nep-hea New Economics Papers
on Health Economics
Issue of 2022‒03‒21
34 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Health Insurance Menu Design for Large Employers By Kate Ho; Robin S. Lee
  2. How Do Copayment Coupons Affect Branded Drug Prices and Quantities Purchased? By Leemore Dafny; Kate Ho; Edward Kong
  3. Rules vs. Discretion: Treatment of Mental Illness in U.S. Adolescents By Emily Cuddy; Janet Currie
  4. The Shadow of the Neolithic Revolution on Life Expectancy: A Double-Edged Sword By Oded Galor; Omer Moav; Ömer Özak
  5. Air Pollution, Avoidance Behavior and Labor Supply: Evidence from the United States By Djoumessi, Berenger Tiague
  6. Is There a VA Advantage? Evidence from Dually Eligible Veterans By David C. Chan Jr; David Card; Lowell Taylor
  7. The Opioid Epidemic Was Not Primarily Caused by Economic Distress But by Other Factors that Can be More Readily Addressed By Janet Currie; Hannes Schwandt
  8. The Downward Spiral By Jeremy Greenwood; Nezih Guner; Karen A. Kopecky
  9. Desert Locust Swarms and Child Health By Le, Kien; Nguyen, My
  10. The Impact of Working Conditions on Mental Health: Novel Evidence from the UK. By Belloni, Michele; Carrino, Ludovico; Meschi, Elena
  11. The Long-Term Effects of Early-Life Pollution Exposure: Evidence from the London Smog By Stephanie von Hinke; Emil N. S{\o}rensen
  12. Maternal Displacements during Pregnancy and the Health of Newborns By Stefano Cellini; Livia Menezes; Martin Foureaux Koppensteiner
  13. Designing Benefits for Platform Workers By Jonathan Gruber
  14. Membership in Mutual Health Insurance Societies: The Case of Swedish Manufacturing, circa 1900 By Stanfors, Maria; Karlsson, Tobias; Andersson, Lars-Fredrik; Eriksson, Liselotte
  15. The Cost of Imbalance in Clinical Trials By Sylvain Chassang; Rong Feng
  16. Inferring Occupation Arduousness from Poor Health Beyond the Age of 50 By Arno Baurin; Sandy Tubeuf; Vincent Vandenberghe
  17. Applying the principles of Evidence-Based Public Health in addressing the diabetes mellitus epidemic among African-American communities living in the district of Colombia: a literature review By opara, Nnennaya; Opara, Emmanuel
  18. Does high workload reduce the quality of healthcare? Evidence from rural Senegal By Kovacs, Roxanne J.; Lagarde, Mylène
  19. Interventions and participatory clinical research for the enhancement of health systems interfacing with displaced Afghan women By Ramos, Amaya Alexandra
  20. Rural Pension System and Farmers' Participation in Residents' Social Insurance By Xu, Tao
  21. From Anti-vax Intentions to Vaccination: Panel and Experimental Evidence from Nine Countries By Vincenzo Galasso; Vincent Pons; Paola Profeta; Michael Becher; Sylvain Brouard; Martial Foucault
  22. How Much Does COVID-19 Increase with Mobility? Evidence from New York and Four Other U.S. Cities By Edward L. Glaeser; Caitlin S. Gorback; Stephen J. Redding
  23. A Two Covid-19 Years Quartile Comparison of Official with Excess Mortality: Voice and Accountability and the Impact of Vaccines By Joshua Aizenman; Alex Cukierman; Yothin Jinjarak; Sameer Nair-Desai; Weining Xin
  24. Social protection tools for coping with the impacts of the COVID-19 pandemic: The Latin American experience By Robles, Claudia; Rossel, Cecilia
  25. “COVID-19 really impacted our work”: Changes in services for families and staff experiences in Cape Town, South Africa By Shenderovich, Yulia; Sacolo-Gwebu, Hlengiwe; Fang, Zuyi; Lachman, Jamie; Cluver, Lucie; Ward, Catherine
  26. Labour market trajectories and conciliation efforts among female Uber drivers By Marina Luz GARCÍA
  27. Communicating safety precautions can help maintain in-person voter turnout during a pandemic By Merkley, Eric; Bergeron, Thomas; Loewen, Peter John; Elias, Angelo; Lapp, Miriam
  28. Post-COVID-19 era and Fourth Industrial Revolution: Contemporary Trends in Labor Relations and Organizational Adaptation By Vlados, Charis; Koutroukis, Theodore; Chatzinikolaou, Dimos
  29. How Pandemic-Related Changes in Global Attitudes Toward the Scientific Community Shape “Post-Pandemic” Environmental Opinion By Motta, Matt; Benegal, Salil D
  30. Behavioral epidemiology: An economic model to evaluate optimal policy in the midst of a pandemic By Shomak Chakrabarti; Ilia Krasikov; Rohit Lamba
  31. Nudging for lockdown: behavioural insights from an online experiment By Phu Nguyen-Van; Thierry Blayac; Dimitri Dubois; Sebastien Duchene; Ismael Rafai; Bruno Ventelou; Marc Willinger
  32. COVID-19, Job Loss, and Intimate Partner Violence in Peru By Jorge M. Agüero; Erica Field; Ignacio Rodriguez Hurtado; Javier Romero
  33. Corporate Flexibility in a Time of Crisis By John W. Barry; Murillo Campello; John Graham; Yueran Ma
  34. Initial impacts of the pandemic on consumer behavior: Evidence from linked income, spending, and savings data By Natalie Cox; Peter Ganong; Pascal Noel; Joseph Vavra; Arlene Wong

  1. By: Kate Ho (Princeton University); Robin S. Lee (Harvard University)
    Abstract: We explore the challenges faced by a large employer designing a health insurance plan menu for its employees. Using detailed administrative data from Harvard University, we estimate a model of plan choice and utilization, and evaluate the benefits of cost sharing and plan variety. For a single plan with a generous out-of-pocket maximum, we find that modest cost sharing of approximately 30% maximizes average employee surplus. Further gains from offering choice are limited if based solely on financial dimensions, but can be economically significant if paired with other features that appeal to sicker households.
    Keywords: Health insurance, Health care
    JEL: I11 I13 L20
    Date: 2021–01
  2. By: Leemore Dafny; Kate Ho; Edward Kong
    Abstract: Drug copayment coupons to reduce patient cost-sharing have become nearly ubiquitous for high-priced brand-name prescription drugs. Medicare bans such coupons on the grounds that they are kickbacks that induce utilization, but they are commonly used by commercially-insured enrollees. We estimate the causal effects of coupons for branded drugs without bioequivalent generics using variation in coupon introductions over time and comparing differential responses across enrollees in commercial and Medicare Advantage plans. Using data on net-of-rebate prices and quantities from a large Pharmacy Benefits Manager, we find that coupons increase quantity sold by 21-23% for the commercial segment relative to Medicare Advantage in the year after introduction, but do not differentially impact net-of-rebate prices, at least in the short-run. To quantify the equilibrium price effects of coupons, we employ individual-level data to estimate a discrete choice model of demand for multiple sclerosis drugs. We use our demand estimates to parameterize a model of drug price negotiations. For this category of drugs, we estimate that coupons raise negotiated prices by 8% and result in just under $1 billion in increased U.S. spending annually. Combined, the results suggest copayment coupons increase spending on couponed drugs without bioequivalent generics by up to 30 percent.
    JEL: I11 I13 L13
    Date: 2022–02
  3. By: Emily Cuddy (Princeton University); Janet Currie (Princeton University)
    Abstract: Mental health disorders are a leading cause of disability worldwide. Many mental health disorders start in adolescence and appropriate treatment at the outset may improve trajectories. We use a large national data base of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next two years. We find that receiving follow up mental health treatment in the first three months after an initial mental health claim increases the total cost of care over the next 24 months. These higher costs are entirely accounted for by children who receive treatment that is not consistent with practice guidelines. Our estimates imply that, within 24 months, children who initially received a red-flag drug have 205% higher costs than those of the average treated child and are 131% more likely to have used an emergency room or experienced a hospitalization. These results show that large numbers of U.S. children are receiving mental health care that falls outside of accepted guidelines and poses risks to their health. In doing so, they provide support for the guidelines themselves, and demonstrate that analyses of large-scale claims data can provide a useful complement to clinical research studies in identifying best practices.
    Keywords: Health, Healthcare, Mental Illness
    JEL: I1 I11
    Date: 2020–10
  4. By: Oded Galor (Brown University); Omer Moav (University of Warwick); Ömer Özak (Southern Methodist University)
    Abstract: This research explores the persistent effect of the Neolithic Revolution on the evolution of life expectancy in the course of human history. It advances the hypothesis and establishes empirically that the onset of the Neolithic Revolution and the associated rise in infectious diseases triggered a process of adaptation reducing mortality from infectious diseases while increasing the propensity for autoimmune and inflammatory diseases. Exploiting an exogenous source of variation in the timing of the Neolithic Revolution across French regions, the analysis establishes the presence of these conflicting forces - the beneficial effects on life expectancy before the second epidemiological transition and their adverse effects thereafter.
    Keywords: Life Expectancy, Health, Mortality, Neolithic Revolution, Epidemiological Transition, Infectious Disease, Auto-immune Disease, Diabetes, Crohn's Disease, HIV, COVID-19
    JEL: I10 I15 J10 N00 N30 O10 O33 Z10
    Date: 2022–03
  5. By: Djoumessi, Berenger Tiague
    Abstract: I estimate the effects of exposure to ambient air pollution on daily health-related behaviors, weekly labor supply, and productivity at the workplace among US individuals. Using an individual fixed-effects regression approach, I examine how increases in daily outdoor air quality influence the time spent on daily health-related activities. I find that only when the air quality index becomes very unhealthy or hazardous, there is a 21% decrease in the minutes spent on outdoor sport and exercise activities, and a 263% increase in minutes spent watching TV. I also implement an instrumental variable (IV) strategy using wind direction as an exogenous shock to satellite-based aerosol optical depth to understand how changes in air pollution affect labor supply. I find that increase in the total aerosol optical depth (AOD) leads to no overall change in labor supply decisions, both on the decision to go to work and the weekly worked hours, but it does so on the likelihood of going to work for women. The effects across subgroups also suggest differential effects in avoidance behaviors across the income distribution, age groups, occupations, race, and ethnicity, especially when the air quality is very unhealthy or hazardous.
    Date: 2022–02–15
  6. By: David C. Chan Jr; David Card; Lowell Taylor
    Abstract: We study public vs. private provision of health care for veterans aged 65 and older who may receive care provided by the US Department of Veterans Affairs (VA) and in private hospitals financed by Medicare. Utilizing the ambulance design of Doyle et al. (2015), we find that the VA reduces 28-day mortality by 46% (4.5 percentage points) and that these survival gains are persistent. The VA also reduces 28-day spending by 21% and delivers strikingly different reported services relative to private hospitals. We find suggestive evidence of complementarities between continuity of care, health IT, and integrated care.
    JEL: H4 H51 I10 I18
    Date: 2022–02
  7. By: Janet Currie (Princeton University); Hannes Schwandt (Northwestern University)
    Abstract: Without the opioid epidemic, American life expectancy would not have declined prior to 2020. In turn, the epidemic was sparked by the development and marketing of a new generation of prescription opioids and provider behavior is still helping to drive it. There is little relationship between the opioid crisis and contemporaneous measures of labor market opportunity. Cohorts and areas that experienced poor labor market conditions do show lagged increases in opioid mortality, but the effect is modest relative to the scale of the epidemic. Instead, we argue that there are specific policies and features of the U.S. health care market that led to the current crisis. It will not be possible to quickly reverse depressed economic conditions, but it is possible to implement policies that would reduce the number of new opioid addicts and save the lives of many of those who are already addicted.
    Keywords: opioid epidemic, health
    JEL: I12 I14
    Date: 2020–08
  8. By: Jeremy Greenwood; Nezih Guner; Karen A. Kopecky
    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 misuse 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.
    JEL: D11 E13 E70 I12 I14 I31 J11 J17
    Date: 2022–02
  9. By: Le, Kien; Nguyen, My
    Abstract: This study evaluates how in-utero exposure to an insect pest invasion, particularly, the outbreak of desert locust swarms, affects early childhood health in Africa and Asia over the past three decades (1990-2018). Employing the difference-in-differences model, we find that children being prenatally exposed to the outbreak have their height-for-age, weight-for-height, and weight-for-age z-scores lower by 0.159, 0.148, and 0.155 standard deviations, respectively, compared to unexposed children. Our heterogeneity analyses show that the health setbacks disproportionately fall on children of disadvantaged backgrounds, i.e., those born to lower-educated mothers, poorer mothers, and rural mothers. To the extent that poor health in early life exerts long-lasting irreversible consequences over the life cycle, the study calls for effective measures to minimize the pernicious effects of the desert locust swarm outbreak.
    Keywords: Desert Locust; Child Health; Developing Countries.
    JEL: I1
    Date: 2022–01
  10. By: Belloni, Michele; Carrino, Ludovico; Meschi, Elena (University of Turin)
    Abstract: This paper investigates the causal impact of working conditions on mental health in the UK, combining new comprehensive longitudinal data on working conditions from the European Working Condition Survey with microdata from the UK Household Longitudinal Survey (Understanding Society). Our empirical strategy accounts for the endogenous sorting of individuals into occupations by including individual fixed effects. It addresses the potential endogeneity of occupational change over time by focusing only on individuals who remain in the same occupation (same ISCO), exploiting the variation in working conditions within each occupation over time. This variation, determined primarily by general macroeconomic conditions, is likely to be exogenous from the individual point of view. Our results indicate that improvements in working conditions have a beneficial, statistically significant, and clinically meaningful impact on depressive symptoms for women. A one standard deviation increase in the skills and discretion index reduces depression score by 2.84 points, which corresponds to approximately 20% of the GHQ score standard deviation, while a one standard deviation increase in working time quality reduces depression score by 0.97 points. The results differ by age: improvements in skills and discretion benefit younger workers (through increases in decision latitude and training) and older workers (through higher cognitive roles), as do improvements in working time quality; changes in work intensity and physical environment affect only younger and older workers, respectively. Each aspect of job quality impacts different dimensions of mental health. Specifically, skills and discretion primarily affect the loss of confidence and anxiety; working time quality impacts anxiety and social dysfunction; work intensity affects the feeling of social dysfunction among young female workers. Finally, we show that improvements in levels of job control (higher skills and discretion) and job demand (lower intensity) lead to greater health benefits, especially for occupations that are inherently characterised by higher job strain.
    Date: 2022–01
  11. By: Stephanie von Hinke (School of Economics, University of Bristol, Erasmus School of Economics, Erasmus University Rotterdam, Institute for Fiscal Studies); Emil N. S{\o}rensen (School of Economics, University of Bristol)
    Abstract: This paper uses a large UK cohort to investigate the impact of early-life pollution exposure on individuals' human capital and health outcomes in older age. We compare individuals who were exposed to the London smog in December 1952 whilst in utero or in infancy to those born after the smog and those born at the same time but in unaffected areas. We find that those exposed to the smog have substantially lower fluid intelligence and worse respiratory health, with some evidence of a reduction in years of schooling.
    Date: 2022–02
  12. By: Stefano Cellini (University of Surrey); Livia Menezes (University of Birmingham); Martin Foureaux Koppensteiner (University of Surrey)
    Abstract: In this paper, we estimate the effect of maternal displacements during pregnancy on birth outcomes by leveraging population-level administrative data from Brazil on formal employment linked to birth records. We find that involuntary job separation of pregnant single mothers leads to a decrease in birth weight (BW) by around 28 grams (-1% ca.) and an increase in the incidence of low BW by 10.5%. In contrast, we find a significant positive effect on the mean BW and a decrease in the incidence of low BW for mothers in a marriage or stable union. We document more pronounced negative effects for single mothers with lower earnings and no effect for mothers in the highest income quartile, suggesting a mitigating role of self-insurance from savings. Exploiting variation from unemployment benefits eligibility, we also provide evidence on the mitigating role of formal unemployment insurance using a Regression Discontinuity design exploiting the cutoff from the unemployment insurance eligibility rule.
    Keywords: Dismissals, birth outcomes, informal insurance, unemployment insurance
    JEL: D14 I10 J65
    Date: 2022–03
  13. By: Jonathan Gruber
    Abstract: Designing benefits for the growing platform workforce in the U.S. poses significant challenges. While platform workers need protection against unforeseen shocks, work that is often part time and spread across multiple platforms makes the traditional benefits model untenable. This paper reports the results from a survey of drivers and couriers working with Uber to help understand their benefits preferences. We find that there is a wide diversity across these workers in platform earnings, the share of platform earnings from Uber, the share of family earnings from platform work and the availability of benefits from other jobs. We use willingness-to-pay questions to show that workers are willing to trade off additional income for benefits; after accounting for the tax advantage of benefits, workers are roughly indifferent on average between the two. While there are some trends in valuation, such as higher valuation for pension than for health contributions, the most notable feature of the data is the wide variation across workers in their preferences across benefits types and relative to income. Workers also show a preference for benefits that can help them commit to increase savings in the future.
    JEL: I13 J32 J41
    Date: 2022–02
  14. By: Stanfors, Maria (Department of Economic History, Lund University); Karlsson, Tobias (Department of Economic History, Lund University); Andersson, Lars-Fredrik (Unit of Economic History, Umeå University); Eriksson, Liselotte (Umeå Centre for Gender Studies, Umeå University)
    Abstract: Industrialization brought significant economic and social changes. As a response to the risk of income loss due to illness and workplace accidents, mutual health insurance was the main financial vehicle for workers at the turn of the twentieth century across the Western world. We studied individual and firm-level determinants of membership in health insurance societies among male workers in Swedish manufacturing by using matched employer-employee data from the tobacco, printing, and mechanical engineering ndustries. Such data are extremely rare but important for our purpose. They cover all workers (i.e., members and non-members) and firms in a specific year around 1900 (N>12,000). In the years before the first statutory attempts to improve working conditions, we find remarkably high rates of membership, especially in mechanical engineering. We also find an association between membership and age, which is mainly a difference between younger and older adults, but the societies’ egalitarian pricing gave workers no reason to defer enrolment until a higher age related to health problems. Social interaction may explain early membership in the printing and tobacco industries, where we find a positive association between membership among older workers and the enrolment of younger workers.
    Keywords: health; health insurance; adverse selection; mutual aid societies; micro data; matched employer-employee data; labour markets; manufacturing industry; industrialization; Sweden; 19th century; 20th century
    JEL: I13 N33 N63
    Date: 2022–03–15
  15. By: Sylvain Chassang (Princeton University); Rong Feng (New York University)
    Abstract: Clinical trials following the "gold standard" of random assignment frequently use independent lotteries to allocate patients to treatment and control arms. Unfortunately, independent assignment can generate treatment and control arms that are unbalanced (i.e. treatment and control populations with significantly different demographics). This is regrettable since other assignment methods such as matched pair designs ensure balance across arms while maintaining randomization and permitting inference. This paper seeks to measure the cost of imbalance with respect to gender in a sample of roughly 2000 clinical studies. We document significant imbalance: 25% of experiments have at least 26% more men in one treatment arm than in the other. In addition, clinical trials with greater imbalance have more dispersed treatment effects, indicating that imbalance reduces the informativeness of experiments. A simple structural model suggests that for a typical experiment, using a balanced random design could deliver informativeness gains equivalent to increasing the sample size by 18%.
    Keywords: clinical trials, balance, gender, informativeness
    JEL: I11 I14
    Date: 2020–09
  16. By: Arno Baurin (UNIVERSITE CATHOLIQUE DE LOUVAIN, Institut de Recherches Economiques et Sociales (IRES)); Sandy Tubeuf (UNIVERSITE CATHOLIQUE DE LOUVAIN, Institut de Recherches Economiques et Sociales (IRES), Institute of Health and Society (IRSS, UCLouvain)); Vincent Vandenberghe (UNIVERSITE CATHOLIQUE DE LOUVAIN, Institut de Recherches Economiques et Sociales (IRES))
    Abstract: This paper shows that the analyst with no information on occupation arduousness could reasonably infer it from poor health beyond 50. Using retrospective lifetime data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including the respondents' professional career described with ISCO 2-digit, this paper finds a statistically significant link between many occupations and the risk of poor health beyond the age of 50. Next, we quantify the relative contribution of professional occupation to poor health compared to other factors decomposing the variance of health disparities between sources. We find that occupation's arduousness - although a significant predictor of poor health - is less consequential than initial health endowment, demographics or country fixed effects in explaining differences in health at an older age.
    Keywords: Health, Work, Occupation Arduousness, Variance Decomposition
    JEL: I10 J26 J28
    Date: 2022–03–02
  17. By: opara, Nnennaya; Opara, Emmanuel
    Abstract: Diabetes is an epidemic in the United States and is ranked as the sixth leading cause of death in the District of Columbia. According to the US Census population in 2010, >52,000 out of 610,000 residents have been diagnosed with diabetes. The highest prevalence was noted in wards 4, 5, 7, and 8, with the worst impact recorded in ward 8. The diabetes death rate among African Americans is five times that for Caucasians living in Colombia district, according to the DC department of health. There is an 11% disparity in the prevalence of diabetes when comparing black- and white people in the district (14% and 3%, respectively). This amounts to more than double the 6% disparity in the national population. This is also evident at both district and nationwide levels (prevalence of diabetes among people with no high school diploma, 21%; that in college graduates, 5%). The incidence of end-stage renal disease (ESRD), a life-threatening condition and diabetes-related complication is increasing in Colombia district and is rated as the number one cause of death from diabetes. In 2010, the newly diagnosed ESRD cases (420) and total number of ESRD cases due to diabetes (642) in the district were twice that of neighboring states (Maryland, Virginia, and West Virginia) and the entire US. In this review, the importance of implementing an evidence-based public health program in solving the epidemic of diabetes among the black community living in Ward 8 is emphasized. This study applies to every poor or minority ethnic group worldwide and in the US.
    Date: 2022–02–13
  18. By: Kovacs, Roxanne J.; Lagarde, Mylène
    Abstract: There is a widely held perception that staff shortages in low and middle-income countries (LMICs) lead to excessive workloads, which in turn worsen the quality of healthcare. Yet there is little evidence supporting these claims. We use data from standardised patient visits in Senegal and determine the effect of workload on the quality of primary care by exploiting quasi-random variation in workload. We find that despite a lack of staff, average levels of workload are low. Even at times when workload is high, there is no evidence that provider effort or quality of care are significantly reduced. Our data indicate that providers operate below their production possibility frontier and have sufficient capacity to attend more patients without compromising quality. This contradicts the prevailing discourse that staff shortages are a key reason for poor quality primary care in LMICs and suggests that the origins likely lie elsewhere.
    Keywords: workload; quality of care; standardised patients; Sengal; ESRC/MRC/DfID/Wellcome Trust grant MR/M014681/1; Research Fellowships in Humanities and Social Science 219744/Z/19/Z.; MR/M014681/1
    JEL: I10 I11 J45
    Date: 2022–03–01
  19. By: Ramos, Amaya Alexandra
    Abstract: In light of the 2021 United States military withdrawal from Afghanistan and the humanitarian crises of mass displacement and health system strain that have ensued, this article focuses on Afghan family systems as a means of enhancing practitioner awareness of the potential impact of adverse life experiences on resettled Afghans’ receptivity to psychosocial interventions at least partially rooted in Western methodologies. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, in addition to migration and conflict-induced stress, women from Afghanistan may have high baseline trauma levels upon resettlement. In the absence of robust literature on evidence-based psychosocial interventions for this population, ethnographic work and literature on existing clinical models alleged to be compatible with Afghan norms is reviewed and synthesized. The article finds the need for improved provider education in working with foreign-born populations, and thus proposes participatory research design considerations for future clinical studies, elaborating on important considerations for the evaluation of extant understandings following social reorganization on a massive scale.
    Date: 2022–02–02
  20. By: Xu, Tao
    Abstract: As the ageing population and childlessness are increasing in rural China, social pensions will become the mainstream choice for farmers, and the level of social pensions must be supported by better social insurance. The paper compares the history of rural pension insurance system, outlines the current situation and problems, analyses China Family Panel Studies data and explores the key factors influencing farmers' participation through an empirical approach. The paper shows that residents' social pension insurance is facing problems in the rural areas such as low level of protection and weak management capacity, which have contributed to the under-insured rate, and finds that there is a significant impact on farmers' participation in insurance from personal characteristics factors such as gender, age, health and (family) financial factors such as savings, personal income, intergenerational mobility of funds. And use of the Internet can help farmers enroll in pension insurance. The paper argues for the need to continue to implement the rural revitalisation strategy, with the government as the lead and the market as the support, in a concerted effort to improve the protection and popularity of rural pension insurance.
    Keywords: Countryside; Rural pension system; Residents' social insurance; Rural revitalization; Family panel studies
    JEL: H5 H53 H55 J1 J2 J6 P2
    Date: 2021–11–20
  21. By: Vincenzo Galasso; Vincent Pons; Paola Profeta; Michael Becher; Sylvain Brouard; Martial Foucault
    Abstract: Millions of people refuse COVID-19 vaccination. Using original data from two surveys in nine OECD countries, we analyze the determinants of anti-vax intentions in December 2020 and show that half of the anti-vax individuals were vaccinated by summer 2021. Vaccinations were more likely among individuals aged 50+, exposed to COVID-19, compliant with public restrictions, more informed on traditional media, trusting scientists, and less concerned about vaccines’ side effects. We run a survey experiment with informational messages. In EU countries, a message about protecting health largely increases vaccinations, even among anti-vax individuals. In the U.K. and U.S., a message about protecting the economy generates similar effects. Our findings suggest that informational campaigns should adopt adequate narratives and address concerns about vaccines’ side effects.
    JEL: D83 I12 I18
    Date: 2022–02
  22. By: Edward L. Glaeser (Harvard University); Caitlin S. Gorback (National Bureau of Economic Research); Stephen J. Redding (Princeton University)
    Abstract: How effective are restrictions on geographic mobility in limiting the spread of the COVID-19 pandemic? Using zip code data for Atlanta, Boston, Chicago, New York (NYC), and Philadelphia, we estimate that total COVID-19 cases per capita decrease on average by approximately 20 percent for every ten percentage point fall in mobility between February and May 2020. To address endogeneity concerns, we instrument for travel by the share of workers in remote work friendly occupations, and find a somewhat larger average decline of COVID-19 cases per capita of 27 percent. Using weekly data by zip code for NYC and a panel data specification including week and zip code fixed effects, we estimate a similar average decline of around 17 percent, which becomes larger when we measure mobility using NYC turnstile data rather than cellphone data. We find substantial heterogeneity across both space and over time, with stronger effects for NYC, Boston and Philadelphia than for Atlanta and Chicago, and the largest estimated coefficients for NYC in the early stages of the pandemic.
    Keywords: COVID-19, pandemic, travel, transportation
    JEL: H12 I12 J17 R41
    Date: 2020–07
  23. By: Joshua Aizenman; Alex Cukierman; Yothin Jinjarak; Sameer Nair-Desai; Weining Xin
    Abstract: We evaluate the quartile ranking of countries during the Covid-19 pandemic using both official (i.e., confirmed) and excess mortality data. Contrasting countries’ rankings using these two data sources reveal sharp and systematic differences. While higher GDP per capita is associated with a worse mortality ranking when using official Covid-19 mortality, there is no such sharp association when using excess mortality data. By the end of 2021, the quartile rankings of three-fifths of the countries in our sample differ when ranked by excess vs. official mortality. On average, countries that are ‘doing substantially better’ in the excess mortality dataset are characterized by lower population density; higher GDP/Capita; and higher scores on institutional and policy variables. To characterize these differences, we perform two sets of regressions, in which the ratio of Cumulative Excess to Official Covid-19 mortalities (E/O ratio) is regressed on a large set of covariates. Our sample composes over 140 countries, and the analysis is run both at the end of 2020 and the end of 2021. In the first, narrow experiment, we only control for GDP/Capita and vaccination rates. In the second, broad experiment, we add other institutional and policy variables. In the narrow experiment, by December 2021 the E/O ratio was smaller in countries with higher vaccination rates. In the broad experiment, the E/O ratio was smaller in countries with higher degree of voice and accountability. Our results suggest that the arrival of vaccines in early 2021 and voice and accountability had a discernible association with the gap between excess and official mortality.
    JEL: F5 F6 H12 H84 I18
    Date: 2022–02
  24. By: Robles, Claudia; Rossel, Cecilia
    Abstract: The coronavirus disease (COVID-19) pandemic has triggered an unprecedented worldwide social, economic and health crisis. This emergency has prompted the Latin American and Caribbean countries to deploy a series of social protection measures in an attempt to mitigate its impacts, especially for the most vulnerable population groups. In view of this situation and given the possibility of other crises in the future, the role of social protection systems has become one of fundamental importance, and strategies have to be devised for making those systems universal, comprehensive and sustainable on the basis of an approach that is sensitive to difference. This study looks at a number of the social protection measures implemented by the countries of the region in response to the pandemic and explores different social protection tools that could contribute to a recovery with equality and sustainability.
    Date: 2022–02–17
  25. By: Shenderovich, Yulia; Sacolo-Gwebu, Hlengiwe; Fang, Zuyi; Lachman, Jamie; Cluver, Lucie; Ward, Catherine
    Abstract: COVID-19 pandemic has created new pressures for many families, and organisations supporting them. In interviews with staff from three community-based organisations in Cape Town, South Africa, and other stakeholders, we looked at how organisations adapted their delivery of two evidence-informed parenting interventions and other services for families. Data from 22 interviews conducted August 2020 - May 2021 were analysed using framework approach. Participants perceived increased job losses, food insecurity, and stress experienced by families. Organisations changed how they worked with families, in response to the pandemic and restrictions on gathering, reductions in available resources, changing community needs and funding priorities. The organisations focused on boosting food provision and developed COVID prevention activities and safety measures. Organisations adapted parenting programme delivery by changing the physical settings and group size for in-person programmes and taking up digital delivery and phone communication with families. Participants reported a positive change in their perceptions of digital delivery as a feasible approach for working with families - but limited internet and phone access were a challenge. The pandemic brought new tasks and responsibilities for staff, and challenges associated with working from home and health risks of in-person work.
    Date: 2022–02–18
  26. By: Marina Luz GARCÍA
    Abstract: This article examines female Uber drivers’ labour trajectories, paying attention to the way in which gender-based occupational segregation is reproduced and/or challenged in the context of the platform. It also asks how female drivers balance between paid labour and care responsibilities. The analysis focuses on the impacts of the Covid-19 pandemic on platform female drivers work-life balance. The article uses qualitative interviews with Uber female drivers, finding that the entry of female drivers into Uber comes with a significant challenge to the gender division of labour. With respect to the Argentinian context, their participation defies the idea that occupations involving driving or circulating in public spaces are inappropriate for women. However, these women’s conquests finds strong limits. In particular, the daily efforts to reconcile paid work (and its implications in terms of earnings levels and health) together with domestic care activities expose the omnipresent nature of a gender order that still needs to be systematically questioned and confronted.
    Keywords: Argentine
    JEL: Q
    Date: 2022–03–08
  27. By: Merkley, Eric; Bergeron, Thomas; Loewen, Peter John; Elias, Angelo; Lapp, Miriam
    Abstract: Scholars have linked cost and life stress to lower voter turnout with clear implications for voting during the COVID-19 pandemic. We ask whether COVID-19 reduces turnout intention and how election agencies can mitigate this effect. We use a series of six survey and conjoint experiments implemented in samples totalling over 28,000 Canadian respondents collected between July and November of 2020 to show that: 1) priming people to think about COVID-19 reduces turnout intention, especially among those who feel most threatened by the disease; 2) safety measures for in-person voting, such as mandatory masks and physical distancing, can improve safety perceptions and willingness to vote in-person, and 3) providing people information about safety precautions for in-person voting mitigates the negative effect of priming COVID-19. These studies illustrate the importance of both the implementation and communication of measures by election agencies designed to make people safe – and feel safe – while voting in-person.
    Date: 2021–11–11
  28. By: Vlados, Charis (Democritus University of Thrace, Department of Economics); Koutroukis, Theodore (Democritus University of Thrace, Department of Economics); Chatzinikolaou, Dimos (Democritus University of Thrace, Department of Economics)
    Abstract: The outbreak of the COVID-19 pandemic seems to be structurally transforming the global economy. This article explores how these recent changes impact the different types of organizations and the ways these may adapt in this repositioned context. First, we present the central dimensions of the unfolding health crisis and the subsequent broader socioeconomic crisis. Then, it is argued that this global-scale emerging transformation has brought about fundamental changes in the working environment within the accelerated Fourth Industrial Revolution. The article concludes that all socioeconomic organizations (irrespectively of size and sectoral scope) are now required to grow as swiftly as possible their strategic, technological, and managerial potential to innovate and adapt in this emerging reality. Τhis innovational adaptation to exit this structural crisis seems to be requiring the structuration of corresponding change management mechanisms.
    Keywords: Change management; COVID-19; Fourth Industrial Revolution; Innovation; Labor relations; Organizational adaptation
    JEL: E24 F66 M19 O10
    Date: 2021–09–29
  29. By: Motta, Matt (Oklahoma State University); Benegal, Salil D
    Abstract: Low public concern about anthropogenic climate change (ACC) – due in part to distrust toward the global scientific community – may decrease demand for policies aimed at mitigating and adapting to the deleterious effects of climate change. Encouragingly, though, recent public opinion research suggests that experiences with the COVID-19 pandemic has elevated trust in scientific expertise worldwide. Consequently, amid the suffering associated with global pandemic, one “silver lining” might be that trust in the scientific community attributable to COVID-19 pandemic response is spilling over to increase public acceptance of other contentious aspects of scientific consensus: such as the reality of ACC. We explore this possibility by turning to globally-representative survey data from 111 countries (N = 119,088) conducted during the COVID-19 pandemic. We show that trust medical experts’ handling of the COVID-19 pandemic is associated with increased acceptance of ACC, worldwide. These findings hold even when accounting for individuals’ broader trust in the scientific community, and therefore do not appear to be confounded by more-general orientations toward science. Problematically, though, we also show that effect of trust in medical professionals is strongest in countries experiencing the most positive change in attitudes toward the scientific community, which we demonstrate (via multivariate country-level analyses) tend to be disproportionately wealthy, and perhaps less likely to bear the deleterious and unequal effects of ACC. We conclude by discussing how this work helps elucidate the role of pandemic psychology on “post-pandemic life,” and discuss the potentially-far-reaching benefits of improving trust in medical institutions in the developing world.
    Date: 2022–02–08
  30. By: Shomak Chakrabarti; Ilia Krasikov; Rohit Lamba
    Abstract: This paper combines a canonical epidemiology model of disease dynamics with government policy of lockdown and testing, and agents' decision to social distance in order to avoid getting infected. The model is calibrated with data on deaths and testing outcomes in the Unites States. It is shown that an intermediate but prolonged lockdown is socially optimal when both mortality and GDP are taken into account. This is because the government wants the economy to keep producing some output and the slack in reducing infection is picked up by social distancing agents. Social distancing best responds to the optimal government policy to keep the effective reproductive number at one and avoid multiple waves through the pandemic. Calibration shows testing to have been effective, but it could have been even more instrumental if it had been aggressively pursued from the beginning of the pandemic. Not having any lockdown or shutting down social distancing would have had extreme consequences. Greater centralized control on social activities would have mitigated further the spread of the pandemic.
    Date: 2022–02
  31. By: Phu Nguyen-Van; Thierry Blayac; Dimitri Dubois; Sebastien Duchene; Ismael Rafai; Bruno Ventelou; Marc Willinger
    Abstract: We test the effectiveness of a social comparison nudge to enhance lockdown compliance during the Covid-19 pandemic, using a French representative sample (N=1154). Respondents were randomly assigned to a favourable/unfavourable informational feedback (daily road traffic mobility patterns, in Normandy - a region of France) on peer lockdown compliance. Our dependent variable was the intention to comply with a possible future lockdown. We controlled for risk, time, and social preferences and tested the effectiveness of the nudge. We found no evidence of the effectiveness of the social comparison nudge among the whole French population, but the nudge was effective when its recipient and the reference population shared the same geographical location (Normandy). Exploratory results on this subsample (N=52) suggest that this effectiveness could be driven by non-cooperative individuals.
    Keywords: COVID-19; Lockdown compliance; Social Comparison; Nudge; Risk preferences; Time preferences; Social preferences
    JEL: C90 D90 I10
    Date: 2022
  32. By: Jorge M. Agüero (University of Connecticut); Erica Field (Duke University, NBER and BREAD); Ignacio Rodriguez Hurtado (Duke University); Javier Romero (The World Bank and Universidad de Piura)
    Abstract: We collect retrospective panel survey data on household socioeconomic status and do-mestic conflict from a large nationwide sample in Peru and find a sizable and sustained increase in intimate partner violence (IPV) during the COVID-19 pandemic. The in-cidence of physical IPV increased by an estimated 56% from 2019 to April/May 2020, and the increase was sustained until July/August 2020, the latest data point collected in our survey. Households most likely to lose a job experienced the largest increases in IPV over the period, measured by variation in the level of job loss across occupations. These patterns suggest that part of the increase in IPV was a causal effect of income shocks created by the COVID-19 pandemic.
    JEL: J12 J16 K42 O15
    Date: 2022–03
  33. By: John W. Barry; Murillo Campello; John Graham; Yueran Ma
    Abstract: We use the COVID shock to study the direct and interactive effects of several forms of corporate flexibility on short- and long-term real business plans. We find that i) workplace flexibility, namely the ability for employees to work remotely, plays a central role in determining firms’ employment plans during the health crisis; ii) investment flexibility allows firms to increase or decrease capital spending based on their business prospects in the crisis, with effects shaped by workplace flexibility; and iii) financial flexibility contributes to stronger employment and investment, in particular when fixed costs are high. While the role of workplace flexibility is new to the COVID crisis, CFOs expect lasting effects for years to come: high workplace flexibility firms foresee continuation of remote work, stronger employment recovery, and shifting away from traditional capital investment, whereas low workplace flexibility firms rely more on automation to replace labor.
    JEL: G01 G17 G31
    Date: 2022–02
  34. By: Natalie Cox (Princeton Unviersity); Peter Ganong (University of Chicago); Pascal Noel (University of Chicago); Joseph Vavra (University of Chicago); Arlene Wong (Princeton University)
    Abstract: We use U.S. household-level bank account data to investigate the heterogeneous effects of the pandemic on spending and savings. Households across the income distribution all cut spending from March to early April. Since mid April, spending has rebounded most rapidly for low-income households. We find large increases in liquid asset balances for households throughout the income distribution. However, lower-income households contribute disproportionately to the aggregate increase in balances, relative to their pre-pandemic shares. Taken together, our results suggest that spending declines in the initial months of the recession were primarily caused by direct effects of the pandemic, rather than resulting from labor market disruptions. The sizable growth in liquid assets we observe for low-income households suggests that stimulus and insurance programs during this period likely played an important role in limiting the effects of labor market disruptions on spending.
    Keywords: U.S., Northern America, Consumer, Distribution, Households, Income, Income Distribution, Recession, Saving, Pandemic
    JEL: D12 D31 E21 E32 E62 G51 I12
    Date: 2020–07

This nep-hea issue is ©2022 by Nicolas R. Ziebarth. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.