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on Health Economics |
| By: | Boeri, Tito; de Porto, Edoardo; Naticchioni, Paolo; Scrutinio, Vincenzo |
| Abstract: | Absent providers of key public services, such as schooling and health, are a major problem in both developed and developing countries. This paper provides the first analysis of a population-wide controlled field experiment for home visits checking on sick leave in the public sector. The experiment was carried out in Italy, a country with large absenteeism in the public sector, and it concerned the universe of public employees. We exploit unique administrative data from the Italian social security administration (INPS) on sick leave and work histories. We find that receiving a home visit reduces the number of days on sick leave in the following 16 months by about 12% (5.5 days). The effect is stronger for workers who are found irregularly on sick leave (-10.2 days). We interpret our findings as a deterrence effect of home visits: workers being found irregularly on sick leave experience a decline of about 2% of their wage in the following 12 months. Uncertainty aversion (there is no automatism in these sanctions) can play a role in these results. Our estimates suggest that home visits are cost-effective: every Euro spent for the visits involves up to 10 Euros reductions in sick benefits outlays. We estimate the marginal value of public funds (MVPF) spent on home visits at about 1.13, which is significantly lower than estimates of MVPF of income taxes in the US. |
| Keywords: | sick leave; absenteeism; randomized trial |
| JEL: | I12 J45 |
| Date: | 2021–05–21 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:114391&r= |
| By: | Raute, Anna (Queen Mary, University of London); Weber, Andrea (Central European University); Zudenkova, Galina (TU Dortmund) |
| Abstract: | A child's family structure is a fundamental determinant of future well-being, making it essential to understand how public policies affect the involvement of fathers. In this paper, we exploit a reform of the German parental leave system—which increased mother's income and reduced legal father's financial support burden—to measure the impact on the relationship contract choices of parents who were unmarried at conception. Based on detailed birth record data, we demonstrate that short-run reform incentives during the first period after birth nudge unmarried fathers into the long-term commitment of acknowledging paternity. This shift reduces single motherhood by 6% but leaves the share of marriages at birth constant. Moreover, the change in relationship contract choices is mostly driven by parents of boys. These findings are compatible with predictions from a model where parents choose between three types of relationship contracts based on the mother's and father's incomes and support obligations. Our results highlight the necessity of studying intermediate relationship contracts (i.e., between the extremes of marriage and single motherhood) to improve our understanding of potential risk groups among the rising number of children growing up outside of marriage. |
| Keywords: | paid parental leave, family structure, paternity establishment |
| JEL: | H42 I38 J12 J13 J16 J18 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15113&r= |
| By: | Kniesner, Thomas J. (Claremont Graduate University); Viscusi, W. Kip (Vanderbilt University) |
| Abstract: | The most enduring measure of how individuals make personal decisions affecting their health and safety is the compensating wage differential for job safety risk revealed in the labor market via hedonic equilibrium outcomes. The decisions in turn reveal the value of a statistical life (VSL), the value of a statistical injury (VSI), and the value of a statistical life year (VSLY), which have both mortality and morbidity aspects that we describe and apply here. All such tradeoff rates play important roles in policy decisions concerning improving individual welfare. Specifically, we explicate the recent empirical research on VSL and its related concepts and link the empirical results to the on-going examinations of many government policies intended to improve individuals' health and longevity. We pay special attention to recent issues such as the COVID pandemic and newly emerging foci on distributional consequences concerning which demographic groups may benefit most from certain regulations. |
| Keywords: | value of statistical life, VSL, value of statistical injury, VSI, value of a statistical life year, VSLY, mortality risk, morbidity risk, benefit cost analysis, hedonic labor market equilibrium, compensating wage differential, evaluation of health and safety programs |
| JEL: | J17 I18 H40 K32 J28 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15117&r= |
| By: | Jonathan Gruber; Adrienne Sabety; Rishi Sood; Jin Yung Bae |
| Abstract: | In 2016, New York City designed and implemented an intervention reducing frictions in accessing safety-net care: randomly making initial primary care appointments for 2,428 undocumented immigrants. We leverage a novel survey-administrative data linkage to show that the program resulted in a more efficient allocation of care. The program increased self-reported access to primary care, leading to a 21% fall in emergency department (ED) use. This effect was driven by high-risk individuals whose ED visits fell by 42% on average. Among those visiting sponsored clinics, chronic condition diagnoses and preventive screens increased, positively affecting long-run health. |
| JEL: | I10 I14 I18 J15 J61 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29838&r= |
| By: | Zack Cooper; Joseph J. Doyle Jr.; John A. Graves; Jonathan Gruber |
| Abstract: | We analyze whether receiving care from higher-priced hospitals leads to lower mortality. We overcome selection issues by using an instrumental variable approach which exploits that ambulance companies are quasi-randomly assigned to transport patients and have strong preferences for certain hospitals. Being admitted to a hospital with two standard deviations higher prices raises spending by 52% and lowers mortality by 1 percentage point (35%). However, the relationship between higher prices and lower mortality is only present at hospitals in less concentrated markets. Receiving care from an expensive hospital in a concentrated market increases spending but has no detectable effect on mortality. |
| JEL: | I10 I11 I13 I18 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29809&r= |
| By: | Ambade, Mayanka (Brandeis University); Menon, Nidhiya (Brandeis University); Subramanian, S. V. (Brandeis University) |
| Abstract: | We evaluate the impact of oral polio vaccines on the incidence of disabilities in India, focusing on polio-related disability. Polio was hyperendemic in India even as recently as the early 1990s but the country was declared wild polio virus-free in 2014. Average treatment effects on the treated from difference-in-differences with multiple time period models that condition on time-invariant demographic and socio-economic characteristics reveal that with access to oral polio vaccines in the year of birth, the incidence of any disability, locomotor disability and polio-related disability declined by 61.4%, 57.3% and 55.9%, respectively. We test for pre-trends and estimate alternate specifications that offer support for these results. Heterogeneity analyses show that in general, access to oral vaccines in the year of birth lowers the incidence of disabilities across gender, rural/urban and education stratifications. An exception is low-caste groups where there is some evidence that post-period average ATT rose. The eradication of polio saved a significant number of lives and brought measurable health and economic benefits to the country. |
| Keywords: | polio, locomotor, disability, acute flaccid paralysis, oral polio vaccines, early childhood, difference-in-differences with multiple time period models |
| JEL: | I15 I12 I18 O12 J13 J14 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15094&r= |
| By: | Barkowski, Scott; Jun, Dajung; Zhang, Yuting |
| Abstract: | The 2014 Medicaid expansion excluded Americans over 65, but they could still be affected via spillover effects. Using Medicare administrative data, we test for spillovers in Medicaid coverage and Medicare spending among Medicare beneficiaries. We analyze two separate birth cohorts: those under 65 in 2014, who could have been induced by the expansion to take up Medicaid before joining Medicare; and those 65 or older in 2014, whose Medicaid eligibility was never affected by the expansion. Our analysis shows that spillovers only flowed into the under-65 cohort, with Medicaid coverage increasing and average Medicare spending falling for this group, with little effect on health conditions. A lack of an effect on those over 65 in 2014 suggests Medicare beneficiaries were not crowded out of health care access by the expansion. Instead, those under 65 used Medicaid to satisfy “pent-up” demand, consuming care they would have otherwise consumed later under Medicare. |
| Keywords: | Health Insurance, Medicare, Medicaid expansion, ACA, spillovers |
| JEL: | I13 I18 |
| Date: | 2022–03–02 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:112178&r= |
| By: | Michael L. Anderson; Jeremy Magruder |
| Abstract: | Formal analysis plans limit false discoveries by registering and multiplicity adjusting statistical tests. As each registered test reduces power on other tests, researchers prune hypotheses based on prior knowledge, often by combining related indicators into evenly-weighted indices. We propose two improvements to maximize learning within these types of analysis plans. First, we develop data-driven optimized indices that can yield more powerful tests than evenly-weighted indices. Second, we discuss organizing the logical structure of an analysis plan into a gated tree that directs type I error towards these high-powered tests. In simulations we show that researchers may prefer these "optimus gates" across a wide range of data-generating processes. We then assess our strategy using the community-driven development (CDD) application from Casey et al. (2012) and the Oregon Health Insurance Experiment from Finkelstein et al. (2012). We find substantial power gains in both applications, meaningfully changing the conclusions of Casey et al. (2012). |
| JEL: | C12 C55 C81 C9 C93 O1 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29843&r= |
| By: | Emily A. Beam; Yusufcan Masatlioglu; Tara Watson; Dean Yang |
| Abstract: | We implemented a field experiment designed to increase participants’ willingness to visit a health clinic. We find differential responses to a $50 incentive framed as a loss versus framed as a gain. We find little support for the notion that loss aversion is responsible for the effectiveness of loss framing. Instead, it appears that loss framing promotes take-up by raising the perceived probability that the incentive will be provided as promised. The results suggest trust is an alternative pathway through which loss framing may affect behavior, and trust may be an important way to promote desirable health behaviors. |
| JEL: | C93 D03 I12 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29828&r= |
| By: | Abboud, Tatiana (University of Montreal); Bellou, Andriana (University of Montreal); Lewis, Joshua (University of Montreal) |
| Abstract: | This paper provides the first long-run assessment of adolescent alcohol control policies on later-life health and labor market outcomes. Our analysis exploits cross-state variation in the rollout of "Zero Tolerance" (ZT) Laws, which set strict alcohol limits for drivers under age 21 and led to sharp reductions in youth binge drinking. We adopt a difference-in-differences approach that combines information on state and year of birth to identify individuals exposed to the laws during adolescence and tracks the evolving impacts into middle age. We find that ZT Laws led to significant improvements in later-life health. Individuals exposed to the laws during adolescence were substantially less likely to suffer from cognitive and physical limitations in their 40s. The health effects are mirrored by improved labor market outcomes. These patterns cannot be attributed to changes in educational attainment or marriage. Instead, we find that affected cohorts were significantly less likely to drink heavily by middle age, suggesting an important role for adolescent initiation and habit-formation in affecting long-term substance use. |
| Keywords: | Zero Tolerance laws, disability, alcohol consumption, labor market |
| JEL: | I18 I12 J20 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15114&r= |
| By: | Green, Colin P. (Norwegian University of Science and Technology (NTNU)); Wilson, Luke B. (University of Sheffield); Zhang, Anwen (University of Glasgow) |
| Abstract: | Physically attractive individuals experience a range of advantages in adulthood including higher earnings; yet, how attractiveness influences earlier consequential decisions is not well understood. This paper estimates the effect of attractiveness on engagement in risky behaviours in adolescence. We find marked effects across a range of risky behaviours with notable contrasts. More attractive adolescents are more likely to engage in underage drink- ing; while they are less likely to smoke, use drugs, or practice unprotected sex. Investigation into the underlying channels reveals that popularity, self-esteem, and personality attractiveness have roles as mechanisms. Our findings suggest physical attractiveness in adolescence carries long-lasting consequences over the life course. |
| Keywords: | beauty, risky behaviours, adolescent development |
| JEL: | I12 J10 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15106&r= |
| By: | Barron, Kai; Parry, Charles D. H.; Bradshaw, Debbie; Dorrington, Rob; Groenewald, Pam; Laubscher, Ria; Matzopoulos, Richard |
| Abstract: | This paper evaluates the impact of a sudden and unexpected nation-wide alcohol sales ban in South Africa. We find that this policy causally reduced injury-induced mortality in the country by at least 14% during the five weeks of the ban. We argue that this estimate constitutes a lower bound on the true impact of alcohol on injury-induced mortality. We also document a sharp drop in violent crimes, indicating a tight link between alcohol and aggressive behavior in society. Our results underscore the severe harm that alcohol can cause and point towards a role for policy measures that target the heaviest drinkers in society. |
| Keywords: | alcohol,mortality,economics,health,crime,South Africa,COVID-19,violence |
| JEL: | I18 I12 K42 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:wzbeoc:spii2022301&r= |
| By: | Neil K. Mathur; Christopher J. Ruhm |
| Abstract: | Over the last two decades there has been considerable movement at the state-level to legalize marijuana, initially for medical purposes and more recently for recreational consumption. Despite prior research, it is unclear how, if at all, these policies are related to rates of opioid-involved overdose deaths, which have trended rapidly upwards over time and represent a major public health problem. We provide two types of new information on this question. First, we replicate and extend upon previous investigations and show that the empirical results of those studies are frequently fragile and that, in most cases, the inclusion of more comprehensive controls, longer analysis periods and more correctly defined dependent variables results in less favorable estimates, often including predicted increases in opioid deaths. Second, we present new estimates from generalized differences-in-differences and event study models that incorporate more recent data and improvements developed in our replication and extension of early research. These results indicate that legal medical marijuana, particularly when available through retail dispensaries, is associated with higher opioid mortality. The results for recreational marijuana, while less reliable, also suggest that retail sales through dispensaries are associated with greater death rates relative to the counterfactual of no legal cannabis. |
| JEL: | I10 I12 I18 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29802&r= |
| By: | Dolan, Paul; Krekel, Christian; Shreedhar, Ganga; Lee, Helen; Marshall, Claire; Smith, Allison |
| Abstract: | There is a strong suggestion from the existing literature that volunteering improves the wellbeing of those who give up their time to help others, but much of it is correlational and not causal. In this paper, we estimate the wellbeing benefits from volunteering for England's National Health Service (NHS) Volunteer Responders programme, which was set up in response to the Covid-19 pandemic. Using a sample of over 9,000 volunteers, we exploit the oversubscription of the programme and the random assignment of volunteering tasks to estimate causal wellbeing returns, across multiple counterfactuals. We find that active volunteers report significantly higher life satisfaction, feelings of worthwhileness, social connectedness, and belonging to their local communities. A social welfare analysis shows that the benefits of the programme were at least 140 times greater than its costs. Our findings advance our understanding of the ways in which pro-social behaviours can improve personal wellbeing as well as social welfare. |
| Keywords: | subjective wellbeing; volunteering; pro-social action; quasi-natural experiment; social welfare analysis; 221400/Z/20/Z] |
| JEL: | I31 I38 D61 D64 |
| Date: | 2021–05–31 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:114387&r= |
| By: | David M. Cutler; Noémie Sportiche |
| Abstract: | We examine the effect of the Great Recession of 2007-2009 on the mental health of older adults, using longitudinal Health and Retirement Study data linked to area-level data on house prices. We use a variety of measures to capture mental health and rely on the very large cross-sectional variation in falling house prices to identify the impact of the Great Recession on those outcomes. We also account for people who moved in response to falling prices by fixing each person’s location immediately prior to the house price collapse. Our central finding is that the Great Recession had heterogeneous effects on health. While mental health was not affected for the average older adult, mental health declined among homeowners with few financial assets, who were therefore more vulnerable to falling house prices. Importantly, health impacts in this group differed by race and ethnicity: depression and functional limitations worsened among Black and other non-white homeowners and medication use increased among white homeowners. There were no measurable impacts for Hispanic homeowners. These results highlight the importance of examining heterogeneity across multiple dimensions when examining the health impacts of economic conditions. |
| JEL: | I1 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29817&r= |
| By: | Pereira, Rita; Biroli, Pietro (University of Bologna); von hinke, stephanie; Van Kippersluis, Hans (Erasmus University Rotterdam); Galama, Titus; Rietveld, Niels; Thom, Kevin |
| Abstract: | Nature (one's genes) and nurture (one's environment) jointly contribute to the formation and evolution of health and human capital over the life cycle. This complex interplay between genes and environment can be estimated and quantified using genetic information readily available in a growing number of social science data sets. To help the novice reader interested in understanding individual decision making, public policy, and inequality using genetic data, we introduce essential genetic terminology, review the literature in economics and social-science genetics---with a focus on the interplay between genes and environment---and discuss policy implications and future prospects of the use of genetic data in the social sciences and economics. |
| Date: | 2022–03–04 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:d96z3&r= |
| By: | Clark, Andrew E.; D'Ambrosio, Conchita; Ghislandi, Simone; Lepinteur, Anthony; Menta, Giorgia |
| Abstract: | We here address the causal relationship between maternal depression and child human capital using UK cohort data. We exploit the conditionally-exogenous variation in mothers’ genomes in an instrumentalvariable approach, and describe the conditions under which mother’s genetic variants can be used as valid instruments. An additional episode of maternal depression between the child’s birth up to age nine reduces both their cognitive and non-cognitive skills by 20 to 45% of a SD throughout adolescence. Our results are robust to a battery of sensitivity tests addressing, among others, concerns about pleiotropy and the maternal transmission of genes to her child. |
| Keywords: | mendelian randomisation; maternal depression; human capital; instrumental variables; ALSPAC |
| JEL: | J24 |
| Date: | 2021–02–26 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:114414&r= |
| By: | Carpenter, Christopher S. (Vanderbilt University); Lee, Maxine J. (University of San Francisco); Nettuno, Laura (Vanderbilt University) |
| Abstract: | We provide the literature's first estimates of economic outcomes for transgender people and other gender minorities in the United States using nationally representative data from the Household Pulse Survey. We find that transgender women – individuals who were assigned male at birth but who identify as female – are significantly less likely to be employed, have higher poverty rates, are more likely to have public health insurance, and report greater food insecurity compared to otherwise similar cisgender men. Differences between non-cisgender individuals who were assigned female at birth and cisgender women are smaller. Non-cisgender Black individuals fare significantly worse than non-cisgender white individuals, regardless of sex assigned at birth. Our results demonstrate the precarious economic position of gender minority populations in America. |
| Keywords: | transgender, gender minority, economic outcomes, Household Pulse Survey |
| JEL: | J1 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15116&r= |
| By: | Moscelli, Giuseppe (University of Surrey); Sayli, Melisa (University of Surrey); Mello, Marco (University of Surrey) |
| Abstract: | We investigate the relationship among staff engagement, job complementarities and labour supply in the hospital sector, where excessive turnover of the clinical staff (doctors and nurses) can be detrimental for quality of care. We exploit a unique and rich panel dataset constructed by combining employee-level payroll and survey records from the universe of English NHS hospitals. System-GMM estimates remove the endogeneity bias due to reverse causality, revealing nurses' elasticities of retention with respect to engagement of 0.1 and 0.85, and doctors' elasticities of retention with respect to nurses' retention of 0.16 and 0.2, respectively within the hospital and the NHS. Estimates of unconditional quantile regressions confirm these findings, with nurses' engagement-elasticities as large as 1.4 for providers with low retention. Higher engagement is also beneficial to reduce staff absences. Our work is informative on the role played by staff engagement and labour supply complementarities in the workforce planning and management of large organizations. |
| Keywords: | labour supply, workforce retention, staff engagement, job complementarities, healthcare organization, endogeneity |
| JEL: | C33 C36 I11 J22 J28 J63 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15126&r= |
| By: | Maynou, Laia; Pearson, Georgia; McGuire, Alistair; Serra-Sastre, Victoria |
| Abstract: | This paper examines the adoption and diffusion of medical technology as associated with the dramatic recent increase in the surgical use of robots. We consider specifically the sequential adoption and diffusion patterns of three interrelated surgical technologies within a single healthcare system (the English NHS): robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar patient benefits, but the newer robotic technique requires a high initial investment cost to purchase the robot and carries high maintenance costs over time. Using data from a large UK administrative database, Hospital Episodes Statistics, for the period 2000–2018, we analyse 173 hospitals performing radical prostatectomy, the most prevalent and earliest surgical area of adoption of robotic surgery. Our empirical analysis first identifies substitution effects, with robotic surgery replacing the incumbent technology, including the recently diffused laparoscopic technology. We then quantify the spillover of robotic surgery as it diffuses to other surgical specialties. Finally, we perform time-to-event analysis at the hospital level to quantitatively examine the adoption. Results show that a higher number of urologists and a wealthier referral area favor robot adoption. |
| Keywords: | adoption; diffusion; robotic surgery; substitution; technology; Efficiency Research Program funded by The Health Foundation; Award Reference Number 7432. |
| JEL: | O33 I12 C41 C33 J20 |
| Date: | 2022–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:114535&r= |
| By: | Chan, Ho Fai (Queensland University of Technology); Cheng, Zhiming (University of New South Wales); Mendolia, Silvia (University of Wollongong); Paloyo, Alfredo R. (University of Wollongong); Tani, Massimiliano (University of New South Wales); Proulx, Damon (University of Newcastle, Australia); Savage, David (University of Newcastle, Australia); Torgler, Benno (Queensland University of Technology) |
| Abstract: | During the COVID-19 pandemic, governments have struggled to find the right balance between restrictive measures to contain the spread of the virus, and the effects of these measures on people's psychological wellbeing. This paper investigates the relationship between limitations to mobility and mental health for British population during the COVID-19 pandemic, combining the use of high frequency mobility data from Google and longitudinal monthly data collected during the pandemic. We show that more time spent at home predicts a worsening of mental wellbeing even when we account for the prevalence of COVID-19 in the region and the general stringency of the lockdown. There is some heterogeneity in these effects, with young healthy people, living alone, with an active working life, showing particularly high levels of distress. |
| Keywords: | COVID-19, mental health, human movement, mobility restriction, stay-at-home lockdowns |
| JEL: | I0 I14 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15111&r= |
| By: | Wallace, Matthew; Wilson, Ben |
| Abstract: | The migrant mortality advantage has been observed extensively, but its authenticity is debated. In particular, concerns persist that the advantage is an artefact of the data, generated by the problems of recording mobility among foreign-born populations. Here, we build on the intersection of two recent developments: the first showing substantial age variation in the advantage-a deep U-shaped advantage at peak migration ages-and the second showing high levels of population over-coverage, the principal source of data artefact, at the same ages. We use event history analysis of Sweden's population registers (2010-15) to test whether this over-coverage can explain age variation in the migrant mortality advantage. We document its U-shape in Sweden and, crucially, demonstrate that large mortality differentials persist after adjusting for estimated over-coverage. Our findings contribute to ongoing debate by demonstrating that the migrant mortality advantage is real and by ruling out one of its primary mechanisms. |
| Keywords: | censoring bias; data artefact/artifact; emigration; event history analysis; health; international migration; mortality; over-coverage; population registers; Sweden; 2019-00603]; 2016-07105; 2016–07115; 340- 2013-5164] |
| JEL: | N0 |
| Date: | 2022–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:114300&r= |
| By: | Bent Jesper Christensen; Malene Kallestrup-Lamb; John Kennan |
| Abstract: | The paper analyzes consumption decisions of retired workers, using Danish register data. A major puzzle, which motivates much of the analysis below, is that wealth actually increases for a large fraction of the people in our data. One would expect that wealth accumulated before retirement would be used to augment consumption in later life, with the implication that wealth should decline over time. The risk of large out-of-pocket medical expenditures is negligible in Denmark, so although explanations associated with such expenditures might explain similar patterns in U.S. data, these explanations are not plausible for Denmark (and therefore also questionable for the U.S.). Our analysis instead attempts to explain wealth paths using a model that emphasizes fluctuations in the marginal utility of consumption. The results show that a latent state variable extension of the standard life-cycle consumption model is quite successful in explaining the curious observed wealth patterns after retirement for singles. |
| JEL: | E21 J26 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29826&r= |
| By: | Erkmen G. Aslim; Shin-Yi Chou; Kuhelika De |
| Abstract: | Is healthcare employment recession proof? We examine the hypothesis that healthcare employment is stable across the business cycle. We explicitly distinguish between negative aggregate demand and supply shocks in studying how healthcare employment responds to recessions, and show that this response depends largely on the type of the exogenous shock triggering the recession. We find that healthcare employment responds procyclically to demand-induced recessions; and the reduction is driven by layoffs and discharges rather than voluntary quits. In evaluating additional mechanisms, we find evidence of a reduction in real personal healthcare expenditures resulting from an adverse demand shock. By contrast, we find that healthcare employment is fairly stable and even responds countercyclically to supply-induced recessions, suggesting compositional changes such as downskilling particularly in nursing sectors. Our findings establish that employment responses during economic downturns are heterogeneous across healthcare sub-sectors. More generally, by isolating the impact of the structural demand shock from supply shock on healthcare employment, we provide new empirical evidence that healthcare employment is not recession proof. |
| JEL: | C32 E32 I11 J22 J23 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29799&r= |
| By: | Le, Kien; Nguyen, My |
| Abstract: | This study evaluates the extent to which fetal exposure to rainfall shocks influences birth weight outcomes in Kyrgyzstan, one of the most climate change vulnerable countries in Central Asia. We detect detrimental impacts of rainfall shocks during the prenatal period on birth weight. Specifically, a 0.1 log point increase in in-utero rainfall relative to the local norm reduces birth weight by 23.4 grams (or 0.84%). Furthermore, children born to poor mothers and mothers residing in rural areas are disproportionately affected. The adverse impacts of prenatal exposure to rainfall shocks could be partly attributed to prenatal care, diseases, and nutrient intakes. Besides, the impacts tend to concentrate in the first trimester of pregnancy. |
| Keywords: | Birth Weight, Rainfall, Climate Change, Kyrgyzstan |
| JEL: | I10 I15 I18 Q54 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:112539&r= |
| By: | Philippe De Donder; Humberto Llavador; Stefan Penczynski; John E. Roemer; Roberto Vélez |
| Abstract: | Whether or not to vaccinate one’s child is a decision that a parent may approach in several ways. The vaccination game, in which parents must choose whether to vaccinate a child against a disease, is one with positive externalities (herd immunity). In some societies, not vaccinating is an increasingly prevalent behavior, due to deleterious side effects that parents believe may accompany vaccination. The standard game-theoretic approach assumes that parents make decisions according to the Nash behavioral protocol, which is individualistic and non-cooperative. Because of the positive externality that each child’s vaccination generates for others, the Nash equilibrium suffers from a free-rider problem. However, in more solidaristic societies, parents may behave cooperatively –they may optimize according to the Kantian protocol, in which the equilibrium is efficient. We test, on a sample of six countries, whether childhood vaccination behavior conforms better to the individualistic or cooperative protocol. In order to do so, we conduct surveys of parents in these countries, to ascertain the distribution of beliefs concerning the subjective probability and severity of deleterious side effects of vaccination. We show that in all the countries of our sample the Kant model dominates the Nash model. We conjecture that, due to the free-rider problem inherent in the Nash equilibrium, a social norm has evolved, quite generally, inducing parents to vaccinate with higher probability than they would in the non-cooperative solution. Kantian equilibrium offers one precise version of such a social norm. |
| Keywords: | Kantian equilibrium, Nash equilibrium, vaccination, social norm |
| JEL: | C72 D62 D63 I12 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_9507&r= |
| By: | Kumar, Santosh (Sam Houston State University); Kumar, Kaushalendra (International Institute for Population Sciences); Laxminarayan, Ramanan (CDDEP); Nandi, Arindam (CDDEP) |
| Abstract: | Health at birth is an important indicator of human capital development over the life course. This paper uses longitudinal data from the Young Lives survey and employs instrumental variable regression models to estimate the effect of birth weight on cognitive development during childhood in India. We find that a 10 percent increase in birth weight increases cognitive test scores by 8.1 percent or 0.11 standard deviations at ages 5-8 years. Low birth weight infants experienced a lower test score compared with normal birth weight infants. The positive effect of birth weight on a cognitive test score is larger for girls, children from rural households, and those with less-educated mothers. Our findings suggest that health policies designed to improve birth weight could improve human capital in resource-poor settings. |
| Keywords: | children, PPVT, cognition, test score, birth weight, instrumental variable, India |
| JEL: | I12 I15 I18 J13 J24 O12 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15124&r= |
| By: | Le, Kien; Nguyen, My |
| Abstract: | Recorded history demonstrates the preference for sons in every aspect of life. Today, despite being considered a powerful manifestation of gender inequality and discrimination against women, the preference for sons over daughters is still prevalent worldwide. In this study, we investigate the extent to which son preference influences health disparities between sons and daughters in 66 developing countries. We find that the differences in height-for-age and weight-for-age z-scores between daughters and their peers are 0.135 and 0.098 standard deviation lower compared to the analogous differences between sons and their peers due to son preference. Our heterogeneity analysis further shows that son preference disproportionately affects children of disadvantaged backgrounds such as those living in rural areas, born to lower-educated mothers, and coming from poor families. |
| Keywords: | Son preference; health disparities; developing countries |
| JEL: | I1 I10 I14 I15 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:112348&r= |
| By: | Mokashi, Tushar; Panigrahi, Smruti; Raman, A. Venkat; Muraleedharan, V. R.; Chokshi, Maulik |
| Abstract: | A comprehensive and collaborative knowledge translation and decision-making approach can help reduce the longstanding barriers to using research in policy and practice. Regular interaction between researchers and decision-makers increases the likelihood of using research knowledge. This interaction continuing over the entire research cycle is critical for developing research directions and potential use of the research outputs that benefit the health system. The India Health Systems Collaborative and ACCESS Health International have conducted a rigorous exercise to arrive at the priority research topics. A consensus-based method customised to the existing need was created, adapting from the Child Health and Nutrition Research Initiative (CHNRI) method for research priority setting. In this method, conducting literature reviews, key informant interviews and survey-based stakeholder consultations are critical steps for identifying policy-relevant research topics that demand utmost attention in the Indian setting. This article documents the processes followed to develop a preliminary list of core research priorities requiring urgent attention to facilitate policy development. Additionally, the article is about the essential and immediate next steps and the critical actions taken to undertake collaborative research on the identified research topics. The special issue of the Journal for Health Management dedicated to strengthening the Indian health system sets the foundation for promoting collaborative research, its dissemination for broader use by researchers and ensuing policy dialogues. |
| Keywords: | evidence-based policymaking; health policy and systems research; health systems strengthening; policy relevance; Priority setting; Grant number: 007165). |
| JEL: | R14 J01 |
| Date: | 2022–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:114463&r= |
| By: | Frances R. Lu; Tom Vogl |
| Abstract: | We study the intergenerational persistence of inequality by estimating grandmother-mother associations in the loss of a child, using pooled data from 119 Demographic and Health Surveys in 44 developing countries. Compared with compatriots of the same age, women with at least one sibling who died in childhood face 39% higher odds of having experienced at least one own-child death, or 7 percentage points at age 49. Place fixed effects reduce estimated mortality persistence by 47%; socioeconomic covariates explain far less. Within countries over time, persistence falls with aggregate child mortality, so that mortality decline disproportionately benefits high-mortality lineages. |
| JEL: | I14 I15 J62 O15 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29810&r= |
| By: | Srijit Mishra (Indira Gandhi Institute of Development Research) |
| Abstract: | A critical look into the nature of observational data from a study on effect of COVID-19 vaccine of health care workers points out some methodological and ethical concerns. Further analysis with relative and absolute risk reductions indicate that the effect size was lower, at times not significant and even negative when one tried to compare fully vaccinated with single dose, or tried to use person days (rather than number of health care workers) to account for differences in exposure. This, on the one hand, calls for caution in the media while reporting such results, and on the other hand, it calls for transparency and sharing of information in the public domain to facilitate wider scrutiny and informed debate. |
| Keywords: | Absolute risk reduction, COVID-19, health care workers, relative risk reduction |
| JEL: | C19 I18 |
| Date: | 2021–09 |
| URL: | http://d.repec.org/n?u=RePEc:ind:igiwpp:2021-023&r= |
| By: | Humlum, Maria Knoth (Aarhus University); Morthorst, Marius Opstrup (Aarhus University); Thingholm, Peter Rønø (Aarhus University) |
| Abstract: | We investigate the effects of the introduction of a population-wide Human Papillomavirus (HPV) vaccination program on the vaccine take-up of the targeted group of 15-year-old girls and their older sisters. For identification, we rely on a regression discontinuity design and high-quality Danish administrative data to exploit that date of birth determines program eligibility. We find that the program increased the HPV vaccine take-up of both the targeted girls and their older sisters. While the direct effects of the program reduced vaccine-takeup inequality, the spillover effects, in contrast, contributed to an increase in vaccine take-up inequality. |
| Keywords: | health investments, health behavior, peer effects, sibling spillovers, HPV, vaccine, health inequality |
| JEL: | I10 I18 I12 I14 |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15109&r= |
| By: | Batabyal, Amitrajeet; Beladi, Hamid |
| Abstract: | We focus on a poor region and study the nexuses between health interventions undertaken by a regional authority (RA) and this region’s Holling resilience in the presence of a pandemic such as Covid-19. First, we show how a health intervention by the RA probabilistically affects an appropriately defined health indicator. Second, we compute the chance that the health status of this region’s population falls below a minimum acceptable level in the presence of the health intervention. Third, we solve an optimization problem in which the RA maximizes the likelihood that the health status of this region’s population stays above a minimum acceptable level at a given economic cost. Our analysis demonstrates that there is a connection between a health intervention, a region’s health status, and its Holling resilience by presenting two applications. Our analysis reveals that this paper’s methodology can be used to compute a region’s Holling resilience with a particular health intervention. The main policy implications of our analysis concern the need for a RA to pay attention to (i) a region’s health infrastructure and financing, (ii) sufficient engagement with the region’s population, (iii) regional heterogeneity, (iv) data collection, and (v) the likelihood that sicker regions are likely to require more health interventions at a higher cost. |
| Keywords: | Cost, Pandemic, Regional Health Indicator, Resilience, Uncertainty |
| JEL: | I18 R11 |
| Date: | 2021–01–17 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:112159&r= |
| By: | Florian Dorn; Sahamoddin Khailaie; Marc Stoeckli; Sebastian C. Binder; Tanmay Mitra; Berit Lange; Stefan Lautenbacher; Andreas Peichl; Patrizio Vanella; Timo Wollmershäuser; Clemens Fuest; Michael Meyer-Hermann |
| Abstract: | We develop a novel approach integrating epidemiological and economic models that allows databased simulations during a pandemic. We examine the economically optimal opening strategy that can be reconciled with the containment of a pandemic. The empirical evidence is based on data from Germany during the Sars-Cov-2 pandemic. Our empirical findings reject the view that there is necessarily a conflict between health protection and economic interests and suggest a non-linear U-shape relationship: it is in the interest of public health and the economy to balance non-pharmaceutical interventions in a manner that further reduces the incidence of infections. Our simulations suggest that a prudent strategy that leads to a reproduction number of around 0.75 is economically optimal. Too restrictive policies cause massive economic costs. Conversely, policies that are too loose lead to higher deaths tolls and higher economic costs in the long run. We suggest this finding as a guide for policymakers in balancing interests of public health and the economy during a pandemic. |
| Keywords: | Covid-19, optimal strategy, economy, deaths, integrated simulations, real-time analysis |
| JEL: | C15 C54 C63 I15 I18 I19 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_9600&r= |
| By: | Bradley Larsen; Marc J. Hetherington; Steven H. Greene; Timothy J. Ryan; Rahsaan D. Maxwell; Steven Tadelis |
| Abstract: | We report a large-scale randomized controlled trial designed to assess whether the partisan cue of a provaccine message from Donald Trump would induce Americans to get COVID-19 vaccines. Our study involved presenting a 27-second advertisement to millions of U.S. YouTube users in October 2021. Results indicate that the campaign increased the number of vaccines in the average treated county by 103. Spread across 1,014 treated counties, the total effect of the campaign was an estimated increase of 104,036 vaccines. The campaign was cost-effective: with an overall budget of about $100,000, the cost to obtain an additional vaccine was about $1 or less. |
| JEL: | D8 I12 I18 M3 |
| Date: | 2022–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29896&r= |
| By: | Silvia Angerer; Daniela Glätzle-Rützler; Philipp Lergetporer; Thomas Rittmannsberger |
| Abstract: | Peoples' willingness to vaccinate is critical to combating the COVID-19 pandemic. We devise a representative experiment to study how the design of the vaccine approval procedure affects public attitudes towards vaccination. Compared to an Emergency Use Authorization, choosing the more thorough Accelerated Authorization approval procedure increases vaccination intentions by 13 percentage points. Effects of increased duration of the approval procedure are positive and significant only for Emergency Use Authorization. Treatment effects are homogenous across population subgroups. Increased trust in the vaccine is the key mediator of treatment effects on vaccination intentions. |
| JEL: | I12 I18 C93 D83 |
| Date: | 2022–04 |
| URL: | http://d.repec.org/n?u=RePEc:inn:wpaper:2022-04&r= |
| By: | Casey B. Mulligan |
| Abstract: | The human capital investment model with endogenous labor supply is generalized to consumer and health behaviors while retaining the tractability of comparative-static analysis of a single first-order condition. Accounting for the endogenous specialization responses is essential to properly distinguish supply and demand factors and to understand how the magnitude of their effects vary across time and circumstances. Even signing effects of policy interventions can hinge on the existence and extent of personal increasing returns. Applications include the gender gap in earnings, the dynamics of substance abuse, effects of taxes on human capital, the tradeoff between product quality and quantity, and unintended consequences of energy regulation. Metrics are provided for assessing the extent of personal increasing returns. |
| JEL: | D11 I12 J24 |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29832&r= |
| By: | ZHAO, Wenjing; Zhang, Lin; Wang, Junling; Wang, Lili |
| Abstract: | In the context of the most challenging health crisis since World War II that is COVID-19, gaining insights into how academia has responded to this urgent challenge is of great significance. This paper presents academic response patterns at a global, regional, and national level from an analysis of publication volume versus reported cases of COVID-19, scientific collaboration, and research focus. We also compare academic activity associated with this newly-emerging infection to that related to long-standing infections. Our results show that the research community has responded quickly to COVID-19. The highly developed countries, which have the highest number of confirmed cases, are also the major academic contributors. National-level analysis reveals diverse response patterns from different countries. Specifically, academic research in the UK remained at a relatively constant level throughout the whole year (2020), while the global share of China’s research output was prone to shift as its domestic pandemic status changed. Strong alliances have formed among countries with academic capabilities in response to the COVID-19 pandemic. The distribution of disciplines is relatively decentralized, indicating that a diverse and broad knowledge base contributes to the COVID-19 literature. Most of the analyzed countries show dynamic patterns of research focus that vary over time as the pandemic evolves, except India. As one of the world’s biggest suppliers of vaccines, India makes consistent efforts on vaccine research, especially those related to pharmaceutical preparations. Our findings may serve as resources for fostering strategies to respond to future threats of pandemics. |
| Date: | 2022–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:zbe5c&r= |
| By: | Emanuele Amodio; Michele Battisti; Antonio Francesco Gravina; Andrea Mario Lavezzi; Giuseppe Maggio |
| Abstract: | Do school openings trigger Covid-19 diffusion when school-age vaccination is available? We investigate this question using a unique geo-referenced high frequency database on school openings, vaccinations, and Covid-19 cases from the Italian region of Sicily. The analysis focuses on the change of Covid-19 diffusion after school opening in a homogeneous geographical territory. The identification of causal effects derives from a comparison of the change in cases before and after school opening in 2020/21, when vaccination was not available, and in 2021/22, when the vaccination campaign targeted individuals of age 12-19 and above 19. The results indicate that, while school opening determined an increase in the growth rate of Covid-19 cases in 2020/2021, this effect has been substantially reduced by school-age vaccination in 2021/2022. In particular, we find that an increase of approximately 10% in the vaccination rate of school-age population reduces the growth rate of Covid-19 cases after school opening by approximately 1.4%. In addition, a counterfactual simulation suggests that a permanent no vaccination scenario would have implied an increase of 19% in ICU beds occupancy. |
| Date: | 2022–03 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2203.12331&r= |
| By: | Amy S. Patterson |
| Abstract: | Tanzania received significant global attention for its COVID-19 response during the first year of the pandemic. It did not share pandemic statistics, require masks, implement lockdowns, or close borders; it questioned testing and vaccine efficacy; and it emphasized traditional medicines as a cure. The country's response reflected a centralized, paternalistic state that emerged under postcolonial president Julius Nyerere and that stressed self-reliance and national unity. |
| Keywords: | Tanzania, Nationalism, State authority, State capacity, State legitimacy, Electoral authoritarianism |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:unu:wpaper:wp-2022-34&r= |
| By: | Radford, Jason; Green, Jon; Quintana, Alexi; Safarpour, Alauna (Harvard University); Simonson, Matthew D; Baum, Matthew; Lazer, David; Ognyanova, Katherine (Rutgers University); Druckman, James; Perlis, Roy |
| Abstract: | COVID-19 fundamentally changed the world in a matter of months. To understand how it was impacting life in the United States, we fielded a non-probability survey in all 50 states concerning people's attitudes, beliefs, and behaviors, designed to be representative at the state level. Here, we evaluate the generalizability of this study by assessing the representativeness and convergent validity of our estimates. First, we evaluate the representativeness of the sample by comparing it to baseline estimates and auditing the size of the weights we use to reduce bias. We find our sample is diverse and most weights are below levels of concern with the exception of Hispanic respondents. Second, we assess the convergent validity of our survey by evaluating how our estimates of attitudes, behaviors, and opinions compare to estimates from other surveys and administrative data. Third, we perform a direct comparison of our results to the Kaiser Family Foundation’s probability-based COVID-19 Vaccine Monitor. Overall, our estimates deviate from others by 1%-7% with the larger differences stemming from states with small populations and few other data sources and estimates from items with differing question wording or response choices. Here, we put forward a standard for evaluating the representativeness of surveys, non-probability or otherwise. |
| Date: | 2022–03–07 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:cwkg7&r= |