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on Health Economics |
| By: | Gorodnichenko, Yuriy (University of California, Berkeley); Kudlyak, Marianna (Federal Reserve Bank of San Francisco); Sahin, Aysegül (University of Texas at Austin) |
| Abstract: | In February 2022, Russia launched a full-scale invasion of Ukraine. The ensuing war has a devastating destructing impact in Ukraine. This article focuses on the humanitarian cost of war. The article develops a framework for the analysis of the effect of a war on country’s human capital. We then identify the following key directions for rebuilding and further developing human capital in Ukraine: quantity and quality of schooling for children, quality of higher education, training and retraining programs for adults, assistance for people with disabilities, post-deployment re-integration into the civilian sector, population growth and fertility, and promotion of self-motivating mechanisms. |
| Keywords: | human capital, growth, schooling, skills of the future, health, war, displacement |
| JEL: | I2 J24 O4 |
| Date: | 2022–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izapps:pp185&r= |
| By: | Michael Baker; Nina Drange; Hege Marie Gjefsen |
| Abstract: | Starting in the 2016/17 academic year, high school students in Norway who missed more than 10 percent of the hours in a given course without a medical excuse could not receive a final grade. We examine the impacts of this policy on student absenteeism, the incidence of the no grade penalty and two measures of student achievement. The policy had the intended impact on absenteeism, reducing total absence by 20-28 percent, and chronic absence by 29-39 percent in the high school grades. This behavioral response was largely sufficient to avoid the academic penalty for absence over the 10 percent threshold under the new law. Finally, we find a mixed impact on student achievement: little impact on externally graded, end of year exams, and modest evidence of a positive impact of 6 percent of a standard deviation on teacher awarded GPA. |
| JEL: | I21 J24 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30194&r= |
| By: | Krekó, Judit (Budapest Institute); Prinz, Daniel (Institute for Fiscal Studies, London); Weber, Andrea (Central European University) |
| Abstract: | In most disability insurance programs beneficiaries lose some or all of their benefits if they earn above an earnings threshold. While intended to screen out applicants with high remaining working capacity, earnings limits can also distort the labor supply of beneficiaries. We develop a simple framework to evaluate this trade-off. We use a reduction in the earnings limit in Hungary to examine screening and labor supply responses. We find that the policy changed selection into the program modestly but reduced labor supply significantly. Viewed through the lens of our model, these findings suggest that the earnings threshold should be higher. |
| Keywords: | disability insurance, policy reform, earnings limit, labor supply |
| JEL: | H53 H55 I38 J22 |
| Date: | 2022–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15377&r= |
| By: | Hannah Bae; Katherine Meckel |
| Abstract: | In 2010, the Affordable Care Act (ACA) mandated that private insurance plans extend coverage to adult dependents under the age of 26. We hypothesize that this policy may have had the unintended consequence of increasing "job lock" among parents who would otherwise leave their employer. We use a large panel of insurance claims that links members covered by the same plan and follows individuals over time. To identify the effects of additional dependent coverage provided under the ACA, we estimate a regression discontinuity design in dependent birth date that exploits the fact that, on average, adult dependents born in January became eligible for more months of coverage than those born in December. We first show that, compared to their December-born counterparts, dependents with January births were more likely to enroll in their parent's plan and enrolled for a longer period of time. Correspondingly, we find that their parent is more likely to remain with their pre-ACA employer and remain with that employer for longer. Effects are larger for parents approaching early retirement and dependents who are only children. Our findings provide new insight into the welfare effects of mandated insurance coverage and the importance of intra-family spillovers. |
| JEL: | H0 I13 I28 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30200&r= |
| By: | Leonardo Bursztyn; Jonathan T. Kolstad; Aakaash Rao; Pietro Tebaldi; Noam Yuchtman |
| Abstract: | We study how the politicization of policies designed to correct market failures can undermine their effectiveness. The Patient Protection and Affordable Care Act (ACA) was among the most politically divisive expansions of the US government. We examine whether partisanship distorted enrollment and market outcomes in the ACA insurance marketplaces. Controlling for observable characteristics and holding fixed plans and premiums available, Republicans enrolled less than Democrats and independents in ACA marketplace plans. Selection out of the ACA marketplaces was strongest among Republicans with lower expected healthcare costs, generating adverse selection. Computing enrollment and average cost with and without partisan differences, we find that this political adverse selection reduced enrollment by around three million people and raised average costs in the marketplaces, increasing the level of public spending necessary to provide subsidies to low-income enrollees by around $105 per enrollee per year. Lower enrollments and higher costs are concentrated in more Republican areas, potentially contributing to polarized views of the ACA. |
| JEL: | H0 I13 L38 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30214&r= |
| By: | Borgschulte, Mark (University of Illinois at Urbana-Champaign); Molitor, David (University of Illinois at Urbana-Champaign); Zou, Eric Yongchen (University of Oregon) |
| Abstract: | We study how air pollution impacts the U.S. labor market by analyzing effects of drifting wildfire smoke that can affect populations far from the fires themselves. We link satellite smoke plume with labor market outcomes to estimate that an additional day of smoke exposure reduces quarterly earnings by about 0.1 percent. Extensive margin responses, including employment reductions and labor force exits, can explain 13 percent of the overall earnings losses. The implied welfare cost of lost earnings due to air pollution exposure is on par with standard valuations of the mortality burden. The findings suggest that labor market channels warrant greater consideration in policy responses to air pollution. |
| Keywords: | air pollution, labor market, wildfires |
| JEL: | J21 Q51 Q52 Q53 Q54 |
| Date: | 2022–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15373&r= |
| By: | Costa-Font, Joan; Vilaplana-Prieto, Cristina |
| Abstract: | We study biased survival expectations across two domains and examine whether such biased expectations influence health and financial behaviors. Combining individual-level longitudinal data, retrospective, and end of life data from several European countries for more than a decade, we estimate time-varying individual level bias in ‘survival expectations' (BSE) at the individual level and compare it biased ‘meteorological expectations' (BME). We exploit variation in an individual's family history (parental age at death) to estimate the effect of BSE on health and financial behaviors and compare it to BME, and other tests to discuss whether the effect of BSE results from the effect of private information. We find that BSE increases the probability of adopting less risky behaviors and financial behaviors. We estimate that a one standard deviation increase in BSE reduces the average probability of smoking by 48% and holding retirement accounts by 69%. In contrast, BME barely affects healthy behaviors, and is only associated with a change in some financial behaviors. |
| Keywords: | biased expectations; survival expectations; meteorological expectations; longevity optimism; private information; health behaviour; financial behaviour; Springer deal |
| JEL: | I18 D14 G22 |
| Date: | 2022–07–25 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:112709&r= |
| By: | Bhalotra, Sonia; Clarke, Damian; Walther, Selma |
| Abstract: | This paper discusses research on the relationship between fertility and women's labour force participation. It surveys methods used to obtain causal identification, and provides an overview of the evidence of causal effects in both directions. We highlight a few themes that we regard as important in guiding research and in reading the evidence. These include the importance of distinguishing between extensive and intensive margin changes in both variables; consideration not only of women's participation but also of occupational and sectoral choice and of relative earnings; the relevance of studying dynamic effects and of analysing changes across the lifecycle and across successive cohorts; and of recognizing that women's choices over both fertility and labour force participation are subject to multiple constraints. We observe that, while technological innovations in reproductive health technologies have muted the familycareer tradeoff primarily by allowing women to time their fertility, policy has not achieved as much as it might. |
| Keywords: | fertility,birth spacing,abortion,ART,IVF,contraception,female labour force participation,gender wage gap,job loss,recession |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1120&r= |
| By: | Joanna N. Lahey; Marianne H. Wanamaker |
| Abstract: | Recent studies based on 20th century US data conclude that abortion access raises children’s average socioeconomic outcomes. We generalize a model of fertility, highlighting assumptions under which these abortion predictions can be reversed. Using 19th century abortion restrictions, we empirically demonstrate these points. Despite a more than 5 percent increase in birth rates among abortion-restricted cohorts, we find little evidence of negative selection at birth. Longevity was affected nevertheless; in the first ten years of life, children in these larger cohorts died of infectious disease more frequently. These mortality effects diminish with age, potentially reversing at older ages as a result of disease immunity or other offsetting factors. |
| JEL: | H75 J1 J13 J16 J18 K14 K15 K38 N3 N31 N4 N41 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30201&r= |
| By: | Osea Giuntella; Giulia La Mattina; Climent Quintana-Domeque |
| Abstract: | We use a unique data set of linked birth records from Florida to analyze the intergenerational transmission of health at birth by parental gender. We show that both paternal and maternal birth weights significantly predict the child’s birth weight, even after accounting for all genetic and environmental factors that are common and time-invariant within a family. Our estimates reveal that a one standard deviation increase in mother’s birth weight (535 grams) translates into a 0.13-0.24 standard deviations increase in child’s birth weight (70-128 grams), accounting or not for maternal grandmother fixed effects. On the father’s side, we find that a one standard deviation increase in father’s birth weight (563 grams) translates into a 0.10-0.15 standard deviations increase in child’s birth weight (56-78 grams), accounting or not for paternal grandmother fixed effects. The significant role of both maternal and paternal health at birth in explaining offspring health at birth is confirmed when using alternative metrics: intrauterine growth, being small for gestational age or being too heavy (i.e., macrosomic). |
| JEL: | I0 J10 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30237&r= |
| By: | Brodeur, Abel; Yousaf, Hasin |
| Abstract: | In this paper, we investigate the economic consequences of mass shootings. We find that shootings have negative effects on targeted counties' economies. Estimates using three different comparison groups yield similar results. Examining the mechanisms, we find that residents of targeted areas: (i) develop pessimistic views of financial and local business conditions; and (ii) are more likely to report poor mental health, which hinders usual activities such as work, suggesting that shootings lead to decreases in productivity. Further, we find that greater national media coverage of shootings exacerbates their local economic consequences. |
| Keywords: | Mass Shootings,Employment,Absenteeism,Economic Expectations,Media Coverage |
| JEL: | D74 L82 C13 I15 D84 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1133&r= |
| By: | Josten, Cecily; Lordan, Grace |
| Abstract: | We investigate whether responses to the UK public places smoking ban depend on personality. Drawing on individual level panel data from the British Household Panel Survey (BHPS) we exploit variation in the timing and location of these bans to establish their overall effect on smoking outcomes, and how this differs by personality. We measure personality using the Big Five personality traits. We are particularly interested in conscientiousness, given the evidence that it is a good proxy for self-control. Overall, we find that a one standard deviation increase in conscientiousness leads to a 1.4 percentage point reduction in the probability of smoking after the ban. Notably, this is the only Big Five personality trait that interacts with the smoking ban. This finding is very robust to different specifications. |
| Keywords: | conscientiousness; five factor model; personality; smoking ban |
| JEL: | C23 I10 I12 H75 |
| Date: | 2020–08–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:113435&r= |
| By: | Casey B. Mulligan |
| Abstract: | In theory, equilibrium profits for drug patent holders would not involve significant restraints on production and patient utilization if the market had a mechanism for two-part pricing (Oi 1971) or quantity commitments (Murphy, Snyder, and Topel 2014). In fact, patent expiration has little effect on drug utilization especially when those drugs are delivered through insurance plans. This paper provides a quantitative model consistent with the theory and evidence in which pharmacy benefit management on behalf of insurance plans serves these and other purposes in both monopoly and oligopoly provider settings. Calibrating the model to the U.S. market, I conclude that pharmacy benefit management is worth at least $145 billion annually beyond its resource costs. PBM services add at least $192 billion annually in value to society compared to a manufacturer price-control regime. Requiring all PBM services to be self-provided by plan sponsors would forgo about 40 percent of the net value of PBM services largely by increasing management costs. Due to changes in the incidence of PBM services over the drug life cycle, the services encourage innovation even though they reduce the profits of incumbent manufacturers. |
| JEL: | D43 D71 I11 I13 L14 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30231&r= |
| By: | Guillaume Sekli (CRESE EA3190, Univ. Bourgogne Franche-Comté, F-25000 Besançon, France) |
| Abstract: | This article focuses on the sharing of a bundled payment for integrated healthcare. We model this problem by means of cooperative game theory. Various approaches are considered, each of which gives rise to a particular cooperative game, and make it possible to take the chronology of medical events into account. The Shapley value, a priority rule and a proportional allocation rule are used to (partially) refund the healthcare professionals on the basis of the fee paid by the patient and we establish some properties. We also show that the core of some of these aformentioned games is non-empty and can contain these allocation rules. |
| Keywords: | Integrated Healthcare, Healthcare chain, Chronic diseases, Shapley value |
| JEL: | C71 I11 |
| Date: | 2022–06 |
| URL: | http://d.repec.org/n?u=RePEc:crb:wpaper:2022-06&r= |
| By: | Drydakis, Nick |
| Abstract: | Given the assigned health inequalities faced by sexual minorities, it is fitting to assess whether m-health could be associated with better health-related outcomes for these sexual minorities. The present study examines associations between m-physical and m-mental health apps and sexual minorities' physical and mental health status in Greece. The study utilized three waves of panel data collected in 2018, 2019, and 2020. The findings indicated associations between the use of m-physical and m-mental health apps and increased physical and mental health status for sexual minorities. The work concludes that m-health could enhance informational capabilities associated with increased levels of physical and mental health for sexual minorities. Indeed, the study found that, during the COVID-19 pandemic, sexual minorities experienced physical and mental health deteriorations. Interestingly, the estimates indicated that the association between the use of m-physical and m-mental health apps and increased mental health status for sexual minorities was stronger during the COVID-19 pandemic than before. The study suggests that tracking health-related information through m-health apps during periods of increased uncertainty could be associated with better health prevention and management. If m-health apps can alleviate adverse physical and mental health symptoms for sexual minorities, their potential should be considered. |
| Keywords: | m-Health,Smartphone,Apps,Physical Health,Mental Health,COVID-19,Sexual Minorities |
| JEL: | I1 I14 O3 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1121&r= |
| By: | Liu, Yinan; Zai, Xianhua |
| Abstract: | The Medicaid Home and Community-Based Services (HCBS) subsidizes long-term care to satisfy the increasing desire to age at home among older adults. The HCBS program may improve health outcomes of this population by allowing them to age-in- place, but less quality and quantity of home-based care comparing to nursing home care could offset some of the potential benefits. We use plausibly exogenous policy expenditure across states over time linked with detailed health information from the restricted Health and Retirement Study (HRS) to identify the causal effects of HCBS on general health, physical health, and mental health of older adults. Overall, our findings suggest that HCBS is beneficial to health: a $1,000 increase in HCBS per older person improves health status by 6 percent, mitigates functional mobility limitations by 5 percent, and reduces negative psychological feelings by 10 percent. The positive effect on physical health is concentrated among people with limited financial resources, while the reducing impact on mental health is significant among the richer group. The HCBS program improves health outcomes mainly through three mechanisms: decreasing risk behavior on drinking, increasing healthcare use, and spending more time accompanying with family. |
| Keywords: | Medicaid HCBS,Long-Term Care,Health,Aging |
| JEL: | I12 I18 I30 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1079r&r= |
| By: | Costa-Font, Joan (London School of Economics); D’Amico, Francesco (CEP, London School of Economics); Vilaplana-Prieto, Cristina (Universidad de Murcia) |
| Abstract: | We study the effect of long-term care (LTC) subsidies and supports on the wellbeing of unpaid caregivers. We draw on evidence from a policy intervention, that universalized previously means-tested caregiving supports in Scotland, known as free personal care (FPC). We document causal evidence of an increase in the well-being (happiness) of unpaid carers after the introduction of FPC. Our estimates suggest economically relevant improvements in the happiness (12pp increase in subjective wellbeing) among caregivers exposed to FPC and that provide at least 35 hours of care per week. Consistently, these results are larger among women and non-actively employed caregivers (17pp increase in happiness). Estimates are not driven by selection into caregiving (we find similar wellbeing effects among caregivers at baseline and caregivers throughout the sample), and are driven by income effects of FPC among caregivers. |
| Keywords: | caregiver's wellbeing, subjective wellbeing, long-term care subsidies, caregiving, Scotland |
| JEL: | J22 |
| Date: | 2022–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15369&r= |
| By: | De La Mata, Dolores; Machado, Matilde P.; Olivella, Pau; Valdés, Maria Nieves |
| Abstract: | We extend Rothshild and Stiglitz (1976) model to two sources of risk to better proxy real-world health insurance markets. This extension produces an interesting theoretical possibility: Take individuals A and B, who are low risks in one dimension but A is riskier in the other dimension. Then, A may enjoy less coverage than B in the former dimension (coverage reversal). The existence of this reversal determines which individuals are more likely to suffer adverse selection. We adapt Chiappori and Salanié (2000) positive correlation test to account for this multi-dimensionality and apply it to individual-level claims data for the privately insured in Chile. |
| Keywords: | Insurance Markets; Health Insurance; Adverse Selection; Advantageous Selection; Positive Correlation Test; Competitive Multidimensional Screening |
| JEL: | I13 L13 D82 |
| Date: | 2022–07–12 |
| URL: | http://d.repec.org/n?u=RePEc:cte:werepe:35441&r= |
| By: | Philippe de Donder (TSE - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - Université Fédérale Toulouse Midi-Pyrénées - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Marie-Louise Leroux (UQAM - Université du Québec à Montréal = University of Québec in Montréal); François Salanié (TSE - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - Université Fédérale Toulouse Midi-Pyrénées - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | Advantageous (or propitious) selection occurs when an increase in the premium of an in- surance contract induces high-cost agents to quit, thereby reducing the average cost among remaining buyers. Hemenway (1990) and many subsequent contributions motivate its ad- vent by differences in risk-aversion among agents, implying different prevention efforts. We argue that it may also appear in the absence of moral hazard, when agents only differ in riskiness and not in (risk) preferences. We first show that profit-maximization implies that advantageous selection is more likely when markup rates and the elasticity of insurance demand are high. We then move to standard settings satisfying the single-crossing prop- erty and show that advantageous selection may occur when several contracts are offered, when agents also face a non-insurable background risk, or when agents face two mutually exclusive risks that are bundled together in a single insurance contract. We exemplify this last case with life care annuities, a product which bundles long-term care insurance and annuities, and we use Canadian survey data to provide an example of a contract facing advantageous selection. |
| Keywords: | Propitious selection,Positive or negative correlation property,Contract bundling,Long-term care insurance,Annuity |
| Date: | 2022–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-03711744&r= |
| By: | Raphaël Franck; Oded Galor; Omer Moav; Ömer Özak |
| Abstract: | This research explores the persistent effect of the Neolithic Revolution on the evolution of life expectancy in the course of human history. It advances the hypothesis and establishes empirically that the onset of the Neolithic Revolution and the associated rise in infectious diseases triggered a process of adaptation reducing mortality from infectious diseases while increasing the propensity for autoimmune and inflammatory diseases. Exploiting an exogenous source of variation in the timing of the Neolithic Revolution across French regions, the analysis establishes the presence of these conflicting forces - the beneficial effects on life expectancy before the second epidemiological transition and their adverse effects thereafter. |
| JEL: | I15 O10 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30221&r= |
| By: | Richard Jaimes; Ed Westerhout; Ed Westerhout |
| Abstract: | We analyze optimal social security in a two-period overlapping generations model with endogenous retirement and demographic change. In this model, households choose to spend the second period of their lives in full retirement if the tax rate on labor income exceeds a certain threshold. We find that this threshold is increasing in life expectancy and decreasing in the fertility rate, which implies that both types of demographic change increase the relevance of the partial retirement case in which households participate on the labor market. Related, both an increase in life expectancy and a drop in fertility imply that retirement is delayed in the partial retirement case. We also show that when the government decides about the retirement age, the command optimum can be replicated through social security policies as long as the laissez-faire equilibrium features an overaccumulation of capital. When households decide about their retirement age themselves, however, replication of the command optimum is not possible, even if overaccumulation of capital applies. In both cases, it is optimal to expand social security when longevity increases and to reduce it when fertility drops. |
| Keywords: | Aging, Retirement, Optimal taxation. |
| JEL: | J11 J26 H21 |
| Date: | 2022–06–14 |
| URL: | http://d.repec.org/n?u=RePEc:col:000416:020316&r= |
| By: | Chairina Hanum Siregar (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)); Muhammad Rifqi Aufari (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)); Hamdan Bintara (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)); Raka Rizky Fadilla (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)); Wildan Al Kautsar Anky (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)); Nia Kurnia Sholihah (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)); Lovina Aisha Malika Putri (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)); Alin Halimatussadiah (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)); Jahen Fachrul Rizki (Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia (LPEM FEB UI)) |
| Abstract: | Many workers in Indonesia experienced job loss and decreasing income during the pandemic of COVID-19. These phenomena have a tremendous impact on workers since they were affected by economic losses and worsened their mental health. To help the worker, the Government of Indonesia (GoI) is releasing Kartu Prakerja program (Pre-employment Card), an on-demand and self-targeting program.This study investigates the impact of Kartu Prakerja program on people’s mental health conditions. We use online survey data collected from 4000 respondents from all over Indonesia in August–September 2020. Our main independent variables are mental health-related variables, such as happiness, sadness, anxiety, and anger level. By using ordered logistic regression, this study shows a positive andsignificant relationship between people who are receiving Kartu Prakerja on their sadness, anxiety, and anger level. Receiving Kartu Prakerja could reduce their sadness, anxiety and anger level. Whereas it does not affect their happiness levels. |
| Keywords: | COVID-19 — kartu prakerja — mental health — indonesia |
| JEL: | I18 I19 I38 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:lpe:wpaper:202270&r= |
| By: | Lagarde, Mylène; Blaauw, Duane |
| Abstract: | Overtreatment is widespread in health, with potentially dire consequences for patients, health systems and public health. It may be fuelled by providers when they do not bear the cost of treatment (moral hazard), even they do not profit financially from it (i.e. benevolent providers). We test this hypothesis by creating an exogeneous change in the incentives faced by private doctors in South Africa. We find that provider moral hazard has no effect on overtreatment in volume but fuels overtreatment in cost: when they do not bear the marginal treatment cost, doctors choose more expensive drugs. While these results suggest that provider moral hazard contributes to overtreatment in primary care, we consider other plausible channels, such as responses to a perceived demand for high-quality drugs or market segmentation. We discuss the potential scope for supply-side cost-sharing incentives to reduce inefficiency in future health system reforms in South Africa. |
| Keywords: | ES/P004059/1; Elsevier deal |
| JEL: | C93 D64 O15 |
| Date: | 2022–06–10 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:115383&r= |
| By: | Von Grafenstein, Liza; Klasen, Stephan; Hoddinott, John |
| Abstract: | This paper re-enters the contested discussion surrounding the Indian Enigma, the high prevalence of chronic undernutrition in India relative to sub-Saharan Africa. Jayachandran & Pande argue that the key to the Indian enigma lies in the worse treatment of higher birth order children, particularly girls. Analyzing new data, we find: (1) Parameter estimates are sensitive to sampling design and model specification; (2) The gap between the heights of pre-school African and Indian children is closing; (3) The gap does not appear to be driven by differential associations by birth order and child sex; (4) The remaining gap is associated with differences in maternal heights. If Indian women had the heights of their African counterparts, pre-school Indian children would be taller than pre-school African children; and (5) Once we account for survey design, sibling size and maternal height, the coefficient associated with being an Indian girl is no longer statistically significant. |
| Keywords: | Food Consumption/Nutrition/Food Safety, Health Economics and Policy, Institutional and Behavioral Economics, Labor and Human Capital, Research Methods/ Statistical Methods |
| Date: | 2022–06 |
| URL: | http://d.repec.org/n?u=RePEc:ags:gausfs:322717&r= |
| By: | Marwan-Al-Qays Bousmah (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale, ISSPAM - Institut des sciences de la santé publique [Marseille], CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPC - Université Paris Cité); Collins Iwuji (University of Sussex); Nonhlanhla Okesola (AHRI - Africa Health Research Institute [KwaZulu-Natal]); Joanna Orne-Gliemann (BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale); Deenan Pillay (UCL - University College of London [London]); Francois Dabis (BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale); Joseph Larmarange (CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPC - Université Paris Cité); Sylvie Boyer (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale, ISSPAM - Institut des sciences de la santé publique [Marseille]) |
| Abstract: | Universal HIV testing is now recommended in generalised HIV epidemic settings. Although home-based HIV counselling and testing (HB-HCT) has been shown to be effective in achieving high levels of HIV status awareness, little is still known about the cost implications of universal and repeated HB-HCT. We estimated the costs of repeated HB-HCT and the scale economies that can be obtained when increasing the population coverage of the intervention. We used primary data from the ANRS 12249 Treatment as Prevention (TasP) trial in rural South Africa (2012-2016), whose testing component included six-monthly repeated HB-HCT. We relied on the dynamic system generalised method of moments (GMM) approach to produce unbiased short- and long-run estimates of economies of scale, using the number of contacts made by HIV counsellors for HB-HCT as the scale variable. We also estimated the mediating effect of the contact quality - measured as the proportion of HIV tests performed among all contacts eligible for an HIV test - on scale economies. The mean cost (standard deviation) of universal and repeated HB-HCT was $24.2 (13.7) per contact, $1694.3 (1527.8) per new HIV diagnosis, and $269.2 (279.0) per appropriate referral to HIV care. The GMM estimations revealed the presence of economies of scale, with a 1% increase in the number of contacts for HB-HCT leading to a 0.27% decrease in the mean cost. Our results also suggested a significant long-run relationship between mean cost and scale, with a 1% increase in the scale leading to a 0.36% decrease in mean cost in the long run. Overall, we showed that significant cost savings can be made from increasing population coverage. Nevertheless, there is a risk that this gain is made at the expense of quality: the higher the quality of HB-HCT activities, the lower the economies of scale. |
| Keywords: | AIDS/HIV,Prevention,Cost of care,Economies of scale,Interventions,Clinical trials,South Africa |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03701046&r= |
| By: | Pagel, Jeff |
| Abstract: | This paper studies whether extractive resource activities provoke an ecological response on the emergence and proliferation of malaria by altering the reproductive environment of mosquitoes. In January 2004, the government of the Philippines launched the Minerals Action Plan (MAP) with the goal of revitalizing the mining sector, which significantly reduced the average lag between application and grant of a mining permit. I exploit the timing of the reform and the spatial distribution of mineral endowments through a difference-in-differences (DID) approach that compares provinces with and without gold deposits before and after the reform. After the MAP reform, provinces with deposits of gold had 32 percent more malaria cases relative to provinces without gold deposits. Additionally, the impact on malaria appears to be persistent 10 years beyond the implementation of the policy. I perform several falsification tests as well as investigate other potential mechanisms to further suggest that the main mechanism is through gold mining’s creation of slow-moving bodies of stagnant water, which provide an ideal breeding site for Anopheles mosquitoes, malaria’s main transmission vector, to propagate and reproduce. |
| Keywords: | natural resource curse; malaria; extractive resources; health and economic development |
| JEL: | Q32 Q57 I18 |
| Date: | 2022–05–10 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:115532&r= |
| By: | Ricardo Martínez (Department of Economics, Universidad de Granada;); Juan D. Moreno-Ternero (Department of Economics, Universidad Pablo de Olavide;) |
| Abstract: | During a pandemic, each country (or region) is characterized by a status matrix indicating its positive cases, hospitalizations and deaths. A pandemic performance indicator is a real- valued mapping from the set of status matrices to the set of non-negative real numbers, whereby lower values stand for better performance. We show that four axioms together characterize a family of indicators arising from a weighted average of the incidence rate, morbidity rate and mortality rate. We use these indicators to evaluate the impact of COVID- 19 in major countries worldwide. |
| Keywords: | pandemic, incidence, hospitalizations, deaths, axioms. |
| JEL: | D63 I10 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:pab:wpaper:22.10&r= |
| By: | Nick Robins; James Rydge; Nicholas Stern; Sam Unsworth; Anna Valero; Dimitri Zenghelis |
| Abstract: | The UK and the world have suffered disruption and hardship from the COVID-19 pandemic on an immense scale. Together with the tragic consequences of the health crisis, there is now a real risk of protracted global depression. Strong and timely action can increase confidence, steer expectations and channel productive private and public investment into a sustainable, inclusive and resilient recovery across the UK. |
| Keywords: | Covid-19, sustainable recovery, investment, productivity, infrastructure, net zero greenhouse emissions, 'building back better', uk economy |
| Date: | 2020–07–02 |
| URL: | http://d.repec.org/n?u=RePEc:cep:cepcvd:cepcovid-19-005&r= |
| By: | Susan Athey; Kristen Grabarz; Michael Luca; Nils Wernerfelt |
| Abstract: | During the course of the COVID-19 pandemic, a common strategy for public health organizations around the world has been to launch interventions via advertising campaigns on social media. Despite this ubiquity, little has been known about their average effectiveness. We conduct a large-scale program evaluation of campaigns from 174 public health organizations on Facebook and Instagram that collectively reached 2.1 billion individuals and cost around \$40 million. We report the results of 819 randomized experiments that measured the impact of these campaigns across standardized, survey-based outcomes. We find on average these campaigns are effective at influencing self-reported beliefs, shifting opinions close to 1% at baseline with a cost per influenced person of about \$3.41. There is further evidence that campaigns are especially effective at influencing users' knowledge of how to get vaccines. Our results represent, to the best of our knowledge, the largest set of online public health interventions analyzed to date. |
| Date: | 2022–06 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2206.10214&r= |
| By: | Thomas B. Foster; Leticia Fernandez; Sonya R. Porter; Nikolas Pharris-Ciurej |
| Abstract: | Research on the impact of the COVID-19 pandemic in the United States has highlighted substantial racial/ethnic disparities in excess mortality, but reports often differ in the details with respect to the size of these disparities. We suggest that these inconsistencies stem from differences in the temporal scope and measurement of race/ethnicity in existing data. We address these issues using death records for 2010 through 2021 from the Social Security Administration, covering the universe of individuals ever issued a Social Security Number, linked to race/ethnicity responses from the decennial census and American Community Survey. We use these data to (1) estimate excess all-cause mortality at the national level and for age-, sex-, and race/ethnicity-specific subgroups, (2) examine racial/ethnic variation in excess mortality over the course of the pandemic, and (3) explore whether and how racial/ethnic mortality disparities vary across states. |
| Keywords: | COVID-19; Excess Mortality; Mortality Disparities; Race/Ethnicity |
| Date: | 2022–05 |
| URL: | http://d.repec.org/n?u=RePEc:cen:wpaper:22-18&r= |
| By: | Guilhem Cassan (UNamur - Université de Namur [Namur], CEPR - Center for Economic Policy Research - CEPR, CEPREMAP - Centre pour la recherche économique et ses applications - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres, CRED - Centre de Recherche en Economie et Droit - Université Paris-Panthéon-Assas, DeFiPP - Development Finance and Public Policies); Marc Sangnier (UNamur - Université de Namur [Namur], AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université) |
| Abstract: | Soon after the onset of the COVID-19 pandemic, the French government decided to still hold the first round of the 2020 municipal elections as scheduled on March 15. What was the impact of these elections on the spread of COVID-19 in France? Answering this question leads to intricate econometric issues as omitted variables may drive both epidemiological dynamics and electoral turnout, and as a national lockdown was imposed at almost the same time as the elections. In order to disentangle the effect of the elections from that of confounding factors, we first predict each department's epidemiological dynamics using information up to the election. We then take advantage of differences in electoral turnout across departments to identify the impact of the election on prediction errors in hospitalizations. We report a detrimental effect of the first round of the election on hospitalizations in locations that were already at relatively advanced stages of the epidemic. Estimates suggest that the elections accounted for at least 3,000 hospitalizations, or 11% of all hospitalizations by the end of March. Given the sizable health cost of holding elections during an epidemic, promoting ways of voting that reduce exposure to COVID-19 is key until the pandemic shows signs of abating. |
| Keywords: | COVID-19,Hospitalizations,Electoral turnout,Municipal elections,Prediction errors |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03670012&r= |
| By: | Susan Athey; Juan Camilo Castillo; Esha Chaudhuri; Michael Kremer; Alexandre Simoes Gomes; Christopher Snyder |
| Abstract: | We review economic arguments for using public policy to accelerate vaccine supply during a pandemic. Rapidly vaccinating a large share of the global population helps avoid economic, mortality, and social losses, which in the case of Covid-19 mounted into trillions of dollars. However, pharmaceutical firms are unlikely to have private incentives to invest in vaccine capacity at the socially optimal scale and speed. The socially optimal level of public spending may cause some sticker shock but—as epitomized by the tagline “spending billions to save trillions”—is eclipsed by the benefits and can be restrained with the help of careful policy design and advance preparations. Capacity is so valuable during a pandemic that fractional dosing and other measures to stretch available capacity should be explored. |
| JEL: | D47 H44 I15 I18 O31 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30192&r= |
| By: | Jeffrey Clemens; Philip G. Hoxie; John Kearns; Stan Veuger |
| Abstract: | We estimate whether federal aid for state and local governments played a role in advancing population testing for COVID-19 and the administration of vaccines. To overcome biases that can result from the endogeneity of federal aid allocations, we use an instrumental-variables estimator reliant on the substantial variation in federal aid predicted by variation in states’ congressional representation. We find that federal fiscal assistance dollars had a modest if any impact on the pace of vaccine rollouts, may have improved the equitability of vaccine administration, and had a substantial impact on the volume of tests administered. Regarding the total number of vaccines delivered, we estimate that an additional $1,000 in fiscal relief per resident, which would amount to $330 billion nationwide, translated into just under 1,200 extra doses of the vaccine being delivered per 100,000 people, with the upper bound of our confidence interval suggesting that we can rule out effects in excess of 7,030 extra doses per 100,000 people. We find that federal dollars predict a smaller gap between the vaccination rates of those with a college education relative to those with a high school education. Finally, our baseline estimate implies that each $1,000 in COVID-19 relief aid per capita generated 55,850 additional tests per 100,000 people. |
| JEL: | H75 H77 I14 |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30206&r= |
| By: | OTA Rui; ITO Arata; SATO Masahiro; YANO Makoto |
| Abstract: | At the beginning of the COVID-19 outbreak, knowledge about the disease and its prevention was scarce. For example, there was no scientific evidence that masks could prevent the disease. However, masks were rapidly purchased in large quantities in Japan, resulting in a severe shortage after late January 2020. The purpose of this paper is to clarify what factors caused this change in people's behavior toward infection prevention. To this end, we employ high-resolution consumer panel data and newspaper articles nationally or locally published in Japan to empirically analyze the impact of consumers' information reception on their mask purchasing behavior. Logistic regression results demonstrate that the cumulative number of articles was significantly related to the frequency of mask purchases with respect to any period of the first wave of infections. We found that early information in a pandemic is important and that learning from public information, or social learning, can significantly induce behavioral change. |
| Date: | 2022–07 |
| URL: | http://d.repec.org/n?u=RePEc:eti:dpaper:22065&r= |
| By: | Chowdhury, Subhasish; Karmakar, Senjuti |
| Abstract: | We survey the literature in economics and related fields on the relationship between the COVID-19 pandemic and conflict behavior. We cover the effects of the pandemic on micro-level conflict (among individuals), macro-level conflict (interstate, intrastate, and extra-state), and the effect of existing conflict on the spread of the pandemic. We find an increase in intimate partner violence, a spillover between work-family conflict and domestic violence, and a spike in the anti-East-Asian crimes. While there was an initial drop in the macro-level conflict count, it eventually returned to the pre-pandemic level. Deteriorating economy and food insecurity associated with the pandemic were major drivers of conflict in the developing countries, but appropriate state stimulus reduced such conflicts. The existing history of conflict has a heterogeneous effect in different societies in terms of the spread of the pandemic. We conclude by pointing out the future research avenues. |
| Keywords: | Survey; COVID-19; Pandemic; Conflict; Violence |
| JEL: | D74 F51 I15 Q34 |
| Date: | 2022–06–08 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:113311&r= |
| By: | Goldfayn-Frank, Olga; Lewis, Vivien; Wehrhöfer, Nils |
| Abstract: | As part of Germany's fiscal response to the Covid-19 pandemic, parents received three payments totalling e450 per child. Randomization in the payment dates and daily scanner data allow us to identify the effects of these transfers on household spending. We find a significant but small spending effect of the first transfer, with an estimated marginal propensity to consume of about 12%. The effect is higher for low-income and liquidity-constrained households, and in areas with lower infection rates. The second and third payment failed to increase spending. Our results indicate that the child bonus was redistributive rather than stimulative. |
| Keywords: | child bonus,Covid-19,fiscal stimulus,household spending,marginal propensity to consume,pandemic,transfer |
| JEL: | D12 E21 E62 H24 H31 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:bubdps:262022&r= |