcare service utilization; magnetic resonance imaging; medical practice variation; Open access funding
    JEL: C33 H51 I18
    Date: 2021–08–01
  6. By: Costa-Font, Joan (London School of Economics); Vilaplana-Prieto, Cristina (Universidad de Murcia)
    Abstract: We study biased survival expectations across two domains and examine whether such biased expectations influence health and financial behaviors. Combining individual-level longitudinal data, retrospective, and end of life data from several European countries for more than a decade, we estimate time-varying individual level bias in 'survival expectations' (BSE) at the individual level and compare it biased 'meteorological expectations' (BME). We exploit variation in an individual's family history (parental age at death) to estimate the effect of BSE on health and financial behaviors and compare it to BME, and other tests to discuss whether the effect of BSE results from the effect of private information. We find that BSE increases the probability of adopting less risky behaviors and financial behaviors. We estimate that a one standard deviation increase in BSE reduces the average probability of smoking by 48% and holding retirement accounts by 69%. In contrast, BME barely affects healthy behaviors, and is only associated with a change in some financial behaviors.
    Keywords: biased expectations, survival expectations, meteorological expectations, longevity optimism, private information, health behaviour, financial behaviour
    JEL: I18 D14 G22
    Date: 2021–11
  7. By: Bindler, Anna (University of Gothenburg); Hjalmarsson, Randi (University of Gothenburg); Ketel, Nadine (Vrije Universiteit Amsterdam); Mitrut, Andreea (University of Gothenburg)
    Abstract: Many rights are conferred on Dutch youth at ages 16 and 18. Using national register data for all reported victimizations, we find sharp and discontinuous increases in victimization rates at these ages: about 13% for both genders at 16 and 9% (15%) for males (females) at 18. These results are comparable across subsamples (based on socio-economic and neighborhood characteristics) with different baseline victimization risks. We assess potential mechanisms using data on offense location, cross-cohort variation in the minimum legal drinking age driven by a 2014 reform, and survey data of alcohol/drug consumption and mobility behaviors. We conclude that the bundle of access to weak alcohol, bars/clubs and smoking increases victimization at 16 and that age 18 rights (hard alcohol, marijuana coffee shops) exacerbate this risk; vehicle access does not play an important role. Finally, we do not find systematic spillover effects onto individuals who have not yet received these rights.
    Keywords: victimization, crime, youth, youth protection laws, alcohol, inequality, RDD
    JEL: K42 K36 J13 I12 I14
    Date: 2021–12
  8. By: Maclean, Catherine; Pichler, Stefan; Ziebarth, Nicolas R.
    Abstract: This paper evaluates how sick pay mandates operate at the job level in the United States. Using the National Compensation Survey and difference-in-differences models, we estimate their impact on coverage rates, sick leave use, labor costs, and non-mandated fringe benefits. Sick pay mandates increase coverage significantly by 18 percentage points from a baseline level of 66% in the first two years. Newly covered employees take two additional sick days per year. We find little evidence that mandating sick pay crowds-out non-mandated fringe benefits. Finally, we develop a model of optimal sick pay provision and illustrate the trade-offs when assessing welfare.
    Keywords: sick pay mandates,take-up,social insurance,fringe benefits,moral hazard,unintended consequences,medical leave,National Compensation Survey,optimal social insurance,Baily-Chetty,welfare
    JEL: I12 I18 J22 J28 J32 J38 J88 H75
    Date: 2021
  9. By: Geyer, Johannes; Lorenz, Svenja; Zwick, Thomas; Bruns, Mona
    Abstract: Early retirement options are usually targeted at employees at risk of not reaching their regular retirement age in employment. An important at-risk group comprises employees who have worked in demanding jobs for many years. This group may be particularly negatively affected by the abolition of early retirement options. To measure differences in labor market reactions of employees in low- and high-demand jobs, we exploit the quasi-natural experiment of a cohort-specific pension reform that increased the early retirement age for women from 60 to 63 years. Based on a large administrative dataset, we use a regression-discontinuity approach to estimate the labor market reactions. Surprisingly, we find the same relative employment increase of about 25% for treated women who were exposed to low and to high job demand. For older women in demanding jobs, we also do not find substitution effects into unemployment, partial retirement, disability pension, or inactivity. Eligibility for the pension for women required highlabor market attachment; thus, we argue that this eligibility rule induced a positive selection of healthy workers into early retirement.
    Keywords: pension reform,job demand,early retirement,quasi-experimental variation
    JEL: J14 J18 J22 J26 H31
    Date: 2021
  10. By: Dolado, Juan J. (Universidad Carlos III de Madrid); Guerra, Airam (Universidad Carlos III de Madrid)
    Abstract: This paper investigates the roots of labour market discrimination underlying the negative correlation between body fat percentage and wages. Using a large panel dataset of individuals drawn from the 1997 National Longitudinal Survey of Youth (NLSY97) for the US, we test whether residual wage gaps (once observed differences in productivity related to obesity are controlled for) are due to prejudice (taste-based discrimination) or statistical discrimination. Our main contribution is to examine how these two types of discrimination hinge on a wide range of obese individuals' specific job and occupational characteristics (drawn from the O * Net Online database). Our analysis sheds light on whether discrimination originates from the attitudes of clients, fellow-workers or employers. We find strong empirical evidence supporting taste-based discrimination against obese females, especially as they become older, in jobs requiring frequent communication with either clients or employers. The evidence on this issue for males is weaker. These differences may be explained both by an over-representation of males among employers and different image concerns against people of the same gender.
    Keywords: obesity, wages, job characteristics, NLSY97, O*Net Online
    JEL: J71 J15 J31
    Date: 2021–12
  11. By: Casey B. Mulligan
    Abstract: This paper revisits Peltzman (1973) in light of two recent opportunities to quantitatively assess tradeoffs in drug regulation. First, reduced regulatory barriers to drug manufacturing associated with the 2017 reauthorization of Generic Drug User Fee Amendments were followed by significantly more entry and lower consumer prices for prescription drugs. Using a simple and versatile industry model and historical data on entry, I find that easing generic restrictions discourages innovation, but this welfare cost is more than offset by consumer benefits from enhanced competition, especially after 2016. Second, accelerated vaccine approval in 2020 had unprecedented net benefits as it not only improved health but substantially changed the trajectory of the wider economy. The evidence suggests that cost-benefit analysis of FDA regulation is incomplete without accounting for substitution toward potentially unsafe and ineffective treatments that are both outside FDA jurisdiction and heavily utilized prior to FDA approval. Moreover, the policy processes initiating these 21st century regulatory changes show a clear influence of Peltzman’s 1973 findings.
    JEL: I18 L51 L65 O31
    Date: 2021–12
  12. By: Ling Wang; Mei Choi Chiu; Hoi Ying Wong
    Abstract: This paper investigates the time-consistent mean-variance reinsurance-investment (RI) problem faced by life insurers. Inspired by recent findings that mortality rates exhibit long-range dependence (LRD), we examine the effect of LRD on RI strategies. We adopt the Volterra mortality model proposed in Wang et al.(2021) to incorporate LRD into the mortality rate process and describe insurance claims using a compound Poisson process with the intensity represented by stochastic mortality rate. Under the open-loop equilibrium mean-variance criterion, we derive explicit equilibrium RI controls and study the uniqueness of these controls in cases of constant and state-dependent risk aversion. We simultaneously resolve difficulties arising from unbounded non-Markovian parameters and sudden increases in the insurer's wealth process. We also use a numerical study to reveal the influence of LRD on equilibrium strategies.
    Date: 2021–12
  13. By: Reka Sundaram-Stukel
    Abstract: Abstract Aims: To re-introduce the Heckman model as a valid empirical technique in alcohol studies. Design: To estimate the determinants of problem drinking using a Heckman and a two-part estimation model. Psychological and neuro-scientific studies justify my underlying estimation assumptions and covariate exclusion restrictions. Higher order tests checking for multicollinearity validate the use of Heckman over the use of two-part estimation models. I discuss the generalizability of the two models in applied research. Settings and Participants: Two pooled national population surveys from 2016 and 2017 were used: the Behavioral Risk Factor Surveillance Survey (BRFS), and the National Survey of Drug Use and Health (NSDUH). Measurements: Participation in problem drinking and meeting the criteria for problem drinking. Findings: Both U.S. national surveys perform well with the Heckman model and pass all higher order tests. The Heckman model corrects for selection bias and reveals the direction of bias, where the two-part model does not. For example, the coefficients on age are upward biased and unemployment is downward biased in the two-part where the Heckman model does not have a selection bias. Covariate exclusion restrictions are sensitive to survey conditions and are contextually generalizable. Conclusions: The Heckman model can be used for alcohol (smoking studies as well) if the underlying estimation specification passes higher order tests for multicollinearity and the exclusion restrictions are justified with integrity for the data used. Its use is merit-worthy because it corrects for and reveals the direction and the magnitude of selection bias where the two-part does not.
    Date: 2021–12
  14. By: Christopher Rick (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Jeehee Han (Bush School of Government and Public Service, Texas A&M); Spencer Shanholtz (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Amy Ellen Schwartz (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244)
    Abstract: While advocates argue that gentrification changes the neighborhood food environment critical to children’s diet and health, we have little evidence documenting such changes or the consequences for their health outcomes. Using rich longitudinal, individual-level data on nearly 115,000 New York City children, including egocentric measures of their food environment and BMI, we examine the link between neighborhood demographic change (“gentrification”) and children’s access to restaurants and supermarkets and their weight outcomes. We find that children in rapidly gentrifying neighborhoods see increased access to fast food and wait-service restaurants and reduced access to corner stores and supermarkets compared to those in non-gentrifying areas. Boys and girls have higher BMI following gentrification, but only boys are more likely to be obese or overweight. We find public housing moderates the deleterious effect of gentrification on children’s weight outcomes, possibly due to different changes to the food environment.
    Keywords: Gentrification, Food Environment, Childhood Obesity, Public Housing
    Date: 2022–01
  15. By: Laffan, Kate; Sunstein, Cass; Dolan, Paul
    Abstract: Although there has been a proliferation of research and policy work into how nudges shape people's behaviour, most studies stop far short of consumer welfare analysis. In the current work, we critically reflect on recent efforts to provide insights into the consumer welfare impact of nudges using willingness to pay and subjective well-being reports and explore an unobtrusive approach that can speak to the immediate emotional impacts of a nudge: automatic facial expression coding. In an exploratory lab study, we use facial expression coding to assess the short-run emotional impact of being presented with calorie information about a popcorn snack in the context of a stylised ‘Cinema experience’. The results of the study indicate that calorie information has heterogeneous impacts on people's likelihood of choosing the snack and on the emotions they experience during the moment of choice which varies based on their level of health-consciousness. The information does not, however, affect the emotions people go on to experience while viewing movie clips, suggesting that the emotional effects of the information are short-lived. We conclude by emphasising the potential of automatic facial expression coding to provide new insights into the immediate emotional impacts of nudges and calling for further research into this promising technique.
    Keywords: nudging; emotions; automatic facial coding; calorie labelling; CUP deal
    JEL: L81
    Date: 2021–11–11
  16. By: Cobb-Clark, Deborah A. (University of Sydney); Dahmann, Sarah C. (University of Melbourne); Kamhöfer, Daniel A. (Düsseldorf Institute for Competition Economics (DICE)); Schildberg-Hörisch, Hannah (Heinrich Heine University Düsseldorf)
    Abstract: This study investigates the predictive power of self-control for individuals and their children using population representative data. We use the well-established Brief Self-Control Scale to demonstrate that people's trait self-control is highly predictive of their life outcomes. Higher self-control is associated with better health, education, and employment outcomes as well as greater financial and overall well-being. Importantly, self-control often adds explanatory power beyond more frequently studied personality traits and economic preferences. The self-control of children is correlated with that of their parents, while higher parental self-control is also linked to fewer behavioral problems among children. Our results suggest that social interventions targeting self-control may be beneficial.
    Keywords: Brief Self-Control Scale, personality traits, intergenerational transmission
    JEL: D91 D01 J24
    Date: 2021–12
  17. By: Omang O. Messono (University of Douala, Douala, Cameroon); Simplice A. Asongu (Yaoundé, Cameroon)
    Abstract: This study examines the effects of the historical prevalence of infectious diseases on contemporary entrepreneurship. Previous studies reveal the persistence of the effects of historical diseases on innovation, through the channel of culture. Drawing on the epidemiological origin of institutions, we propose a framework which argues that the impact of infectious disease prevalence on contemporary entrepreneurship is mediated by property rights. The central hypothesis posits that a guarantee of property rights reduces the effect of past diseases on entrepreneurship. Using data from 125 countries, we find strong and robust evidence on the proposed hypothesis and other results. Property rights are higher in countries where the prevalence of diseases was low, which leads to good entrepreneurship scores. In contrast, countries with high disease prevalence did not have time to develop strong institutions to secure property rights. This explains their low level of entrepreneurship today. These results are robust to alternative methods and measures of property rights. Furthermore, our results also confirm the level of development, culture and the digitalization of economies as transmission channels between past diseases and the current level of entrepreneurship.
    Keywords: entrepreneurship; institutions; diseases; property rights
    JEL: I0 J24 I21 I31
    Date: 2021–09
  18. By: Giorgio Chiovelli; Stelios Michalopoulos; Elias Papaioannou; Sandra Sequeira
    Abstract: We examine the impact of conflict-driven displacement on human capital. We focus on the Mozambican civil war (1977–1992), during which more than four million civilians fled to the countryside, cities, and refugee camps and settlements in neighboring countries. We leverage the full post-war census to compare siblings separated during the war, using those who stayed behind as a counterfactual to one’s displacement path. Uprooted children register higher investments in education. Second, we quantify the relative importance of place-based and displacement effects. The latter increases education and decreases attachment to agriculture by the same rate as being exposed to an environment approximately one standard deviation more developed than one’s birthplace. Third, we conduct a survey in Nampula, whose population doubled during the civil war. Those who fled to the city have significantly higher education than their siblings who remained in the countryside and they converged to the levels of schooling of non-mover urban-born individuals. However, those displaced exhibit significantly lower social/civic capital and have worse mental health, even three decades after the war. These findings reveal that displacement shocks can trigger human capital investments, breaking links with subsistence agriculture, but at the cost of long-lasting, social, and psychological traumas.
    JEL: J10 J15 J20 O1 O15 O18
    Date: 2021–12
  19. By: Fontrier, Anna-Maria; Visintin, Erica; Kanavos, Panos
    Abstract: Health technology assessment (HTA) systems across countries vary in the way they are set up, according to their role and based on how funding decisions are reached. Our objective was to study the characteristics of these systems and their likely impact on the funding of technologies undergoing HTA. Based on a literature review, we created a conceptual framework that captures key operating features of HTA systems. We used this framework to map current HTA activities across 32 countries in the European Union, the UK, Canada and Australia. Evidence was collected through a systematic search of competent authority websites and grey literature sources. Primary data collection through expert consultation validated our findings and further complemented the analysis. Sixty-three HTA bodies were identified. Most have a national scope (76%), are independent (73%), have an advisory role (52%), evaluate pharmaceuticals predominantly or exclusively (76%), assess health technologies based on their clinical and cost-effectiveness (73%) and involve various stakeholders as members of the HTA committee (94%) and/or through external consultation (76%). The majority of HTA outcomes are not legally binding (81%). Although all study countries implement HTA, the way it fits into decision-making, negotiation processes, and coverage and funding decisions differs significantly across countries. HTA is a dynamic and transformative process and there is a need for transparency to investigate whether evidence-based information influences coverage decisions.
    JEL: I10 I11 I18
    Date: 2021–11–29
  20. By: Javed, Rashid; Mughal, Mazhar
    Abstract: Using data from two representative Demographic and Health Surveys, we examine the change in son preference over the past three decades and its effects on Pakistani women’s fertility. We analyse a number of indicators and employ different empirical methods to come up with strong and persistent evidence for both the revealed and stated preference for sons. This disproportionate preference for boys is visible in increasing desired sex ratio and worsening sex ratio at last birth. Reliance over differential birth-stopping has significantly increased over time as couples are more likely to stop childbearing once the desired number of boys is achieved.
    Keywords: Son preference,Fertility,parity progression,Pakistan
    JEL: D13 J13 O15 C13 Z13
    Date: 2022
  21. By: Mitterling, Thomas (World Data Lab); Fenz, Katharina (World Data Lab); Martinez Jr, Arturo (Asian Development Bank); Bulan, Joseph (Asian Development Bank); Addawe, Mildred (Asian Development Bank); Durante, Ron Lester (Asian Development Bank); Martillan, Marymell (Asian Development Bank)
    Abstract: Granular spatial information on the distributions of human population is relevant to a variety of fields like health, economics, and other areas of public sector planning. This paper applies ensemble methods and aims at assessing their applicability to analyzing and forecasting population density on a grid level. In a first step, we use a Random Forest approach to estimate population density in the Philippines and Thailand on a 100 meter by 100-meter level. Second, we use different specifications of Random Forest and Bayesian model averaging techniques to create forecasts of the grid-level population density in three Thailand provinces and evaluate their predictive power.
    Keywords: population mapping; big data; random forest estimation; Philippines; Thailand
    JEL: C19 D30 O15
    Date: 2021–12–31
  22. By: Berta, Paolo (Università degli Studi di Milano-Bicocca); Bratti, Massimiliano (University of Milan); Fiorio, Carlo V. (University of Milan); Pisoni, Enrico (European Commission Joint Research Centre (JRC)); Verzillo, Stefano (European Commission Joint Research Centre (JRC))
    Abstract: Does the organisation of healthcare systems affect health outcomes in a pandemic situation? To answer this question, we analysed the effects of the Covid-19 pandemic by focusing on mortality rate outcomes and exploited the heterogeneity of the healthcare organisational models among Italian regions, which makes Italy an ideal "laboratory". Within a common national healthcare system, Italian regions are allowed large autonomy to organise themselves as mixed-markets based on choice and competition, network or centralised leadership models, each delivering different responses to the Covid-19 emergency. Exploiting the discontinuity of healthcare organisational models across the Italian regional borders around Lombardy — the region that most convincingly embraced the mixed-market model fostering competition among health service providers — we applied a difference in geographic regression discontinuity design (DiD-GRDD) to compare mortality rates in 2020 of Lombardy's municipalities with that of neighbouring municipalities in other regions and also exploited the pre-crisis period (2017-2019). Our analysis shows that mortality rates in Lombardy during the first wave were higher by 1-2 percentage points among the population of residents aged 80 years or more, compared to the past, as opposed to regions adopting different organisational models. The mortality rate differential disappeared during the second wave following the implementation of a national policy based on risk zones, limiting mobility and taking stock of the experience developed during the first wave. Finally, by investigating the channels causing higher mortality during the first wave, we show that the role of organisational model differences vanishes, as differential mortality is mostly explained by the decision of the Lombardy regional government to use care homes for hosting Covid-19 patients and reduce the excess demand on the hospital system.
    Keywords: COVID-19, mortality, administrative borders, regions, Italy
    JEL: I10 H12
    Date: 2021–12
  23. By: Virat Agrawal; Jonathan H. Cantor; Neeraj Sood; Christopher M. Whaley
    Abstract: The COVID-19 pandemic has led to a “second pandemic” of anxiety and depression. While vaccines are primarily aimed at reducing COVID-19 transmission and mortality risks, they may have important secondary benefits. We use data from U.S. Census Bureau’s Household Pulse Survey merged to state-level COVID-19 vaccination eligibility data to estimate the secondary benefits of COVID-19 vaccination on mental health outcomes. To address endogenous COVID-19 vaccination, we leverage state-level variation in the timing of when age groups are eligible for vaccination. We estimate that COVID-19 vaccination reduces anxiety and depression symptoms by nearly 30%. Nearly all the benefits are private benefits, and we find little evidence of spillover effects, that is, increases in community vaccination rates are not associated with improved anxiety or depression symptoms among the unvaccinated. We find that COVID-19 vaccination is associated with larger reductions in anxiety or depression symptoms among individuals with lower education levels, who rent their housing, who are not able to telework, and who have children in their household. The economic benefit of reductions in anxiety and depression are approximately $350 billion. Our results highlight an important, but understudied, secondary benefit of COVID-19 vaccinations.
    JEL: I1 I12
    Date: 2021–12
  24. By: Nie, Peng (Xi’an Jiaotong University); Wang, Lu (Xi’an Jiaotong University); Dragone, Davide (University of Bologna); Lu, Haiyang (Southwestern University of Finance and Economics); Sousa-Poza, Alfonso (University of Hohenheim); Ziebarth, Nicolas R. (Cornell University)
    Abstract: The health risks of the current COVID-19 pandemic, together with the drastic mitigation measures taken in many affected nations, pose an obvious threat to public mental health. The social science literature has already established a clear link between mental health and sociodemographic as well as economic factors, and a growing number of studies investigate the role of biased risk perceptions. To assess this role in the context of COVID-19, this study first implements survey-based measures of over- and underconfidence in the health self-perceptions among Chinese adults during the pandemic. Then, it analyzes their relation to three mental health outcomes: life satisfaction, happiness, and depression (as measured by the CES−D). We show that the health overconfidence displayed by approximately 30% of the survey respondents is a clear risk factor for mental health problems; it is a statistically significant predictor of depression and low levels of happiness and life satisfaction. We also document that these effects are stronger in regions that experienced higher numbers of confirmed COVID-19 cases and deaths. Recent research has shown that health overconfidence can influence risky behaviors such as smoking and excessive alcohol consumption, which may be particularly detrimental during a pandemic. Our results also offer clear guidelines for the implementation of effective interventions to temper overconfidence, particularly in uncontrollable situations like the COVID-19 pandemic.
    Keywords: health perception bias, overconfidence, underconfidence, mental health, China, COVID-19
    JEL: I12 I18 P46
    Date: 2021–12
  25. By: Konstantinos Angelopoulos; Spyridon Lazarakis; Rebecca Mancy; Max Schroeder
    Abstract: The main waves of a pandemic and subsequent disease outbreaks in the following years influence the evolution of the distributions of health and wealth, leading to differences in the ability to mitigate future income shocks. We study consumption smoothing and precautionary behaviour associated with the main pandemic waves and recurrent outbreak risk in a model in which health and wealth are jointly determined under income and health risk that are related to disease outbreak risk. We calibrate the model to the UK and find that the impact shock of COVID-19 and recurrent outbreak risk amplify existing inequalities in wealth and health, implying persistent increases in wealth inequality that are characterised by increases in wealth for households in higher income groups and/or with higher initial wealth, and decreases for those in lower income groups and/or with lower wealth. These changes lead to inequality in exposure to post-pandemic income risk and, in particular, an increase in the vulnerability of those already with very little wealth prior to the pandemic. We assess public insurance policy to mitigate income losses for those with low wealth and find that, by disincentivising wealth accumulation and incentivising investment in health for those with low wealth and health, it reduces health inequality and, in the short run, the probability of low consumption, but increases wealth inequality and, in the medium run, the probability of low consumption.
    Keywords: pandemics, outbreak risk, wealth inequality, health inequality, risk exposure
    JEL: E21 D31 I14 D15 E62
    Date: 2021
  26. By: Reka Sundaram-Stukel; Richard J Davidson
    Abstract: Background The COVID-19 pandemic has increased mental distress globally. The proportion of people reporting anxiety is 26%, and depression is 34% points. Disentangling associational and causal contributions of behavior, COVID-19 cases, and economic distress on mental distress will dictate different mitigation strategies to reduce long-term pandemic-related mental distress. Methods We use the Household Pulse Survey (HPS) April 2020 to February 2021 data to examine mental distress among U.S. citizens attributable to COVID-19. We combined HPS survey data with publicly available state-level weekly: COVID-19 case and death data from the Centers for Disease Control, public policies, and Apple and Google mobility data. Finally, we constructed economic and mental distress measures to estimate structural models with lag dependent variables to tease out public health policies' associational and causal path coefficients on economic and mental distress. Findings From April 2020 to February 2021, we found that anxiety and depression had steadily climbed in the U.S. By design, mobility restrictions primarily affected public health policies where businesses and restaurants absorbed the biggest hit. Period t-1 COVID-19 cases increased job loss by 4.1% and economic distress by 6.3% points in the same period. Job-loss and housing insecurity in t-1 increased period t mental distress by 29.1% and 32.7%, respectively. However, t-1 food insecurity decreased mental distress by 4.9% in time t. The pandemic-related potential causal path coefficient of period t-1 economic distress on period t depression is 57.8%, and anxiety is 55.9%. Thus, we show that period t-1 COVID-19 case information, behavior, and economic distress may be causally associated with pandemic related period t mental distress.
    Date: 2021–12
  27. By: Yana Roshchina (National Research University Higher School of Economics); Sergey Roshchin (National Research University Higher School of Economics); Ksenia Rozhkova (National Research University Higher School of Economics)
    Abstract: Vaccination is the main tool available to handle the COVID-19 pandemic globally. Though no vaccine is proven to be 100% effective, vaccination secures against getting seriously ill and dying from the disease. Russia announced the development of its first domestic vaccine back in August 2020 and launched the nationwide immunization campaign at the beginning of 2021. Despite these achievements, as for mid-October 2021, only 36% of the population got at least one shot of the vaccine. Massive vaccination hesitancy and refusal pose a great threat to public health and postpone social and economic recovery. Using nationally representative data from the general adult population of Russia, this study explores the scope of vaccination hesitancy and refusal as well as the determinants of vaccination attitudes. The results suggest that only 45% of Russian population demonstrated positive attitudes towards COVID-19 vaccination prior the launch of nationwide vaccination. We analyze a wide array of demographic, socio-economic, and health-related factors in relation to vaccination intentions. We also explore the deep-rooted causes of vaccination reluctance by looking at personality traits, religiosity, and trust. The obtained results are vital for designing policy measures to promote vaccination as a “fourth wave” of COVID-19 in Russia is currently progressing.
    Keywords: COVID-19; coronavirus; vaccination attitudes; vaccination hesitancy; vaccination resistance; risk attitudes; personality traits; Russia
    JEL: I11 I12
    Date: 2021
  28. By: Kristiaan Kerstens (LEM - Lille économie management - UMR 9221 - UA - Université d'Artois - UCL - Université catholique de Lille - Université de Lille - CNRS - Centre National de la Recherche Scientifique); Zhiyang Shen
    Abstract: This contribution defines short- and long-run output- and input-oriented plant capacity measures and evaluates them relative to convex and nonconvex technologies. By applying these different plant capacity concepts, the authors seek to measure the use of existing capacities, as well as the evolution and build-up of extra hospital capacity in the Chinese province of Hubei during the outbreak of the COVID-19 epidemic in early 2020. Furthermore, medical literature has established that mortality rates increase with high capacity utilization rates, an insight that this study leverages to select the most plausible of eight plant capacity concepts. The preliminary results indicate that a relatively new, input-oriented plant capacity concept correlates best with mortality.
    Keywords: Data envelopment analysis,Free disposal hull,Efficiency,Plant capacity utilization,Mortality
    Date: 2021–05
  29. By: Fleming, Jenny; Brown, Jennifer
    Abstract: Policing is a high-stress occupation requiring emotional management when facing job-related violence, threats to safety and well-being, work-life disruption, and unpredictable hours. A national health pandemic coupled with public order and restraint imperatives has compounded the levels of stress in policing. In the UK, new working patterns have been negotiated to manage the constraints of a different working environment during COVID-19. Using a self-administered survey, this article explores the experiences of 473 female police officers working during the first lockdown in 2020. The article shows that the COVID-19 preventative measures forced police services to navigate new and varied working patterns for their employees. Previous resistance to flexible working practices in policing was put aside as police services sought to manage the virus in its own ranks as well as policing the public. Preliminary findings suggest that officers working from home were more likely to feel satisfied with management responses compared with those working on the front line, although negative attitudes from colleagues and management towards those working from home were present. Those not working from home reported higher levels of stress related to their Force's lack of communication with them about their welfare.
    Keywords: Covid-19; coronavirus
    JEL: R14 J01
    Date: 2021–09–01
  30. By: Maani, Sholeh A. (University of Auckland)
    Abstract: The Covid-19 pandemic caused major shifts in the operation and fortunes of several industries within New Zealand, including an immediate impact on the workforce. In this setting, the combined epidemiological and economic responses of the government, businesses and the general public played a significant role in the health of, and the provision of basic necessities to, the population, maintaining the viability of the economy despite lockdowns. Indeed, New Zealand's combination of policy responses resulted in one of the world's lowest death rates, while the economy's economic loss was on a par with the European countries. Policy responses to workforce disruptions included the swift designation of essential service workers, a government-sponsored wage subsidy scheme and the facilitation of remote work and digital commerce, which allowed uninterrupted operations for many businesses and public sector agencies. This paper discusses the changes in the business environment in New Zealand from an economics perspective, and the special elements of the government's policy response to the Covid-19 pandemic.
    Keywords: COVID-19, economic impact, labour market, remote work, essential workers, wage subsidy
    JEL: H12 J18 J10 D7 D78 H25 I30 I31
    Date: 2021–12
  31. By: Mr. Niels-Jakob H Hansen; Rui C. Mano
    Abstract: We quantify the effect of vaccinations on economic activity in the United States using weekly county level data covering the period end-2020 to mid-2021. Causal effects are identified through instrumenting vaccination rates with county-level pharmacy density interacted with state-level vaccine allocations, and by including county and state-time fixed effects to control for unobserved factors. We find that vaccinations are a significant and substantial shot in the arm of the economy. Specifically, an increase of initiated vaccination rates of 1 percentage point increases weekly consumer spending by 0.6 percent and reduces weekly initial unemployment claims by 0.004 percentage points of the 2019 labor force. Vaccinations also increase workrelated mobility. Importantly, we find that the effects vary with county characteristics. Specifically, urban counties and counties with initially worse socioeconomic conditions and lower education levels exhibit larger effects of vaccinations. This way, vaccinations are also a fair shot in the arm for the economy, which highlights that equitable distribution of vaccines is important to reduce inequality. Our results are specific to the United States, but hold important lessons for the expected economic impact of vaccinations in other countries.
    Keywords: COVID-19; pandemics; vaccinations.
    Date: 2021–12–03

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