nep-hea New Economics Papers
on Health Economics
Issue of 2022‒08‒29
fourteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Impact of Climate Change on Mortality in the United States: Benefits and Costs of Adaptation By Olivier Deschenes
  2. Unemployment and Health: A Meta-Analysis By Picchio, Matteo; Ubaldi, Michele
  3. Effects of Extending Paid Parental Leave On Children's Socio-Emotional Skills and Well-Being in Adolescence By Houmark, Mikkel Aagaard; Jørgensen, Cecilie Marie Løchte; Kristiansen, Ida Lykke; Gensowski, Miriam
  4. Public Health Policy at Scale: Impact of a Government-Sponsored Information Campaign on Infant Mortality in Denmark By Altindag, Onur; Greve, Jane; Tekin, Erdal
  5. Displaced or Depressed? The Effect of Working in Automatable Jobs on Mental Health By Blasco, Sylvie; Rochut, Julie; Rouland, Benedicte
  6. Ticket to Paradise? The Effect of a Public Transport Subsidy on Air Quality By Niklas Gohl; Philipp Schrauth
  7. Results of the California Teens Nicotine and Tobacco Survey By Chaffee, Benjamin W; Couch, Elizabeth T; Fan Cheng, Nancy; Ameli, Niloufar; Gansky, Stuart A
  8. Only the Fit Survive Recessions: Estimating Labor Market Penalties for the Obese Over the Business Cycle By Rachel Inafuku
  9. Who Did the Affordable Care Act Medicaid Expansion Impact? Using Linear Discriminant Analysis to Estimate the Probability of Being a Complier By Benjamin C. Chu
  10. Value and Price of Multi-indication Cancer Drugs in the USA, Germany, France, England, Canada, Australia, and Scotland By Michaeli, Daniel Tobias; Mills, Mackenzie; Kanavos, Panos
  11. 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
  12. The Gray Zone By Federico Crudu; Roberta Di Stefano; Giovanni Mellace; Silvia Tiezzi
  13. Were Small Businesses More Likely to Permanently Close in the Pandemic? By Robert W. Fairlie; Frank M. Fossen; Reid L. Johnsen; Gentian Droboniku
  14. Situating the COVID-19 pandemic in the context of the Indian economy By Jha, Praveen K.; Goyal, Meghna

  1. By: Olivier Deschenes
    Abstract: This paper reviews and extends the recent empirical literature on the impact of climate change on mortality and adaptation in the United States. The analysis produces several new facts. First, the reductions in the impact of extreme heat on mortality risk previously documented up to 2004 have continued up to 2019, consistent with continued investments in health-protecting adaptations to high temperatures. The second part of the paper examines the private and external costs of electricity generation and consumption related to high temperatures, a commonly-used proxy for measuring the consumption of adaptation services. Extreme temperatures increase electricity demand in the residential sector (relative to moderate temperatures), but not in the commercial, industrial, and transportation end-use sectors. The additional electricity demand in response to high temperatures results in significant external costs due to the release of local and global pollutants caused by the combustion of fossil fuels in order to produce electricity. These external costs, documented for the first time in this paper, are one order of magnitude larger than the private cost of adaptation associated with electricity consumption.
    JEL: I1 Q4 Q5 Q54
    Date: 2022–07
  2. By: Picchio, Matteo (Università Politecnica delle Marche, Ancona); Ubaldi, Michele (Marche Polytechnic University)
    Abstract: This paper is a meta-analysis on the relationship between unemployment and health. Our meta-dataset is made up of 327 study results coming from 65 articles published in peer-reviewed journals between 1990 and 2021. We find that publication bias is important, but only for those study results obtained through difference-in-differences or instrumental variables estimators. The average effect of unemployment on health is negative, but small in terms of partial correlation coefficient. We investigate if findings are heterogeneous among several research dimensions. We find that unemployment is mostly effective on the psychological domains of health and that short- and long-term unemployment spells equally affect health. Dealing with endogeneity issues is important and, when this is done, the unemployment effects on health are closer to be nil.
    Keywords: unemployment, health, meta-analysis, meta-regression, publication bias
    JEL: C52 I10 I12 J64
    Date: 2022–07
  3. By: Houmark, Mikkel Aagaard (Aarhus University); Jørgensen, Cecilie Marie Løchte (Aarhus University); Kristiansen, Ida Lykke (University of Copenhagen); Gensowski, Miriam (Rockwool Foundation Research Unit)
    Abstract: We study how children's socio-emotional skills and well-being in adolescence are affected by an increase in the duration of parental care during infancy. Exploiting a Danish reform that extended paid parental leave in 2002 and effectively delayed children's entry into formal out-of-home care, we show that longer leave increases adolescent well-being, conscientiousness and emotional stability, and reduces school absenteeism. The effects are strongest for children of mothers who would have taken short leave in absence of the reform. This highlights how time spent with a parent is particularly productive during very early childhood.
    Keywords: parental leave, early childhood, skill formation, parental investments, socio-emotional skills, personality, well-being, adolescence
    JEL: J13 J18 J24 I31
    Date: 2022–07
  4. By: Altindag, Onur (Bentley University); Greve, Jane (VIVE - The Danish Centre for Social Science Research); Tekin, Erdal (American University)
    Abstract: We evaluate the impact of a nationwide public health intervention on deaths from sudden infant death syndrome (SIDS), using population data from Denmark in a regression discontinuity research design. The information campaign–implemented primarily through a universal nurse home visiting program–reduced infant mortality by 17.2 percent and saved between 11.6-13.5 lives over 10,000 births. The estimated effect sizes are 11-14 times larger among low birthweight and preterm infants relative to the overall population. Improvement in infant mortality is concentrated among those with low socio-economic status and with limited access to health information, thereby reducing health inequities at birth.
    Keywords: SIDS, information campaign, infant mortality, Denmark
    JEL: I12 I24 I18
    Date: 2022–06
  5. By: Blasco, Sylvie (GAINS, Université du Maine); Rochut, Julie; Rouland, Benedicte (University of Nantes)
    Abstract: Automation may destroy jobs and change the labour demand structure, thereby potentially impacting workers' health and well-being. Using French individual survey data, we estimate the effects of working in automatable jobs on mental health. Implementing propensity score matching to solve the issue of endogenous exposure to automation risk, we find that workers whose job is at risk of automation in the future are about 4 pp more likely to suffer at present from severe mental disorders. Fear of job loss within the year and fear of qualification or occupational changes seem relevant channels to explain our findings.
    Keywords: mental health, automation, job insecurity, propensity score matching
    JEL: I10 J24
    Date: 2022–07
  6. By: Niklas Gohl (University of Potsdam, DIW Berlin, Berlin School of Economics); Philipp Schrauth (University of Potsdam)
    Abstract: This paper provides novel evidence on the impact of public transport subsidies on air pollution. We obtain causal estimates by leveraging a unique policy intervention in Germany that temporarily reduced nationwide prices for regional public transport to a monthly flat rate price of 9 Euros. Us-ing DiD estimation strategies on air pollutant data, we show that this intervention causally reduced a benchmark air pollution index by more than six percent. Our results illustrate that public transport subsidies – especially in the context of spatially constrained cities – offer a viable alterna-tive for policymakers and city planers to improve air quality, which has been shown to crucially affect health outcomes.
    Keywords: air pollution, public transport, transport subsidies
    JEL: Q53 Q58 R12 R48
    Date: 2022–08
  7. By: Chaffee, Benjamin W; Couch, Elizabeth T; Fan Cheng, Nancy; Ameli, Niloufar; Gansky, Stuart A
    Abstract: This report summarizes the main results from the first wave of the Teens, Nicotine, and Tobacco (TNT) Project Online Survey, which was a statewide online survey conducted in California during 2021-2022.
    Keywords: Social and Behavioral Sciences, Adolescent tobacco use, vapes, e-cigarettes, marijuana, smokeless tobacco, adolescent perceptions, public health, California
    Date: 2022–08–09
  8. By: Rachel Inafuku (University of Hawaii)
    Abstract: There is evidence of labor market discrimination against minority groups based on race, gender, beauty and other characteristics. Using two national surveys, I measure labor market differentials between obese and healthy weight workers over business cycle fluctuations. I find that during economic downturns, obese individuals experience larger declines in income relative to those who are not obese. These findings are robust to the inclusion of occupation fixed effects, suggesting the findings cannot be fully explained by obese workers selecting careers that tend to have greater sensitivity to business cycle fluctuations.
    JEL: J71 I14 E29
    Date: 2022–07
  9. By: Benjamin C. Chu (University of Hawaii)
    Abstract: What is the likelihood of being a complier in the ACA Medicaid expansion? Using linear discriminant analysis (LDA), I estimate how characteristics relating to socioeconomic status and race/ethnicity affect the likelihood that an individual will be a complier, defined as those induced by the expansion to obtain Medicaid coverage. Across multiple specifications, part-time and full-time workers are more likely than non-workers to be compliers. Not only is this result more prominent for Black individuals, but they are also more likely to be compliers compared to other racial/ethnic groups. This paper not only serves to identify the types of individuals who were directly impacted by the expansion, but it also introduces a new approach that combines complier analysis with techniques from machine learning.
    Keywords: Medicaid, ACA, Complier, Linear discriminant analysis
    JEL: I13
    Date: 2022–08
  10. By: Michaeli, Daniel Tobias; Mills, Mackenzie; Kanavos, Panos
    Abstract: Purpose: Oncology drugs are often approved for multiple indications, for which their clinical benefit varies. Aligning a single price to this differing value remains a challenge. This study examines the clinical and economic value, price, and reimbursement of multi-indication cancer drugs across seven countries, representing different approaches to value assessment, pricing, and coverage decisions: the USA, Germany, France, England, Canada, Australia, and Scotland. Methods: Twenty-five multi-indication cancer drugs across 100 indications were identified with US Food and Drug Administration (FDA) approval between 2009 and 2019. For each indication data on Health Technology Assessment (HTA) recommendations, disease prevalence, and drug prices were obtained. Quality-adjusted life years (QALYs) gained, disease prevalence, list prices, and HTA outcomes were then compared across indications and regions. Results: First approved indications provide a higher clinical benefit whilst targeting a smaller patient group than indication extensions. Quality-adjusted life year gains were higher for first (0.99, 95% CI 0.05–3.25) compared to second (0.51, 95% CI 0.02–1.63, p
    JEL: J1
    Date: 2022–05–02
  11. 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.
    Keywords: COVID-19, SIR model, epidemiology, value of a statistical life
    JEL: E17 E70 I18
    Date: 2022–08
  12. By: Federico Crudu; Roberta Di Stefano; Giovanni Mellace; Silvia Tiezzi
    Abstract: On March 23, 2020, in response to the COVID-19 pandemic, Italy declared a nation-wide lockdown. A month earlier, on February 23, the Italian government ordered its military police to seal the borders and declared a Red Zone around 10 municipalities of the province of Lodi and in Vo' Euganeo, a small town in Padua province. On the same day, Confindustria Bergamo, the province's industrial association, posted a video on social media against having a lockdown in the area of Bergamo and was supported by key business leaders and local administrators. Despite having a similar infection rate to the Red Zone municipalities, the government decided not to extend the Red Zone to the municipalities of Bergamo province with high infection rates. Bergamo later became one of the deadliest outbreaks of the first wave of the virus in the Western world. What would have happened had the Red Zone been extended to that area? We use the Synthetic Control Method to estimate the causal effect of (not) declaring a Red Zone in the Bergamo area on daily excess mortality. We find that about two-thirds of the reported deaths could have been avoided had the Italian government declared the area a Red Zone.
    Keywords: COVID-19, causal impact, synthetic control method, Red Zone, Bergamo, non-pharmaceutical interventions.
    JEL: C23 I18 O57
    Date: 2022–03
  13. By: Robert W. Fairlie; Frank M. Fossen; Reid L. Johnsen; Gentian Droboniku
    Abstract: Previous estimates indicate that COVID-19 led to a large drop in the number of operating businesses operating early in the pandemic, but surprisingly little is known on whether these shutdowns turned into permanent closures and whether small businesses were disproportionately hit. This paper provides the first analysis of permanent business closures using confidential administrative firm-level panel data covering the universe of businesses filing sales taxes from the California Department of Tax and Fee Administration. We find large increases in closures rates in the first two quarters of 2020, but a strong reversal of this trend in the third quarter of 2020. The increase in closures rates in the first two quarters of the pandemic was substantially larger for small businesses than large businesses, but the rebound in the third quarter was also larger. The disproportionate closing of small businesses led to a sharp concentration of market share among larger businesses as indicated by the Herfindahl-Hirschman Index with only a partial reversal after the initial increase. The findings highlight the fragility of small businesses during a large adverse shock and the consequences for the competitiveness of markets.
    JEL: H25 I18 L26
    Date: 2022–07
  14. By: Jha, Praveen K.; Goyal, Meghna
    Abstract: The COVID-19 pandemic has caused a major global health crisis, the onset of which, and containment policies for, have also led to a global economic crisis. The effects of the pandemic on the economies of various countries depended on their position in the international economic hierarchy, and critically, the fiscal and monetary policy tools they employed to manage the economy. In India, we find that the pandemic and ensuing lockdown policy led to various supply chain disruptions and standstills of economic activity in most sectors such that output, employment, wages, and demand suffered a huge decline. Furthermore, our analysis shows that monetary and fiscal policy tools were largely inadequate in dealing with these big challenges to the economy. Fiscal stimulus amounted to a small percentage of the GDP and did not undertake sufficient social provisioning; and monetary policy's thrust was toward the injection of liquidity through credit provision when demand for loans was low. The policy package of the pandemic has led to an overall contraction of the Indian economy and widening income inequality. Estimations for India's economic revival are bleak and worsening with recent developments in the global economy.
    Keywords: COVID-19,fiscal policy,growth,inequality,monetary policy
    JEL: E61 F62 I18
    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.