nep-hea New Economics Papers
on Health Economics
Issue of 2022‒05‒16
nineteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Reinsuring the Insurers of Last Resort By David Dranove; Craig Garthwaite; Christopher Ody
  2. The Anatomy of U.S. Sick Leave Schemes: Evidence from Public School Teachers By Christopher J. Cronin; Matthew C. Harris; Nicolas R. Ziebarth
  3. Sickness Absence due to Covid Test Obligations in the Workplace By Wanger, Susanne; Weber, Enzo
  4. Smoking, Selection, and Medical Care Expenditures By Michael E. Darden; Robert Kaestner
  5. The Female Happiness Paradox By David G. Blanchflower; Alex Bryson
  6. The Effects of Incentivizing Early Prenatal Care on Infant Health By Kamila Cygan-Rehm; Krzysztof Karbownik
  7. Impacts of Basic Income on Health and Economic Well-Being: Evidence from the VA’s Disability Compensation Program By David Silver; Jonathan Zhang
  8. A Comparative Perspective on Long-Term Care Systems By Rainer Kotschy; David E. Bloom
  9. Measuring Diagnostic Test Performance Using Imperfect Reference Tests: A Partial Identification Approach By Filip Obradovi\'c
  10. Air Pollution and the Labor Market: Evidence from Wildfire Smoke By Mark Borgschulte; David Molitor; Eric Zou
  11. Clean Energy Access: Gender Disparity, Health, and Labour Supply By Anjali P. Verma; Imelda
  12. Grandfathers and Grandsons: Social Security Expansion and Child Health in China By Yang, Jinyang; Chen, Xi
  13. Heterogeneity in Place Effects on Health: The Case of Time Preferences and Adolescent Obesity By Ashlesha Datar; Nancy Nicosia; Anya Samek
  14. Less Cash, Less Theft? Evidence from Fintech Development in the People’s Republic of China By Jiang, Hongze; Liang, Pinghan
  15. The medium-term impact of non-pharmaceutical interventions. The case of the 1918 influenza in US cities By Guillaume Chapelle
  16. Explaining Vaccine Hesitancy: A Covid-19 Study of the United States By Rajeev K. Goel; James W. Saunoris
  17. Tutoring in (Online) Higher Education: Experimental Evidence By David Hardt; Markus Nagler; Johannes Rincke
  18. Vaccination Rates and COVID Outcomes across U.S. States By Robert J. Barro
  19. Substance Abuse during the Pandemic: Implications for Labor-Force Participation By Jeremy Greenwood; Nezih Guner; Karen Kopecky

  1. By: David Dranove; Craig Garthwaite; Christopher Ody
    Abstract: Hospitals face large and variable costs from treating indigent care patients. Two methods of “reinsuring” hospitals against these costs are providing these patients with insurance and directly providing hospitals with supplemental payments to cover the expected costs of treating the indigent. Currently, the U.S. uses a hybrid of these approaches, insuring some indigent patients through Medicaid and providing hospitals with supplemental payments through programs such as Medicaid Disproportionate Share. We evaluate the economic fundamentals of supplemental payments in the U.S. safety net. We find that providing indigent care patients with insurance and providing hospitals with supplement payments are imperfect substitutes to hospitals because they differ in the extent to which they protect hospitals from risk, incentivize cost control, and and incentivize certain investments. Overall, we find that supplemental payments are used to increase access to hospitals in areas with many indigent patients, rather than to provide efficient intertemporal risk-protection to hospitals or incentivize cost control.
    JEL: H0 H4 I1 I13 I18
    Date: 2022–03
  2. By: Christopher J. Cronin; Matthew C. Harris; Nicolas R. Ziebarth
    Abstract: This paper studies how U.S. employees use paid sick leave. The most common U.S. sick-leave schemes operate as individualized credit accounts---paid leave is earned over time and unused leave accumulates, producing an employee-specific "leave balance." We construct a unique administrative dataset containing the daily balance information and leave behavior of 982 public school teachers from 2010 to 2018. We have three main findings: First, we provide evidence of judicious sick-leave use---namely, teachers use more sick leave during higher flu activity---but no evidence of inappropriate use for the purposes of leisure. Second, we find that leave use is increasing in the leave balance with an average balance-use elasticity of 0.45. This relationship is strongest at the very bottom of the balance distribution. Third, we find that a higher leave balance reduces the likelihood that a teacher works sick ("presenteeism"), especially during flu season. Taken together, these results suggest that a simple alteration to the current sick-leave scheme could reduce the likelihood of presenteeism, thereby lowering infection risk in schools, with few adverse consequences.
    JEL: I12 I13 I18 J22 J28 J32 J38
    Date: 2022–04
  3. By: Wanger, Susanne (Institute for Employment Research (IAB), Nuremberg, Germany); Weber, Enzo (Institute for Employment Research (IAB), Nuremberg, Germany ; Univ. Regensburg)
    Abstract: "As vaccines for Covid-19 became available, in 2021 many countries introduced an obligation for employees to provide proof of their Covid status in the workplace, in Germany also known as the 3G rule (vaccinated, recovered, tested). In view of the controversial debate, concerns arose that employees might attempt to circumvent this obligation by taking sick leave. For an empirical panel analysis we combine data from health insurance providers with epidemiological data for the German federal states. In fact, our findings do show that – while controlling for infection rates – a one percentage-point lower vaccination rate led to an increase in the sickness absence rate by 0.021 percentage points when the 3G rule came into effect." (Author's abstract, IAB-Doku) ((en))
    Keywords: IAB-Open-Access-Publikation
    JEL: I10 J81 H12
    Date: 2022–04–27
  4. By: Michael E. Darden; Robert Kaestner
    Abstract: The contribution of cigarette smoking to national health expenditures is thought to be large, but our current understanding of the effect of smoking on annual medical expenditures is limited to studies that use cross-sectional data to make comparisons of medical care expenditures between smokers and never smokers at a particular age. We develop a dynamic economic model of smoking and medical care use that highlights two forms of selection: selective mortality and non-random cessation. To test predictions from our model, we construct novel longitudinal profiles of medical expenditures of smokers and never smokers from merged National Health Interview Survey and Medicare claims information. Consistent with our theory, we find that, from a given age, smokers generate higher expenditures prospectively, because of a higher incidence in inpatient usage, and lower expenditures retrospectively, because of lower outpatient usage. Between ages 65 and 84, we find that the expected value of the discounted sum of total expenditures is lower for smokers, mainly because of excess mortality. We find no evidence that cigarette smoking is a burden on Medicare.
    JEL: I1 I12 I18
    Date: 2022–03
  5. By: David G. Blanchflower; Alex Bryson
    Abstract: Using data across countries and over time we show that women are unhappier than men in unhappiness and negative affect equations, irrespective of the measure used – anxiety, depression, fearfulness, sadness, loneliness, anger – and they have more days with bad mental health and more restless sleep. Women are also less satisfied with many aspects of their lives such as democracy, the economy, the state of education and health services. They are also less happy in the moment in terms of peace and calm, cheerfulness, feeling active, vigorous, fresh and rested. However, prior evidence on gender differences in global wellbeing metrics – happiness and life satisfaction – is less clear cut. Differences vary over time, location, and with model specification and the inclusion of controls especially marital status. We also show that there are significant variations by month in happiness data regarding whether males are happier than females but find little variation by month in unhappiness data. It matters which months are sampled when measuring positive affect but not with negative affect. These monthly data reveal that women’s happiness was more adversely affected by the COVID shock than men’s, but also that women’s happiness rebounded more quickly suggesting resilience. As a result, we now find strong evidence that males have higher levels of both happiness and life satisfaction in recent years even before the onset of pandemic. As in the past they continue to have lower levels of unhappiness. A detailed analysis of several data files, with various metrics, for the UK confirms that men now are happier than women.
    JEL: I31 J16
    Date: 2022–03
  6. By: Kamila Cygan-Rehm; Krzysztof Karbownik
    Abstract: We investigate the effects of incentivizing early prenatal care utilization on infant health by exploiting a reform that required expectant mothers to initiate prenatal care during the first ten weeks of gestation to obtain a one-time monetary transfer paid after childbirth. Applying a difference-in-differences design to individual-level data on the population of births and fetal deaths, we identify modest but statistically significant positive effects of the policy on neonatal health. We further provide suggestive evidence that improved maternal health-related knowledge and behaviors during pregnancy are plausible channels through which the reform might have affected fetal health.
    Keywords: prenatal care, neonatal health, conditional cash transfers, prenatal care timing
    JEL: I12 I18 J13
    Date: 2022
  7. By: David Silver; Jonathan Zhang
    Abstract: We study impacts of a cash transfer program with no means-test and no work restrictions: the US Department of Veteran Affairs (VA) Disability Compensation program. Our empirical strategy leverages quasi-random assignment of veterans claiming mental disorder disability to examiners who vary in their assessing tendencies. We find that an additional $1,000 per year in transfers decreases food insecurity and homelessness by 4.1% and 1.3% over five years, while the number of collections on VA debts declines by 6.4%. Despite facing virtually no direct monetary costs, healthcare utilization increases by 2.5% over the first five years, with greater engagement in preventive care and improved medication adherence. This demand response is in part explained by the ability to overcome indirect costs of accessing care ("ordeals"). Additionally, VA-conducted surveys suggest that transfers improve communication and trust between veterans and VA clinicians, leading to greater overall satisfaction. Apart from a reduction in self-reported pain, we estimate precise null effects on mental and physical health, including depression, alcohol and substance use disorders, body mass index, blood pressure, and glucose levels. Effects on mortality are small: we can rule out reductions greater than 0.011 percentage points (0.14%) over five years.
    JEL: H51 H53 I1 I3 I38 J01
    Date: 2022–03
  8. By: Rainer Kotschy; David E. Bloom
    Abstract: This paper investigates challenges of aging for long-term care. Our analysis proceeds in three steps. In the first step, we estimate the prospective care demand for 30 developed countries based on projected aging and disabilities among the elderly. In the second step, we outline challenges for care systems with respect to shortages of care workers, increasing skill requirements for care workers, barriers to universal and equitable access to care, and cost containment subject to adequate care quality. In the third step, we identify solutions for these challenges by comparing the care systems of Germany, Israel, Japan, the Netherlands, and South Korea.
    JEL: H51 H75 I18 I38 J11
    Date: 2022–04
  9. By: Filip Obradovi\'c
    Abstract: Diagnostic tests are almost never perfect. Studies quantifying their performance use knowledge of the true health status, measured with a reference diagnostic test. Researchers commonly assume that the reference test is perfect, which is not the case in practice. When the assumption fails, conventional studies identify only the "apparent" performance or performance with respect to the reference that is not of interest. This paper provides the smallest possible bounds on the measures of true performance - sensitivity and specificity, in standard settings. Existing methods for inference based on moment inequalities are used to construct uniformly consistent confidence sets in level over a relevant family of data distributions. Analysis of published studies for the ubiquitous Abbott BinaxNOW COVID-19 Ag2 CARD antigen test demonstrates that the bound estimates can be very informative. Under plausible assumptions, estimates based on the Emergency Use Authorization (EUA) study data reveal that the false negative rates can be up to 3.89 times higher than the frequently cited "apparent" false negative rate. Independent study data show the estimated false negative rates in asymptomatic patients are up to 5.4 times higher than the cited "apparent" figure, warranting further attention.
    Date: 2022–03
  10. By: Mark Borgschulte; David Molitor; Eric Zou
    Abstract: We study how air pollution impacts the U.S. labor market by analyzing effects of drifting wildfire smoke that can affect populations far from the fires themselves. We link satellite smoke plumes with labor market outcomes to estimate that an additional day of smoke exposure reduces quarterly earnings by about 0.1 percent. Extensive margin responses, including employment reductions and labor force exits, can explain 13 percent of the overall earnings losses. The implied welfare cost of lost earnings due to air pollution exposure is on par with standard valuations of the mortality burden. The findings suggest that labor market channels warrant greater consideration in policy responses to air pollution.
    JEL: J21 Q51 Q52 Q53 Q54
    Date: 2022–04
  11. By: Anjali P. Verma (The University of Texas at Austin); Imelda (IHEID, Graduate Institute of International and Development Studies, Geneva)
    Abstract: Women bear a disproportionate share of the health and time burden associated with lack of access to modern energy. We study the impact of clean energy access on adult health and labour supply outcomes by exploiting a nationwide rollout of a clean cooking fuel program in Indonesia. We find that access to clean cooking fuel led to an improvement in women's health and an increase in their work hours. We also find an increase in men's work hours and in their propensity to have an additional job, primarily in those households where women accrued the largest program benefits.
    Keywords: gender inequality; energy access; health; labour supply; Indonesia
    JEL: H51 I15 I18 J22 O13 Q48 Q53
    Date: 2022–05–06
  12. By: Yang, Jinyang (Virginia Tech); Chen, Xi (Yale University)
    Abstract: We examine the multigenerational impacts of a nationwide social pension program in China, the New Rural Pension Scheme (NRPS). NRPS was rolled out in full scale since 2012, and rural enrollees over age 60 are eligible to receive a minimum of 70 CNY non-contributory monthly pension. We leverage age eligibility and variations in pension receipt to identify the inter-generational effect of NRPS on health among grandchildren. We find NRPS substantially increases child weight without impacting height. Overall, child BMI z score increases by 1.09, which is largely driven by grandfathers' pension receipt raising rates of overweight and obesity among grandsons. Among the potential mechanisms, our findings are more plausibly explained by a mixture of income effect, son preference, and rising inter-generational co-residence and childcare.
    Keywords: social pension, child health, inter-generational relationship, intra-household allocation, migration, living arrangement, China
    JEL: H23 H31 H55 I38 J22 O15
    Date: 2022–04
  13. By: Ashlesha Datar; Nancy Nicosia; Anya Samek
    Abstract: We leverage a natural experiment in combination with data on adolescents’ time preferences to assess whether there is heterogeneity in place effects on adolescent obesity. We exploit the plausibly exogenous assignment of military servicemembers, and consequently their children, to different installations to identify place effects. Adolescents’ time preferences are measured by a validated survey scale. Using the obesity rate in the assigned installation county as a summary measure of its obesity-related environments, we show that exposure to counties with higher obesity rates increases the likelihood of obesity among less patient adolescents but not among their more patient counterparts.
    JEL: I10 J13 R23
    Date: 2022–04
  14. By: Jiang, Hongze (Asian Development Bank Institute); Liang, Pinghan (Asian Development Bank Institute)
    Abstract: We investigate the impact of fintech development on an important type of crime: theft. Based on Becker’s rational criminal theory, we suggest that fintech development could mitigate theft activities by increasing the earnings from legitimate work, relaxing potential criminals’ financial constraints, and reducing the expected gains from theft. We established a unique dataset containing information on more than 1 million theft defendants during the period 2014–2018, which we extracted from 874,000 judgment statements. Then, we aggregated them to construct a city-year panel of theft activities and matched it with the city-level economic activities and Fintech development level. The results show that a 1 standard deviation increase in the fintech development level has a significant association with a 0.39 standard deviation decrease in thefts’ density. Robustness checks and instrumental variable estimation support the main results. Further, the development of fintech reduces the density of thefts by reducing residents’ cash holding and providing more job opportunities. Finally, we utilized a nationally representative household survey to estimate the cost of theft for households, finding that victims suffer from more mental health problems, increasing their health expenditure. Our results suggest an unexpected source of welfare gain from the development of fintech: an improvement in public security.
    Keywords: fintech; theft; crime; People’s Republic of China
    JEL: C81 G59 K14 K42
    Date: 2021–08
  15. By: Guillaume Chapelle (LIEPP - Laboratoire interdisciplinaire d'évaluation des politiques publiques (Sciences Po) - Sciences Po - Sciences Po, CY - CY Cergy Paris Université)
    Abstract: This paper uses a difference-in-differences (DID) framework to estimate the impact of Non-Pharmaceutical Interventions (NPIs) used to fight the 1918 influenza pandemic and control the resultant mortality in 43 U.S. cities. The results suggest that NPIs such as school closures and social distancing, as implemented in 1918, and when applied for a relatively long and sustained time, might have reduced individual and herd immunity and the population general health condition, thereby leading to a significantly higher number of deaths in subsequent years.
    Keywords: non-pharmaceutical interventions,1918 influenza,difference-in-differences,health policies
    Date: 2020–10–01
  16. By: Rajeev K. Goel; James W. Saunoris
    Abstract: Using recent data on the unvaccinated across U.S. states, this paper focuses on the determinants of vaccine hesitancy related to the COVID-19 pandemic. Results show that more prosperous states and states with more elderly and physicians have lower vaccine hesitancy. There was some evidence of the significance of race, but internet access and history of other contagious diseases failed to make a difference. States with centralized health systems and those with mask mandates generally had a lower percentage of unvaccinated populations. Finally, the presence of Democrats in state legislatures tended to result in lower vaccination hesitancies, ceteris paribus.
    Keywords: Covid-19, vaccination, vaccine hesitancy, pandemic, government, elderly, race religion, politics, United States
    JEL: D11 I18 K42
    Date: 2022
  17. By: David Hardt; Markus Nagler; Johannes Rincke
    Abstract: Demand for personalized online tutoring in higher education is growing but there is little research on its effectiveness. We conducted an RCT offering remote peer tutoring in micro- and macroeconomics at a German university teaching online due to the Covid-pandemic. Treated students met in small groups, in alternating weeks with and without a more senior student tutor. The treatment improved study behavior and increased contact to other students. Tutored students achieved around 30% more credits and a one grade level better GPA across treated subjects. Our findings suggest that the program reduced outcome inequality. We find no impacts on mental health.
    Keywords: tutoring, higher education, online teaching, Covid, mental health
    JEL: I20 I23 I24 I10
    Date: 2022
  18. By: Robert J. Barro
    Abstract: Rates of COVID deaths and cases differ markedly across U.S. states, as do rates of vaccination. This study uses cross-state regressions to assess impacts of vaccinations on COVID outcomes. A number of familiar issues concerning cross-sectional regressions arise, including omitted variables, behavioral responses to vaccination, and reverse causation. The benefits from a field context and from the broad range of observed variations suggest the value from dealing with these issues. Results along these lines reveal sizable negative effects of vaccination on deaths and cases up to early December 2021, although vaccine efficacy seems to wane over time. The estimates imply that 250 additional doses, with a marginal cost around $5000, leads to one expected life saved. This $5000 is far below typical estimates of the value of a statistical life. Results since December 2021 suggest smaller effects of vaccinations on deaths and, especially, cases. These findings may reflect diminishing effectiveness of vaccines against new forms of the virus, especially the omicron variant. A further possibility is that confidence engendered by vaccinations may have motivated individuals and governments to lessen non-pharmaceutical interventions, such as masking and social distancing.
    JEL: I1
    Date: 2022–03
  19. By: Jeremy Greenwood; Nezih Guner; Karen Kopecky
    Abstract: The labor-force participation rates of prime-age U.S. workers dropped in March 2020—the start of the COVID-19 pandemic—and have still not fully recovered. At the same time, substance-abuse deaths were elevated during the pandemic relative to trend indicating an increase in the number of substance abusers, and abusers of opioids and crystal methamphetamine have lower labor-force participation rates than non-abusers. Could increased substance abuse during the pandemic be a factor contributing to the fall in labor-force participation? Estimates of the number of additional substance abusers during the pandemic presented here suggest that increased substance abuse accounts for between 9 and 26 percent of the decline in prime-age labor-force participation between February 2020 and June 2021.
    JEL: E24 I12 J11 J21
    Date: 2022–04

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