nep-hea New Economics Papers
on Health Economics
Issue of 2022‒09‒05
twenty papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Another Day, Another Visit: Impact of Arkansas's Mandatory Waiting Period for Women Seeking an Abortion by Demographic Groups By Onur Altindağ; Theodore J. Joyce
  2. Heterogeneity in Disease Resistance and the Impact of Antibiotics in the US. By C. Justin Cook; Jason Fletcher
  3. Selection on moral hazard in the Swiss market for mandatory health insurance: Empirical evidence from Swiss Household Panel data By Francetic Igor
  4. Does It Matter Who Cares for You? The Effect of Substituting Informal with Formal Personal Care on the Care Recipients' Health By Hollingsworth, Bruce; Ohinata, Asako; Picchio, Matteo; Walker, Ian
  5. Genetic Endowments, Educational Outcomes and the Mediating Influence of School Investments By Benjamin W. Arold; Paul Hufe; Marc Stoeckli
  6. Is the intergenerational transmission of overweight 'gender assortative'? By Costa-Font, Joan; Jofre-Bonet, Mireia
  7. Misinformation, Consumer Risk Perceptions, and Markets: The Impact of an Information Shock on Vaping and Smoking Cessation By Lawrence Jin; Donald S. Kenkel; Michael F. Lovenheim; Alan D. Mathios; Hua Wang
  8. Malleability of Alcohol Consumption: Evidence from Migrants By Marit Hinnosaar; Elaine M. Liu
  9. Does Reference Pricing Drive Out Generic Competition in Pharmaceutical Markets? Evidence from a Policy Reform By Kurt R. Brekke; Chiara Canta; Odd Rune Straume
  10. How Can Research Improve Foster Care Policy and Practice? By Kroeger, Sarah; Monahan, Tess; Perry, Brendan
  11. Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu By Sergio Correia; Stephan Luck; Emil Verner
  12. The Effect of Vaccine Mandates on Disease Spread: Evidence from College COVID-19 Mandates By Riley K. Acton; Wenjia Cao; Emily E. Cook; Scott A. Imberman; Michael F. Lovenheim
  13. When Reality Bites: Local Deaths and Vaccine Take-up By Giulietti, Corrado; Vlassopoulos, Michael; Zenou, Yves
  14. Media coverage and pandemic behaviour: Evidence from Sweden By Garz, Marcel; Zhuang, Maiting
  15. Social Protection and Social Distancing During the Pandemic: Mobile Money Transfers in Ghana By Dean Karlan; Matt Lowe; Robert Darko Osei; Isaac Osei-Akoto; Benjamin N. Roth; Christopher R. Udry
  16. The economic cost of social distancing during a pandemic: an optimal control approach in the SVIR model By Alessandro Ramponi; Maria Elisabetta Tessitore
  17. Mask Independency: Taiwan's response to mask shortage in the COVID-19 pandemic By Nadja Katharina Meichle; Manuel Torres Lajo
  18. The Impact of COVID-19 on Community College Enrollment and Student Success: Evidence from California Administrative Data By Bulman, George; Fairlie, Robert W.
  19. The double burden: The impact of school closures on labor force participation of mothers By Kozhaya, Mireille
  20. Experience of the COVID-19 pandemic in Wuhan leads to a lasting increase in social distancing By Darija Barak; Edoardo Gallo; Ke Rong; Ke Tang; Wei Du

  1. By: Onur Altindağ; Theodore J. Joyce
    Abstract: Twenty-six states require that women seeking an abortion wait between 18 and 72 hours after receipt of counseling before the abortion can be completed. Thirteen states require that the counseling be given in person necessitating at least two visits to the provider. In April of 2015, Arkansas increased the waiting period for an abortion from 24 to 48 hours and more significantly, required that women receive the counseling in person. We use a regression discontinuity design to analyze the immediate effect of Arkansas’s 2015 mandatory waiting period (MWP) law on abortion rates. We use de-identified, individual-level data from the Arkansas Department of Health (DOH) on all abortions performed in Arkansas from 2000 to 2020. Abortion rates fell 17 percent among all women, but 22 percent among white non-Hispanics and 14 percent among black non-Hispanics immediately after the law went into effect. We show that the law decreased abortion rates the most among unmarried adults with children. Abortion is now illegal in Arkansas. Given the decline in abortion rates associated the MWP’s two-visit requirement, abortion rates will likely fall further as travel distance to the nearest legal provider increases.
    JEL: I12 K36
    Date: 2022–07
  2. By: C. Justin Cook; Jason Fletcher
    Abstract: We hypothesize that the impact of antibiotics is moderated by a population’s inherent (genetic) resistance to infectious disease. Using the introduction of sulfa drugs in 1937, we show that US states that are more genetically susceptible to infectious disease saw larger declines in their bacterial mortality rates following the introduction of sulfa drugs in 1937. This suggests area-level genetic endowments of disease resistance and the discovery of medical technologies have acted as substitutes in determining levels of health across the US. We also document immediate effects of sulfa drug exposure to the age of the workforce and cumulative effects on educational attainment for cohorts exposed to sulfa drugs in early life.
    JEL: I1 I14 I15 J1
    Date: 2022–07
  3. By: Francetic Igor
    Abstract: Selection on moral hazard represents the tendency to select a specific health insurance coverage depending on the heterogeneity in utilization "slopes". I explore the extent of selection on moral hazard in the Swiss managed competition system. I use data from the Swiss Household Panel and from publicly available regulatory data. I estimate a Roy-type model to obtain responses in (log) doctor visits at lowest and highest deductible levels. I also explore an instrumental variable approach comparing responses of individuals switching deductible to those maintaining the same level of coverage. Individuals with high propensity to select the highest deductible respond to coverage between two and three times more compared to the average difference in utilisation at highest vs. any lower deductible. This is consistent with individuals who are more likely to select a more comprehensive coverage using substantially more healthcare compared to what is implied by simple adverse selection.
    Date: 2022–08
  4. By: Hollingsworth, Bruce (Lancaster University); Ohinata, Asako (University of Leicester); Picchio, Matteo (Università Politecnica delle Marche, Ancona); Walker, Ian (Lancaster University)
    Abstract: We show that a Scottish policy reform, which introduced free formal personal home care for those aged 65 and above, reduced the probability and the hours of receiving informal personal care. Moreover, we find that the group of individuals that most benefited from the policy introduction, i.e. women aged 75 and above, experienced the largest fall in informal care. We go on to investigate whether such reductions in informal and increases in formal personal care impacted on the care recipients' health outcomes. Our results demonstrate that switching from informal to formal care does very little to the recipients' hospital usage and health outcomes.
    Keywords: long-term elderly care, ageing, financial support, difference-in-differences
    JEL: C21 D14 I18 J14
    Date: 2022–07
  5. By: Benjamin W. Arold; Paul Hufe; Marc Stoeckli
    Abstract: Genetic endowments are fixed at conception and matter for the educational attainment of individuals. Do investments in schooling environments mitigate or magnify the outcomes of this genetic lottery? Using data from a representative sample of US adolescents, we analyse the interdependent associations of genetic endowments, teacher quality and teacher quantity with educational attainment. Our results suggest that higher-quality teachers act as substitutes for genetic endowments: a 1 SD increase in teacher quality reduces the positive association between educational attainment and a 1 SD increase in the relevant polygenic score from 0.37 to 0.30 years—a decrease of 20%. In particular, high-quality teachers increase the probability that genetically disadvantaged students complete college. This increase is underpinned by gains in health, language ability, patience, and risk aversion.
    Keywords: polygenic scores, school resources, skill formation
    JEL: I29 I21 J24
    Date: 2022
  6. By: Costa-Font, Joan; Jofre-Bonet, Mireia
    Abstract: Using almost two decades worth of data from the Health Survey for England, that contain representative records of clinically measured weight and height, this paper studies whether parents and children's overweight (including obesity) is ‘gender assortative’. Our findings suggest that the intergenerational transmission of parent's overweight differs by children's sex and is statistically different for fathers and mothers. Gender assortative overweight is stronger among pre-school age and school-aged children. The parent-child associations are large and precisely estimated, heterogeneous by children's age and sex and stronger among white children and children of older parents. These results suggest there is a gender assortative intergenerational association of overweight.
    Keywords: Gender-assortative transmission; Gender assortative; Child obesity; Child overweight; Role models; Inter-generational transmission
    JEL: I18
    Date: 2020–12–01
  7. By: Lawrence Jin; Donald S. Kenkel; Michael F. Lovenheim; Alan D. Mathios; Hua Wang
    Abstract: Smoking is the leading preventable cause of death in the U.S. Because e-cigarettes do not involve the combustion of tobacco, vaping offers the potential to prevent most of the health consequences of smoking. We study the impact of an information shock created by an outbreak of lung injuries apparently related to e-cigarettes. We use data from multiple sources: surveys of risk perceptions conducted before, during, and after the outbreak; an in-depth survey we conducted on risk perceptions and vaping and smoking behavior; and national aggregate time-series sales data. We find that after the outbreak, consumer perceptions of the riskiness of e-cigarettes sharply increased, so that in contrast to almost all experts, the majority of consumers perceive e-cigarettes to be relatively and absolutely riskier than cigarettes. From our estimated e-cigarette demand models, we conclude that the information shock reduced e-cigarette demand by about 30 percent. We also estimate that the information shock decreased the use of e-cigarettes for smoking cessation, again by about 30 percent. Over time, the reduced smoking cessation due to the information shock will in turn increase smoking-related illness and death.
    JEL: I12
    Date: 2022–07
  8. By: Marit Hinnosaar; Elaine M. Liu
    Abstract: How malleable is alcohol consumption? Specifically, how much is alcohol consumption driven by the current environment versus individual characteristics? To answer this question, we analyze changes in alcohol purchases when consumers move from one state to another in the United States. We find that if a household moves to a state with a higher (lower) average alcohol purchases than the origin state, the household is likely to increase (decrease) its alcohol purchases right after the move. The current environment explains about two-thirds of the differences in alcohol purchases. The adjustment takes place both on the extensive and intensive margins.
    JEL: D12 I12 I18 L66
    Date: 2022–07
  9. By: Kurt R. Brekke; Chiara Canta; Odd Rune Straume
    Abstract: Policy makers use reference pricing to curb pharmaceutical expenditures by reducing coverage of expensive branded drugs. In a theoretical analysis we show that the net effect of reference pricing is generally ambiguous when accounting for entry by generic producers. Reference pricing shifts demand towards generics but also induces the branded producer to become more agressive, which triggers price competition and potentially deters entry by generic producers. To investigate the counter- vailing effects, we exploit a policy reform in Norway with a gradual implementation of reference pricing across substances over time. Using a difference-in-differences approach, we find that treated substances have a sharper decline in both branded and generic drug prices and branded market shares. Despite fiercer price competition, the number of generic producers and products increases after exposure to reference pricing, resulting in a reduction of 30 percent in pharmaceutical expenditures. Thus, we find no evidence for a countervailing entry deterring effect of reference pricing.
    Keywords: pharmaceuticals, reference pricing, generic competition
    JEL: I11 I18 L13 L65
    Date: 2022
  10. By: Kroeger, Sarah; Monahan, Tess; Perry, Brendan
    Abstract: Foster care in childhood predicts lower education levels and employment rates in adulthood relative to non-foster care children, including higher rates of incarceration, and adverse mental and physical health outcomes. These differences persist even after controlling for racial, economic, and neighborhood effects. Given these disparities and that 4-6 percent of the United States population experiences foster care at some point in childhood, there is a clear need to identify policies and programs that are effective in improving outcomes for individuals during and after foster care. This paper surveys the existing research and policy landscape to highlight what approaches are being taken and what is currently known about effective services for children and youth in foster care. We identify high priority foster care research questions and offer suggestions for how to best pursue these questions. The majority of published research papers related to foster care programs or best practices lack the requisite design or minimum sample size to identify causal impact.
    Keywords: Child welfare, foster care, best practices, policy landscape
    JEL: I30 I38 Y80
    Date: 2022–08–01
  11. By: Sergio Correia; Stephan Luck; Emil Verner
    Abstract: We study the impact of non-pharmaceutical interventions (NPIs) on mortality and economic activity across U.S. cities during the 1918 Flu Pandemic. The combination of fast and stringent NPIs reduced peak mortality by 50% and cumulative excess mortality by 24% to 34%. However, while the pandemic itself was associated with short-run economic disruptions, we find that these disruptions were similar across cities with strict and lenient NPIs. NPIs also did not worsen medium-run economic outcomes. Our findings indicate that NPIs can reduce disease transmission without further depressing economic activity, a finding also reflected in discussions in contemporary newspapers.
    Date: 2022–07
  12. By: Riley K. Acton; Wenjia Cao; Emily E. Cook; Scott A. Imberman; Michael F. Lovenheim
    Abstract: Since the spring of 2021, nearly 700 colleges and universities in the U.S. have mandated that their students become vaccinated against the COVID-19 virus. We leverage rich data on colleges’ vaccination policies and semester start dates, along with a variety of county-level public health outcomes, to provide the first estimates of the effects of these mandates on the communities surrounding four-year, residential colleges. In event study specifications, we find that, over the first 13 weeks of the fall 2021 semester, college vaccine mandates reduced new COVID-19 cases by 339 per 100,000 county residents and new deaths by 5.4 per 100,000 residents, with an estimated value of lives saved between $9.7 million and $27.4 million per 100,000 residents. These figures suggest that the mandates reduced total US COVID-19 deaths in autumn 2021 by approximately 5%.
    JEL: H75 I18 I23
    Date: 2022–07
  13. By: Giulietti, Corrado (University of Southampton); Vlassopoulos, Michael (University of Southampton); Zenou, Yves (Monash University)
    Abstract: We investigate whether COVID-19 deaths that occurred before vaccination rollouts impact subsequent vaccination take-up. We use data on local vaccination rates and COVID-19-related deaths from England measured at high geographic granularity. We find that vaccination take-up as of November 2021 is positively associated with pre-vaccine COVID-19-related deaths, controlling for demographic, economic, and health-related characteristics of the localities, while including geographic fixed effects. In addition, the share of ethnic minorities in a locality is negatively associated with vaccination rates, and localities with a larger share of ethnic minorities increase their vaccination rates if they are exposed to more COVID-related-deaths. Further evidence on vaccination intention at the individual level from a representative sample corroborates these patterns. Overall, our evidence suggests that social proximity to victims of the disease triggers a desire to take protective measures against it.
    Keywords: vaccination hesitancy, COVID-19, social interactions, information, behavior change
    JEL: H51 I12
    Date: 2022–07
  14. By: Garz, Marcel (Jönköping University); Zhuang, Maiting (Mistra Center for Sustainable Markets (Misum))
    Abstract: We study the effect of media coverage on individual behaviour during a public health crisis. For this purpose, we collect a unique dataset of 200,000 newspaper articles about the Covid-19 pandemic from Sweden – one of the few countries that did not impose mandatory lockdowns or curfews. We show that mentions of Covid-19 significantly lowered the number of visits to workplaces and retail and recreation areas, while increasing the duration of stays in residential locations. Using two different identification strategies, we show that these effects are causal. The impacts are largest when Covid-19 news stories are more locally relevant, more visible and more factual. We find larger behavioural effects for articles that reference crisis managers (as opposed to medical experts) and contain explicit public health advice. These results have wider implications for the design of public communications and the value of the local media.
    Keywords: Covid-19; Mobility; Newspapers; Persuasion; Public health
    JEL: D83 H12 I12 I18 J22 L82
    Date: 2022–08–02
  15. By: Dean Karlan; Matt Lowe; Robert Darko Osei; Isaac Osei-Akoto; Benjamin N. Roth; Christopher R. Udry
    Abstract: We study the impact of mobile money transfers to a representative sample of low-income Ghanaians during the COVID-19 pandemic. The announcement of the upcoming transfers affects neither consumption, well-being, nor social distancing. Once disbursed, transfers increase food expenditure by 8%, income by 20%, and a social distancing index by 0.08 standard deviations. Over 40% of the transfers were spent on food. The positive effects on income mostly persist at final measurement, eight months after the last transfer. Together, we learn that cash transfers can support households economically while also promoting adherence to public health protocols during a pandemic.
    JEL: H51 H84 O12
    Date: 2022–07
  16. By: Alessandro Ramponi; Maria Elisabetta Tessitore
    Abstract: We devise a theoretical model for the optimal dynamical control of an infectious disease whose diffusion is described by the SVIR compartmental model. The control is realized through implementing social rules to reduce the disease's spread, which often implies substantial economic and social costs. We model this trade-off by introducing a functional depending on three terms: a social cost function, the cost supported by the healthcare system for the infected population, and the cost of the vaccination campaign. Using the Pontryagin's Maximum Principle, we give conditions for the existence of the optimal policy, which we characterize explicitly in three instances of the social cost function, the linear, quadratic, and exponential models, respectively. Finally, we present a set of results on the numerical solution of the optimally controlled system by using Italian data from the recent Covid--19 pandemic for the model calibration.
    Date: 2022–08
  17. By: Nadja Katharina Meichle; Manuel Torres Lajo
    Abstract: In the beginning of the Covid-19 pandemic, most territories worldwide suffered from face mask shortages, given its huge demand and limited production capacity. However, Taiwan faced such a shortage only briefly due to their ability to swiftly increase local production of face masks. This not only allowed them to guarantee local supply for all their citizens but also to export them for profit at a later stage. In this paper, we argue that several reasons led to the success of Taiwan's mask independence. First, its previous experience with the 2003 SARS epidemic that subsequently led to institutional and legal changes, an increased awareness in the population about PPE and hygiene, and experienced technocrats. Also, the developmental state model offers the basis for a quick change of the national market and an increased cooperation between the private sector and the government.
    Keywords: COVID-19 pandemic, face mask production, SARS epidemic, developmental state
    Date: 2021–12
  18. By: Bulman, George (University of California, Santa Cruz); Fairlie, Robert W. (University of California, Santa Cruz)
    Abstract: This paper examines how the pandemic impacted the enrollment patterns, fields of study, and academic outcomes of students in the California Community College System, the largest higher-education system in the country. Enrollment dropped precipitously during the pandemic - the total number of enrolled students fell by 11 percent from fall 2019 to fall 2020 and by another 7 percent from fall 2020 to fall 2021. The California Community College system lost nearly 300,000 students over this period. Our analysis reveals that enrollment reductions were largest among Black/African-American and Latinx students, and were larger among continuing students than first-time students. We find no evidence that having a large online presence prior to the pandemic protected colleges from these negative effects. Enrollment changes were substantial across a wide range of fields and were large for both vocational courses and academic courses that can be transferred to four-year institutions. In terms of course performance, changes in completion rates, withdrawal rates, and grades primarily occurred in the spring of 2020. These findings of the effects of the pandemic at community colleges have implications for policy, impending budgetary pressures, and future research.
    Keywords: pandemic, COVID-19, coronavirus, community college, enrollment, grades, completion, students of color, Black students, Latinx students
    JEL: I23 I21
    Date: 2022–07
  19. By: Kozhaya, Mireille
    Abstract: This paper investigates the effect of school closure on the labor force participation, hours worked, extensive, and the intensive margin of women in Mexico for the years 2017 to 2021. Using a difference-in-differences approach, I analyze how school closure, due to the COVID-19 pandemic, affects the labor supply of women with school-aged children, 6 to 14 years old, versus women with nursery-aged children, 0 to 5 years old. This approach allows me to isolate the impact of school closure from the economic impact of the COVID-19 pandemic. The findings show that on average mothers with children younger than 14 decrease their labor force participation by about 2.6 percentage points. Mothers with school-aged children, however, decrease their labor force participation by an additional 1.7 percentage points and increase their domestic work. While the increase in domestic work occurs immediately after the school closure, the impact on the labor force is only observed several months later. The decrease is observed for all women with low or middle education level, formal and informal employment, and income quantiles. However, I find no decrease for single-mothers and mothers with access to informal child care.
    Keywords: Child care,COVID-19,women's labor supply,school closure
    JEL: J1 J16 J2 J23
    Date: 2022
  20. By: Darija Barak; Edoardo Gallo; Ke Rong; Ke Tang; Wei Du
    Abstract: On 11th Jan 2020, the first COVID-19 related death was confirmed in Wuhan, Hubei. The Chinese government responded to the outbreak with a lockdown that impacted most residents of Hubei province and lasted for almost three months. At the time, the lockdown was the strictest both within China and worldwide. Using an interactive web-based experiment conducted half a year after the lockdown with participants from 11 Chinese provinces, we investigate the behavioral effects of this `shock' event experienced by the population of Hubei. We find that both one's place of residence and the strictness of lockdown measures in their province are robust predictors of individual social distancing behavior. Further, we observe that informational messages are effective at increasing compliance with social distancing throughout China, whereas fines for noncompliance work better within Hubei province relative to the rest of the country. We also report that residents of Hubei increase their propensity to social distance when exposed to social environments characterized by the presence of a superspreader, while the effect is not present outside of the province. Our results appear to be specific to the context of COVID-19, and are not explained by general differences in risk attitudes and social preferences.
    Date: 2022–08

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