nep-hea New Economics Papers
on Health Economics
Issue of 2022‒04‒04
eighteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Effect of a Universal Preschool Programme on Long-Term Health Outcomes: Evidence from Spain By Bosque-Mercader, L.;
  2. Grading Bias and Young Adult Mental Health By Linder, Anna; Nordin, Martin; Gerdtham, Ulf-G.; Heckley, Gawain
  3. Does Higher Education Reduce Mortality? Evidence from a Natural Experiment By Gonzalez, Felipe; Martinez, Luis R.; Muñoz, Pablo; Prem, Mounu
  4. Occupational safety in a frictional labor market By Kerndler, Martin
  5. Voluntary health insurance markets in France: . Economic rationales and legal mechanisms By Philippe Batifoulier; Anne-Sophie Ginon
  6. Gone with the Wind: The Welfare Effect of Desert Locust Outbreaks By Marending, Myriam; Tripodi, Stefano
  7. Why Healthcare CCTs may not Improve Children's Health:Insights from India's Janani Suraksha Yojana By Harsh Malhotra
  8. Aggregate Health Shock and Retirement Decision By Hyunduk Suh; SeEun Jung
  9. When generic measures fail to reflect what matters to patients: three case studies By Mott, D.; Schirrmacher, H.; Garau, M.
  10. Health, income, and the Preston Curve: a long view By Prados de la Escosura, Leandro
  11. Shortages of medicines in OECD countries By Suzannah Chapman; Guillaume Dedet; Ruth Lopert
  12. The Shadow of the Neolithic Revolution on Life Expectancy: A Double-Edged Sword By Franck, Raphael; Galor, Oded; Moav, Omer; Özak, Ömer
  13. Understanding how COVID-19 has Changed Teachers’ Chances of Remaining in the Classroom By Zamarro, Gema; Camp, Andrew; Fuchsman, Dillon; McGee, Josh B.
  14. Environment, public debt and epidemics * By Marion Davin; Mouez Fodha; Thomas Seegmuller
  15. Innovation and patenting activities of COVID-19 vaccines in WTO members: Analytical review of Medicines Patent Pool (MPP) COVID-19 Vaccines Patent Landscape (VaxPaL) By Chiang, Ting-Wei; Wu, Xiaoping
  16. Association of COVID-19 Incidence and Mortality Rates With School Reopening in Brazil During the COVID-19 Pandemic By Lichand, Guilherme; Belchior, Carlos Alberto; Leal Neto, Onicio Batista; Cossi, João
  17. Managing Contagion: COVID, Public Health, and Reflexive Behavior By Davis, John B.
  18. Quantitative Effects of COVID-19 Pandemic Containment Policies By Beomsoo Kim; Sangsoo Park; Sunbin Kim

  1. By: Bosque-Mercader, L.;
    Abstract: Early childhood education programmes are expected to improve child conditions including educational attainment, labour, and health outcomes. This study evaluates the effect of a Spanish universal preschool programme, which implied a large-scale expansion of full-time high-quality public preschool for three-year-olds in 1991, on long-term health. Using a difference-in-differences approach, I exploit the timing of the policy and the differential initial speed of implementation of public preschool expansion across regions. I compare long-term health of cohorts aged three before to those aged three after the start of the policy residing in regions with varying initial implementation intensity of the programme. The results show that the policy does not affect long-term health outcomes and use of healthcare services, except for two outcomes. A greater initial intensity in public preschool expansion by 10 percentage points decreases the likelihood of being diagnosed with asthma by 2.1 percentage points, but hospitalisation rates increase by 2.7%. The findings indicate that the effect on asthma is larger for men, hospitalisation rates are higher for pregnant women, and disadvantaged children benefit the most in terms of a lower probability of taking medicines and being diagnosed with asthma and mental health disorders.
    Keywords: universal preschool programme; long-term effects; health outcomes; difference-in-differences; Spain;
    JEL: I10 I28 J13
    Date: 2022–03
  2. By: Linder, Anna (Centre for Economic Demography, Lund University); Nordin, Martin (AgriFood Economics Centre, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University); Heckley, Gawain (Centre for Economic Demography, Lund University)
    Abstract: Various grading reforms and trends of more lenient grading have contributed to grade inflation in Sweden and other countries. Previous research shows that over-grading increases higher education enrolment, achievements and earnings, but no study has yet addressed the potential impact of grading bias on health. In this paper, we hypothesize that over-grading has a protective impact on mental health, either through a direct effect of performance feedback, or through mechanisms such as self-efficacy and university admission distortions. We test this hypothesis using Swedish individual-level register data for individuals graduating from upper secondary school in the years 2001-2004. Grading bias, which we interpret as over-grading, is constructed as the residual of final upper secondary school grades having controlled for results in a standardised test, itself not subject to grading leniency. Over-grading is further isolated by considering only within-school variation in over-grading and controlling for prior grades and school production. We show that over-grading has substantial significant protective impacts on the mental health of young adults, but only among female students. That grades themselves, independent of knowledge, substantially impact the production of health highlights an important health production mechanism, and also implies that any changes to the design of grading systems must consider these wider health implications.
    Keywords: Grading bias; grade inflation; mental health; human capital development
    JEL: I10 I21 I28
    Date: 2022–03–29
  3. By: Gonzalez, Felipe; Martinez, Luis R.; Muñoz, Pablo; Prem, Mounu
    Abstract: We provide new evidence on the causal eect of education on health. Our empirical strategy exploits the reduction in access to college experienced by individuals reaching college age shortly after the 1973 military coup in Chile, which led to a sharp downward kink in enrollment for the aected cohorts. Using data from the vital statistics for the period 1994-2017, we document an upward kink in the age-adjusted yearly mortality rate for these cohorts, a pattern that we also observe in matched individual-level records for hospitalized patients. Leveraging the downward kink in college enrollment, we estimate a negative eect of college on mortality, which is larger for men, but also sizable for women. Aected individuals have worse labor market outcomes, lower income, and are more likely to be enrolled in the public health system. They also report lower consumption of health services, which suggests that economic disadvantage and limited access to care plausibly contribute to the eect of education on health.
    Date: 2022–02–28
  4. By: Kerndler, Martin
    Abstract: This paper studies the provision of occupational safety when the labor market is subject to search frictions. While safety measures are costly for firms, they reduce workers' mortality. We show that the presence of search frictions decreases the socially optimal level of occupational safety relative to a frictionless labor market, leading to excess mortality. In a decentralized setting where wages and safety measures are bargained at the firm level, matching externalities and a labor supply externality may further reduce safety provision. We obtain conditions under which these externalities are internalized by firms and workers, and discuss the role of policy for promoting occupational safety. Calibrating the model to the US, we find that search frictions explain 8%-14% of the work-related mortality rate, which indirectly makes them the third largest cause of work-related death.
    Keywords: occupational safety,mortality,search frictions,Nash bargaining
    JEL: J17 J28 J32 J38 J64
    Date: 2022
  5. By: Philippe Batifoulier (CEPN - Centre d'Economie de l'Université Paris Nord - UP13 - Université Paris 13 - USPC - Université Sorbonne Paris Cité - CNRS - Centre National de la Recherche Scientifique); Anne-Sophie Ginon
    Abstract: In France, there are two types of health insurance: compulsory public health insurance and voluntary private health insurance which is organized as a market. This paper deals with private health insurance. We define the market place (position and scope) according to two criteria. On the one hand, the standardization or differentiation strategies of the insurance companies, which structure competition through quality and innovation. Secondly, the type of pooling (or mutualisation) at work in insurance contracts, distinguishing between commercial pooling and solidarity-based pooling. We draw up a typology of four "ideal-type" market configurations: residual market, educated market, polarized market and autonomous market.
    Date: 2022–02–22
  6. By: Marending, Myriam (Department of Economics, Copenhagen Business School); Tripodi, Stefano (Department of Economics, Copenhagen Business School)
    Abstract: Desert locust outbreaks and other pests pose a significant threat to food security for millions of people. In this paper we quantify the size of the productivity and welfare loss caused by a desert locust outbreak that hit Ethiopia in 2014. We identify the causal effect of locust swarms on agricultural output and children’s nutritional status by modelling swarms’ movements based on wind speed and direction to identify areas in which they likely land (affected areas). We corroborate our finding by using a “recentered” measure of exposure to swarms that removes the bias due to non random exposure. We find that agricultural output is about 10-11% lower in areas hit by the shock compared to areas that are not affected. On average, children nutritional status is not negatively impacted by the shock, but each additional swarm affecting an enumeration area decreases BMI and weight-for-height z-scores by about 0.03 standard deviations, compared to children living in non affected areas.
    Keywords: agricultural shocks; desert locust swarms; food security; Ethiopia; child health
    JEL: D13 I15 Q12 Q18 Q54
    Date: 2022–01–24
  7. By: Harsh Malhotra
    Abstract: This paper evaluates a conditional cash transfer program, Janani Suraksha Yojana, which drove a large expansion in the use of public health facilities by mothers and their newborn children in India.The program did not improve children’s mortality (as previous research documents and I confirm). I focus on understanding why. Using birth-histories from the Indian Human Development Survey (2011 and 2005), I estimate within-mother effects of the staggered arrival of the program across districts in India. The key finding is that families’ preference for sons over daughters has an important bearing on the program’s effects, especially in regions where the health system is less developed. A triple difference strategy reveals that families that were more likely to desire a son - those with no sons at baseline - increased fertility under the program (relative to the other families), and, exhibited a worsening of newborn mortality for daughters, but not for sons. This finding holds for under-developed regions where healthcare is of poor quality. This highlights a challenge for demand-side interventions in healthcare: the character of demand may reflect social biases that undermine children’s health in the first place. In settings where the quality of healthcare is low, this may have stark consequences.
    Date: 2022–02
  8. By: Hyunduk Suh (Inha University); SeEun Jung (Inha University)
    Abstract: The retirement of old workers increased during the COVID-19 pandemic, and health concerns are considered as a critical factor. To isolate the effect of pure health concerns during the pandemic, we analyze the impact of the aggregate health shock on retirement decisions using a life-cycle model. The aggregate health shock changes the economy from the normal state to the pandemic state, where the probability of adverse idiosyncratic health shock increases, especially if agents are working. Simulation results suggest that the shock accelerates the retirement of agents aged between 60 and 64. Its impact is quantitatively greater than the effect of a five percent reduction in labor income. The retirement response is heterogeneous across agent types, influenced by various factors, including preference, income, health status, and health expenditure. The negative effect of the aggregate health shock is significant even though the shock is expected to be temporary. Also, the effect hinges on the assumption that working poses a greater risk of receiving a negative health shock than retiring.
    Keywords: Retirement, Health shock, COVID-19, Life-cycle model
    JEL: J26 I18 E24
    Date: 2022–03
  9. By: Mott, D.; Schirrmacher, H.; Garau, M.
    Abstract: Generic preference-based measures are often used for capturing patients' health-related quality of life (QOL) to assess quality-adjusted life years (QALYs) in health technology assessment (HTA). Whilst this type of measure, which includes commonly used EQ-5D instruments, are useful for enabling comparability between assessments, they might not always capture all the dimensions of QOL that are important to patients. This interactive summary report provides three case studies exploring examples of health conditions where the EQ-5D has been shown to, or is likely to, perform sub-optimally in reflecting the dimensions of QOL that matter to patients - - Multiple sclerosis - Alzheimer's disease - Sickle cell disease Our [earlier report on the measurement of QOL for HTA]( provides a summary of the potential alternatives to generic preference-based measures for measuring QOL.
    JEL: I1
    Date: 2022–03–01
  10. By: Prados de la Escosura, Leandro
    Abstract: Well-being is increasingly viewed as a multidimensional phenomenon, of which income is only one facet. In this paper I focus on another one, health, and look at its synthetic measure, life expectancy at birth, and its relationship with per capita income. International trends of life expectancy and per capita GDP differed during the past 150 years. Life expectancy gains depended on economic growth but also on the advancement in medical knowledge. The pace and breadth of the health transitions drove life expectancy aggregate tendencies and distribution. The new results confirm the relationship between life expectancy and per capita income and its outward shift over time as put forward by Samuel Preston. However, the association between nonlinearlytransformed life expectancy and the log of per capita income does not flattenout over time, but becomes convex suggesting more than proportional increases in life expectancy at higher per capita income levels.
    Keywords: Well-Being; Life Expectancy; Per Capita Income; Inequality; Health Transition; Preston Curve
    JEL: F60 I15 N30 O50
    Date: 2022–03–29
  11. By: Suzannah Chapman (OECD); Guillaume Dedet (OECD); Ruth Lopert (OECD)
    Abstract: Even in wealthy economies, access to medicines is increasingly affected by medicine shortages – an issue exacerbated with the onset of the COVID-19 pandemic. The aim of this paper was to examine the extent and nature of medicine shortages in OECD countries (pre-COVID-19) and explore the reasons for this growing global problem. Although differences in monitoring mechanisms make multi-country analyses challenging, a sample of 14 OECD countries reported a 60% increase in the number of shortage notifications over the period 2017-2019. While the complexity of pharmaceutical manufacturing and supply chains hampers root cause analyses, available literature suggests that shortages, as reported by marketing authorisation holders, are predominantly due to manufacturing and quality issues. Nevertheless, commercial factors - and the policy settings that influence them - may play an important role. Although several OECD countries have implemented policy measures to mitigate, monitor and prevent shortages, more robust data and further analyses of root causes and effective policy responses are needed. The way forward should involve a global approach that engages all relevant actors and looks beyond the health care sector alone.
    JEL: I10 I11 I14 I18 L11
    Date: 2022–03–24
  12. By: Franck, Raphael; Galor, Oded; Moav, Omer; Özak, Ömer (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.
    Date: 2022–03–01
  13. By: Zamarro, Gema (University of Arkansas); Camp, Andrew (University of Arkansas); Fuchsman, Dillon (Sinquefield Center for Applied Economic Research, Saint Louis University); McGee, Josh B. (University of Arkansas)
    Abstract: The 2020-2021 academic year was a trying year for teachers. We use a nationally representative sample of teachers from the RAND American Teacher Panel to document that teachers’ stated consideration of leaving the profession increased during the pandemic. We also study factors associated with teachers’ consideration of leaving the profession and high levels of job burnout during the pandemic. Approaching retirement age (being 55 or older), having to change instruction modes, health concerns, and high levels of job burnout all appear to be important predictors of the probability of considering leaving or retiring from teaching. Hybrid teaching increased consideration of leaving the profession because of COVID. Health concerns and switching instruction modes are all associated with higher levels of concern about job burnout. Interestingly, those approaching retirement ages do not present higher levels of concern about job burnout than younger teachers. Although increased consideration of leaving and concern about burnout do not yet appear to have materialized into higher attrition rates so far, higher levels of job dissatisfaction could affect teacher effectiveness and could harm student academic progress.
    Keywords: Teacher turnover; teacher retention; job burnout; COVID-19
    JEL: I20 J18 J28
    Date: 2022–02–28
  14. By: Marion Davin (CEE-M - Centre d'Economie de l'Environnement - Montpellier - UMR 5211 - UM - Université de Montpellier - CNRS - Centre National de la Recherche Scientifique - Montpellier SupAgro - Institut national d’études supérieures agronomiques de Montpellier - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Mouez Fodha (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PSE - Paris School of Economics - ENPC - École des Ponts ParisTech - ENS-PSL - 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); Thomas Seegmuller (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: We study whether fiscal policies, especially public debt, can help to curb the macroeconomic and health consequences of epidemics. Our approach is based on three main features: we introduce the dynamics of epidemics in an overlapping generations model to take into account that old people are more vulnerable; people are more easily infected when pollution is high; public spending in health care and public debt can be used to tackle the effects of epidemics. We show that fiscal policies can promote convergence to a stable disease-free steady state. When public policies are not able to permanently eradicate the epidemic, public debt, and income transfers could reduce the number of infected people and increase capital and GDP per capita. As a prerequisite, pollution intensity should not be too high. Finally, we define a household subsidy policy that eliminates income and welfare inequalities between healthy and infected individuals.
    Keywords: public debt,overlapping generations,pollution,Epidemics
    Date: 2021–12–06
  15. By: Chiang, Ting-Wei; Wu, Xiaoping
    Abstract: This working paper provides a statistical analysis of 74 patent families which cover subject matter relevant to ten COVID-19 vaccines. These vaccines have accounted for 99% of the global COVID-19 vaccine production as of 31 December 2021, comprising over ten billion doses. Eight of them, namely BNT162b2 (Pfizer/BioNTech), AZD1222 (AstraZeneca/Oxford), Ad26.COV2-S (J&J), mRNA1273 (Moderna), BBIBP-CorV (Sinopharm/Beijing), Coronavac (Sinovac), Covaxin (Bharat/ICMR), and NVX-CoV2373 (Novavax), have been approved by the World Health Organization (WHO) for inclusion in its Emergency Use Listing (EUL). The analysis is based on VaxPaL, a COVID-19 vaccines patent database developed by the Medicines Patent Pool (MPP). Through the detailed examination of patent applicants, filing dates, and offices of first and subsequent filing, the paper identifies patterns and trends of innovation and patenting activities of COVID-19 vaccines in WTO Members, and presents the legal status of the 74 patent families in 105 jurisdictions. This information may provide useful background for policymakers on the significance and potential impact of these patent families with relevance to the access to and production of these vaccines in their individual countries. This, in turn, may help support practical assessments as to potential options within and beyond the current TRIPS framework to promote equitable access to COVID-19 vaccines.
    Keywords: COVID-19,vaccine,patent,whole virus,viral vector,protein subunit,mRNA,filing dates,office of first filing,office of subsequent filing,legal status
    JEL: K11 K15 K30 O30 O31 O34 I18
    Date: 2022
  16. By: Lichand, Guilherme; Belchior, Carlos Alberto; Leal Neto, Onicio Batista (University of Zurich); Cossi, João
    Abstract: School closures because of COVID-19 have left 1.6 billion students around the world without in-person classes for a prolonged period. To our knowledge, no study has documented whether reopening schools in low- and middle-income countries during the pandemic was associated with increased aggregate COVID-19 incidence and mortality with appropriate counterfactuals. This observational study of municipalities in São Paulo State, Brazil, uses a difference-in-differences analysis to examine the association between municipal decisions to reopen schools during the COVID-19 pandemic and municipal-level COVID-19 case and death rates between October and December 2020. The study compared 129 municipalities that reopened schools in 2020 with 514 that did not. The findings indicated that there were no statistically significant differences between municipalities that authorized schools to reopen and those that did not for (1) weekly new cases (difference-in-differences, –0.03; 95% CI, –0.09 to 0.03) and (2) weekly new deaths (difference-in-differences, –0.003; 95% CI, –0.011 to 0.004) before and after October 2020. Reopening schools was not associated with higher disease activity, even in relatively vulnerable municipalities, nor aggregate mobility. The findings from this study suggest that keeping schools open during the COVID-19 pandemic did not contribute to the aggregate disease activity.
    Date: 2022–02–14
  17. By: Davis, John B. (Department of Economics Marquette University)
    Abstract: This paper characterizes a pandemic as one kind of contagion, and defines a contagion as a two-level, two-direction, reflexive feedback loop system. In such a system, experts' opinions can act as self-fulfilling prophecies that significantly influence social behavior. Also, when multiple experts produce multiple, expert opinions can fragment a society's response to a pandemic worsening rather than ameliorating it. This paper models this with two competing expert opinions, associates them with club good and common pool goods types of circumstances, and argues that to combat fragmentation of opinion a focus on public health public good provision needs to be framed in public choice terms, specifically as choices regarding the nature of democratic deliberative institutions. From a constitutional political economy perspective, it argues this entails asking how public reasoning processes can function in an 'inclusive and noncoercive' way that allows society to reconcile competing visions regarding such issues as how to combat a pandemic.
    Keywords: COVID-19, contagion, self-fulfilling prophecy, public health, club goods, common pool goods, public choice, democratic deliberation
    JEL: H41 H70 I10 A13
    Date: 2022–03
  18. By: Beomsoo Kim (Department of Economics, Korea University, South Korea); Sangsoo Park (Department of Economics, Korea University, South Korea); Sunbin Kim (Department of Economics, Yonsei University, South Korea)
    Abstract: Countries are implementing containment policies to fight the coronavirus 2019 pandemic. We extend the susceptible-exposed-infectious-recovered (SEIR) model to include asymptomatic cases, which account for around 20%. We consider the cumulative confirmed and death cases in Italy and South Korea for our model estimation. The data for Italy, collated up to March 14, 2020, are not affected by any containment policy, whereas the data for South Korea collated up to the end of April 2020 reflect four containment policies: social distancing, preemptive quarantine, testing and quarantine of symptomatic or asymptomatic patients. Our policy experiments show that the testing and quarantine of symptomatic patients are very effective to contain, but not enough to extinguish, the epidemic. Thus, testing and quarantine should include the asymptomatic cases as well.
    Keywords: Extended SEIR Model, COVID-19, asymptomatic cases
    JEL: I18 C19
    Date: 2022

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