nep-hea New Economics Papers
on Health Economics
Issue of 2022‒02‒21
twenty-six papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Presenteeism when employers are under pressure: Evidence from a high-stakes environment By Mario Lackner; Hendrik Sonnabend
  2. Health and Labor Market Impacts of Twin Birth: Evidence from a Swedish IVF Policy Mandate By Bhalotra, Sonia R.; Clarke, Damian; Mühlrad, Hanna; Palme, Mårten
  3. Multigenerational Effects of Smallpox Vaccination By Lazuka, Volha; Sandholt Jensen, Peter
  4. Who Increases Emergency Department Use? New Insights from the Oregon Health Insurance Experiment By Augustine Denteh; Helge Liebert
  5. Inequality in socio-emotional skills: a cross-cohort comparison By Orazio Attanasio; Richard Blundell; Gabriella Conti; Giacomo Mason
  6. 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
  7. Education, health and health-related behaviors: Evidence from higher education expansion By Massimiliano Bratti; Elena Cottini; Paolo Ghinetti
  8. How well targeted are soda taxes? By Pierre Dubois; Rachel Griffith; Martin O'Connell
  9. Imitative Pricing: The Importance of Neighborhood Effects in Physicians' Consultation Prices By Benjamin Montmartin; Marcos Herrera-Gomez
  10. Exiting Primary Care Providers By Zocher, Katrin
  11. The Effect of Medicaid Home and Community-Based Services on Health Outcomes By Liu, Yinan; Zai, Xianhua
  12. Costing healthy diets and measuring deprivation: New indicators and modeling approaches By Pauw, Karl; Ecker, Olivier; Thurlow, James; Comstock, Andrew R.
  13. Measuring healthcare quality variation using multicategory ordinal data: an application to primary care services in England By Paul Allanson; Richard Cookson
  14. Nutrition, crowding and disease among low-income households in Tokyo in 1930 By Ogasawara, Kota; Gazeley, Ian; Schneider, Eric B.
  15. Subjective well-being and climate change: Evidence for Portugal By Ary José A. Souza-Jr.
  16. Disability types and children’s schooling in Africa By Zhang, Huafeng; Holden, Stein Terje
  17. Pandemic Pressures and Public Health Care : Evidence from England By Fetzer, Thiemo; Rauh, Christopher
  18. Lockdown Strictness and Mental Health Effects Among Older Populations in Europe By Ariadna García-Prado; Paula González; Yolanda Rebollo-Sanz
  19. The Unintended Effect of Medicaid Aging Waivers on Informal Caregiving By Liu, Yinan; Zai, Xianhua
  20. COVID-19 school closures and mental health of adolescent students: Evidence from rural Mozambique By Chimbutane, Feliciano; Herrera-Almanza, Catalina; Karachiwalla, Naureen; Lauchande, Carlos; Leight, Jessica
  21. Early-stage spatial disease surveillance of novel SARS-CoV-2 variants of concern in Germany with crowdsourced data By Mitze, Timo; Rode, Johannes
  22. The Downward Spiral By Jeremy Greenwood; Nezih Guner; Karen A. Kopecky
  23. Measuring Constitutional Loyalty: Evidence from the Covid-19 Pandemic By Gutmann, Jerg; Sarel, Roee; Voigt, Stefan
  24. The Politicized Pandemic: Ideological Polarization and the Behavioral Response to COVID-19 By Gianluca Grimalda; Fabrice Murtin; David Pipke; Louis Putterman; Matthias Sutter
  25. A note of caution in interpreting crosscountry correlations of COVID-19 vaccination and infection rates By Francesco Bartolucci; Franco Peracchi; Daniele Terlizzese
  26. The preserving effect of social protection on social cohesion during the COVID-19 pandemic: Evidence from Kenya By Strupat, Christoph

  1. By: Mario Lackner; Hendrik Sonnabend (Fernuni Hagen)
    Abstract: This study analyses whether the decision to work while sick can be linked to workload fluctuations. Drawing on data collected from professional soccer, we exploit the dynamics of a season and use additional (national and international) cup games conducted in the second half of a season as a source of exogenous variation. We find robust evidence that players are 6.1 percentage points more likely to return from injuries earlier than expected when their teams are exposed to a high workload. The effect is driven by players who are more important to their teams and those who are less vulnerable to injuries. Finally, we find that presenteeism comes at the cost of an early comeback significantly shortening the time until the next injury by approximately 27 days.
    Keywords: sickness absence; presenteeism; workload variations; soccer
    JEL: I19 J22 Z2
    Date: 2021–12
  2. By: Bhalotra, Sonia R. (University of Warwick); Clarke, Damian (University of Chile); Mühlrad, Hanna (IFN - Research Institute of Industrial Economics); Palme, Mårten (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, along-side 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: J13 I11 I12 I38 J24
    Date: 2022–01
  3. By: Lazuka, Volha (Department of Economic History, Lund University); Sandholt Jensen, Peter (Linneaus University and University of Southern Denmark)
    Abstract: This paper aims at finding whether vaccination in childhood is an important source of improved health over the life cycle and across generations. We leverage high-quality individual-level data from Sweden covering the full life spans of three generations between 1790 and 2016 and a historical quasi-experiment – a smallpox vaccination campaign. To derive the causal impact of this campaign, we employ the instrumental-variables approach and the siblings/cousins fixed effects. Our results show that the vaccine injection by age 2 improved longevity of the first generation by 14 years and made them much wealthier in adult ages. These effects, with the magnitude reduced by two thirds, persisted to the second and the third generation. Such magnitudes make vaccination a powerful health input in the very long term and suggest the transmission of environmental beyond genetic factors.
    Keywords: intergenerational transmission of health; smallpox vaccination; instrumental- variables; Sweden
    JEL: E24 I12 I15 I18 I38 J24 N43
    Date: 2021–12–13
  4. By: Augustine Denteh (Department of Economics, Tulane University); Helge Liebert (Department of Economics, University of Zurich)
    Abstract: We provide new insights into the finding that Medicaid increased emergency department (ED) use from the Oregon experiment. Using nonparametric causal machine learning methods, we find economically meaningful treatment effect heterogeneity in the impact of Medicaid coverage on ED use. The effect distribution is widely dispersed, with significant positive effects concentrated among high-use individuals. A small group - about 14% of participants - in the right tail with significant increases in ED use drives the overall effect. The remainder of the individualized treatment effects is either indistinguishable from zero or negative. The average treatment effect is not representative of the individualized treatment effect for most people. We identify four priority groups with large and statistically significant increases in ED use - men, prior SNAP participants, adults less than 50 years old, and those with pre-lottery ED use classified as primary care treatable. Our results point to an essential role of intensive margin effects - Medicaid increases utilization among those already accustomed to ED use and who use the emergency department for all types of care. We leverage the heterogeneous effects to estimate optimal assignment rules to prioritize insurance applications in similar expansions.
    Date: 2022–01
  5. By: Orazio Attanasio (Institute for Fiscal Studies and Yale University); Richard Blundell (Institute for Fiscal Studies and University College London); Gabriella Conti (Institute for Fiscal Studies and University College London); Giacomo Mason (Institute for Fiscal Studies)
    Abstract: We examine changes in inequality in socio-emotional skills very early in life in two British cohorts born 30 years apart. We construct comparable scales using two validated instruments for the measurement of child behaviour and identify two dimensions of socio-emotional skills: ‘internalising’ and ‘eternalising’. Using recent methodological advances in factor analysis, we establish comparability in the inequality of these early skills across cohorts, but not in their average level. We document for the first time that inequality in socio-emotional skills has increased across cohorts, especially for boys and at the bottom of the distribution. We also formally decompose the sources of the increase in inequality and find that compositional changes explain half of the rise in inequality in externalising skills. On the other hand, the increase in inequality in internalising skills seems entirely driven by changes in returns to background characteristics. Lastly, we document that socio-emotional skills measured at an earlier age than in most of the existing literature are significant predictors of health and health behaviours. Our results show the importance of formally testing comparability of measurements to study skills di?erences across groups, and in general point to the role of inequalities in the early years for the accumulation of health and human capital across the life course.
    Date: 2020–04–01
  6. 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
  7. By: Massimiliano Bratti; Elena Cottini (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore); Paolo Ghinetti
    Abstract: This study throws light on the potential non-linear effects of education on individual health and health-related behaviors, finding a strong role for higher education. Using an instrumental variables (IVs) strategy, which leverages changes in withinprovince between-municipality college proximity across birth cohorts, we demonstrate that higher education affects individual health-related behavior. By contrast, IVs estimates based on a compulsory schooling age reform show mostly non-significant effects. Our results point to a complex link between education and health. On the one hand, higher education channels individuals into some healthy behaviors and better health outcomes namely healthy eating, more physical activity and a lower risk of obesity. On the other hand, it also appears to increase the prevalence of certain unhealthy behaviors, such as greater smoking and drinking prevalence and higher cigarettes consumption. Albeit effects are generally similar across genders, except in few cases (e.g. smoking behavior), our analysis highlights heterogeneous effects by age and helps explain potential differences in results reported in past quasi-experimental studies in which the cohorts affected by the educational reforms used for identification are observed at given ages and not over an individual’s entire life-cycle.
    Keywords: education; health; higher education expansion; health-related behavior.
    JEL: I12 I24
    Date: 2022–02
  8. By: Pierre Dubois (Institute for Fiscal Studies and Toulouse School of Economics); Rachel Griffith (Institute for Fiscal Studies and University of Manchester); Martin O'Connell (Institute for Fiscal Studies and University of Wisconsin)
    Abstract: Soda taxes aim to reduce excessive sugar consumption. Policymakers highlight the young, particularly from poor backgrounds, and high sugar consumers as groups whose behavior they would most like to influence. There are also concerns about the policy being regressive. We assess who are most impacted by soda taxes. We estimate demand using micro longitudinal data covering on-the-go purchases, and exploit the panel dimension to estimate individual specific preferences. We relate these preferences and counterfactual predictions to individual characteristics and show that soda taxes are relatively effective at targeting the sugar intake of the young, are less successful at targeting the intake of those with high total dietary sugar, and are unlikely to be strongly regressive especially if consumers benefit from averted internalities.
    Date: 2020–03–30
  9. By: Benjamin Montmartin (SKEMA Business School; Université Côte d'Azur; OFCE Sciences.Po; GREDEG CNRS); Marcos Herrera-Gomez (CONICET - IELDE; National University of Salta, Argentina)
    Abstract: During the last 30 years in France, concerns about healthcare access have grown as physician fees have increased threefold. In this paper, we developed an innovative structural framework to provide new insights into free-billing physician pricing behavior. We test our theoretical framework using a unique geolocalized database covering more than 4,000 private practitioners in three specializations (ophthalmology, gynecology and pediatrics). Our main findings highlight a low price competition environment driven by local imitative pricing between physicians, which increases with competition density. This evidence in the context of growing spatial concentration and an increasing share of free-billing physicians calls for new policies to limit additional fees.
    Keywords: Imitative pricing, Health care access, Local competition, Spatial effects
    JEL: H51 C21 I11 I18
    Date: 2022–01
  10. By: Zocher, Katrin
    Abstract: This article studies the impact of primary care providers (PCPs) exit from the local health care system on the patients health care utilization. In the empirical analysis, I compare patients, whose family physician leave the health care system with patients, whose PCP leave the health care system some years later. Estimation results indicate that in the face of approaching PCP leave, soon-exiting physicians are changing their behavior and this change has a significant impact on patients' health care spending. In addition, successors and new PCPs provide significantly more preventive services in the post-period and refer patients more often to specialists for further examinations than the physicians of the control group. The increased inpatient expenditures in the post-exit period are caused by patients themselves (through outpatient department visits), by the new PCPs (through referrals), and presumably by specialists. Self-initiated substitution behavior of the patients (e.g. less PCP care more specialist care) in the post-exit period can be observed but is low in magnitude. Despite the comprehensive provided services, mortality among patients experiencing disruption is increased. A possible explanation for this is the poor follow-up care of patients who are referred to the hospital by their soon leaving PCP in the pre-exit period and get discharged right before or during the PCP exit.
    Keywords: physician exit,retirement,disruption,discontinuity,successor
    JEL: I12 I11 I18
    Date: 2022
  11. By: Liu, Yinan; Zai, Xianhua
    Abstract: The Medicaid Home and Community- Based Services (HCBS) program in the United States subsidizes the long-term care provided at home or in community-based settings for older adults. Little is known about how HCBS affects the well-being of the aging population. Using detailed information about health from the Health and Retirement Study (HRS) linked with state-level HCBS policy expenditures, we show that HCBS indeed helps older people avoid institutionalization and stay at home longer. Furthermore, the program is positively associated with the probability of older individuals reporting better mental health, especially among people with limited resources.
    Keywords: Medicaid HCBS,Long-Term Care,HRS,Health
    Date: 2022
  12. By: Pauw, Karl; Ecker, Olivier; Thurlow, James; Comstock, Andrew R.
    Abstract: One of the greatest global challenges today is ensuring widespread availability and equitable access to affordable, nutritious foods produced in an environmentally sustainable manner. A rich literature exists around the definition of a healthy diet and the drivers of dietary change. We contribute to this literature by proposing a new quantifiable diet deprivation measure estimated from standard household consumption and expenditure surveys. The Reference Diet Deprivation (ReDD) index measures the incidence, breadth, and depth of diet deprivation across multiple, essential food groups in a single indicator. Although useful as a standalone measure, we show how ReDD can be integrated into an economywide model to examine changes in household diet quality under different simulation scenarios. Using Nigeria as case study, hypothetical agricultural productivity growth scenarios reveal that dairy, pulses, fruit, and red meat value chains have the greatest potential to reduce overall diet deprivation in Nigeria per unit of GDP growth generated, while productivity growth in more widely consumed crops such as cereals and root crops do little to improve diet quality. These findings have implications for the prioritization of agricultural development initiatives aimed at improving the quality of diets. More generally, the integration of a diet quality indicator in an economywide model allows for a deeper understanding of the drivers of dietary change.
    Keywords: NIGERIA; WEST AFRICA; AFRICA SOUTH OF SAHARA; AFRICA; diet; dietary guidelines; consumer behaviour; modelling; dietary diversity; food prices; value chains; diet quality; diet deprivation; affordability of healthy diets; dietary change; economywide modeling
    Date: 2021
  13. By: Paul Allanson; Richard Cookson
    Abstract: The paper proposes a framework for measuring both the comparative quality of a set of healthcare providers and the variation in quality between them. The measures are directly calculable using the multicategory response data increasingly available from patient experience surveys but are also well defined for standard cardinal quality indicators. Moreover, they are sensitive to the full distribution of quality scores for each provider, not just the mean nor the proportion meeting some binary quality threshold. We illustrate our approach by providing comparable estimates of the variation in the quality of primary care services in England using three different sources of publicly available, general practice-level information: multicategory response patient experience data, ordinal inspection ratings and cardinal clinical achievement scores. Our results reveal considerable variation in the quality of primary care services at both local and regional level: for example, a randomly chosen patient from the best practice in England had a 26.0 percentage point higher chance of reporting a better rather than worse experience than a patient from anywhere in the country, whereas one from the worst practice had a 30.7 percentage point lower chance. Weak correlation between the comparative quality indices calculated using the alternative quality indicators provides evidence that inspection ratings and clinical process indicators capture different aspects of GP quality than patient experience. Finally we investigate the impact of standardisation, reporting results based on both raw and indirectly standardised practice quality profiles, with the latter based on the estimation of a distribution regression model.
    Keywords: healthcare variation; comparative quality evaluation; ordinal data, primary care services, England
    JEL: D63 I14 I18
    Date: 2021–07
  14. By: Ogasawara, Kota; Gazeley, Ian; Schneider, Eric B.
    Abstract: This article employs a household survey of low-income working-class households conducted in Tokyo in 1930 to investigate nutritional attainment levels and the relationship between calorie intake and morbidity. We find that the daily calorie intake was 2,118 kcal per adult male equivalent, high enough to satisfy the energy requirements for moderate physical activity. Richer households purchased more expensive calories mainly by substituting meat and vegetables for rice. We find negative associations between morbidity and income and crowding, but no significant associations for nutrition, tentatively suggesting that income and crowding were more important for morbidity in 1930 Tokyo than nutrition.
    Keywords: nutrition; morbidity; health; ES/L002523/1
    JEL: N35
    Date: 2020–03–01
  15. By: Ary José A. Souza-Jr.
    Abstract: This paper analyses the impact of air pollution, climate conditions, and extreme weather events on subjective well-being across the Portuguese regions through estimating an ordered probit model. The estimation applies data at the individual level from the 8th and 9th waves of the European Social Survey, along with an air quality indicator, environmental variables, national forest inventory, and a study about the possible future effects of the sea-level rise on vulnerable areas and people living therein. Even after controlling for socio-economic variables and personal traits, the results suggest the existence of differences between regional welfare levels. Air pollution has a negative impact on life satisfaction due to its bad impacts on health (aggravating the condition of individuals with heart and lung diseases). The paper’s key finding is to show that at the regional level, both past (forest fires) and «possible» future (floods due to sea-level rise) extreme weather events may impact the current welfare level. Also, assessments of implicit willingness do to pay demonstrate that climate change effects have a relevant impact on their quality of life nowadays.
    Keywords: climate, extreme, region, flood, fire.
    Date: 2022–02
  16. By: Zhang, Huafeng (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Holden, Stein Terje (Centre for Land Tenure Studies, Norwegian University of Life Sciences)
    Abstract: The Sustainable Development Goals (SDGs) set up by the United Nations include an overarching principle of “leaving no one behind” and aim for, among other goals, equal access to education for children with disabilities. Our study contributes to the knowledge on the school enrolment of disabled children with different disability types, with a focus here on eight countries in Sub-Saharan Africa. Comparing the situation with children without disabilities as a benchmark, we assess early school enrolment for young children below ten years old, school enrolment for older children aged 10–17 years old, and the dropout rates of children from school. We perform our analysis as a natural experiment where different types of disabilities are considered as random treatments, which allows us to assume that the average deviation in certain school performance indicators from the average for non-disabled children is a result of the disability type, specifically vision, hearing, walking, intellectual capacity, and multi-disability. Our study finds that, compared with non-disabled children, children with vision and hearing disabilities do not lag behind in school enrolment. In contrast, children with walking disability have a higher risk of starting school late. Children with intellectual disabilities are less likely to enrol in school, less likely to remain enrolled, and more likely to drop out than their counterfactual peers. Children with multiple disabilities tend to experience the most severe challenges in enrolling at school, both at a young age and later. However, once enrolled in school, children with multiple disabilities are not more likely to drop out earlier than other children. Based on the first and probably the only large-scale application to date of the standard Washington Group Child function module as a disability measurement tool, our study is the first comprehensive multi-country study of disabled children’s schooling in Sub-Saharan Africa based on recent nationally representative data.
    Keywords: Children with disability; disability types; disability effects on schooling; SDG; Sub-Saharan Africa
    JEL: I24
    Date: 2022–02–07
  17. By: Fetzer, Thiemo (University of Warwick, CAGE and CEPR.); Rauh, Christopher (University of Cambridge, Trinity College Cambridge, CEPR)
    Abstract: This paper documents that the COVID-19 pandemic induced pressures on the health care system have significant adverse knock-on effects on the accessibility and quality of non-COVID-19 care. We observe persistently worsened performance and longer waiting times in A&E; drastically limited access to specialist care; notably delayed or inaccessible diagnostic services; acutely undermined access to and quality of cancer care. We find that providers under COVID-19 pressures experience notably more excess deaths among non-COVID related hospital episodes such as, for example, for treatment of heart attacks. We estimate there to be at least one such non-COVID-19 related excess death among patients being admitted to hospital for non-COVID-19 reasons for every 30 COVID-19 deaths that is caused by the disruption to the quality of care due to COVID-19. In total, this amounts to 4,003 non COVID-19 excess deaths from March 2020 to February 2021. Further, there are at least 32,189 missing cancer patients that should counterfactually have started receiving treatment which suggests continued increased numbers of excess deaths in the future due to delayed access to care in the past.
    Keywords: Health ; Externalities ; COVID-19 ; Coronavirus ; Excess deaths ; Cancer ; NHS ; Public health care JEL Classification: I18 ; I10 ; D62 ; H12 ; H55
    Date: 2022
  18. By: Ariadna García-Prado (Departamento de Economía, Universidad Pública de Navarra); Paula González (Department of Economics, Universidad Pablo de Olavide); Yolanda Rebollo-Sanz (Department of Economics, Universidad Pablo de Olavide)
    Abstract: This paper investigates whether lockdown policies aggravated mental health problems of older populations (50 and over) in Europe during the first COVID-19 wave. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE COVID-19 questionnaire) and from the Oxford COVID-19 Government Response Tracker for 17 countries, we estimate the causal effect of lockdown policies on mental health by combining cross-country variability in the strictness of the policies with cross-individual variability in face-to-face contacts prior to the pandemic. We find that lockdown policies worsened insomnia, anxiety, and depression by 5, 7.2 and 5.1 percentage points, respectively. This effect was stronger for women and those aged between 50 and 65. Interestingly, lockdown policies notably damaged the mental health of healthy populations. We close with a discussion of lockdown policies targeted at individuals above 65 and/or with pre-existing conditions.
    Keywords: COVID-19, Mental Health, Lockdown, Confinement, Containment Index, Mobility Restrictions, Senior and Older Europeans, Causality.
    JEL: I18 I31
    Date: 2022
  19. By: Liu, Yinan; Zai, Xianhua
    Abstract: Medicaid aging waivers incentivize older adults who need long-term care to stay at home rather than move into a nursing facility. However, this policy may inadvertently shift care burdens onto informal caregivers. Using data on state-level waiver expenditures from 1998 to 2014 linked with the restricted access Health and Retirement Study (HRS), this paper investigates whether program funding is associated with the probability that an HRS respondent provides informal care to her older parents. Changes to state-level policy funding produce a quasi-experiment, which allows us to use two-way fixed effects models to estimate a causal relationship between the program and informal caregiving. The findings show that a 10 percent increase in aging waiver expenditures increases the overall likelihood that an adult child becomes an informal caregiver to her parents by 0.1 percentage points (0.3 percent). The overall estimate is composed of differential effects on different types of care. The results show that the Medicaid aging waiver funding is positively associated with the likelihood of being an errands caregiver and a non-intensive caregiver who spends fewer hours providing care, but unrelated to the likelihood of providing personal care and intensive care. The findings are mainly driven by the mechanism that aging-at-home is more attractive supported by the aging waivers.
    Keywords: Medicaid Aging Waiver,Long-Term Care,HRS,Informal Care
    JEL: I18 J14 J18
    Date: 2022
  20. By: Chimbutane, Feliciano; Herrera-Almanza, Catalina; Karachiwalla, Naureen; Lauchande, Carlos; Leight, Jessica
    Abstract: The onset of the COVID-19 pandemic, entailing widespread school closures as well as acute disruptions to household livelihoods, has presumably had substantial consequences for adolescent well-being in developing country contexts that remain largely unexplored. We present novel evidence about the prevalence of mental health challenges among adolescent students as well as educators in rural Mozambique using data from an in-person survey conducted in 175 schools. In our sample, 31% of students report low levels of well-being (though only 10% suffer from high anxiety): students enrolled in schools that used a wider variety of distance learning measures report lower anxiety, while students reporting familial shocks linked to the pandemic report higher anxiety and lower well-being. Educators experience comparatively lower levels of anxiety and higher well-being, and household-level shocks are most predictive of variation in mental health. However, well-being is negatively affected by the range of hygiene-related measures implemented in schools upon reopening.
    Keywords: MOZAMBIQUE; SOUTHERN AFRICA; AFRICA SOUTH OF SAHARA; AFRICA; Coronavirus; coronavirus disease; Coronavirinae; COVID-19; mental health; rural areas; adolescents; students; school closures
    Date: 2021
  21. By: Mitze, Timo; Rode, Johannes
    Abstract: The emergence and rapid spread of novel variants of concern (VOC) of the coronavirus 2 constitute a major challenge for spatial disease surveillance. We explore the possibility to use close to real-time crowdsourced data on reported VOC cases (mainly the Alpha variant) at the local area level in Germany. The aim is to use these data for early-stage estimates of the statistical association between VOC reporting and the overall COVID-19 epidemiological development. For the first weeks in 2021 after international importation of VOC to Germany, our findings point to significant increases of up to 35–40% in the 7-day incidence rate and the hospitalization rate in regions with confirmed VOC cases compared to those without such cases. This is in line with simultaneously produced international evidence. We evaluate the sensitivity of our estimates to sampling errors associated with the collection of crowdsourced data. Overall, we find no statistical evidence for an over- or underestimation of effects once we account for differences in data representativeness at the regional level. This points to the potential use of crowdsourced data for spatial disease surveillance, local outbreak monitoring and public health decisions if no other data on new virus developments are available.
    Date: 2022–01–18
  22. By: Jeremy Greenwood (University of Pennsylvania); Nezih Guner (Centro de Estudios Monetarios y Financieros (CEMFI)); Karen A. Kopecky (Federal Reserve Bank of Atlanta)
    Abstract: There have been more than 500,000 opioid overdose deaths since 2000. To analyze the opioid epidemic, a model is constructed where individuals, with and without pain, choose whether to abuse opioids knowing the probabilities of addiction and dying. These odds are functions of opioid use. Markov chains are estimated from the US data for the college and non-college educated that summarize the transitions into and out of opioid addiction as well as to a deadly overdose. A structural model is constructed that matches the estimated Markov chains. The epidemic's drivers, and the impact of medical interventions, are examined.
    Keywords: addiction, college/non-college educated, deaths, fentanyl, Markov chain, medical interventions, opioids, OxyContin, pain, prices, structural model
    JEL: D11 D12 E13 I12 I14 I31 J11 J17
    Date: 2022–02
  23. By: Gutmann, Jerg; Sarel, Roee; Voigt, Stefan
    Abstract: Constitutional loyalty, the importance ascribed to complying with constitutional rules, is difficult to measure across countries due to differences in context, history, and culture. We overcome this challenge by exploiting the COVID-19 pandemic as an ideal setting in which societies around the world face a novel and similar public health crisis, inducing governments to adopt comparable policies. Based on a survey carried out in 53 countries around the world in 2021, we show that citizens' support for Covid-19 mitigation policies declines if courts signal doubts about their constitutionality. We further demonstrate that this effect of constitutional loyalty depends on citizens' characteristics, such as their confidence in the courts and their moral convictions.
    Keywords: Constitutional loyalty,Constitutions,Courts,Covid-19,Judicial power
    JEL: D02 H12 I18 K40 P48
    Date: 2022
  24. By: Gianluca Grimalda (Kiel Institute for the World Economy); Fabrice Murtin (OECD Statistics and Data Directorate); David Pipke (Kiel Institute for the World Economy); Louis Putterman (Brown University); Matthias Sutter (Max Planck Institute for Research on Collective Goods, University of Cologne, University of Innsbruck, and IZA)
    Abstract: We investigate the relationship between political attitudes and prosociality in a survey of a representative sample of the U.S. population during the first summer of the COVID-19 pandemic. We find that an experimental measure of prosociality correlates positively with adherence to protective behaviors. Liberal political ideology predicts higher levels of protective behavior than conservative ideology, independently of the differences in prosociality across the two groups. Differences between liberals and conservatives are up to 4.4 times smaller in their behavior than in judging the government’s crisis management. This result suggests that U.S. Americans are more polarized on ideological than behavioral grounds.
    Keywords: Polarization, Ideology, Trust in politicians, COVID-19, Prosociality, Health behavior, Worries
    JEL: D01 D72 D91 I12 I18 H11 H12
    Date: 2022–01
  25. By: Francesco Bartolucci (University of Perugia); Franco Peracchi (University of Rome Tor Vergata and EIEF); Daniele Terlizzese (EIEF)
    Abstract: We show that the finding in Subramanian and Kumar (2021) of no discernible linear relationship between COVID-19 vaccination rates and new infection rates in a cross-section of countries is misleading, because it ignores the substantial degree of heterogeneity across countries. The latter reflects large differences in the stages of the infection and the vaccination process, healthcare systems, people's attitude towards vaccination, etc. In the presence of such heterogeneity simple correlations are hardly interpretable. This is a well-known phenomenon, sometimes referred to as the Simpon's paradox. Exploiting longitudinal data, they show that the estimated linear relationship becomes negative and statistically significant when controlling for time-invariant differences across countries.
    Date: 2021
  26. By: Strupat, Christoph
    Abstract: This paper examines empirically whether social protection in the form of adapted social assistance programmes are affecting social cohesion during the COVID-19 pandemic. Using unique primary data from nationally representative, in-person surveys from Kenya allows for the exploration of the effect of social protection on attributes of social cohesion (trust, cooperation and identity). The analysis employs a difference-in-differences approach that compares households with and without social assistance coverage before and after the first wave of the pandemic. The findings suggest that social assistance programmes have a preserving effect on social cohesion. Attributes of social cohesion remain stable for beneficiaries, while they decline for non-beneficiaries due to the pandemic. This result is pronounced in regions that faced larger restrictions due to government lockdown policies. Overall, the results suggest that existing national social assistance programmes and their adaptation in times of large covariate shocks, such as the COVID-19 pandemic, can be beneficial for social cohesion.
    Keywords: social protection; social assistance; social cohesion; COVID-19; Kenya
    JEL: F63 I15
    Date: 2021–12

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