nep-hea New Economics Papers
on Health Economics
Issue of 2022‒08‒08
38 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Firm responses to a more generous insurance against high sick pay costs By Hall, Caroline; Liljeberg, Linus; Lindahl, Erica
  2. How Does Job Coaching Help Disability Insurance Recipients Work While on Claim? By Fontenay, Sébastien; Tojerow, Ilan
  3. Does Schooling Improve Cognitive Abilities at Older Ages: Causal Evidence from Nonparametric Bounds By Amin, Vikesh; Behrman, Jere R.; Fletcher, Jason M.; Flores, Carlos A.; Flores-Lagunes, Alfonso; Kohler, Hans-Peter
  4. School selectivity and mental health: Evidence from regression discontinuity design By Tiina Kuuppelomäki
  5. A Model of Errors in BMI Based on Self-Reported and Measured Anthropometrics with Evidence from Brazilian Data By Davillas, Apostolos; de Oliveira, Victor Hugo; Jones, Andrew M.
  6. Spillover Effects of Old-Age Pension across Generations: Family Labor Supply and Child Outcomes By Kaufmann, Katja Maria; Özdemir, Yasemin; Ye, Han
  7. Disclosure Policy Design and Regulatory Agent Behavior By Makofske, Matthew
  8. From downcoding to upcoding: DRG based payment in hospitals By Carine Milcent
  9. The Prediction of Diabetes By Massaro, Alessandro; Magaletti, Nicola; Cosoli, Gabriele; Giardinelli, Vito O. M.; Leogrande, Angelo
  10. A Shot at Economic Prosperity: Long-term Effects of India’s Childhood Immunization Program on Earnings and Consumption Expenditure By Amit Summan; Arindam Nandi; David E. Bloom
  11. Long-Haulers and Labor Market Outcomes By Dasom I. Ham
  12. Uncharted Waters: Effects of Maritime Emission Regulation By Jamie Hansen-Lewis; Michelle M. Marcus
  13. Old age takes its toll: long-run projections of health-related public expenditure in Luxembourg By Gastón A. Giordana; María Noel Pi Alperin
  14. The Causal Effect of Cycling Infrastructure on Traffic and Accidents: Evidence from Pop-up Bike Lanes in Berlin By Philipp Schrauth
  15. Forced displacement and social capital: long-run impact of the Indian partition By Prasad S. Bhattacharya; Abhiroop Mukhopadhyay
  16. Terrorism and Child Mortality: Evidence from Africa By Daniel Meierrieks; Max Schaub
  17. Medication Against Conflict By Andrea Berlanda; Matteo Cervellati; Elena Esposito; Dominic Rohner; Uwe Sunde
  18. Antivax and inequality By Carmen Camacho; Chrysovalantis Vasilakis
  19. Comparing the German and Japanese nursing home sectors: Implications of demographic and policy differences By Karmann, Alexander; Sugawara, Shinya
  20. Revolution in Progress? The Rise of Remote Work in the UK By Draca, Mirko; Duchini, Emma; Rathelot, Roland; Turrell, Arthur; Vattuone, Giulia
  21. Problems with recording the spread of COVID-19 in developing countries: Evidence from a phone survey in Indonesia By Budy P. Resosudarmo; Rus'an Nasrudin; Pyan A. Muchtar; Usep Nugraha; Anna Falentina
  22. Social media charity campaigns and pro-social behavior. Evidence from the Ice Bucket Challenge By Andrea Fazio; Francesco Scervini; Tommaso Reggiani
  23. Economic Determinants of Intimate Partner Violence: The Case of Sweden during Covid-19 By Perrotta Berlin, Maria; Gerrell, Manne
  24. Victims of electoral violence and their children experience irreversible stunting: The long-term welfare effects of electoral violence By Roxana Gutiérrez-Romero
  25. Local Variations in the Labour Market Impact of COVID-19 By Richard Dorsett; Jessica Hug
  26. The Effects of Hosting the Olympic and Paralympic Games on COVID-19 in Tokyo: Ex-Ante Analyses By Asako Chiba; Daisuke Fujii; Yuta Maeda; Masataka Mori; Kenichi Nagasawa; Taisuke Nakata; Wataru Okamoto
  27. COVID-19 – Countermeasures and the Consequences for German State Finances By Olbrisch-Ziegler, Annette
  28. Industrial Robots, Workers' Safety, and Health By Rania Gihleb; Osea Giuntella; Luca Stella; Tianyi Wang
  29. Knowledge, beliefs, perceptions, and behavior related to the corona (COVID-19) pandemic among university students in Malawi By Holden, Stein T.; Katengeza, Samson; Tione, Sarah; Tilahun, Mesfin
  30. Schooling in the Nordic countries during the COVID-19 pandemic By Hall, Caroline; Hardoy, Inés; Lundin, Martin
  31. COVID-19 and Suicide in Japan By Quentin Batista; Daisuke Fujii; Taisuke Nakata; Takeki Sunakawa
  32. Understanding Cross-Country Heterogeneity in Health and Economic Outcomes during the COVID-19 Pandemic: A Revealed-Preference Approach By Daisuke Fujii; Sohta Kawawaki; Yuta Maeda; Masataka Mori; Taisuke Nakata
  33. Covid-19 Lockdown and Wine Consumption Frequency in Portugal and Spain By Rebelo, João; Compés, Raúl; Faria, Samuel; Gonçalves, Tânia; Pinilla, Vicente; Simón-Elorz, Katrin
  34. Religion, perceptions, and behavior during the corona/COVID-19 pandemic among university students in Malawi By Holden, Stein T.; Katengeza, Samson; Tione, Sarah; Tilahun, Mesfin
  35. Cross-Regional Heterogeneity in Health and Economic Outcomes during the COVID-19 Pandemic: An Analysis of Japan By Shotaro Beppu; Daisuke Fujii; Hiroyuki Kubota; Kohei Machi; Yuta Maeda; Taisuke Nakata; Haruki Shibuya
  36. Fighting Covid-19 amidst Civil Conflict: Micro-level evidence from Burkina Faso By Mohammad H. Sepahvand; Philip Verwimp
  37. Covid-19 and Brexit: Real-time updates on business performance in the United Kingdom By Josh De Lyon; Swati Dhingra
  38. Indikationsbaserad prissättning av läkemedel i Sverige By Lindgren, Peter; Persson, Ulf; Gralén, Katarina

  1. By: Hall, Caroline (IFAU - Institute for Evaluation of Labour Market and Education Policy); Liljeberg, Linus (IFAU - Institute for Evaluation of Labour Market and Education Policy); Lindahl, Erica (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: This paper presents evidence on how firms react to a more generous insurance against high sick pay costs. We exploit a reform launched in Sweden in 2015, which introduced different thresholds for insurance reimbursement depending on firm size. By comparing workers in smaller firms with workers in large firms over time, we evaluate the effects of the reform. We find no indication of changed behaviour among employees in the smallest firms (on average 15 employees), but an increase in sickness absence among those employed in middle-sized firms (on average 38 employees). The increased absence in middle-sized firms is entirely driven by new hires, but the newly hired employees do not seem to be differently selected. We find no evidence indicating that the more generous insurance made firms more inclined to employ more sick-prone individuals. Further analysis suggests that the absence of behavioural responses among employees in the smallest firms might be related to a large production loss from an absent worker, which the insurance cannot fully compensate for. Taken together, we find no support for any societal benefits of a more generous insurance against high sick pay costs in terms of an increased employment-probability among more sick-prone individuals.
    Keywords: sickness absence; sick pay; firm size; insurance; recruitment
    JEL: J22 J23 L23 M51
    Date: 2022–07–04
  2. By: Fontenay, Sébastien (Free University of Brussels); Tojerow, Ilan (Free University of Brussels)
    Abstract: We evaluate the effects of a Supported Employment (SE) program aimed at Disability Insurance (DI) recipients with mental conditions. The program is characterized by a "work-first" approach, which includes intensive job coaching and follow-along support. Using a Randomized Control Trial with more than 660 participants over a follow-up period of 18 months, we compare the benefits of this newly introduced program to regular vocational rehabilitation services traditionally used in Belgium. We find that SE increases the probability that DI recipients with mental conditions work while on claim and reduces their reliance on DI benefits. Specifically, we estimate that 18 months after the start of their return-to-work program, participants in the SE group are 9.5 percentage points more likely to be working, and receive 6% less in DI benefits than those in the control group.
    Keywords: employment support, disability insurance, mental health, randomized experiment
    JEL: H55 I38 J24
    Date: 2022–06
  3. By: Amin, Vikesh (Central Michigan University); Behrman, Jere R. (University of Pennsylvania); Fletcher, Jason M. (University of Wisconsin-Madison); Flores, Carlos A. (California Polytechnic State University); Flores-Lagunes, Alfonso (Syracuse University); Kohler, Hans-Peter (University of Pennsylvania)
    Abstract: We revisit the much-investigated relationship between schooling and health, focusing on cognitive abilities at older ages using the Harmonized Cognition Assessment Protocol in the Health & Retirement Study. To address endogeneity concerns, we employ a nonparametric partial identification approach that provides bounds on the population average treatment effect using a monotone instrumental variable together with relatively weak monotonicity assumptions on treatment selection and response. The bounds indicate potentially large effects of increasing schooling from primary to secondary but are also consistent with small and null effects. We find evidence for a causal effect of increasing schooling from secondary to tertiary on cognition. We also replicate findings from the Health & Retirement Study using another sample of older adults from the Midlife in United States Development Study Cognition Project.
    Keywords: schooling, cognition, bounds, aging, partial identification
    JEL: I10 I26 J14
    Date: 2022–06
  4. By: Tiina Kuuppelomäki (Työn ja talouden tutkimus LABORE)
    Abstract: The school environment forms a large part of adolescents’ lives and can thus have a large impact on their mental health. However, fairly little is known on the specific impact of school characteristics, such as selectivity. In this paper, comprehensive Finnish register data is used to investigate how studying at a more selective, preferred upper secondary school affects students’short- and long-term mental health. A regression discontinuity design is employed for the analysis, finding that, while access to more selective school has little overall effect on individual’s short- or long-term mental health, it does have positive effects during the time of matriculation examinations. Further analysis also reveals heterogeneity based on the selectivity difference between the preferred school and next-best alternative.
    Keywords: education, secondary, mental health, selectivity, peers
    JEL: I21 I26 I12 I31
    Date: 2021–12–15
  5. By: Davillas, Apostolos (University of East Anglia); de Oliveira, Victor Hugo (Instituto de Pesquisa e Estratégia Econômica do Ceará (IPECE)); Jones, Andrew M. (University of York)
    Abstract: The economics of obesity literature implicitly assumes that measured anthropometrics are error-free and they are often treated as a gold standard when compared to self-reported data. We use factor mixture models to analyse and characterize measurement error in both self-reported and measured anthropometrics with national representative data from the 2013 National Health Survey in Brazil. Indeed, a small but statistically significant fraction of measured anthropometrics are attributed to data-recording errors. The estimated mean body weight (height) for those cases that are subject to error is 10% higher (2.9% lower) than the estimated mean of latent true body weight (height). As they are imprecisely measured and due to individual's reporting behaviour, only between 10% and 24% of our self-reported anthropometrics are free from any measurement error. Post-estimation analysis allows us to calculate hybrid anthropometric predictions that best approximate the true body weight and height distribution. BMI distributions based on the hybrid measures are close to those based on measured data, while BMI based on self-reported data under-estimates the true BMI distribution. Analysis of regression models for health care utilization shows little differences between the relationship with BMI when it is based on measured data or on our hybrid BMI measure, however some differences are observed when both are compared to BMI based on self-reported data.
    Keywords: body mass index, measurement error, mixture models, obesity
    JEL: C18 C81 I10
    Date: 2022–06
  6. By: Kaufmann, Katja Maria (University of Mainz); Özdemir, Yasemin (University of Mainz); Ye, Han (University of Mannheim)
    Abstract: We study the impact of grandparental retirement decisions on family members' labor supply and child outcomes by exploiting a Dutch pension reform in a fuzzy Regression Discontinuity design. A one-hour increase in grandmothers' hours worked causes adult daughters with young children to work half an hour less. Daughters without children, with older children and sons/daughters-in-law are not affected. We show important long-run impacts on maternal labor supply and on the child penalty. Test score effects are positive for children aged 4-7 (substitution from grandparental to maternal care), and negative for children aged 11-12 (substitution from grandparental to formal childcare).
    Keywords: spillover effects, retirement, grandparental childcare, maternal labor supply, child development
    JEL: J22 J26 I38 D64
    Date: 2022–06
  7. By: Makofske, Matthew
    Abstract: Mandatory disclosure promotes self-regulation of product quality, but may also provide incentives for firms to manipulate disclosed information. Collection of quality information by inspectors protects against direct manipulation, but firms may attempt to unduly influence inspectors. In Las Vegas, Nevada, food-service health inspections are numerically scored, with health code violations from three categories carrying prescribed demerit amounts. For disclosure however, numeric scores are coarsened into letter grades, which may encourage lobbying of inspectors to under-report violations near threshold scores. Beginning in 2013, the demerit amount prescribed for each good-practices violation was reduced from 1 to 0; while the letter-grade scale and penalties prescribed for major and critical violations (3 and 5 demerits each) remained unchanged. Exploiting this removal of scoring implications from good-practices violations, coupled with the discontinuous punishment severity inherent in letter-grade disclosure, I find that inspectors significantly under-reported good-practices violations prior to 2013—by 31 to 90 percent in some cases—when those violations were likely to affect letter grades. Without careful design, disclosure policies supplementing inspection programs may inadvertently undermine the regulatory efforts they were meant to support.
    Keywords: regulatory inspection, mandatory disclosure, restaurant hygiene, manipulation
    JEL: D82 I18 K32 L15
    Date: 2022–06–30
  8. By: Carine Milcent (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement)
    Abstract: A prospective disease group-based payment is a reimbursement rule used in a wide array of countries. It turns to be the hospital's payment rule to imply. The secret of this payment is a fee payment as well as a hospital's activity based payment. There is a consensus to consider this rule of payment as the least likely to be manipulated by the actors. However, the defined fee per group depends on recorded information that is then processed using complex algorithms. What if the data itself can be manipulated? The result would be a fee per group based on manipulated factors that would lead to an inefficient budget allocation between hospitals. Using a unique French longitudinal database with 145 million stays, I unambiguously demonstrate that the implementation of a finer classification led to an upcoding-learning effect. The end result has been a budget transfer from public non-research hospitals to for-profit hospitals. The 2009 policy lead to upcoding disconnected from any changes in the trend of production of care.
    Keywords: Hospital stays,Diagnosis-related groups (DRGs),Upcoding,Manipulated database,heterogeneity in responses
    Date: 2021
  9. By: Massaro, Alessandro; Magaletti, Nicola; Cosoli, Gabriele; Giardinelli, Vito O. M.; Leogrande, Angelo
    Abstract: The following article presents an analysis of the determinants of diabetes using a dataset containing the surveys of 2000 patients from the Frankfurt Hospital in Germany. The data were analyzed using the following models, namely: Tobit, Probit, Logit, Multinomial Logit, OLS, WLS with heteroskedasticity. The results show that the presence of diabetes is positively associated with "Pregnancies", "Glucose", "BMI", "Diabetes Pedigree Function", "Age" and negatively associated with "Blood Pressure". A cluster analysis is realized using the fuzzy c-Means algorithm optimized with the Elbow method and three clusters were found. Finally a confrontation among eight different machine learning algorithms is realized to select the best performing algorithm to predict the probability of patients to develop diabetes.
    Keywords: Machine Learning, Clusterization, Elbow Method, Prediction, Correlation Matrix, Principal Component Analysis, Binary and non-Binary regression models.
    JEL: I10 I11 I12 I13 I14 I15 I18
    Date: 2022–06–13
  10. By: Amit Summan; Arindam Nandi; David E. Bloom
    Abstract: Routine childhood vaccinations are among the most cost-effective interventions. In recent years, the broader benefits of vaccines, which include improved cognitive and schooling outcomes, have also been established. This paper evaluates the long-term economic benefits of India’s national program of childhood vaccinations, known as the Universal Immunization Programme (UIP). We combine individual-level data from the 68th round of the National Sample Survey of India (2011–2012) with district-wise data on the rollout of UIP in 1985–1990. We employ age-district fixed effects regression models to compare the earnings and per capita household consumer spending of 21- to 26-year-old adults who were born in UIP-covered districts vis-à-vis non-UIP districts in 1985–1990. We find that exposure to UIP in infancy increases weekly wages by 13.8% (95% CI: 7.6% to 20.3%, p
    JEL: I15 I18 J31 J38
    Date: 2022–06
  11. By: Dasom I. Ham
    Abstract: There have been growing concerns about long-haulers or individuals with long-term COVID-19 health complications (long-haul COVID). While the medical field has been investigating the health complications, there has been limited research on the relationship between long-haul COVID and labor market outcomes. To investigate this relationship, I used the University of Southern California Understanding America Study COVID-19 longitudinal survey to provide a snapshot of mid-2021. I first find about 24.1% of individuals who have had COVID are long-haulers and 25.9% of long-haulers reported that their long-haul COVID affected employment or work hours. I then find that a majority of these affected long-haulers remained employed and in same employment type. But I find that their mean change in work hours and paycheck declined. Afterwards, I tested whether long-haul COVID is associated with negative changes in labor market outcomes. When I combined long-haulers who reported that their health complications did or did not affect work, I failed to find that long-haulers are less likely to be employed relative to individuals without prior COVID infection. But, when I discern long-haulers by whether long-haul COVID affected work, I find that long-haulers who reported long-haul COVID affected work are 10 percentage points less likely to be employed and, on average, work 50% fewer hours than individuals without prior COVID infection. In contrast, I failed to find evidence that affected long-haulers receive a lower paycheck earning relative to individuals without prior COVID infection. Lastly, when comparing these affected long-haulers against similar individuals, I find evidence that they are more impacted in their employed status and work hours. Due to limitations, future data collection and research would provide a more robust picture.
    Keywords: Labor market outcomes; Long-COVID
    JEL: I12 J20
    Date: 2022–07–07
  12. By: Jamie Hansen-Lewis; Michelle M. Marcus
    Abstract: Maritime shipping emits as much fine particulate matter as half of global road traffic. We are the first to measure the consequences of US maritime emissions standards on air quality, human health, racial exposure disparities, and behavior. The introduction of US maritime emissions control areas significantly decreased fine particulate matter, low birth weight, and infant mortality. Yet, only about half of the forecasted fine particulate matter abatement was achieved by the policy. We show evidence consistent with behavioral responses among ship operators, other polluters, and individuals that muted the policy's impact, but were not incorporated in ex-ante models.
    JEL: F18 I14 Q52 Q53 Q56
    Date: 2022–06
  13. By: Gastón A. Giordana; María Noel Pi Alperin
    Abstract: This paper simulates long-term trends in Luxembourg’s public expenditure on healthcare and on long-term care. We combine population projections with micro-simulations of individuals’ health status that account for their demographic, socio-economic characteristics and their childhood circumstances. Model equations estimated on data from the SHARE survey and from several branches of Social Security provide a rich framework to study policy-relevant applications. We simulate public expenditure on healthcare and long-term care under different scenarios to evaluate the separate contributions of population ageing, costs of producing health-related services, and the distribution of health status across age cohorts. Results suggest that rising per capita expenditure on healthcare will mostly result from production costs, while rising expenditure on long-term care will mostly reflect population ageing.
    Keywords: Ageing, Dynamic micro-simulation, Healthcare, Health-related public expenditure, Health status, Long-term care, Luxembourg, SHARE.
    JEL: D3 H30 I10 I12
    Date: 2022–04
  14. By: Philipp Schrauth (University of Potsdam)
    Abstract: This paper analyzes the effect of new bicycle lanes on traffic volume, congestion, and accidents. Crucially, the new bike lanes replace existing car lanes thereby reducing available space for motorized traffic. In order to obtain causal estimates, I exploit the quasi-random timing and location of the newly built cycle lanes. Using an event study design, a two-way fixed effects model and the synthetic control group method on geo-coded data, I show that the construction of pop-up bike lanes significantly reduced average car speed by 8 to 12 percentage points (p.p.) and up to 16 p.p. in peak traffic hours. In contrast, the results for car volume are modest, while the data does not allow for a conclusive judgment of accidents.
    Keywords: congestion, urban, traffic, environment, accidents, cycling, health, COVID-19
    JEL: O18 Q56 R11 R41 R42
    Date: 2022–06
  15. By: Prasad S. Bhattacharya (Deakin University); Abhiroop Mukhopadhyay (Indian Statistical Institute, Delhi)
    Abstract: We investigate whether the historical shock of the Indian Partition, one of the largest forced displacements in the twentieth century, affected social capital in affected parts of India in the long-run. India was partitioned in 1947 into India and Pakistan (East and West Pakistan). At this time, many Hindus and Sikhs migrated from Pakistan to India while Muslims migrated from India to Pakistan. The Partition shock is measured as the proportion of "displaced" migrants in Indian districts in 1951 from census data. Using data from the World Health Organisation Survey on the Aged and Elderly conducted in six Indian states, we find that social capital is lower in districts that received more Partition migrants. The effect remains strongly robust to spatial robustness checks, contemporary differences in demographics and income, public goods provisions, literacy, urbanisation and the gender ratio. We find these effects are mediated through riots, community conflicts and violent crime that start from Partition sixty years ago and continue through to more recent times. Our study contributes to the understanding of large forced displacement events and their shadow on institutions-here social capital-over the long run.
    Keywords: partition, social capital
    Date: 2022–07
  16. By: Daniel Meierrieks (WZB Berlin Social Science Center); Max Schaub (University of Hamburg)
    Abstract: How does terrorism affect child mortality? We use geo-coded data on terrorism and highly spatially disaggregated data on child mortality to study the relationship between both variables for 52 African countries between 2000 and 2017 at the 0.5×0.5 degree grid-cell level. A two-way fixed-effects approach indicates that higher levels of terrorist activity correlate with higher levels of child mortality risk. Our estimates suggest that moderate increases in the terrorism index are linked to several thousand additional deaths of children under the age of five per year. Employing instrumental-variable and panel event-study approaches, we also provide causal evidence that terrorism increases the risk of death for children under the age of five. Effect sizes associated with these causal estimates are several times larger than those from the more conservative two-way fixed-effects approach. Finally, interrogating our data, we show that the direct effects of terrorism (e.g., in terms of its lethality and destruction of public health infrastructure) tend to be very small. This, in turn, suggests that increases in child mortality primarily emerge through the behavioral response of economic agents (e.g., parents, doctors, medical staff, aid workers and policymakers) to terrorism. Indeed, we provide evidence that higher levels of terrorist activity unfavorably correlate with several proximate causes of child mortality.
    Keywords: Africa, child mortality, instrumental-variable approach, panel event-study, Terrorism
    JEL: D74 I10 I12
    Date: 2022–05
  17. By: Andrea Berlanda (University of Lausanne); Matteo Cervellati (University of Bologna and CEPR); Elena Esposito (University of Lausanne); Dominic Rohner (University of Lausanne, E4S and CEPR); Uwe Sunde (University Munich and CEPR)
    Abstract: The consequences of successful public health interventions for social violence and conflict are largely unknown. This paper closes this gap by evaluating the effect of a major health intervention – the successful expansion of anti-retroviral therapy (ART) to combat the HIV/AIDS pandemic – in Africa. To identify the effect, we combine exogenous variation in the scope for treatment and global variation in drug prices. We find that the ART expansion significantly reduced the number of violent events in African countries and sub-national regions. The effect pertains to social violence and unrest, not civil war. The evidence also shows that the effect is not explained by general improvements in economic prosperity, but related to health improvements, greater approval of government policy, and increased trust in political institutions. Results of a counterfactual simulation reveal the largest potential gains in countries with intermediate HIV prevalence where disease control has been given relatively low priority.
    Keywords: HIV, conflict, social violence, ART expansion, trust, Africa, health intervention, domestic violence
    JEL: C36 D47 I15 O10
    Date: 2022–04
  18. By: Carmen Camacho (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Chrysovalantis Vasilakis (Bangor University)
    Abstract: We build a Susceptible-Infected-Vaccinated Economic growth model to measure and study the evolution of inequality in an economy with two groups of workers, who are differently exposed to an epidemic. In the context of the recent COVID-19 pandemic and using data on the United Kingdom and Canada, we describe how exposure to COVID-19 varies dramatically across occupational groups. Our regressions on 14 European countries show that the vaccination rate, the COVID-19 death rate and the number of hospitalisations do explain GDP per capita. Using our theoretical model, we prove that the economy can lead in the long run to various scenarios, which range from the disease-free economy to a scenario in which only the most exposed group suffers from the virus. We complete our theoretical analysis with some numerical exercises which show that long-run inequality increases with the share of vaccination, and it decreases with the exposure rate of the most exposed group since the economy becomes poorer.
    Keywords: Inequality,Epidemics,COVID-19,Vaccination JEL Codes: C6
    Date: 2022–06–10
  19. By: Karmann, Alexander; Sugawara, Shinya
    Abstract: This research provides a comparative study of the Japanese and German nursing home sectors. Faced with aging populations, both countries share similar long-term care policies based on social insurance. However, descriptive statistics indicate significant differences in the outcomes and costs in their respective nursing home sectors. This research aims to identify the reasons for this state of affairs by examining demographic and policy differences between the two countries. To shed light on the subject from multiple angles, we conduct three types of empirical analysis - regression, the Blinder-Oaxaca decomposition, and data envelopment analysis - on regional data from the past decade. Our findings indicate that the different outcomes are driven by both demographic and policy differences where policy relates to long-term care as well as to additional welfare aid. In terms of policy, a key difference is found in the designs of the welfare programs for low-income elders. In Germany, our results are consistent with moral hazard due to the generous design of the welfare program, while in Japan, our results do not indicate moral hazard, which may be due to strict nursing home admission rules for welfare recipients.
    Keywords: Japanese and German nursing home sectors,long-term care insurance,Blinder-Oaxaca decomposition,comparative study,moral hazard,welfare policy
    JEL: I13 I18 J14
    Date: 2022
  20. By: Draca, Mirko (University of Warwick, Department of Economics); Duchini, Emma (University of Essex, Department of Economics); Rathelot, Roland (Institut Polytechnique de Paris); Turrell, Arthur (Office for National Statistics); Vattuone, Giulia (University of Warwick)
    Abstract: The pandemic was accompanied by a wave of adoption of remote work practices. This paper uses online job vacancy data to study how UK firms have adopted remote work. Overall, remote work increased by 300%. Our analysis finds little evidence that occupations have fundamentally changed to better accommodate remote work tasks, nor evidence of changes in the occupational composition of jobs. We find that the overall increase in remote working is driven by the increasing use of remote work at the firm level, especially among firms that were less likely to use remote work before the pandemic. This is consistent with changes in organisational practices or updated information about the viability of large-scale remote working. JEL codes: J23 ; J32.
    Keywords: vacancies ; remote working ; pandemic
    Date: 2022
  21. By: Budy P. Resosudarmo; Rus'an Nasrudin; Pyan A. Muchtar; Usep Nugraha; Anna Falentina
    Abstract: During the COVID-19 pandemic governments in developing countries tended to underestimate the actual spread of the pandemic due to limited number of tests. To provide alternative to the government announced COVID-19 figures, many non-governmental agencies/individuals used various methods to gather data on the spread of the pandemic. One of the methods applied is phone survey approach of directly asking respondents whether they are infected and how the sickness impacts on their livelihood. This paper focuses on evaluating the reliability and usefulness of this approach by carefully conducting a phone survey on our own. The findings suggest that by developing a careful algorithm, a phone survey might be able to provide a better estimate than those announced by the government in developing countries where capabilities of conducting COVID-19 test are limited. Nevertheless, our findings also reveal that the reliability of a phone survey could be low when the response rate is too low.
    Keywords: Indonesia, COVID-19 pandemic, phone survey, developing countries
    JEL: I18 I15 C83 H12
    Date: 2022
  22. By: Andrea Fazio (University of Pavia, Pavia, Italy); Francesco Scervini (University of Pavia, Pavia, Italy); Tommaso Reggiani (Masaryk University, Brno, Czech Republic)
    Abstract: Social media play a relevant role in shaping social attitudes and economic behaviors of individuals. One of the first very well-known examples of social media campaign is the Ice Bucket Challenge (IBC), a charity campaign that went viral on social networks in August 2014 aiming at collecting money for the research on amyotrophic lateral sclerosis (ALS). We rely on UK longitudinal data to investigate the causal impact of the Ice Bucket Challenge on pro-social behaviors. In detail, this study shows that having been exposed to the IBC increases the probability of donating money, and it increases the amount of donating money among those who donate at most £100. We also find that exposure to the IBC has increased the probability of volunteering and the level of interpersonal trust. However, all these results, but the one on the intensive margins of donations, have a short duration, limited to less than one year, supporting the prevalent consensus that social media campaigns may have only short-term effects.
    Keywords: Donations, Volunteering, Altruism, Social media campaigns, Ice bucket challenge
    JEL: D64 O35
    Date: 2022–07
  23. By: Perrotta Berlin, Maria (Stockholm Institute of Transition Economics); Gerrell, Manne (Malmo University)
    Abstract: We document an increase in intimate partner violence (IPV) against women in Sweden during the first wave of the Covid-19 pandemic, notwithstanding the famously lasseiz-faire approach taken by the country. We investigate the role of different mediating factors, affected by the pandemic, by the containment policies, or by their economic consequences, and spilling over to violence incidence, connecting to established theories of violence. We find support for the importance of time spent at home and female unemployment. We also find a positive correlation with alcohol sales.
    Keywords: COVID-19; domestic violence; unemployment; self-incapacitation
    JEL: J12 J16 K14
    Date: 2022–06–23
  24. By: Roxana Gutiérrez-Romero (Queen Mary University of London, School of Business and Management,)
    Abstract: Despite the extensive literature on civil conflict, little is known about the medium- and long-term effects of electoral violence on young children and adolescents. This paper shows that electoral violence of low scale yet recursive nature has a detrimental effect on the height of children and adolescents of affected households. Our identification strategy uses the variation of electoral violence across time and space in Kenya during 1992−2013. We find that infants and adolescents exposed to electoral violence are shorter as adults if compared to similar people not exposed to violence during their growing age. We also find inter-generation effects as the children of the victims of electoral violence, particularly boys, also have reduced height-for-age. Higher food prices and changes in diet experienced during outbreaks of violence are important mechanisms. No impact is found on the educational attainment of school-aged pupils as electoral violence has been concentrated during the school holidays.
    Keywords: electoral violence, household victimization, height-for-age, education, Kenya, Africa
    JEL: D74 I1 J24 O55
    Date: 2021–12
  25. By: Richard Dorsett; Jessica Hug
    Abstract: This paper provides new evidence on the disruption brought by the coronavirus (COVID-19) pandemic to local labour markets in the U.K.. After presenting key trends on local labour markets, a matching function is estimated using monthly data on vacancies and unemployment. This matching function is specified to capture local variations in efficiency. These estimates of labour market efficiency are then included in an individual-level regression of year-on-year transitions between employment, unemployment and inactivity. The results show that, for males, living in an area with a more efficient labour market pre-COVID was associated with a reduced likelihood of being unemployed in 2021 but that for females there was no such association.
    Keywords: efficiency, labour market transitions, matching function
    JEL: E24 J63 J64
    Date: 2022–07
  26. By: Asako Chiba (Tokyo Foundation for Policy); Daisuke Fujii (University of Tokyo); Yuta Maeda (University of Tokyo); Masataka Mori (Middlebury College); Kenichi Nagasawa (University of Warwick); Taisuke Nakata (University of Tokyo); Wataru Okamoto (University of Tokyo)
    Abstract: We present a series of quantitative analyses conducted from mid-May of 2021 to mid-June of 2021 that examined the effects of hosting the Tokyo 2020 Olympic and Paralympic Games on the spread of COVID-19 in Tokyo. Our ex-ante quantitative analyses pointed out that (i) the direct effects on the spread of COVID-19 of welcoming Games-related foreign visitors to Japan or allowing spectators in competition venues would be either limited or manageable, but (ii) a festive mood generated by the Games could greatly contribute to the spread of COVID-19 if it led to a decline in people’s willingness to take preventive actions against infection. Ex-post, the key results of our ex-ante analyses are broadly in line with available circumstantial evidence as well as ex-post consensus by public-health experts on how the Games affected the spread of COVID-19 in Tokyo.
    Date: 2022–06
  27. By: Olbrisch-Ziegler, Annette
    Abstract: In addition to medical, the corona pandemic has recently left its mark on German society, socially, and above all, economically. The attempts to revive the economy and to minimize the upheavals by a large wreath of various state measures in society as well as the economy can be assessed as successful in large parts. The consequences for German public finances are considerable and increase the debt ratio. An analysis of European countries debt situation after COVID-19 will be topic of a consecutive paper.
    Keywords: Corona-Pandemic,State Finances
    JEL: H20 H11
    Date: 2022
  28. By: Rania Gihleb; Osea Giuntella; Luca Stella; Tianyi Wang
    Abstract: This study explores the relationship between the adoption of industrial robots and workplace injuries. Using establishment-level data on injuries, we find that a one standard deviation increase in our commuting zone-level measure of robot exposure reduces work-related annual injury rates by approximately 1.2 cases per 100 workers. US commuting zones more exposed to robot penetration experience a significant increase in drug- or alcohol-related deaths and mental health problems. Employing longitudinal data from Germany, we exploit within-individual changes in robot exposure and document that a one standard deviation change in robot exposure led to a 4% decline in physical job intensity and a 5% decline in disability, but no evidence of significant effects on mental health and work and life satisfaction.
    JEL: I10 J0 J28
    Date: 2022–06
  29. By: Holden, Stein T. (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Katengeza, Samson (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Tione, Sarah (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Tilahun, Mesfin (Centre for Land Tenure Studies, Norwegian University of Life Sciences)
    Abstract: This study is based on a survey of 764 students at the Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi. It aims to provide evidence on the extent of exposure to the pandemic among university students, their knowledge and beliefs related to the corona virus and the ways they protect themselves against getting infected, the sources of information that they rely on, and other factors influencing their knowledge, beliefs, and behavior. The study was undertaken in the period of February-March 2022 during which the fourth wave of the pandemic in the country took place and in this period the omicron variant of the virus dominated. We investigate factors associated with the extent of knowledge about the corona virus and COVID risk perceptions, information updating behavior, preferences for alternative protective measures, especially vaccination and use of facemasks. We also assessed beliefs about the effects of vaccination, trust in vaccines, and passive and active demand for vaccination. Finally, we investigate facemask use intensity and factors influencing the likelihood of infection and COVID-19 disease based on subjective self-reported experiences.
    Keywords: Corona; COVID-19; pandemic; university students; knowledge; beliefs; behavior.
    JEL: I12 I15 I18
    Date: 2022–06–30
  30. By: Hall, Caroline (IFAU - Institute for Evaluation of Labour Market and Education Policy); Hardoy, Inés (Institutt for Samfunnsforskning); Lundin, Martin (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: This article provides an overview of the extent of school closures and the use of distance learning in the Nordic countries during the COVID-19 pandemic (March 2020 to June 2021). Taking the preparedness of the educational systems into consideration and combining several reports summarising student and teacher experiences with research on the causal impact of distance learning, we discuss expected and revealed effects on student outcomes in the short and long term. Survey evidence indicates that the Nordic education systems were relatively well-prepared for a transition to distance learning in terms of access to digital technology. Overall, Sweden stands out as having kept compulsory schools open to a greater extent than the other countries, while policies put in place at the upper secondary level were more similar across the region. The literature suggests that school closures can be expected to have long term negative effects on skill formation and future earnings and that the negative impacts are likely to be larger for more disadvantaged students and larger the younger the students are when exposed to remote instruction. Given the extent of school closures, students in compulsory schooling in Norway, Finland and Denmark seem particularly vulnerable as do disadvantaged groups of upper secondary school students in all of the countries, since they have been exposed to distance learning for the longest periods. The size of the long-term effects will eventually depend on the success of policies put in place to counteract the potential negative effects.
    Keywords: school closures; distance learning; COVID-19; student performance
    JEL: I21 I24 I26 I28
    Date: 2022–06–21
  31. By: Quentin Batista (MIT); Daisuke Fujii (University of Tokyo and RIETI); Taisuke Nakata (University of Tokyo); Takeki Sunakawa (Hitotsubashi University)
    Abstract: We quantify the effects of the COVID-19 crisis on suicides in Japan using a time-series model relating the number of suicides to the unemployment rate as well as private-sector forecasts of the unemployment rate before the crisis. We find that (i) the COVID-19 crisis increased suicides in Japan by about 7,000 from March 2020 to April 2022, (ii) the increase in the unemployment rate can only account for one third of the excess suicides, (iii) the excess suicides are skewed towards younger generations and female, and (iv) lost years of life expectancy associated with the excess suicides are almost as large as those associated with COVID-19 deaths.
    Date: 2022–07
  32. By: Daisuke Fujii (University of Tokyo and RIETI); Sohta Kawawaki (University of Tokyo); Yuta Maeda (University of Tokyo); Masataka Mori (Middlebury College); Taisuke Nakata (University of Tokyo)
    Abstract: There is a large heterogeneity in health and macroeconomic outcomes across countries during the COVID-19 pandemic. We present a novel framework to understand the source of this heterogeneity, combining an estimated macro-epidemiological model and the idea of revealed preference. Our framework allows us to decompose the difference in health and macroeconomic outcomes across countries into two components: preference and constraint. We find that there is a large heterogeneity in both components across countries and that some countries such as Japan or Australia are willing to accept a large output loss to reduce the number of COVID-19 deaths.
    Date: 2022–06
  33. By: Rebelo, João; Compés, Raúl; Faria, Samuel; Gonçalves, Tânia; Pinilla, Vicente; Simón-Elorz, Katrin
    Abstract: This study aims to analyse how psychological factors related to the Covid-19 lockdown affected the frequency of wine consumption among Portuguese and Spanish consumers. To achieve this goal, we used data collected from an online survey in Europe comprising 4489 observations from Portuguese and Spanish samples. Using an ordered probit model, we analysed the wine consumption frequency as a function of a set of explanatory variables related to psychological factors and also sociodemographic variables, motivation-related variables and consumption characterisation. The results allow us to conclude that for Spanish respondents the fear of isolation was a decisive factor in increasing the probability of a higher frequency of wine consumption. Meanwhile, in Portugal, the fear of an economic crisis was the psychological factor leading to a higher consumption frequency. In both countries, psychological factors influenced the frequency of wine consumption during the lockdown due to Covid-19. However, the impact of the Covid-19 crisis has been felt differently in Spain and Portugal. Differences can be observed in both psychological and behavioural attitudes that have influenced the frequency of wine consumption and could also indicate significant cultural differences.
    Keywords: Food Consumption/Nutrition/Food Safety, Consumer/Household Economics
    Date: 2021
  34. By: Holden, Stein T. (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Katengeza, Samson (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Tione, Sarah (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Tilahun, Mesfin (Centre for Land Tenure Studies, Norwegian University of Life Sciences)
    Abstract: This study investigates the covid risk perceptions, information updating behavior related to the pandemic, use of protective measures, especially facemasks, and the demand for vaccines among university students in Malawi. In particular, the study focuses on how religion and belief in prayer as a protective device against covid-19 are affecting perceptions and behavior related to the pandemic. Our findings are from a stratified random sample of 764 students from 48 classes spread across different disciplines and study years for both undergraduate and postgraduate. One-tenth of the students believed that prayer was their most important measure to protect themselves against the pandemic. Students belonging to the Seventh Day Adventists (Baptist) and Pentecostal religions perceived the covid risk to be significantly lower than other students. Students that considered prayer to be the most important protective device also perceived the covid risk to be lower than others; and updated themselves significantly less frequently about the status of the pandemic than other students. Whereas students that perceived their personal health to be at risk updated themselves more frequently about the pandemic. The information updating frequency related to the pandemic and covid risk perceptions were positively correlated with facemask use, including facemask use in church. Those who believed in prayer as a protective device were using facemasks less frequently. Students belonging to the Seventh Day Adventists and Pentecostals were less likely to use facemasks in church. These two student groups represent close to 30% of our sample; and these two groups are less likely to have tried to get vaccinated or having gotten vaccinated. These two groups are therefore at higher risk themselves in future corona waves and may also, due to their beliefs and behavior enhance the spread of the virus. Our findings may be useful for targeting efforts to promote more corona safe behavior.
    Keywords: Corona; COVID-19; pandemic; university students; religion; behavior.
    JEL: I12 I15 I18
    Date: 2022–06–30
  35. By: Shotaro Beppu (University of Tokyo); Daisuke Fujii (University of Tokyo and RIETI); Hiroyuki Kubota (University of Tokyo); Kohei Machi (University of Tokyo); Yuta Maeda (University of Tokyo); Taisuke Nakata (University of Tokyo); Haruki Shibuya (University of Tokyo)
    Abstract: Health and macroeconomic outcomes varied substantially across prefectures in Japan during the COVID-19 crisis. Using an estimated macro-epidemiological model as well as the idea of revealed preference, we compute the marginal rate of substitution (MRS) and the conditional trade-off curve between health and economic outcomes in each prefecture. We find that there is a large heterogeneity in the MRS as well as the location and shape of the conditional trade-off curve.
    Date: 2022–06
  36. By: Mohammad H. Sepahvand (ECARES, Lund University and Université libre de Bruxelles); Philip Verwimp (ECARES and Université libre de Bruxelles)
    Abstract: How does violent conflict affect the spread of Covid-19? In this paper we analyze how violent conflict influences the adoption of preventative measures and infection rate in a very poor, conflict-affected country, Burkina Faso. We use a unique panel of 1,919 households surveyed during the first six months of the Covid-19 pandemic in 2020 and merge these data with indicators of violence at the municipality and regional level. Infection data are leveraged from 65 test centers across the country. We find a lower adoption rate of preventive measures, and a higher infection rate in areas affected by violence. We control for various socio-economic characteristics and discuss potential mechanisms. We argue that political interventions towards peace and stability also help to tackle the Covid-19 pandemic.
    Keywords: Burkina Faso, Covid-19, Poverty, Violent conflict
    JEL: D74 D91 I12 I15
    Date: 2022–05
  37. By: Josh De Lyon; Swati Dhingra
    Abstract: Nearly four months have passed since the UK went into lockdown to restrict the spread of Covid-19. The health effects have been severe, and an inevitable consequence of the lockdown was a huge 20 per cent decline in GDP in April - the worst recession in more than three centuries. Government spending on economic policies has also been unprecedentedly large, with £193 billion of additional spending committed. Alongside dealing with the largest economic downturn in recent history, the UK is also negotiating its exit from the European Union - its largest trading partner. It has turned down an extension to the transition period and will leave the EU at the end of 2020. Brexit will have a profound impact on the UK economy.
    Keywords: Brexit, economic downturn, business performance, CBI, UK, Covid-19
    Date: 2020–07–29
  38. By: Lindgren, Peter (IHE - The Swedish Institute for Health Economics); Persson, Ulf (IHE - The Swedish Institute for Health Economics); Gralén, Katarina (IHE - The Swedish Institute for Health Economics)
    Abstract: Det har blivit vanligare att nya läkemedel godkänns för flera indikationer och att man använder kombinationsterapier. Det innebär utmaningar för den nuvarande utformningen av värdebaserad prissättning (VBP) som innebär att man sätter ett enhetligt pris för en läkemedelsprodukt över alla indikationer, trots att olika indikationer har olika värde. Detta kan medföra att nya läkemedel inte når alla de patienter som skulle få nytta av dem. Indikationsbaserad prissättning (IBP) kan vara en del av lösningen och möjliggöra behandling för fler patienter. <p> Denna nya IHE rapport beskriver olika vägar för att implementera IBP i Sverige och analyserar effekterna på olika aktörer. Studien baseras på dokumentgranskning och intervjuer med olika aktörer från hälso- och sjukvårdssektorn. Rapporten finns för nedladdning längst ned på sidan. <p> Sammanfattning <p> Det sker stora förändringar inom hälso- och sjukvården, bland annat på läkemedelsområdet. Många läkemedel, speciellt inom onkologi, godkänns för användning inom flera indikationer, och kombinationsterapier blir vanligare. Fler patienter kan därmed behandlas, samtidigt som myndigheter och regioner ställs inför ökade utmaningar och svåra prioriteringar, kopplat till exempelvis budget, data och administration. Det kan vara en del av lösningen att använda indikationsbaserad prissättning (IBP) för ett urval av dessa nya läkemedel, eftersom den tar hänsyn till att värdet och kostnadseffektiviteten kan skilja sig kraftigt åt mellan olika indikationer. <p> Denna rapport syftar till att beskriva olika vägar för att implementera IBP för läkemedel i Sverige och att analysera vilka effekterna är på olika aktörerna. Studien genomfördes som en kombination av dokumentgranskning och intervjuer med aktörer inom hälso- och sjukvårdssektorn som bedömdes kunna påverkas om indikationsbaserad prissättning införs. Dokumentgranskningen syftade till att beskriva IBP och tillgängliga dataregister, medan intervjuerna var huvudkällan för att undersöka möjligheter och effekter av att införa IBP i Sverige. <p> Redan idag finns några exempel på inslag av varianter på IBP, genom sidoöverenskommelser och avtal inom nuvarande värdebaserade prissättningssystem. Varianterna omfattar exempelvis viktade genomsnitt, eller trappstegsrabatter som varierar med antalet patienter som behandlas. Det saknas dock explicit struktur kring om, när och hur dessa kan användas. <p> Dagens värdebaserade system behöver utvecklas eftersom det inte är hållbart att varje läkemedelsprodukt ett enhetligt pris, givet utvecklingen med kombinationsterapier och fler läkemedel som godkänds för multiindikationer. Genom att vidareutveckla dagens värdebaserade prissättningssystem till att mer explicit och strukturerat införa IBP för relevanta läkemedel skulle fler patienter få ökad tillgång till behandling. Regionernas och statens budget är begränsad vilket redan idag medför svåra prioriteringar på hälso- och sjukvårdsområdet. Om IBP leder till en utökad volym så kan det innebära ökade kostnader, även om vissa indikationer samtidigt skulle få sänkta priser. Den totala effekten påverkas av hur systemet skulle utformas, exempelvis antal berörda produkter samt antal indikationer, nivå på rabatter och storlek på berörda populationer. <p> IBP förutsätter god tillgång på data. Data kan redan i dagens tillämpning av det värdebaserade systemet saknas på vissa områden eller vara av låg kvalitet, vilket bidrar till att aktörerna även nu tvingas att ta beslut under osäkerhet vid skattning av populationsstorlekar eller för utfallsbaserade betalningsmodeller. En viktig aspekt som kopplas till data är sekretess. Eftersom data om indikation och ordinationsorsak är mycket känslig så finns det stora begräsningar för hur denna får delas och nyttjas. Den nationella läkemedelslistan kommer innehålla information om ordinationsorsak för förskrivningsläkemedel, medan motsvarande information om rekvisitionsläkemedel skulle behöva inhämtas från nationella kvalitetsregister eller journalsystem. <p> Det behövs vidare administrativa resurser för att tillämpa IBP, eftersom inledande förhandlingar och efterföljande uppföljning av avtal är nödvändiga i ett sådant system. Dessa resurser behövs både på TLV, NT-rådet och i regionerna. För produkter som är mycket kostsamma per patient är det samtidigt rimligt att en uppföljning sker, samtidigt som man kan sträva efter en ökad automatisering kring datainhämtning från journalsystem och begränsar till nyckelparametrar. <p> Det är nödvändigt att få en politisk förståelse och ett intresse för dessa frågor för att få upp dem på agendan, och därigenom ge fler patienter tillgång till behandling. Frågan är samtidigt mycket komplex, och det är inte klart vilka offentliga aktörer som har mandat eller incitament att driva frågan. Eftersom IBP skulle kunna vara en viktig nyckel för att öka tillgången till behandling för fler patienter som nu står utan behandling är det av högsta vikt att lyfta denna fråga. <p> IBP kan utformas på olika sätt, där de två huvudvarianterna är att variera listpriset med indikation eller att låta återbäringsavtalen variera med indikation. Dessa påverkar aktörer på olika sätt och i olika omfattning. Slutsatsen från denna studie är att den mest genomförbara varianten är att låta återbäringsavtal variera med indikation, genom att ha ett enhetligt listpris kombinerat med återbäring. Detta får mindre effekt på de olika aktörerna samtidigt som det ökar sortimentsbredden och möjliggör för fler patienter att få behandling. Återbäringsavtal kan vidare delas upp i två undergrupper: viktad återbäring eller uppföljning. <p> Viktad återbäring via prevalensskattning används indirekt redan nu, men skulle kunna formalisera och göras mer explicit exempelvis genom att fastställa under vilka förutsättningar som detta skulle kunna användas. På detta område skulle på kort sikt kunna genomföras en pilotstudie på ett rekvisitionsläkemedel med möjlighet till finjusteringar i upplägget, exempelvis i mindre skala inom en region som sedan utvärderas. <p> Ett annat alternativ är att återbäringen skulle kunna baseras på uppföljningsdata. Detta kräver dock tillräckliga registerdata och/eller att förskrivande kliniker ska rapportera in ytterligare data, och det skiljer sig åt mellan förmåns- och rekvisitionsläkemedel. För rekvisitionsläkemedel skulle kunna användas Registret för cancerläkemedel, kvalitetsregister eller ett separat system för rapportering av indikationer. För förmånsläkemedel är införandet av nationell läkemedelslista intressant eftersom den innehåller ordinationsorsak, men där finns vissa begränsningar i möjligheter att dela information. Socialstyrelsen Läkemedelsregister skulle då kunna vara ett alternativ. <p> För att underlätta en mer strukturerad och formaliserad användning av IBP finns det ett antal åtgärder som kan rekommenderas <p> – Att öka NT-rådets kapacitet <p> – Att regionerna överväger en gemensam organisation eller upphandling av hantering av kontrakt, uppföljning och fakturering <p> – Att NT-rådet, TLV och LIF gemensamt tar fram tydliga kriterier för vilka fall IBP kan vara aktuellt samt hur processen ser ut <p> Sammanfattningsvis bedöms det finnas goda förutsättningarna för användande av IBP i Sverige. Det finns en stor samsyn om de potentiella vinsterna av att tillämpa IBP bland aktörerna och goda förutsättningar för att implementera detta i praktiken inom relativ snar framtid. Det som krävs inför att komma vidare nu är den politiska viljan att få detta till stånd. <p> Executive summary <p> There are major changes taking place in the healthcare sector, including in the field of pharmaceuticals. Many drugs, especially in oncology, are approved for use in several indications, and combination therapies are becoming more common. More patients can thus get access to treatment, while authorities and regions face increasing challenges and difficult priorities related to e.g. budget, data and administration. Using indication-based pricing (IBP) for some of these new drugs may be part of the solution, as it reflects that the value and cost-effectiveness can differ greatly between different indications. <p> This report aims to describe different ways to implement IBP for pharmaceuticals in Sweden and to analyse the effects on different stakeholders. The study was conducted as a combination of document review and interviews with selected stakeholders in the healthcare sector that could be affected if indication-based pricing were to be introduced. The document review aimed at describing IBP and available data registries, while the interviews were the main source to investigate opportunities and effects of implementing IBP in Sweden. <p> Already today there are a few examples of IBP, different types of managed entry agreements within the current value-based pricing (VBP) system. The variants include, for example, weighted averages, or stepwise discounts that vary with the number of patients treated. However, there is a lack of explicit structure around if, when and how these can be used. <p> Today's value-based system needs to be developed because it is not sustainable with each pharmaceutical product having a uniform (single) price, given the development with combination therapies and more drugs approved for multi-indications. By further developing today's value-based pricing system to a more explicitly and structured introduction of IBP for relevant drugs, more patients would have access to treatment. <p> The budget of the regions and the government is limited, which already entails difficult priorities in the field of health care. If IBP would lead to an increased volume, it could mean increased costs, although at the same time for some indications there would be reduced prices. The overall impact is influenced by how the system would be designed, such as the number of products concerned, the number of indications, the level of rebates and the size of the populations concerned. <p> IBP requires sufficient access to data. Data may already in today’s use of the value-based system be lacking in some areas or be of low quality, which contributes to stakeholders being forced even now to make decisions under uncertainty for estimates of population sizes or for outcome-based payment models. An important aspect associated with data is privacy. Since the data on indication and the reason for treatment are very sensitive, there are major limitations on how this data may be shared and used. The National Medication List will contain information on the reason for treatment, while the corresponding information on requisition medicines would need to be obtained from national quality registers or medical record systems. <p> Furthermore, administrative resources are needed for the IBP system, as initial negotiations and subsequent follow-up of agreements are necessary in such a system. These resources are needed both at TLV, the NT Council and in the regions. At the same time, for products that are very costly per patient, it is reasonable for a follow-up to take place, while at the same time striving for increased automation around data collection from medical record systems and limiting collection to key parameters. <p> It is necessary to gain a political understanding and an interest in these issues in order to get them on the agenda, thereby giving more patients access to treatment. At the same time, the issue is very complex, and it is not clear which public stakeholders have the mandate or incentive to pursue the issue. Since IBP could be an important key to increasing access to treatment for more patients who are now without treatment, it is of the utmost importance to raise this issue. <p> IBP can be designed in different ways, where the two main variants are to vary the list price with indication or to let the managed entry agreements with repayments vary with indication. These affect stakeholders in different ways and to different extents. The conclusion from this study is that the most feasible variant is to allow the level of repayment to vary with indication, having a uniform (single) list price combined with a repayment. This has less effect on the different stakeholders while increasing the range of products and enabling more patients to access treatment. Repayment can then be divided into two subgroups: weighted repayment or follow-up. Weighted repayment using estimates of prevalence are already used indirectly, but could be formalised and made more explicit, for example by establishing the conditions under which this could be used. In this area, a pilot study could be carried out in the short term on a requisition drug with the possibility of fine-tuning the set-up, for example on a smaller scale within a region that is then evaluated. <p> Another option is that the repayment could be based on follow-up data. However, this requires sufficient registry data and/or prescribing clinicians to report additional data, which differs between preferential drugs (outpatient prescription drugs included in the Swedish benefits scheme) and requisition drugs. Requisition drugs could use the Register of Cancer Medicines, quality registers or a separate system for reporting indications. For preferential drugs, the introduction of the National Medication List is interesting because it contains the reason for prescription, but there are some limitations in the possibilities to share information. The National Board of Health and Welfare's Register of Medicines could then be an alternative. <p> To facilitate a more structured and formalized use of IBP, there are a number of measures that can be recommended <p> • Increasing the capacity of the NT Council <p> • That the regions consider a joint organisation or procurement of contract management, follow-up and invoicing <p> • That the NT Council, TLV and LIF jointly develop clear criteria for which cases IBP may be relevant and what the process looks like <p> In summary, it is considered that there are favourable conditions for the use of IBP in Sweden. There is a broad consensus on the potential benefits of applying IBP among stakeholders and favourable conditions for implementing this in practice in the relatively near future. What is required to move forward now is the political will to bring this about.
    Keywords: läkemedel; indikationsbaserad prissättning; IBP; värdebaserad prissättning; VBP; hälsoekonomi; health economics
    Date: 2022

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