nep-hea New Economics Papers
on Health Economics
Issue of 2022‒09‒12
fourteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Causal Effects of Youth Cigarette Addiction and Education By Rong Hai; James J. Heckman
  2. Fertility and Labor Market Responses to Reductions in Mortality By Sonia R. Bhalotra; Atheendar Venkataramani; Selma Walther
  3. Producing Health: Measuring Value Added of Nursing Homes By Liran Einav; Amy Finkelstein; Neale Mahoney
  4. Competition and quality in German ambulatory long-term care: Where labour supply matters more than prices By Herr, A.;; Izhak, O.;; Luckemann, M.;
  5. Quality Regulation and Competition: Evidence from Pharmaceutical Markets By Juan Pablo Atal; José Ignacio Cuesta; Morten Sæthre
  6. The impact of structural and strategic competition on hospital quality By Wuckel, Christiane
  7. The effect of ambient air pollution on birth outcomes in Norway By Xiaoguang Ling
  8. Myths of drug consumption decriminalization: effects of Portuguese decriminalization on violent and drug use mortality By Lucas Marín Llanes; Hernando Zuleta
  9. The role of gender inequality in the obesity epidemic: A case study from India By Valentina Alvarez-Saavedra; Pierre Levasseur; Suneha Seetahul
  10. Health, Health Insurance, and Inequality By Chaoran Chen; Zhigang Feng; Jiaying Gu
  11. Influence of geographic access and socioeconomic characteristics on breast cancer outcomes: A systematic review By Benoit Conti; Audrey Bochaton; Hélène Charreire; Hélène Bonsang-Kitzis; Caroline Desprès; Sandrine Baffert; Charlotte Ngo
  12. Are Children's Socio-Emotional Skills Shaped by Parental Health Shocks? By Esteban García-Miralles; Miriam Gensowski
  13. Revolution in Progress? The Rise of Remote Work in the UK By Draca, Mirko; Duchini,Emma; Rathelot, Roland; Arthur Turrell; Giulia Vattuone
  14. COVID-19 and the Gender Gap in University Student Performance By Bratti, Massimiliano; Lippo, Enrico

  1. By: Rong Hai; James J. Heckman
    Abstract: We develop and estimate a life-cycle model in a rational addiction framework where youth choose to smoke, attend school, work part-time, and consume while facing borrowing constraints. The model features multiple channels for studying the reciprocal causal effects of addiction and education. Variations in endowments and cigarette prices are sources of identification. We show that education causally reduces smoking. A counterfactual experiment finds that in absence of cigarettes, college attendance rises by three percentage points in the population. A practical alternative of 40% additional excise tax achieves similar results. Impacts vary substantially across persons of different cognitive and non-cognitive abilities.
    JEL: H23 I12 I18 I24 I28
    Date: 2022–07
  2. By: Sonia R. Bhalotra; Atheendar Venkataramani; Selma Walther
    Abstract: We investigate women’s fertility, labor and marriage market responses to a health innovation that led to reductions in mortality from treatable causes, and especially large declines in child mortality. We find delayed childbearing, with lower intensive and extensive margin fertility, a decline in the chances of ever having married, increased labor force participation and an improvement in occupational status. Our results provide the first evidence that improvements in child survival allow women to start fertility later and invest more in the labor market. We present a new theory of fertility that incorporates dynamic choices and reconciles our findings with existing models of behavior.
    JEL: I18 J13
    Date: 2022–08
  3. By: Liran Einav; Amy Finkelstein; Neale Mahoney
    Abstract: We develop a stylized model that allows us to estimate a value-added measure for nursing homes (“SNFs”) which accounts for patient selection both into and out of a SNF. We use the model, together with detailed data on the physical and mental health of about 6 million Medicare SNF patients between 2011 and 2016, to estimate the value added for about 14,000 distinct SNFs. We document substantial heterogeneity in value added. Nationwide, compared to a 10th percentile SNF, a 90th percentile SNF is able to discharge a patient at the same health level about a week sooner, which is about one third of the median length of stay. Heterogeneity in value added within a market is almost as large as it is nationwide. Our results point to the potential for substantial gains through policies that encourage reallocation of patients to higher-quality SNFs within their market.
    JEL: I1 I11 L15 L8 L88
    Date: 2022–08
  4. By: Herr, A.;; Izhak, O.;; Luckemann, M.;
    Abstract: This paper analyses the effect of competition on the quality of ambulatory long-term care (LTC) services in Germany, which supported 24 percent of the 4.1 million care dependent people in 2019 (21 percent received stationary care, 55 percent informal care). Ambulatory care is politically and individually preferred over stationary care and there are low barriers to entry, while there is little evidence on the effects of competition in this market. In this study, We challenge the theoretical prediction that competition increases quality when prices are regulated. This adds to previous research on UK nursing homes that identified price competition as the relevant mechanism. We use four waves of publicly available quality data of 14,000 ambulatory care units in Germany, reported between 2011 and 2019. To examine causal effects, we apply an instrumental variable approach and look at different quality and competition measures. We show that quality decreases in competition despite the fact that ambulatory care prices are regulated. That is why we examine a new mechanism in a second step and show that nursing staff shortage is correlated with competition and lower quality in German ambulatory LTC. Introducing competition should therefore be accompanied by respective support for more qualified nursing personnel to circumvent adverse quality effects.
    Keywords: long-term care; competition; quality; prices; nursing staff;
    JEL: C90 I10 I11
    Date: 2022–07
  5. By: Juan Pablo Atal; José Ignacio Cuesta; Morten Sæthre
    Abstract: Quality regulation attempts to ensure quality and foster competition by reducing vertical differentiation, but it may also have adverse effects on market structure. We study this trade-off in the context of pharmaceutical bioequivalence, which is the primary quality standard for generic drugs. Exploiting the introduction of bioequivalence in Chile, we find that stronger regulation decreased the number of drugs in the market by 21% and increased average paid prices by 13%. We estimate a model of drug entry, certification, and demand to study the role of drug quality, aversion against generics, and certification costs in shaping the equilibrium effects of quality regulation. We find that quality regulation increased demand for generic drugs by resolving asymmetric information and reducing aversion against unbranded generics, which induced entry of high-quality drugs in place of low-quality drugs. Consumer welfare increased despite higher prices and a lower number of firms. We compare minimum quality standards to quality disclosure and other designs of quality regulation.
    JEL: I11 L11 L15
    Date: 2022–08
  6. By: Wuckel, Christiane
    Abstract: Many health care systems aim to enhance hospital quality by encouraging competition. However, evidence on the relationship between quality and competition is inconclusive. My contribution to this literature is two-fold. Analyzing the relationship between competition and quality for the German hospital market can give valuable insights about the nature of the relationship in a market with regulated prices that is characterized by a high number of hospitals and a diverse ownership structure. While most studies look at competition as market structure, I distinguish effects of market structure from effects of strategic behavior. I find evidence for a significant, non-linear relationship between market structure and care quality. Additionally, I find evidence for strategic behavior.
    Keywords: Hospitals,quality,competition,spatial econometrics
    JEL: C21 I11 L11
    Date: 2022
  7. By: Xiaoguang Ling
    Abstract: In this paper I examine the effects of ambient air pollution on birth outcomes in Norway. I find that prenatal exposure to ambient nitric oxide in the last trimester causes significant birth-weight and birth-length loss, whereas other ambient air pollutants such as nitrogen dioxide and sulfur dioxide appear to be at a safe level for the fetuses. Besides, newborns with disadvantaged parents are more affected by ambient nitric oxide. It worth noting that both average ambient nitric oxide pollution level and occasional high ambient nitric oxide pollution events in the third trimester affect the birth outcome adversely. The contribution of my work includes: First, I find an adverse effect of prenatal exposure to ambient nitric oxide on birth outcomes, which fills the long-standing knowledge gap. Second, by virtue of the large sample size and the sub-postcode geographic division in Norway, I can control for a rich set of spatial-temporal fixed effects in order to overcome much of the endogeneity problem caused by the self-selection for living area and delivery date. Furthermore, I study ambient air pollution problem in an environment with low-level pollution, which provides new evidence on the health effects of low-level ambient air pollution and at the same time avoids potential confounders such as water and soil pollution.
    Date: 2022–08
  8. By: Lucas Marín Llanes; Hernando Zuleta
    Abstract: There is scarce empirical evidence on the impacts of drug consumption decriminalization, especially, on problematic drug use and violence. In 2001, Portugal decriminalized the consumption of all illicit drugs. In this paper, we focus on determining the short, medium, and long-term impact of Portuguese decriminalization on mortality due to drug use and homicides, from both theoretical and empirical perspectives. We model drug consumption using an intertemporal consumption model and the decisions of trafficking firms to gain market share employing an optimization model. Our results suggest a non-linear effect of decriminalization on drug consumption risk and increasing incentives for firms to expand their market share employing violence after decriminalization. Empirically, we estimate a negative short-run effect on drug-related deaths and null long-run impacts of this legal reform. In terms of homicides, we find a positive effects in a range of 28.7%-34.2% in the medium- and long-term.
    Keywords: Illicit drugs, decriminalization, drug policy reform, consumption drug-relateddeaths, homicides.
    JEL: K14 K38 K42 I18
    Date: 2022–07–27
  9. By: Valentina Alvarez-Saavedra (BSE - Bordeaux Sciences Economiques - UB - Université de Bordeaux - CNRS - Centre National de la Recherche Scientifique); Pierre Levasseur (SADAPT - Sciences pour l'Action et le Développement : Activités, Produits, Territoires - AgroParisTech - Université Paris-Saclay - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Suneha Seetahul (World Bank, Human Development Department, The Africa Region - World Bank)
    Abstract: Recent empirical evidence emphasizes the higher prevalence of overweight and obesity for women, especially in developing countries. However, the potential link between gender inequality and obesity has rarely been investigated. Using longitudinal data from India (IHDS 2005-11), we implement Hausman-Taylor and fixed-effect models to estimate the effect of different dimensions of gender inequalities on female overweight. This study demonstrates that the form of gender inequality or women's mistreatment differently affects female bodyweight. Indeed, we show that some forms of women's mistreatments (such as perceived community violence and age difference with husband) increase the risk of female overweight, whereas more severe forms of abuse such as child marriage increase the risk of underweight. Moreover, we also find that higher decision-making power and autonomy about outings are risk factors of weight gain and obesity, especially in urban settings, perhaps indicating a higher exposure to urban obesogenic lifestyles. To conclude, our results suggest that, although improving women's status in society may be a key action to address the epidemic of obesity, policies must also target hazardous habits that emancipation may imply in urban (obesogenic) environments.
    Keywords: India,Gender inequality,Obesity,Hausman-Taylor estimations,Fixed effects estimations,JEL codes: I14 I15 J16
    Date: 2022–08–04
  10. By: Chaoran Chen; Zhigang Feng; Jiaying Gu
    Abstract: This paper identifies a ''health premium" of insurance coverage that the insured is more likely to stay healthy or recover from unhealthy status. We introduce this feature into the prototypical macro-health model and estimate the baseline economy by matching the observed joint distribution of health insurance purchase, health status and income over the life cycle. Quantitative analysis reveals that an individual's insurance status has significant and persistent impact on health, which will be reinforced by and subsequently amplify the feedback effect of health on labor earnings and income inequality. Providing ''Universal Health Coverage" would narrow health and life expectancy gaps, with a mixed effect on income distribution in absence of any additional redistribution of income or wealth.
    Keywords: Health Insurance, Health Disparity, Income Distribution
    JEL: E21 E60 I14 O15
    Date: 2022–08–26
  11. By: Benoit Conti (LVMT - Laboratoire Ville, Mobilité, Transport - ENPC - École des Ponts ParisTech - Université Gustave Eiffel); Audrey Bochaton (LADYSS - Laboratoire Dynamiques Sociales et Recomposition des Espaces - UP1 - Université Paris 1 Panthéon-Sorbonne - UP8 - Université Paris 8 Vincennes-Saint-Denis - UPN - Université Paris Nanterre - CNRS - Centre National de la Recherche Scientifique - UPCité - Université Paris Cité); Hélène Charreire (CRESS - U1153 - Equipe 3: EREN- Equipe de Recherche en Epidémiologie Nutritionnelle - Université Sorbonne Paris Nord - CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité - CNAM - Conservatoire National des Arts et Métiers [CNAM] - HESAM - HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université - USPC - Université Sorbonne Paris Cité - INSERM - Institut National de la Santé et de la Recherche Médicale - UPCité - Université Paris Cité - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, LAB'URBA - LAB'URBA - UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12 - Université Gustave Eiffel); Hélène Bonsang-Kitzis (Hôpital privé des Peupliers (Paris)); Caroline Desprès (CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers - EPHE - École pratique des hautes études - PSL - Université Paris sciences et lettres - INSERM - Institut National de la Santé et de la Recherche Médicale - SU - Sorbonne Université - UPCité - Université Paris Cité); Sandrine Baffert (CEMKA); Charlotte Ngo (Hôpital privé des Peupliers (Paris), CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers - EPHE - École pratique des hautes études - PSL - Université Paris sciences et lettres - INSERM - Institut National de la Santé et de la Recherche Médicale - SU - Sorbonne Université - UPCité - Université Paris Cité)
    Abstract: Socioeconomic and geographical inequalities in breast cancer mortality have been widely described in European countries and the United States. To investigate the combined effects of geographic access and socioeconomic characteristics on breast cancer outcomes, a systematic review was conducted exploring the relationships between: (i) geographic access to healthcare facilities (oncology services, mammography screening), defined as travel time and/or travel distance; (ii) breast cancer-related outcomes (mammography screening, stage of cancer at diagnosis, type of treatment and rate of mortality); (iii) socioeconomic status (SES) at individuals and residential context levels. In total, n = 25 studies (29 relationships tested) were included in our systematic review. The four main results are: The statistical significance of the relationship between geographic access and breast cancer-related outcomes is heterogeneous: 15 were identified as significant and 14 as non-significant. Women with better geographic access to healthcare facilities had a statistically significant fewer mastectomy (n = 4/6) than women with poorer geographic access. The relationship with the stage of the cancer is more balanced (n = 8/17) and the relationship with cancer screening rate is not observed (n = 1/4). The type of measures of geographic access (distance, time or geographical capacity) does not seem to have any influence on the results. For example, studies which compared two different measures (travel distance and travel time) of geographic access obtained similar results. The relationship between SES characteristics and breast cancer-related outcomes is significant for several variables: at individual level, age and health insurance status; at contextual level, poverty rate and deprivation index. Of the 25 papers included in the review, the large majority (n = 24) tested the independent effect of geographic access. Only one study explored the combined effect of geographic access to breast cancer facilities and SES characteristics by developing stratified models.
    Date: 2022
  12. By: Esteban García-Miralles; Miriam Gensowski
    Abstract: Child skills are shaped by parental investments. Health shocks to parents can affect these investments and their children’s skills. This paper estimates causal effects of severe parental health shocks on child socio-emotional skills. Drawing on a large-scale survey linked to hospital records, we find that socio-emotional skills of 11-16 year-olds are robust to these shocks, except for small reductions in Conscientiousness. We estimate short-run effects with child-fixed effects and dynamics around shocks with event studies. In the long-run, we find some evidence of build-up of effects that may be rationalized with shocks having a delayed impact on children’s skills.
    Keywords: Big Five personality traits, development of personality traits, parental health shocks, socio-emotional skills, non-cognitive skills, skill formation
    JEL: J24 I10 I21
    Date: 2022
  13. By: Draca, Mirko (University of Warwick); Duchini,Emma (University of Essex); Rathelot, Roland (Institut Polytechnique de Paris); Arthur Turrell (Office for National Statistics); Giulia Vattuone (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
  14. By: Bratti, Massimiliano (University of Milan); Lippo, Enrico (University of Milan)
    Abstract: The gendered impact of the COVID-19 pandemic has been observed in many domains, such as labor market outcomes and mental health. One sector that was particularly disrupted by the pandemic was education, owing to the need to close educational institutions and move all learning activities online. In this paper, we investigate the gender gap in university student performance, focusing on a large public university located in one of the European regions most affected by the first pandemic wave (Lombardy, in Northern Italy). Despite concerns that the pandemic might have had a heavier toll on the educational performance of female students, our empirical analysis shows that the gender gap in student progression (number of credits earned) was not affected by the pandemic and that in some college majors (social sciences and humanities) women even improved their GPA relative to men.
    Keywords: COVID-19, university, student performance, gender gap
    JEL: I21 I23
    Date: 2022–07

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