nep-hea New Economics Papers
on Health Economics
Issue of 2022‒01‒31
35 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. 40 Years of Dutch Disease Literature: Lessons for Developing Countries By M Goujon; Edouard Mien
  2. US Presidential Party Switches Are Mirrored in Global Maternal Mortality By Bhalotra, Sonia R.; Clarke, Damian; Mühlrad, Hanna; Fernandez Sierra, Manuel
  3. Estimating the Effects of Milk Inspections on Infant and Child Mortality, 1880-1910 By D. Mark Anderson; Kerwin Kofi Charles; Michael McKelligott; Daniel I. Rees
  4. Physician Group Influences on Treatment Intensity and Health: Evidence from Physician Switchers By Joseph J. Doyle Jr.; Becky Staiger
  5. Testing for Ethnic Discrimination in Outpatient Health Care: Evidence from a Field Experiment in Germany By Martin Halla; Christopher Kah; Rupert Sausgruber
  6. Age Penalties and Take-up of Private Health Insurance By Kettlewell, Nathan; Zhang, Yuting
  7. Behavioral Responses to Supply-Side Drug Policy During the Opioid Epidemic By Simone Balestra; Helge Liebert; Nicole Maestas; Tisamarie B. Sherry
  8. Does Physician-Hospital Vertical Integration Signal Care-Coordination? Evidence from Mover-Stayer Analyses of Commercially Insured Enrollees By William Encinosa; Avi Dor; PhuongGiang Nguyen
  9. Which characteristics of working conditions affect employee recognition? Case study of a French teaching hospital By Christophe Baret; Isabelle Recotillet; Cathel Kornig
  10. Joint Retirement: Evidence on the Heterogeneity of Spousal Effects By Sefane Cetin
  11. Evaluating Marginal Internalities: A New Approach By Zarko Kalamov
  12. Run Effects of Military Service: Evidence from the 911 Attacks By John Anders; Craig Wesley Carpenter
  13. Does Self-Assessed Health Reflect the True Health State? By Pavitra Paul; Ulrich Nguemdjo; Natalia Kovtun; Bruno Ventelou
  14. Gender Norms and the Motherhood Employment Gap By Simone Moriconi; Núria Rodriguez-Planas
  15. Inequality in mortality between Black and White Americans by age, place, and cause and in comparison to Europe, 1990 to 2018 By Hannes Schwandt; Janet Currie; Marlies Bär; James Banks; Paola Bertoli; Aline Bütikofer; Sarah Cattan; Beatrice Zong-Ying Chao; Claudia Costa; Libertad González; Veronica Grembi; Kristiina Huttunen; René Karadakic; Lucy Kraftman; Sonya Krutikova; Stefano Lombardi; Peter Redler; Carlos Riumallo-Herl; Ana Rodríguez-González; Kjell Salvanes; Paula Santana; Josselin Thuilliez; Eddy van Doorslaer; Tom van Ourti; Joachim Winter; Bram Wouterse; Amelie Wuppermann
  16. Fuel prices and road deaths: motorcyclists are different By Tong Zhang; Paul J. Burke
  17. A GMM Approach for Non-monotone Missingness on Both Treatment and Outcome Variables By Shenshen Yang
  18. What underlies the observed hospital volume- outcome relationship? By Marius Huguet; Xavier Joutard; Isabelle Ray-Coquard; Lionel Perrier
  19. Managing Dual Practice of Health Workers: Evidence from Indonesia By Gonzalez, Paula; Montes-Rojas, Gabriel V.; Pal, Sarmistha
  20. Cash transfers and the mental health of young people: evidence from South Africa's child support grant By Garman, E.c.; Eyal, K.; Avendano, M.; Evans-lacko, S.; Lund, C.
  21. TRIPS to Where? A Narrative Review of the Empirical Literature on Intellectual Property Licensing Models to Promote Global Diffusion of Essential Medicines By Shiri Mermelstein; Hilde Stevens
  22. How Does Migration Affect Under-5 Mortality in Rural Areas? Evidence from Niakhar, Senegal By Ulrich Nguemdjo; Bruno Ventelou
  23. Ten years of research on psychosocial risks, health, and performance in Latin America: A comprehensive systematic review and research agenda By Pujol-Cols, Lucas J.; Lazzaro-Salazar, Mariana
  24. Intrahousehold Responses to Imbalanced Human Capital Subsidies: Evidence from the Philippine Conditional Cash Transfer Program By Raitzer, David; Batmunkh, Odbayar; Yarcia, Damaris
  25. Willingness to Pay for Workplace Safety By Anelli, Massimo; Koenig, Felix
  26. Online study of health professionals about their vaccination attitudes and behavior in the COVID-19 era: addressing participation bias By Pierre Verger; Dimitri Scronias; Yves Fradier; Malika Meziani; Bruno Ventelou
  27. COVID-19 and the Forces behind Social Unrest By Lackner, Mario; Sunde, Uwe; Winter-Ebmer, Rudolf
  28. Changes of Social Networks during the Covid-19 Pandemic: Who is affected and what are its Consequences for Psychological Strain? By Bertogg, Ariane; Koos, Sebastian
  29. Working more and less hours, profiling old European workers during first wave of COVID-19 pandemic, evidence from SHARE data By Tavares, Aida Isabel
  30. Premature deaths, accidental bequests and fairness By Marc Fleurbaey; Marie-Louise Leroux; Pierre Pestieau; Gregory Ponthiere; Stéphane Zuber
  31. The COVID-19 Pandemic Disrupted Both School Bullying and Cyberbullying By Andrew Bacher-Hicks; Joshua Goodman; Jennifer G. Green; Melissa Holt
  32. Labour demand in the UK during the COVID-19 pandemic : evidence from online job postings By Vacha, Stepan
  33. SMEs Amidst the Pandemic and Reopening: Digital Edge and Transformation By Cong, Lin William; Yang, Xiaohan; Zhang, Xiaobo
  34. A Year of Pandemic: Levels, Changes and Validity of Well-Being Data from Twitter. Evidence from Ten Countries By Sarracino, Francesco; Greyling, Talita; O'Connor, Kelsey J.; Peroni, Chiara; Rossouw, Stephanié
  35. Labor Reallocation and Remote Work During COVID-19: Real-time Evidence from GitHub By Grant R. McDermott; Benjamin Hansen

  1. By: M Goujon (CERDI - Centre d'Études et de Recherches sur le Développement International - UCA [2017-2020] - Université Clermont Auvergne [2017-2020] - CNRS - Centre National de la Recherche Scientifique); Edouard Mien (CERDI - Centre d'Études et de Recherches sur le Développement International - CNRS - Centre National de la Recherche Scientifique - UCA - Université Clermont Auvergne)
    Abstract: This paper surveys the "Dutch disease" literature in developing and emerging countries. It describes the original model of Dutch disease and some main extensions proposed in the theoretical literature, focusing on the ones that match developing countries' conditions. It then reviews various empirical studies that have been conducted and provides evidence that the Dutch disease is still an issue for many developing countries. Finally, it discusses the gaps in the theoretical and empirical literature for understanding the suitable policy instruments to cope with Dutch disease.
    Keywords: Real exchange rate. JEL Codes: O13 • O14 • Q32 • Q33,Resource curse,Structural transformations,Natural resources,Dutch disease
    Date: 2021–11–23
  2. By: Bhalotra, Sonia R. (University of Warwick); Clarke, Damian (University of Chile); Mühlrad, Hanna (IFN - Research Institute of Industrial Economics); Fernandez Sierra, Manuel (Universidad de los Andes)
    Abstract: We provide estimates of impacts on maternal mortality of swings in US aid for family planning and maternal health driven by switches in implementation of the Global Gag Rule (GGR) with US Presidential Party. The GGR is a pro-life policy that prohibits aid to overseas non-governmental organisations (NGOs) if they offer abortion-related information or services (1). Since first implemented by President Reagan in 1984, it has been enacted under every Republican and revoked under every Democrat. It was tightened under President Trump and will very likely be rescinded under President Biden on January 21, 2021. Using data for 1985-2019, we demonstrate that aid for family planning has been 48% higher under Democratic presidential regimes. We estimate that a switch from Democratic to Republican party, for a country with above-median reliance on US family planning aid, is associated with an additional 0.6 deaths per 1,000 women, an increase of 8%. This erodes a fifth of the average worldwide decline in maternal mortality achieved since 1990.
    Keywords: US Presidential Party, overseas aid, maternal mortality, global gag rule, abortion
    JEL: I18 J13
    Date: 2021–12
  3. By: D. Mark Anderson; Kerwin Kofi Charles; Michael McKelligott; Daniel I. Rees
    Abstract: In the mid-19th century, the urban milk supply in the United States was regularly skimmed or diluted with water, reducing its nutritional value. At the urging of public health experts, cities across the country hired milk inspectors, who were tasked with collecting and analyzing milk samples with the goal of preventing adulteration and skimming. Using city-level data for the period 1880-1910, we explore the effects of milk inspections on infant mortality and mortality among children under the age of 5. Event-study estimates are small and statistically insignificant, providing little evidence of post-treatment reductions in either infant or child mortality.
    JEL: I18 J1 N31
    Date: 2021–12
  4. By: Joseph J. Doyle Jr.; Becky Staiger
    Abstract: Treatment intensity varies remarkably across physicians, yet the key drivers are not well understood. Meanwhile, the organization of healthcare is undergoing a secular transformation as physicians increasingly work in groups. This paper tests whether physicians' group affiliation matters for practice styles and patient health. Using Medicare inpatient claims data, we compare these outcomes before and after physicians switch between groups of varying treatment intensity while remaining in the same hospital to control for practice setting. Event studies show that internists who join more-intensive groups immediately increase their own treatment intensity, with an elasticity of approximately 0.3; the opposite is found for internists who switch to groups that are less intensive. This change in Medicare spending largely stems from greater quantities of care provided, with some evidence of a change in coding behavior. We do not detect a change in health outcomes, suggesting that treatment intensity induced by group affiliation may not be productive.
    JEL: I10
    Date: 2021–12
  5. By: Martin Halla (Johannes Kepler University Linz); Christopher Kah (Mercedes-Benz AG); Rupert Sausgruber (Department of Economics, Vienna University of Economics and Business)
    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: 2021–12
  6. By: Kettlewell, Nathan (University of Technology, Sydney); Zhang, Yuting (University of Melbourne)
    Abstract: Penalty mandates are used in many countries to encourage people to purchase health insurance. But are they effective? We use a large administrative dataset for a 10% random sample of all Australian tax-filers to study how people respond to a step-wise age-based mandate, and whether this has changed over time. The mandate creates discontinuities in the incentive to insure by age, which we exploit to estimate causal effects. People who do not insure before the penalty dates face higher premiums in the future, which should encourage them to bring forward purchases. We find that people respond as expected to the initial age-penalty, but not to subsequent penalties. The 2% premium loading results in a 1-4% increase in take-up, with effects increasing after an annual government letter campaign that reminds people approaching the penalty deadline about the policy. We discuss the impact of the mandate on the overall efficiency of the market, and implications of potential reforms.
    Keywords: health insurance, age-based mandate, regression discontinuity, Australia
    JEL: I13 I18 I12
    Date: 2021–11
  7. By: Simone Balestra; Helge Liebert; Nicole Maestas; Tisamarie B. Sherry
    Abstract: We investigate behavioral responses to a staggered disruption in the supply of prescription opioids across U.S. states: the introduction of electronic Prescription Drug Monitoring Programs (PDMPs). Using administrative datasets, we find PDMPs curtail the proliferation of prescription opioids. Physicians respond to monitoring on the extensive margin, limiting the number of patients to whom they prescribe opioids without adjusting dosage or duration. This decreases supply to long-term opioid users, who evade the restrictions by acquiring prescriptions from out-of-state prescribers and by substituting to heroin. This causes a surge in heroin overdoses, which offsets reductions in hospitalizations and deaths from prescription opioids.
    JEL: I12 I18
    Date: 2021–12
  8. By: William Encinosa; Avi Dor; PhuongGiang Nguyen
    Abstract: We examine the impacts of physician-hospital integration on care fragmentation and other measures of care-coordination using a dynamic model of movers and stayers in commercially insured plans. Although recent growth in the share of practicing physicians belonging to these vertical organizations has sparked considerable policy debate, there is a paucity of evidence on the merits of vertical integration in the private segment of the market. We fill the gap by focusing on care-coordination in the relatively open plans that dominate commercial insurance, namely Preferred Provider Organizations (PPOs). We exploit the fact that physician-hospital integration levels vary dramatically across MSA and focus on orthogonal employment-based transfers for identification. We track 415,000 beneficiaries with 17 million claims between 2010 and 2016. We find that standard two-way fixed effect mover-stayer models produce biased estimates since there are heterogeneous effects of integration. Extending the dynamic event study design of Sun and Abraham (2021) to mover-stayer analyses, we are able to avoid these biases. We find that a move from the 10th to 90th percentile of physician integration level causes a 20% relative decrease in a care fragmentation index; similar declines are found in independent markers of fragmentation such as use of out-of-network and single-service facilities. Vertical integration of either primary care physicians or specialists reduced fragmentation significantly. However, only vertical integration of specialists led to significant reductions in medical spending. Our results are robust when adjusting for moves associated with alternative contractual arrangements among providers that do not require outright ownership.
    JEL: I11 L11
    Date: 2021–12
  9. By: Christophe Baret (LEST - Laboratoire d'économie et de sociologie du travail - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique); Isabelle Recotillet (LEST - Laboratoire d'économie et de sociologie du travail - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique); Cathel Kornig (LEST - Laboratoire d'économie et de sociologie du travail - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique)
    Abstract: In France, hospital employees have, for several years, denounced deteriorating working conditions resulting from budgetary restrictions, labour shortages and increased demands for quality of care. At the same time, many health professions ask for more recognition of their qualifications and activities. Can we highlight the link between working conditions and employee recognition ? The concept of workplace recognition has recently emerged in managerial literature. The work undertaken aims to clarify this multi-dimensional concept and to assess its impact on employee behaviour within the organisation. There are few studies that address factors in the need for recognition. Changes in working conditions have been addressed but are not based on empirical results. In this study, we explore four hypotheses on the relationships between certain aspects of workplace conditions and the forms of recognition. We processed 3112 questionnaires at a French university hospital in 2018. The findings indicate that doctors, health care personnel and medical technicians feel the most unrecognised. The primary deficiency is recognition of investment in labour. Executive management is not seen as a source of recognition. It also appears that working conditions exert a similar influence on all forms of recognition. Independence in the workplace, managerial support and resources to perform the work are characteristic of working conditions with the most positive influence on employee recognition.
    Date: 2020–12–04
  10. By: Sefane Cetin (UNIVERSITE CATHOLIQUE DE LOUVAIN, Center for Operations Research and Econometrics (CORE))
    Abstract: Evidence abounds to suggest the existence of retirement spillovers among spouses. Using the Survey of Health and Retirement in Europe (SHARE), this paper not only confirms the existence of joint retirement behavior among dual-worker couples around Europe, but also shows that the intensity of retirement coordination varies a lot. The results of the paper are essentially five fold. First, among spouses there is a gender asymmetry: wives are more likely to be influenced by their husbands' decision to retire. Second, a higher labour market attachment (proxied by education, income quartile or self reported quality of work) translates into a lower propensity of retirement coordination. Especially, for men who belong to the highest income quartile or education level there is absence of joint retirement. Third, being a secondary earner increases the propensity of retirement coordination. Fourth, higher age differences between couples generally reduces joint retirement, but in interaction with eligibility rules. Five, there is evidence on the enhancing role of converging preferences in terms of activities practiced by both partners, whereas convergence in philosophical views or personality traits do not have any significant effect. Among the traditionally discussed determinants of joint retirement, leisure complementarities are important for couples' retirement incentives, nevertheless, they are mostly dominated by income effect and feasibility of joint retirement (eligibility for both partners to retire).
    Keywords: Retirement, pensions, labour supply of couples
    JEL: C23 C26 D10 H31 J14 J16 J26
    Date: 2021–12–22
  11. By: Zarko Kalamov
    Abstract: This paper develops a new sufficient statistic approach for estimating the marginal internality from sin good consumption. It models a biased consumer who faces uncertain health harms and receives mandatory health insurance. I show that the marginal internality can be identified by observing how sin good demand reacts to changes in health insurance coverage. The method does not require to recover the true willingness to pay for the sin good or to elicit consumers’ biases using surveys. I calibrate the model to sugary drinks consumption. My results are consistent with studies that use survey-based measures of biases.
    Keywords: marginal internality, self-control, biased beliefs
    JEL: D11 D62 H21 H31 I12 I13 I18
    Date: 2021
  12. By: John Anders; Craig Wesley Carpenter
    Abstract: We investigate the effect of military service on labor market, health and family formation outcomes, leveraging differential changes in enlistment rates brought about by the September 11th attacks (911). Using restricted microdata, we identify hundreds of “high service" counties in which certain birth-county cohorts exhibit large enlistment responses to 911. We find that individuals born into high service counties between 1977 and 1983 (aged 18-24 at the time of the attack), enlisted at nearly twice the rate of earlier birth cohorts (older than 24 at the time of the attack). These high service birth-county cohorts experienced a 10% increase in wages, decreased unemployment and impacts on other labor market measures as well as key household formation measures including marriage and fertility. We also find increases in the hospitalization and mortality rates. Labor market benefits outweigh mortality costs at standard discount rates.
    Date: 2021–11
  13. By: Pavitra Paul (CNRS, UMIFRE 20 CSH, CNRS-MAE - Partenaires INRAE, Yerevan State Medical University); Ulrich Nguemdjo (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université, LPED - Laboratoire Population-Environnement-Développement - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université); Natalia Kovtun (Taras Shevchenko National University of Kyiv); Bruno Ventelou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université)
    Abstract: Self-assessed health (SAH) is a widely used tool to estimate population health. However, the debate continues as to what exactly this ubiquitous measure of social science research means for policy conclusions. This study is aimed at understanding the tenability of the construct of SAH by simultaneously modelling SAH and clinical morbidity. Using data from 17 waves (2001–2017) of the Russian Longitudinal Monitoring Survey, which captures repeated response for SAH and frequently updates information on clinical morbidity, we operationalise a recursive semi-ordered probit model. Our approach allows for the estimation of the distributional effect of clinical morbidity on perceived health. This study establishes the superiority of inferences from the recursive model. We illustrated the model use for examining the endogeneity problem of perceived health for SAH, contributing to population health research and public policy development, in particular, towards the organisation of health systems.
    Keywords: clinical morbidity,endogeneity,perceived health,recursive,semi-ordered,Russia
    Date: 2021–11
  14. By: Simone Moriconi; Núria Rodriguez-Planas
    Abstract: Using individual-level data from the European Social Survey, we study the relevance of gender norms in accounting for the motherhood employment gap across 186 European NUTS2 regions (over 29 countries) for the 2002-2016 period. The gender norm variable is taken from a question on whether “men should have more right to a job than women when jobs are scarce” and represents the average extent of disagreement (on a scale 1 to 5) of women belonging to the “grandmothers” cohort. We address the potential endogeneity of our gender norms measure with an index of the degree of reproductive health liberalization when grandmothers were 20 years old. We also account for the endogeneity of motherhood with the level of reproductive health liberalization when mothers were 20 years old. We find a robust positive association between progressive beliefs among the grandmothers’ cohort and mothers’ likelihood to work while having a small child (0 to 5 years old) relative to similar women without children. No similar association is found among men. Our analysis underscores the role of gender norms and maternal employment, suggesting that non-traditional gender norms mediate on the employment gender gap mainly via motherhood.
    Keywords: gender norms, motherhood employment gap, instrumenting for motherhood
    JEL: J16 J22
    Date: 2021
  15. By: Hannes Schwandt; Janet Currie; Marlies Bär; James Banks; Paola Bertoli; Aline Bütikofer; Sarah Cattan; Beatrice Zong-Ying Chao; Claudia Costa; Libertad González; Veronica Grembi; Kristiina Huttunen; René Karadakic; Lucy Kraftman; Sonya Krutikova; Stefano Lombardi; Peter Redler; Carlos Riumallo-Herl; Ana Rodríguez-González; Kjell Salvanes; Paula Santana; Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique); Eddy van Doorslaer; Tom van Ourti; Joachim Winter; Bram Wouterse; Amelie Wuppermann
    Abstract: Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990 and 2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in high- and low-income US areas and with reference to six European countries. Inequalities in life expectancy are starker in the United States than in Europe. In 1990, White Americans and Europeans in high-income areas had similar overall life expectancy, while life expectancy for White Americans in low-income areas was lower. However, since then, even high-income White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%. Black American life expectancy increased more than White American life expectancy in all US areas, but improvements in lower-income areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black Americans' mortality reductions included cancer, homicide, HIV, and causes originating in the fetal or infant period. Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both high-income and low-income areas.
    Date: 2021–09–28
  16. By: Tong Zhang; Paul J. Burke
    Abstract: This study estimates the effect of gasoline prices on road deaths by vehicle mode using annual data for 62 countries for 2000–2018 and all states of the United States (US) for 1998–2018. Higher gasoline prices are associated with fewer overall road deaths. The proportional effect on motorcyclist deaths tends to be smaller or even have the opposite sign, especially in countries that are not highly dependent on motorcycles. For the US, a positive effect of gasoline prices on motorcyclist deaths is found, with an elasticity of about 0.3. There is also a positive relationship between gasoline prices and motorcycle registrations in the US. The results confirm that additional attention towards motorcyclist safety is warranted in times of high fuel prices.
    Keywords: fuel price, road deaths, motorcyclist deaths, fuel efficient
    JEL: R41 H23 Q43
    Date: 2021–09
  17. By: Shenshen Yang
    Abstract: I examine the common problem of multiple missingness on both the endogenous treatment and outcome variables. Two types of dependence assumptions for missing mechanisms are proposed for identification, based on which a two-step AIPW GMM estimator is proposed. This estimator is unbiased and more efficient than the previously used estimation methods. Statistical properties are discussed case by case. This method is applied to the Oregon Health Insurance Experiment and shows the significant effects of enrolling in the Oregon Health Plan on improving health-related outcomes and reducing out-of-pocket costs for medical care. There is evidence that simply dropping the incomplete data creates downward biases for some of the chosen outcome variables. Moreover, the estimator proposed in this paper reduced standard errors by 6-24% of the estimated effects of the Oregon Health Plan.
    Date: 2022–01
  18. By: Marius Huguet (UL2 - Université Lumière - Lyon 2, GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - CNRS - Centre National de la Recherche Scientifique - Université de Lyon - UJM - Université Jean Monnet [Saint-Étienne] - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UL2 - Université Lumière - Lyon 2 - ENS Lyon - École normale supérieure - Lyon); Xavier Joutard (LEST - Laboratoire d'économie et de sociologie du travail - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique, OFCE - Observatoire français des conjonctures économiques - Sciences Po - Sciences Po); Isabelle Ray-Coquard (Centre Léon Bérard [Lyon]); Lionel Perrier (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - CNRS - Centre National de la Recherche Scientifique - Université de Lyon - UJM - Université Jean Monnet [Saint-Étienne] - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UL2 - Université Lumière - Lyon 2 - ENS Lyon - École normale supérieure - Lyon, Centre Léon Bérard [Lyon])
    Abstract: Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.
    Keywords: Learning effect,Centralization of care,Volume outcome relationship,France,Epithelial Ovarian Cancer,Instrumental variable,Organization of care,Care pathway
    Date: 2021
  19. By: Gonzalez, Paula (Universidad Pablo de Olavide); Montes-Rojas, Gabriel V. (University of Buenos Aires); Pal, Sarmistha (University of Surrey)
    Abstract: Managing dual practice of health workers has often proved to be challenging, especially in emerging countries characterized by weak monitoring and low motivation. This paper exploits an exogenous variation in the initiation of private practice among heads of local public facilities (known as puskesmas) providing primary health care after the introduction of a 1997 health regulation in Indonesia. This regulation required health professionals to apply for a license for private practice at least three years after their graduation. Exploiting the exogenous variation in private practice after the 1997 regulation, we provide estimates of causal effects of dual practice on provision of public health services, distinguishing between the effects when private practice is located at or away from the public hospital. The estimates suggest that dual practitioners (relative to those engaged in public service only) work significantly less hours per week while they see significantly more patients in their public facilities. These adverse effects of dual practice are most pronounced when private practice is held away from the puskesmas. These results have important bearings on human resource management of universal health care provision.
    Keywords: dual practice of health professionals, Indonesia, Ministry of Health regulation 916, weak monitoring, difference-in-differences
    JEL: I10 I18 J2 J44 J45 O1
    Date: 2021–11
  20. By: Garman, E.c.; Eyal, K.; Avendano, M.; Evans-lacko, S.; Lund, C.
    Abstract: This study examines the longitudinal impact of the South African Child Support Grant (CSG) on risk for depression and life satisfaction among young people (15–19 years). We analysed data from the last three waves of the National Income Dynamics Study (NIDS), a nationally representative panel survey that took place every two years from 2008 to 2017. We used an instrumental variable (IV) approach that exploits multiple changes in age eligibility from 1998 to 2012. Depressive symptoms were assessed using an 8-item version of the Centre for Epidemiological Studies Depression Scale; participants who scored above 8 were considered at risk for depression. Life satisfaction was rated on a scale of 1 (‘very dissatisfied’) to 10 (‘very satisfied’); participants who scored 8 or above were classified as satisfied. We also examined impacts on educational deficit (≥2 years behind) and not being in education, employment or training (NEET) as secondary outcomes, as these are also important for mental health. Age eligibility strongly predicted CSG receipt at Wave 3. In instrumental variable models, CSG receipt did not influence the risk for depression (β = 0.10, SE = 0.10, p = 0.316), nor life satisfaction (β = −0.07, SE = 0.09, p = 0.420) at Wave 3, nor at Waves 4 or 5. Some improvements in educational deficit were observed at Wave 3 among CSG beneficiaries compared to non-beneficiaries. These results were robust to multiple specifications. CSG receipt did not improve the psychological wellbeing of adolescents and young adults, nor did it improve their education or employment outcomes. Our findings highlight the need to identify alternative social policies that address the root causes of youth social disadvantage, in conjunction with targeted approaches to improve the mental health of young South Africans living in poverty.
    Keywords: youth; mental health; education; cash transfer; South Africa; poverty; social protection; LMICs; ES/S001050/1; Mauricio Avendano is also funded by the ESRC (ES/S012567/1)
    JEL: E6
    Date: 2022–01–01
  21. By: Shiri Mermelstein; Hilde Stevens
    Abstract: Governed through the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) since 1995, the current medical R&D system requires significant trade-offs between innovation and high monopoly prices for patented drugs that restrict patient access to medicines. Since its implementation, few amendments have been made to the original TRIPS agreement to allow low- and middle-income countries (LMICs) to facilitate access by generic manufacturers through flexible provisions, such as compulsory licensing and parallel import. Although a useful policy tool in theory, the routine use of TRIPS flexibilities in LMICs in the procurement of new essential medicines (EMs) is regarded as a ‘last resort’ due to strong political response in high-income countries (HICs) and new trade agreements’ restrictions. In this context, access-oriented biomedical Public-Private Partnerships (PPPs) have emerged. More recently, leading multilateral health organizations have recommended different types of intellectual property (IP) interventions, voluntary biomedical patent pools, as strategies to reduce prices and increase the diffusion of novel EMs in LMICs. Nevertheless, the recent Ebola and COVID-19 outbreaks highlight growing concerns regarding the use of TRIPS flexibilities and the limited success of voluntary mechanisms in promoting access to medicines in the Global South amidst health crises. This review aims at describing the state-of-the-art empirical research on IP-related options and voluntary mechanisms applied by emerging PPPs to guarantee timely and affordable access to EM in LMICs and reflect on both models as access paradigms. Some suggestions are put forward for future research paths on the basis of these analyses and in response to contemporary debates on waiving key IP rights on COVID-19 therapies, diagnostics, and vaccines.
    Date: 2022–01
  22. By: Ulrich Nguemdjo (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique, LPED - Laboratoire Population-Environnement-Développement - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université); Bruno Ventelou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique, ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille])
    Abstract: Exploring rich panel data from the Niakhar Health and Demographic Surveillance System, this study investigates the effects of migration on child mortality among families left behind in rural areas. Migration, particularly short-term, is positively associated with the survival probability of under-5 children in the household. We also find that the short-term moves of working-age women impact child mortality more than those of working-age men. Moreover, we detect crossover effects between households in the same compound, consistent with the idea that African rural families share part of their migration-generated gains with an extended community of neighbours. Lastly, we investigate the effect of maternal short-term migration on the survival of under-5 children. The aggregate effect is still positive but much weaker. Specifically, maternal migration during pregnancy seems to enhance children's survival immediately after birth, but the probability of survival tends to decrease after age 1 when the mother is absent.
    Abstract: Explorant les riches données longitudinales fournies par l'Observatoire de santé et de population de Niakhar, cette étude examine les effets des migrations sur la mortalité infanto-juvénile dans les familles rurales restées au village. Les migrations, en particulier de courte durée, sont associées de manière positive aux chances de survie des enfants de moins de cinq ans au sein du ménage. On constate également que les déplacements de courte durée des femmes d'âge actif ont plus d'incidences sur la mortalité des enfants que ceux de leurs homologues masculins. De surcroît, des effets croisés sont identifiés entre ménages de la même concession, ce qui est conforme à l'idée que les familles rurales africaines partagent les gains de l'émigration avec une communauté étendue de voisins. Enfin, l'effet des migrations maternelles de courte durée sur la survie des enfants de moins de cinq ans demeure globalement positif, mais nettement plus modeste. L'émigration de la mère, en particulier pendant la grossesse, semble améliorer la probabilité de survie des enfants juste après la naissance, mais celle-ci tend à diminuer après l'âge d'un an et lorsque la mère est absente.
    Keywords: Niakhar,Senegal,short-term migration,long-term migration,child mortality
    Date: 2021–11–12
  23. By: Pujol-Cols, Lucas J.; Lazzaro-Salazar, Mariana
    Abstract: Most systematic reviews of the relationships between work-related psychosocial risks, health, and performance have only considered papers in English, thus ignoring, to a considerable extent, studies conducted in Latin America. In addition, most systematic reviews that have indeed included Latin-American studies have focused on only one occupation and one kind of psychosocial risk, which contributes to producing scattered empirical evidence of this relationship. This paper reports the results of a comprehensive and critical systematic review of 85 studies that examined the relationships between psychosocial risks, health, and performance across a wide range of organizational contexts in Latin America over the last ten years. The paper contributes to the organizational psychology literature by critically reviewing and integrating the most recent studies on this topic in Latin America, identifying their main limitations, and proposing future lines of research that update the debate on this relationship and move this field of study forward.
    Keywords: Riesgos Psicosociales; Estrés; Bienestar; Psicología del Trabajo; Análisis Bibliométrico;
    Date: 2021–12
  24. By: Raitzer, David (Asian Development Bank); Batmunkh, Odbayar (Asian Development Bank); Yarcia, Damaris (Asian Development Bank)
    Abstract: Extensive global evidence suggests that conditional cash transfers (CCTs) encourage long-term investment in human capital by poor households. However, CCTs also have the potential to distort incentives for investment among children. If only some children in the household are monitored/subsidized for compliance with conditionalities, returns to household investment in those children increase relative to siblings who are unmonitored/unsubsidized. This paper demonstrates that puzzling nutrition effects of the Philippine CCT are driven by effects on children unmonitored for educational compliance, due to a cap of monitoring at most three children per household. Regression discontinuity design interacted with a secondary instrument for monitoring finds that while monitored children have improved human capital investment, such investment declines for unmonitored children relative to nonbeneficiaries. Patterns are consistent for parental expectations, health, anthropometric, and educational outcomes, and are stronger for boys, in accordance with theoretical expectations. Equalized incentives among children can enhance intended CCT effects.
    Keywords: social protection; conditional cash transfer; human capital; intrahousehold allocation
    JEL: D13 D91 I24 I38
    Date: 2021–12–31
  25. By: Anelli, Massimo (Bocconi University); Koenig, Felix (Carnegie Mellon University)
    Abstract: This paper develops a revealed-preference approach that uses budget constrain discontinuities to price workplace safety. We track hourly workers who face the decision of how many hours to work at varying levels of Covid-19 risk and leverage state-specific discontinuities in unemployment insurance eligibility criteria to identify the labor supply behavior. Results show large baseline responses at the threshold and increasing responses for higher health risks. The observed behavior implies that workers are willing to accept 34% lower incomes to reduce the fatality rate by one standard deviation, or 1% of income for a one in a million chance of dying.
    Keywords: hazard pay, workplace safety, non-wage amenities, partial unemployment insurance, COVID-19, labor supply, value of life
    JEL: J17 J22 J28
    Date: 2021–12
  26. By: Pierre Verger (ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille]); Dimitri Scronias (ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille], CIC 1417 - CIC Cochin Pasteur - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - UP - Université de Paris - Groupe hospitalier Broca - Hôpital Cochin [AP-HP] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôtel-Dieu - INSERM - Institut National de la Santé et de la Recherche Médicale); Yves Fradier (Kantar Media); Malika Meziani (Kantar Media); Bruno Ventelou (ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille], AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université)
    Abstract: Online surveys of health professionals have become increasingly popular during the COVID-19 crisis because of their ease, speed of implementation, and low cost. This article leverages an online survey of general practitioners' (GPs') attitudes toward the soon-to-be-available COVID-19 vaccines, implemented in October–November 2020 (before the COVID-19 vaccines were authorized in France), to study the evolution of the distribution of their demographic and professional characteristics and opinions about these vaccines, as the survey fieldwork progressed, as reminders were sent out to encourage them to participate. Focusing on the analysis of the potential determinants of COVID-19 vaccine acceptance, we also tested if factors related to survey participation biased the association estimates. Our results show that online surveys of health professionals may be subject to significant selection bias that can have a significant impact on estimates of the prevalence of some of these professionals' behavioral, opinion, or attitude variables. Our results also highlight the effectiveness of reminder strategies in reaching hard-to-reach professionals and reducing these biases. Finally, they indicate that weighting for nonparticipation remains indispensable and that methods exist for testing (and correcting) selection biases.
    Keywords: health care professionals,online surveys,selection bias,attitudes,practices,covid-19,weighting,Heckman method
    Date: 2021–09
  27. By: Lackner, Mario (University of Linz); Sunde, Uwe (University of Munich); Winter-Ebmer, Rudolf (University of Linz)
    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
    JEL: H
    Date: 2021–11
  28. By: Bertogg, Ariane; Koos, Sebastian
    Abstract: Contact restrictions and distancing measures are among the most effective non-pharmaceutical measures to stop the spread of the SARS-CoV2 virus. Yet, research has only begun to understand the wider social consequences of these interventions. This study investigates how individuals' social networks have changed since the outbreak of the pandemic and how these changes relate to psychological strain. Based on an online survey of the German adult population, four types of change are distinguished: loss, gain, and intensification of ties, as well as pandemic-related conflicts. One in two respondents has experienced at least one of these four changes. Loss is more frequently reported than gain of ties, and intensification occurred more frequently than conflicts. Loss of ties and conflicts are furthermore associated with higher levels of psychological strain.
    Keywords: Network Change,Social Ties,Health Risks,Covid-19
    JEL: L14 I31
    Date: 2021
  29. By: Tavares, Aida Isabel
    Abstract: This study contributes to the discussion about the impact of the COVID-19 pandemic on the working hours and on the workplace by older workers, aged between 55 and 64. Our aim is to find the factors associated with working more and less hours during the first wave of the pandemic among older workers in Europe. We use data collected by SHARE Corona Survey during the summer of 2020. We estimate two logistic regressions on working more and less hours using a set of individual controls, workplace and a country lockdown control. Our findings show that male workers are less likely to work more hours; older workers are more likely to work less hours; more educated workers work more hours and not less; people with difficulty to meet ends are more often working less hours; worsening of health during the pandemic is associated with working more hours; working home or both home and usual work place are correlated with working more and working less hours. The contribution of this work comes from additional knowledge about the profile of older workers and their changed hours of work during a first wave of COVID-19 in Europe.
    Keywords: working hours, older workers, logistic regression, Europe, pandemic COVID-19
    JEL: J01
    Date: 2021–12–27
  30. 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
  31. By: Andrew Bacher-Hicks; Joshua Goodman; Jennifer G. Green; Melissa Holt
    Abstract: One-fifth of U.S. high school students report being bullied each year. We use internet search data for real-time tracking of bullying patterns as COVID-19 disrupted in-person schooling. We first show that, prepandemic, internet searches contain useful information about actual bullying behavior. We then show that searches for school bullying and cyberbullying dropped 30-35 percent as schools shifted to remote learning in spring 2020. The gradual return to in-person instruction starting in fall 2020 partially returns bullying searches to pre-pandemic levels. This rare positive effect may partly explain recent mixed evidence on the pandemic’s impact on students’ mental health and well-being.
    JEL: I20 I21 I28
    Date: 2021–12
  32. By: Vacha, Stepan (University of Warwick)
    Abstract: The COVID-19 pandemic hit the labour market significantly through its impact on human health. This paper uses job posting data to measure the effect of the pandemic on labour demand in the UK throughout 2020, including estimates of recovery. It demonstrates the advantage of using online job vacancies to monitor the labour market compared to lagged estimates or surveys used by the Office for National Statistics (ONS). The labour demand shock is found to be of a similar size to those reported in the US or Sweden. Total weekly vacancies posted online were down by 39% during the fist wave and 12.5% in the second half of 2020, representing a significant, but not full recovery. The significance and size of the shock vary among different industries of the economy. All industries except Human health & social work activities have seen a significant drop in job postings due to the pandemic, with the Accommodation & food service activities sector being hit the most. Although the ONS estimates have grasped the main impact of the pandemic on vacancies, using real-time data can provide the policymakers with a much-needed timely information when dealing with a shock like the global health pandemic.
    Keywords: Labor Demand ; Labor Economics ; Labor Market Data ; COVID-19 JEL Classification: J230
    Date: 2021
  33. By: Cong, Lin William; Yang, Xiaohan; Zhang, Xiaobo
    Abstract: Using administrative universal firm registration data as well as primary offline and online surveys of small businesses in China, we examine (i) whether digitization helps Small and Medium Enterprises (SMEs) better cope with the COVID-19 pandemic, and (ii) whether the pandemic has spurred digital technology adoption. We document significant economic benefits of digitization in increasing SMEs’ resilience against such a large shock, as seen through mitigated demand decline, sustainable cash flow, ability to quickly reopen, and positive outlook for growth. Post the January 2020 lockdown, firm entries exhibited a V-shaped pattern, with entries of e-commerce firms experiencing a less pronounced initial drop and a quicker rebound. Moreover, the pandemic has accelerated digital transformation of existing firms and the aggregate industry in multiple dimensions (e.g., altering operation scope to include e-commerce, allowing remote work, and adopting electronic information systems). The effect persists one year after full reopening, offering suggestive evidence for the long-term impact of the pandemic and transitory mitigation policies.
    Keywords: Health Economics and Policy
    Date: 2021–11–01
  34. By: Sarracino, Francesco; Greyling, Talita (University of Johannesburg); O'Connor, Kelsey J. (STATEC Research – National Institute of Statistics and Economic Studies); Peroni, Chiara (STATEC Research – National Institute of Statistics and Economic Studies); Rossouw, Stephanié (Auckland University of Technology)
    Abstract: In this article, we describe how well-being changed during 2020 in ten countries, namely Australia, Belgium, France, Germany, Great Britain, Italy, Luxembourg, New Zealand, South Africa, and Spain. Our measure of well-being is the Gross National Happiness (GNH), a country-level index built applying sentiment analysis to data from Twitter. We aim to describe how GNH changed during the pandemic within countries, assess its validity as a measure of well-being, and analyse its correlations. We take advantage of a unique dataset of daily observations about GNH, generalised trust and trust in national institutions, fear concerning the economy, loneliness, infection rate, policy stringency and distancing. To assess the validity of the data sourced from Twitter, we exploit various survey data sources, such as the Eurobarometer and consumer satisfaction, and Big Data sources, such as Google Trends. Results indicate that sentiment analysis of tweets can provide reliable and timely information on well-being. This can be particularly useful to timely inform decision-making.
    Keywords: happiness, COVID-19, Big Data, Twitter, Sentiment Analysis, well-being, public policy, trust, fear, loneliness
    JEL: C55 I10 I31 H12
    Date: 2021–11
  35. By: Grant R. McDermott; Benjamin Hansen
    Abstract: We investigate the effect of the COVID-19 pandemic on labor activity using real-time data from millions of GitHub users around the world. We show that the pandemic triggered a sharp pattern of labor reallocation at both the global and regional level. Users were more likely to work on weekends and outside of traditional 9 am to 6 pm hours, especially during the early phase of the pandemic. We also document considerable heterogeneity between different user groups and locations. Some locations show a steady reversion back to historical work patterns, while others have experienced persistent trend deviations in the wake of COVID-19. The pattern of labor reallocation is slightly more pronounced among males in our sample, suggesting that men may have benefited more from the increased flexibility provided by remote work than women. Finally, we show that the pattern of reallocation was accompanied by a simultaneous increase in overall activity, though this effect is more transient. We discuss several potential mechanisms and draw tentative conclusions for broader workplace trends given our study population.
    JEL: J01 J22 J23 J4 O3
    Date: 2021–12

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