nep-hea New Economics Papers
on Health Economics
Issue of 2022‒06‒27
twenty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Impact of Targeted Regulation of Abortion Providers Laws on Abortions and Births By Arnold, Grace E.
  2. Safeguarding Consumers Through Minimum Quality Standards: Milk Inspections and Urban Mortality, 1880-1910 By D. Mark Anderson; Kerwin Kofi Charles; Michael McKelligott; Daniel I. Rees
  3. The Link between Health and Working Longer: Disparities in Work Capacity By Benjamin Berger; Italo Lopez Garcia; Nicole Maestas; Kathleen J. Mullen
  4. The Effects of Alcohol Excise Tax Increases by Drinking Level and by Income Level By Saffer, Henry; Gehrsitz, Markus; Grossman, Michael
  5. On the Short-term Impact of Pollution: The Effect of PM 2.5 on Emergency Room Visits By Evangelina Dardati; Ramiro de Elejalde; Eugenio Giolito
  6. Football, alcohol and domestic abuse By Ria Ivandic; Tom Kirchmaier; Neus Torres-Blas
  7. American postdoctoral salaries do not account for growing disparities in cost of living By Tim Sainburg
  8. Markets, Governments, and the Institutional Structure of Social Welfare Expenditures in the United States and Sweden in the 20th Century By Price V. Fishback
  9. The Future of Long-term Care in Quebec: What are the Cost Savings from a Realistic Shift Towards more Home Care? By Nicholas-James Clavet; Réjean Hébert; Pierre-Carl Michaud; Julien Navaux
  10. Safety Nets and Social Welfare Expenditures in World Economic History By Price V. Fishback
  11. Does a working day keep the doctor away? A critical review of the impact of unemployment and job insecurity on health and social care utilisation By Li, Keyi; Lorgelly, Paula; Jasim, Sarah; Morris, Tiyi; Gomes, Manuel
  12. Excess Female Mortality in Early Infancy? Missing Girls in Ciudad Real and Guadalajara, 1840-1899 By Enrique Llopis; Gloria Quiroga; Felipa Sánchez Salazar; Ã ngel L. Velasco; Ana de la Fuente; Rocío García Calvo; Laura Ramos; Víctor M. Sierra
  13. Historical prevalence of infectious diseases and gender equality in 122 countries By Omang Ombolo Messono; Simplice A. Asongu; Vanessa S. Tchamyou
  14. Does a Universal Pension Reduce Elderly Poverty in China? By Anqi Zhang; Katsushi S. Imai
  15. Economic Restrictions during the COVID-19 Pandemic and Measures of Small Business Health By Timothy E. Dore; Traci L. Mach
  16. Does COVID-19 represent a 'new Beveridge' moment, a crisis that will wash away, or a call to action? By Tania Burchardt
  17. Barriers and enablers to local active travel during COVID-19: A case study of Streetspace interventions in two London boroughs By Lunetto, Maria Elizabeth; Castro, Oscar; Gericke, Chiara; Hale, Joanna
  18. Interaction in Prevention: A General Theory and an Application to COVID-19 Pandemic By P. Battiston; M. Menegatti
  19. A structural model of coronavirus behaviour: what do four waves of Covid tell us? By Meenagh, David; Minford, Patrick
  20. The Vaccine Boost: Quantifying the Impact of the COVID-19 Vaccine Rollout on Measures of Activity By Ashley Sexton; Maria D. Tito
  21. Where Are They Now? Workers with Young Children during COVID-19 By M. Melinda Pitts

  1. By: Arnold, Grace E.
    Abstract: This paper analyzes the impact of supply-side abortion restrictions on aggregate abortion and birth rates in the United States. Specifically, I exploit state and time variation in the implementation of the first targeted regulation of abortion provider (TRAP) law in a state to identify the effects of the laws. I find that TRAP laws are associated with a reduction in the abortion rate of approximately 5% the year the first law is implemented, and an average reduction of 11-14% in subsequent years. There is also evidence that TRAP laws increased birth rates by 2-3%, which accounts for approximately 80-100% of the observed decline in abortion rates.
    Keywords: Abortion,Abortion Providers,Economics of Gender,Public Policy
    JEL: I18 J13 J16 J18
    Date: 2022
  2. By: D. Mark Anderson; Kerwin Kofi Charles; Michael McKelligott; Daniel I. Rees
    Abstract: We examine the effect of enforcing minimum quality standards (MQSs) on consumer health. In the late 1800s, the urban milk supply was regularly skimmed and diluted with water, but consumers could not easily determine its quality because dyes, caramel, and salt were added. To protect consumers, milk inspectors were tasked with enforcing a well-defined MQS. Using city-level data for the period 1880-1910, we find that milk inspections reduced mortality from waterborne and foodborne diseases by 8-19 percent. Ours is the first study to provide evidence that MQSs can improve consumer health when directly applied to an experience or credence good.
    JEL: H75 I18 J18 L51 N31
    Date: 2022–05
  3. By: Benjamin Berger; Italo Lopez Garcia; Nicole Maestas; Kathleen J. Mullen
    Abstract: Good health is important for employment at older ages. However, little is known about how health-related functional abilities interact with occupational demands to shape work capacity. Using new data, we quantify individuals’ functional abilities, combine that information with occupation-specific ability requirements, and create new measures of individuals’ potential occupations and earnings. We find that average functional abilities, potential occupations, and potential earnings decline only slightly with age, indicating that many Americans maintain work capacity into their late 60s. Gaps in work capacity by race/ethnicity and gender are small, suggesting health is not a major driver of observed earnings disparities. However, gaps in work capacity by education are large and increase with age, suggesting diminished prospects for working longer among those with less education. Although work capacity among Black respondents improves across cohorts, today’s middle-aged white Americans have lower work capacity than those now at retirement age, suggesting rising rates of work disability as these cohorts age.
    JEL: J14 J15 J24
    Date: 2022–05
  4. By: Saffer, Henry (National Bureau of Economic Research); Gehrsitz, Markus (University of Strathclyde); Grossman, Michael (CUNY Graduate Center)
    Abstract: The alcohol industry argues that alcohol excise taxes do not reduce heavy drinking because of substitutions to lower-cost products and that these taxes disproportionately burden low-income drinkers. Alternatively, some economists have argued that increases in alcohol excise taxes reduce heavy alcohol consumption. Using data from the Nielsen Homescan we investigate the effects of a large excise tax increase that raised alcohol prices. The results show that heavy drinkers reduce purchases, and this reduction is no different than the reductions by other drinkers. The results also show that only low-income drinkers pay more for ethanol after the tax increase.
    Keywords: alcohol, excise tax, heavy drinking, low income
    JEL: I18 H20
    Date: 2022–05
  5. By: Evangelina Dardati; Ramiro de Elejalde; Eugenio Giolito
    Abstract: In this paper, we study the short-term effect of fine particulate matter (PM2.5) exposure on respiratory Emergency Room (ER) visits in Chile, a middle-income country with high levels of air pollution. To instrument for PM 2.5 we use wind speed at different altitudes (pressure levels). Unlike previous papers, our data allow us to study the impact of increasing air pollution at high levels of pollution. We find that a1microgram per cubic meter (μg/m3) increase in PM 2.5 exposure for one day increases ER visits for respiratory illness by 0.36 percent. The effect is positive for all age groups, including the middle-age population, a novel finding in the literature.
    Keywords: Air Pollution, PM 2.5, Emergency Room Visits.
    JEL: I12 I18 Q51 Q53
    Date: 2022–05
  6. By: Ria Ivandic; Tom Kirchmaier; Neus Torres-Blas
    Abstract: We study the role of alcohol and emotions in explaining the dynamics in domestic abuse following major football games. We match confidential and uniquely detailed individual call data from Greater Manchester with the timing of football matches over a period of eight years to estimate the effect on domestic abuse. We first observe a 5% decrease in incidents during the 2-hour duration of the game suggesting a substitution effect of football and domestic abuse. However, following the initial decrease, after the game, domestic abuse starts increasing and peaks about ten hours after the game, leading to a positive cumulative effect. We find that all increases are driven by perpetrators that had consumed alcohol, and when games were played before 7pm. Unexpected game results are not found to have a significant effect.
    Keywords: domestic abuse, crime, football, alcohol
    Date: 2021–07–04
  7. By: Tim Sainburg
    Abstract: The National Institute of Health (NIH) sets postdoctoral (postdoc) trainee stipend levels that many American institutions and investigators use as a basis for postdoc salaries. Although salary standards are held constant across universities, the cost of living in those universities' cities and towns vary widely. Across non-postdoc jobs, more expensive cities pay workers higher wages that scale with an increased cost of living. This work investigates the extent to which postdoc wages account for cost-of-living differences. More than 27,000 postdoc salaries across all US universities are analyzed alongside measures of regional differences in cost of living. We find that postdoc salaries do not account for cost-of-living differences, in contrast with the broader labor market in the same cities and towns. Despite a modest increase in income in high cost of living areas, real (cost of living adjusted) postdoc salaries differ by 29% ($15k 2021 USD) between the least and most expensive areas. Cities that produce greater numbers of tenure-track faculty relative to students such as Boston, New York, and San Francisco are among the most impacted by this pay disparity. The postdoc pay gap is growing and is well-positioned to incur a greater financial burden on economically disadvantaged groups and contribute to faculty hiring disparities in women and racial minorities.
    Date: 2022–05
  8. By: Price V. Fishback
    Abstract: Social welfare spending on health, welfare, and insurance against adverse outcomes expanded a great deal in all of the developed countries during the 20th century. The institutional structure of the spending varies with respect to the extent that governments or market institutions provide the services. Sweden and the United States are on opposite ends of this spectrum. After discussing the problems with adverse selection and moral hazard that bedevil private and public social welfare organizations, I compare the development of the social welfare institutions in the U.S. and Sweden in the 20th century.
    JEL: H55 N40 N42 N44
    Date: 2022–05
  9. By: Nicholas-James Clavet; Réjean Hébert; Pierre-Carl Michaud; Julien Navaux
    Abstract: This paper aims to estimate the future long-term care needs and expenditures in Quebec while proposing and evaluating a reform package that could deliver increased coverage as well as be more financially sustainable than current policy. This reform package consists of a shift towards more intensive use of home care while increasing public coverage of care needs. A key feature of the proposed reform is to improve the ability of users to choose their provider with the creation of a senior’s care account, an account that grants individuals in need to purchase services from several providers, including both home and institutional care. To improve the neutrality of public support across care arrangements, we also propose to increase residents’ contribution in nursing homes while favoring the continued use of existing tax credits to help seniors with lower needs in terms of care. Using detailed dynamic modelling of care needs, living arrangements, and expenditures, we estimate that long-term care needs will grow rapidly in the next two decades and the costs will quickly become prohibitive under current policy. We show that substantial cost savings may exist.
    Keywords: long-term care, population aging, public finances, soins de longue durée, vieillissement démographique, finances publiques.
    JEL: H51 H68 J14
    Date: 2022
  10. By: Price V. Fishback
    Abstract: The safety nets in high-income countries before 1900 and in low-income countries today were based on savings and aid from extended family, friends, charities, churches, and small amounts from local governments. Mutual societies and eventually insurance companies offered insurance against lost earnings from sickness, injury, death, and old age. Germany led the way in mandating that employers provide benefits. Since 1900 higher income nations have sharply increased public and private social welfare expenditures to well over 20 percent relative to GDP. A large share of this rise has come in increases in aid to the elderly and health care expenses, often in the form of contributory social insurance financed by payroll taxes on workers and employers. Meanwhile, noncontributory transfer programs for the poor have risen relatively little. In most countries, the employer’s share of payroll taxes are higher than the worker’s share. There are some major countries who have followed a path of reliance on private programs, which are largely financed by employers. Probably the most striking feature of social welfare programs world-wide is the very large variation in expenditures relative to GDP, in the categories of spending, and in the mix of taxation, private programs, and government programs.
    JEL: H53 H55 I38 N40
    Date: 2022–05
  11. By: Li, Keyi; Lorgelly, Paula; Jasim, Sarah; Morris, Tiyi; Gomes, Manuel
    Abstract: While the negative impact of unemployment on health is relatively well established, the extent to which that impact reflects on changes in health and social care utilisation is not well understood. This paper critically reviews the direction, magnitude and drivers of the impact of unemployment and job insecurity on health and social care utilisation across different care settings. We identified 28 relevant studies, which included 79 estimates of association between unemployment/job insecurity and healthcare utilisation. Positive associations dominated mental health services (N = 8 out of 11), but not necessarily primary care (N = 25 out of 43) or hospital care (N = 5 out of 22). We conducted a meta-analysis to summarise the magnitude of the impact and found that unemployed individuals were about 30% more likely to use health services compared to those employed, although this was largely driven by mental health service use. Key driving factors included financial pressure, health insurance, social network, disposable time and depression/anxiety. This review suggests that unemployment is likely to be associated with increased mental health service use, but there is considerable uncertainty around primary and hospital care utilisation. Future work to examine the impact across other settings, including community and social care, and further explore non-health determinants of utilisation is needed. The protocol was registered in PROSPERO (CRD42020177668).
    Keywords: health care utilisation; health service use; job insecurity; unemployment
    JEL: R14 J01
    Date: 2022–05–06
  12. By: Enrique Llopis (Universidad Complutense, Madrid, Spain); Gloria Quiroga (Universidad Complutense, Madrid, Spain); Felipa Sánchez Salazar (Universidad Complutense, Madrid, Spain); Ã ngel L. Velasco (Universidad Rey Juan Carlos, Madrid, Spain); Ana de la Fuente (Universidad Complutense, Madrid, Spain); Rocío García Calvo (Universidad Complutense, Madrid, Spain); Laura Ramos (Universidad Complutense, Madrid, Spain); Víctor M. Sierra (Universidad Complutense, Madrid, Spain)
    Abstract: We deal with early-infancy mortality in Ciudad Real and Guadalajara between 1840 and 1899. Our aims are threefold: (1) To inquire whether female excess mortality took place among the neonatal, infant, and early childhood population subsets. (2) To examine the scope of under-registration in the burial and baptisms records over time. (3) To analyze the evolution of gross neonatal, infant, and early-youth mortality rates. We find that: (a) Neither baptisms sex-ratios nor death rates sex-ratios confirm the female over-mortality hypothesis in the early-infancy, although some point to a gender discrimination in terms of burial practices. (b) A meaningful under-registration of child deaths entails a downward bias in the calculation of infant and neonatal mortality rates. (c) The rise of infant mortality in inland Spain during the third quarter of the 19th century was lower than assumed by the literature.
    Keywords: gender discrimination, mortality, early infancy, Castile, 19th century
    JEL: J11 J16 N01 N33
    Date: 2022–03
  13. By: Omang Ombolo Messono (University of Douala, Douala, Cameroon); Simplice A. Asongu (Yaoundé, Cameroon); Vanessa S. Tchamyou (Yaoundé, Cameroon)
    Abstract: This study examines the effects of the historical prevalence of infectious diseases on contemporary gender equality. Previous studies reveal the persistence of the effects of historical diseases on innovation, through the channel of culture. Drawing on the Parasite-Stress Theory, we propose a framework which argues that historical prevalence of infectious disease reduces contemporary gender equality. Using Ordinary Least Squares (OLS) and Two Stage Least Squares (2SLS) in a cross-section with data from 122 countries between 2000 and 2021, we provide support for the underlying hypothesis. Past diseases reduce gender equality both directly and indirectly. The strongest indirect effects occur through innovation output. Gender equality analysis may take these findings into account and incorporate disease pathogens into the design of international social policy.
    Keywords: infectious diseases; gender equality; economic development
    JEL: B15 B40 B54 I31 J24
    Date: 2022–01
  14. By: Anqi Zhang (Department of Economics, The University of Manchester, UK and Institute of Belt and Road & Global Governance, Fudan University, CHINA); Katsushi S. Imai (Department of Economics, The University of Manchester, UK and Research Institute for Economics and Business Administration, Kobe University, JAPAN)
    Abstract: This paper studies the impact of the universal pension programme on elderly poverty in both rural and urban China. Using the three rounds of panel data based on the Health and Retirement Longitudinal Study (CHARLS) in 2011-2015, we examine whether the universal pension programme reduced elderly poverty, comprehensively defined to cover both unidimensional and multidimensional poverty indices of the households and individuals. To utilise the longitudinal nature of the data, we apply the robust Fixed-Effects (FE) Model with Propensity Score Matching (PSM) and the FE Quantile Model with PSM taking into account the unobservable individual characteristics, such as entrepreneurship or risk preference. Our results show that the universal pension programme reduced poverty in monetary and non-monetary terms in both rural and urban areas. While rural people tend to continue to work in the labour market after the receipt of the pension, urban people work less due to the negative income effect of the programme. The panel quantile regression results suggest that the programme decreased the inequality in both monetary and non-monetary dimensions. Our results provide strong evidence to underscore the success of the Chinese universal pension programme in reducing poverty and inequality in both rural and urban areas.
    Keywords: Poverty; Inequality; Multidimensional Poverty Index (MPI); Pension; Impact evaluation; China
    JEL: C23 I32 I38 H75
    Date: 2022–06
  15. By: Timothy E. Dore; Traci L. Mach
    Abstract: Over the course of the COVID-19 pandemic, state and local governments have instituted a wide array of restrictions on activity, easing or tightening these restrictions as concerns about transmission evolved. The particular choices that governments made could have large impacts on both public health and on economic prosperity. In this note, we provide evidence on the correlation between the level of these restrictions and a key component of the vitality of local economies, namely small businesses. We find that, in states with tighter restrictions, a greater proportion of small businesses generally reported levels of significantly curtailed operations than in states with looser restrictions throughout the pandemic, although this relationship weakens by the summer of 2021. In addition, states with tighter restrictions experienced a larger increase in small business loan default rates. At the same time, it appears that the Paycheck Protection Program helped to mitigate effects of government-imposed restrictions on small business health.
    Date: 2022–06–01
  16. By: Tania Burchardt
    Abstract: Report of a roundtable discussion on theories of welfare To what extent do developments in the UK welfare state over the last 25 years tend to confirm or challenge existing accounts of welfare state evolution? What does this imply for the prospects for welfare state reform coming out of the COVID crisis? What does the evolution of the (UK) welfare state over the last 25 years, and the influences on it, tell us about its capacity to respond to the current crisis? What challenges will the welfare state have to address after the worst of the public health crisis has passed, and are these new challenges or more dramatic forms of existing challenges? What do the history and theories of welfare state change tell us about the likelihood of the welfare state responding effectively to these new challenges?
    Keywords: welfare state reform, covid-19, Beveridge
    Date: 2020–06
  17. By: Lunetto, Maria Elizabeth (University College London); Castro, Oscar; Gericke, Chiara; Hale, Joanna (UCL)
    Abstract: During COVID-19, UK local authorities increased emergency active travel interventions. This study aimed to understand what aspects of temporary Streetspace for London schemes representbarriers or enablers to walking and cycling for short local journeys.Focusing on two London boroughs, we sampled 885 publiccomments about Streetspace schemes and conducted 21 semi-structured interviews. We triangulated the data in a thematic analysis to identify barriers and enablers, which were categorised usingthe Capability, Opportunity, Motivation, Behaviour(COM-B)model.Opportunity and motivation were reflected in the barriers (accessibility and integration; controversy, dissatisfaction,and doubt), enablers (new routes and spaces; sustainability and health beliefs) and mixed themes (changes to traffic and environs; feeling safe). Although aspects of Streetspace schemeswere seen to enableactive travel,our findingssuggest that additional processes to address the acceptability, equity, and unintended consequences ofemergency interventions will be important to their long-term success for health and sustainability.
    Date: 2022–04–19
  18. By: P. Battiston; M. Menegatti
    Abstract: Prevention efforts often involve spillovers, positive or negative, on other individuals, but this is neglected by standard models of risk prevention. We analyze strategic interaction between decision makers whose effort affects each other's risk. We characterize response functions and Nash equilibria, providing proof of existence and analyzing the Pareto efficiency and possible multiplicity of equilibria. We then analyze the optimal effort level from a social point of view, finding conditions under which Nash equilibria are characterized by under- or over-provision of effort, which calls for policy interventions. Finally, we specialize our model to describe the risk of COVID-19 infection. The features of contagion are consistent with the existence of asymmetric equilibria where the high effort exerted by one decision maker pushes another to exert low effort. Moreover, socially optimal mandatory policies, for instance concerning face masks, can cause a decision maker to decrease exerted effort.
    Keywords: prevention, interaction, COVID-19, contagion
    JEL: D81 C72 I12
    Date: 2022
  19. By: Meenagh, David (Cardiff Business School); Minford, Patrick (Cardiff Business School)
    Abstract: This paper extends Meenagh and Minford (2021) to the four waves of infection in the UK by end-2021, using the unique newly available sample-based estimates of infections created by the ONS. These allow us to estimate the effects on the Covid hospitalisation and fatality rates of vaccination and population immunity due to past infection: the latter was the most significant factor driving both trends, while the vaccination rate also had a significant short run effect on the fatality rate. We also updated our policy comparison with Sweden for the most recent data, with similar conclusions.: lower Swedish lockdown intensity relative to personal response in waves 1 and 2 caused much lower economic costs with no discernible effect on infections.
    Date: 2022–05
  20. By: Ashley Sexton; Maria D. Tito
    Abstract: This paper investigates the impact of vaccine administration on three main dimensions of activity: spending, mobility, and employment. Our investigation combines two parts. First, we exploit the variation in vaccine administration across states. In panel regressions that include a large set of controls, we find that the rollout has a significant impact on spending, while the results on mobility and employment are mixed. Second, to address concerns of endogeneity, we look at the impact of vaccine lotteries on spending. Using a dynamic event design setting, we find that lotteries have significantly boosted vaccination rates about a week after announcement, with an effect that lasts over the next several days and increases new vaccinations between 3.5 and 5 percent. This boost in vaccination rates, in turn, translates into a significant increase in retail spending, which is larger and somewhat more persistent than what we document in our state-level panel regressions. All told, our findings imply that the vaccine rollout added, on average, 0.5 percentage point to GDP growth in 2021.
    Keywords: COVID-19 vaccine rollout; Economic activity
    JEL: I00 H80
    Date: 2022–06–02
  21. By: M. Melinda Pitts
    Abstract: Employment levels for prime-age workers have been greatly reduced during the COVID-19 pandemic. The decline has fallen disproportionately on females, especially compared to past recessions, and the presence of young children is a driving factor in this differential response. This article identifies the impact of gender, young children, and the presence of a spouse on the attachment to employment for individuals who were employed immediately prior to the pandemic. Compared to the Great Recession and the most recent expansionary period in 2019, women with young children have a relatively lower level of attachment to employment in the pandemic than men and females without children. In addition, women with very young children, who accounted for 10 percent of the prepandemic workforce, accounted for almost a quarter of the unanticipated, or COVID-related, decline in employment. Taken together, these results suggest that children—and perhaps the ability to access quality childcare—are playing a different, and more significant, role than in past recessions and recoveries.
    Keywords: employment; COVID-19; childcare
    JEL: J13 J16 J22
    Date: 2021–09–01

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