nep-hea New Economics Papers
on Health Economics
Issue of 2022‒10‒03
sixteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Market Segmentation and Competition in Health Insurance By Michael J. Dickstein; Kate Ho; Nathaniel Mark
  2. Wage Expectations and Access to Healthcare Occupations: Evidence from an Information Experiment By Juliana Bernhofer; Alessandro Fedele; Mirco Tonin
  3. Effects of Extending Paid Parental Leave on Children’s Socio-Emotional Skills and Well-Being in Adolescence By Mikkel Aagaard Houmark; Cecilie Marie Løchte Jørgensen; Ida Lykke Kristiansen; Miriam Gensowski
  4. Covering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention By Sarah Miller; Laura Wherry
  5. Early Labor Market Origins of Long-Term Mental Health and its Intergenerational Correlation By De Vera, Micole; Garcia-Brazales, Javier; Lin, Jiayi
  6. More than a Ban on Smoking? Behavioural Spillovers of Smoking Bans in the Workplace By Joan Costa-Font; Luca Salmasi; Sarah Zaccagni
  7. The Effect of Health Insurance on Child Nutritional Outcomes. Evidence from a Regression Discontinuity Design in Peru By Bernal, Noelia; Costa-Font, Joan; Ritter, Patricia
  8. The Effect of Universal Health Care on the Out-Of-Pocket Health Expenditures: Evidence from a Natural Experiment By Asali, Muhammad; Pantsulaia, Valida
  9. Do the Retired Elderly in Europe Decumulate Their Wealth? The Importance of Bequest Motives, Precautionary Saving, Public Pensions, and Homeownership By Horioka, Charles Yuji; Ventura, Luigi
  10. Regional Research-Practice-Policy Partnerships in Response to Climate-Related Disparities: Promoting Health Equity in the Pacific. By Palinkas, Lawrence A; O'Donnell, Meaghan; Kemp, Susan; Tiatia, Jemaima; Duque, Yvonette; Spencer, Michael; Basu, Rupa; Del Rosario, Kristine Idda; Diemer, Kristin; Doma, Bonifacio; Forbes, David; Gibson, Kari; Graff-Zivin, Joshua; Harris, Bruce M; Hawley, Nicola; Johnston, Jill; Lauraya, Fay; Maniquiz, Nora Elizabeth F; Marlowe, Jay; McCord, Gordon C; Nicholls, Imogen; Rao, Smitha; Saunders, Angela Kim; Sortino, Salvatore; Springgate, Benjamin; Takeuchi, David; Ugsang, Janette; Villaverde, Vivien; Wells, Kenneth B; Wong, Marleen
  11. Exploiting Knowledge Graphs in Healthcare By Suela Maxhelaku; Elda Xhumari; Endrit Xhina
  12. The Dynamics of Behavioral Responses During a Crisis By Hartung, Corinna; Veramendi, Gregory F.; Winter, Joachim
  13. If You Build it, Will They Vaccinate? The Impact of COVID-19 Vaccine Sites on Vaccination Rates and Outcomes By John Brownstein; Jonathan H. Cantor; Benjamin Rader; Kosali I. Simon; Christopher M. Whaley
  14. Influenza Mortality in French Regions after the Hong Kong Flu Pandemic By Florian Bonnet; Hippolyte d'Albis; Josselin Thuilliez
  15. Tracking Chinese aid through China customs: Darlings and orphans after the COVID-19 outbreak By Fuchs, Andreas; Kaplan, Lennart; Kis-Katos, Krisztina; Schmidt, Sebastian S.; Turbanisch, Felix; Wang, Feicheng
  16. Health economics: A review of theoretical and empirical literature By Fatima Arib; Najat Khaldi

  1. By: Michael J. Dickstein (New York University); Kate Ho (Princeton University); Nathaniel Mark (U.S. Department of Justice)
    Abstract: In the United States, households obtain health insurance through distinct market segments. We explore the economics of this segmentation by comparing coverage provided through small employers versus the individual marketplace. Using data from Oregon, we find households with group coverage spend 26% less on covered health care than households with individual coverage yet face higher markups. We develop a model of plan choice and health spending to estimate preferences in both markets and evaluate integration policies. In our setting, pooling can both mitigate adverse selection in the individual market and benefit small group households without raising taxpayer costs.
    Keywords: health insurance, market segmentation
    JEL: I11 I13 I18 L00
    Date: 2021–10
  2. By: Juliana Bernhofer (Department of Economics, Ca' Foscari University of Venice, Italy); Alessandro Fedele (Free University of Bozen-Bolzano, Italy); Mirco Tonin (Free University of Bozen-Bolzano, Italy)
    Abstract: Health systems around the world face an increasing shortage of workers. It is thus important to understand what motivates people to enter the sector. We study how financial incentives affect the performance on the entry test into medical and healthcare schools, a crucial step for aspiring healthcare professionals. To this end, we conduct a randomized information experiment with Italian applicants. We first elicit applicants' expectations about the starting wage of the healthcare job they want to study for. We then inform the treatment group about the true starting wages, while we provide no information to the control group. We finally collect the test scores obtained by applicants. Correcting wage expectations enhances the test scores when expectations are lower than the true wage level, while no significant effects occur when expectations are higher. The treatment does not induce negative selection in terms of ability and altruism. Our findings provide novel experimental evidence that wages matter for prospective students in the health sector and suggest an impact of prospective financial rewards also at a very early stage of careers.
    Keywords: Information Experiment; Applicants to Medical and Healthcare Schools; Wage Expectations; Admission Test Scores.
    JEL: I1 I23 J3 C9
    Date: 2022–09
  3. By: Mikkel Aagaard Houmark (Department of Economics and Business Economics and TrygFonden’s Centre for Child Research, Aarhus University); Cecilie Marie Løchte Jørgensen (Department of Economics and Business Economics, Aarhus University); Ida Lykke Kristiansen (Department of Economics and CEBI, University of Copenhagen); Miriam Gensowski (Rockwool Foundation Research Unit, and IZA, Bonn)
    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: 2022–09–11
  4. By: Sarah Miller; Laura Wherry
    Abstract: Undocumented immigrants are ineligible for public insurance coverage for prenatal care in most states, despite their children representing a large fraction of births and having U.S. citizenship. In this paper, we examine a policy that expanded Medicaid pregnancy coverage to undocumented immigrants. Using a novel dataset that links California birth records to Census surveys, we identify siblings born to immigrant mothers before and after the policy. Implementing a mothers' fixed effects design, we find that the policy increased coverage for and use of prenatal care among pregnant immigrant women, and increased average gestation length and birth weight among their children.
    Date: 2022–08
  5. By: De Vera, Micole; Garcia-Brazales, Javier; Lin, Jiayi
    Abstract: What drives long-term mental health and its intergenerational correlation? Exploiting variation in unemployment rates upon labor market entry across Australian states and cohorts, we provide novel evidence of persistent effects on mental health two decades after labor market entry. We find that individuals exposed to a one percentage point higher unemployment rate at labor market entry relative to trend have 14% of a standard deviation worse mental health at ages 36–40. We further document an intergenerational impact of labor market entry conditions. Along the extensive margin, females more impacted by labor market entry conditions in terms of mental health increase completed fertility. Along the intensive margin, daughters whose parents experienced a one percentage point higher unemployment rate at entry have 18% of a standard deviation worse mental health during adolescence. Sons’ mental health is not impacted.
    Keywords: Recession,Mental health,Well-being,Intergenerational correlation,Australia
    JEL: E32 I14 J13
    Date: 2022
  6. By: Joan Costa-Font (Department of Health Policy, London School of Economics and Political Science); Luca Salmasi (Department of Economics and Finance, Catholic University, Rome); Sarah Zaccagni (Sarah Zaccagni, Department of Economics, CEBI and CEHA, University of Copenhagen)
    Abstract: Are workplace smoking bans (WSBs) more than a ban on smoking? We study whether WSBs influence smoking cessation and exert behavioural spillover effects on (i) a set of health behaviours, and (ii) on individuals not directly affected by the bans. Drawing upon quasi-experimental evidence from Russia, which introduced a WSB (in addition to a ban on smoking in public places), and adopting a difference-in-differences (DiD) strategy, which compares employed individuals (exposed to the work and public place ban) to unemployed individuals (exposed only to the ban in public places), we document three sets of findings. First, unlike previous studies that focus on smoking bans in public places, we find robust evidence that WSBs increase smoking cessation by 2.9 percentage points (pp) among men. Second, we find that quitters are less likely to use alcohol (6.7 pp reduction among men and 3.5 pp among women), and they reduce their alcohol consumption (10 percent among men). WSBs are found to influence the health behaviour of those not directly affected by the reform, such as never smokers. Our findings are consistent with a model of joint formation of health behaviours, and suggest the need to account for a wider set of spillover effects when estimating the welfare effect of WSBs.
    Keywords: Joint formation of behaviours, workplace smoking bans, behavioural spillovers, smoking, drinking, physical activity, healthy identity, Russia
    JEL: I18 H75 L51
    Date: 2022–09–11
  7. By: Bernal, Noelia (Universidad de Piura); Costa-Font, Joan (London School of Economics); Ritter, Patricia (University of Connecticut)
    Abstract: We study the effect of health insurance expansion on nutrition-related children's health outcomes. We exploit quasi-random variation from an insurance expansion targeted at poor households in Peru. We find that access to insurance reduces childhood obesity and exerts positive and economically significant effects on some preventive health care utilization and behaviours, such as children's regular growth checks-ups and deworming treatments, the duration of breastfeeding, and a substitution of foods rich in carbohydrates for other foods rich in proteins. In contrast, we do not find any effect on other outcomes typically related to other interventions.
    Keywords: children’s health, obesity, overweight, public health insurance, health behaviors, nutrition, breast-feeding
    JEL: J13
    Date: 2022–08
  8. By: Asali, Muhammad (ISET, Tbilisi State University); Pantsulaia, Valida (National Bank of Georgia)
    Abstract: In the first two quarters of 2013 the Georgian government introduced and fully implemented a universal health care (UHC) plan covering all those not-yet publicly or privately insured. We estimate the effect of the introduction of the universal healthcare plan on the level of out-of-pocket (OOP) health expenditures of households. We find that the program saved households an economically and statistically significant amount of 92 GEL per household/ month: a major effect, amounting to about 10% of the average household monthly income and 30% of the average individual monthly income at the time. The OOP payments reduction is almost totally attributed to people utilizing serious, emergency, or life-saving inpatient and outpatient services—lending support to the hypothesis that the UHC program, not only has reduced the OOP health expenditures, but it might have also improved the overall health status in the country.
    Keywords: universal healthcare, out of pocket health expenditures, public health, health insurance
    JEL: I13 I18 H51
    Date: 2022–08
  9. By: Horioka, Charles Yuji; Ventura, Luigi
    Abstract: In this paper, we use micro data on a large number of European countries from the Survey of Health, Ageing and Retirement in Europe (SHARE) to examine the wealth accumulation (saving) behavior of the retired elderly in Europe. To summarize our main findings, we find that less than half of the retired elderly in Europe are decumulating their wealth and that the average wealth accumulation rate of the retired elderly in Europe is positive though relatively moderate (6.6% over a 3-year period). These findings strongly suggest that the Wealth Decumulation (or Retirement Saving) Puzzle (the tendency of the retired elderly to not decumulate their wealth or to decumulate their wealth more slowly than expected) applies in the case of Europe. Moreover, our regression results suggest that bequest motives, generous public pension systems, and the reluctance of retired elderly homeowners to sell or borrow against their owner-occupied housing are the primary explanations for the existence of the Wealth Decumulation Puzzle in Europe.
    Keywords: Aged, bequests, bequest intentions, bequest motives, dissaving, elderly, Europe, household saving, inheritances, intergenerational transfers, life cycle model or hypothesis, precautionary saving, retired elderly, Retirement Saving Puzzle, saving, SHARE, wealth accumulation, wealth decumulation, Wealth Decumulation Puzzle, D14, D15, D64, E21, H55, J14
    Date: 2022–09
  10. By: Palinkas, Lawrence A; O'Donnell, Meaghan; Kemp, Susan; Tiatia, Jemaima; Duque, Yvonette; Spencer, Michael; Basu, Rupa; Del Rosario, Kristine Idda; Diemer, Kristin; Doma, Bonifacio; Forbes, David; Gibson, Kari; Graff-Zivin, Joshua; Harris, Bruce M; Hawley, Nicola; Johnston, Jill; Lauraya, Fay; Maniquiz, Nora Elizabeth F; Marlowe, Jay; McCord, Gordon C; Nicholls, Imogen; Rao, Smitha; Saunders, Angela Kim; Sortino, Salvatore; Springgate, Benjamin; Takeuchi, David; Ugsang, Janette; Villaverde, Vivien; Wells, Kenneth B; Wong, Marleen
    Abstract: Although climate change poses a threat to health and well-being globally, a regional approach to addressing climate-related health equity may be more suitable, appropriate, and appealing to under-resourced communities and countries. In support of this argument, this commentary describes an approach by a network of researchers, practitioners, and policymakers dedicated to promoting climate-related health equity in Small Island Developing States and low- and middle-income countries in the Pacific. We identify three primary sets of needs related to developing a regional capacity to address physical and mental health disparities through research, training, and assistance in policy and practice implementation: (1) limited healthcare facilities and qualified medical and mental health providers; (2) addressing the social impacts related to the cooccurrence of natural hazards, disease outbreaks, and complex emergencies; and (3) building the response capacity and resilience to climate-related extreme weather events and natural hazards.
    Keywords: Humans, Mental Health, Income, Climate Change, Policy, Health Equity, Pacific region, Small Island Developing States, climate change, disasters, health equity, low- and middle-income countries, social determinants of health, Behavioral and Social Science, Basic Behavioral and Social Science, Generic health relevance, Climate Action, Toxicology
    Date: 2022–08–01
  11. By: Suela Maxhelaku (University of Tirana); Elda Xhumari (University of Tirana); Endrit Xhina (University of Tirana)
    Abstract: The use of knowledge graphs in health care has increased the performance in which information is retrieved and patients' diagnoses are made. Because the healthcare domain is made up of complex concepts and many relationships between them, developing knowledge graphs presents numerous challenges. Another issue is the large number of medical standards, such as HL7, ICD-10, SNOMED CT, DICOM, LOINC, and so on. In this paper are analyzed the technologies used in the construction of knowledge graphs in healthcare. In addition, a model for generating knowledge graphs from the APHRO (Albanian Patient Healthcare Records) Ontology is proposed.
    Keywords: Knowledge graphs, Ontology, Healthcare
    JEL: C45 I19
    Date: 2022–07
  12. By: Hartung, Corinna (LMU Munich); Veramendi, Gregory F. (LMU Munich); Winter, Joachim (LMU Munich)
    Abstract: This paper investigates the dynamics of behavioral changes during a crisis. We study this in the context of the first year of the Covid-19 pandemic, where behavioral responses were important in mitigating the costs of the pandemic. To identify behavioral responses to unanticipated and transient health risk shocks, we combine high-frequency cellphone mobility data with detailed incidence data in Germany. Using an event-study design on local outbreaks, we find that county-level mobility immediately and significantly decreased by about 2.5% in response to an outbreak independent of non-pharmaceutical interventions. We also find that the reproduction rate decreased by about 17% in response to a local outbreak. Both behavioral responses are quite persistent even after the relative health risk has dissipated. By the time of the second wave, the behavioral response to a second or third shock is small or negligible. Our results demonstrate the importance of (1) integrating behavioral persistence in models used to study behavior and policies that change behavior, (2) the effectiveness of policies that provide high-frequency localized information on health risks, and (3) the potential persistence of behavioral changes after the Covid-19 pandemic has passed.
    Keywords: dynamics; behavioral response; crisis; covid-19;
    JEL: D90 H12 I12 I18
    Date: 2022–08–15
  13. By: John Brownstein; Jonathan H. Cantor; Benjamin Rader; Kosali I. Simon; Christopher M. Whaley
    Abstract: Safe and effective vaccines have vastly reduced the lethality of the COVID-19 pandemic worldwide, but disparities exist in vaccine take-up. Although the out-of-pocket price is set to zero in the U.S., time (information gathering, signing up, transportation and waiting) and misinformation costs still apply. To understand the extent to which geographic access impacts COVID-19 vaccination take-up rates and COVID-19 health outcomes, we leverage exogenous, pre-existing variation in locations of retail pharmacies participating the U.S. federal government’s vaccine distribution program through which over 40% of US vaccine doses were administered. We use unique data on nearly all COVID-19 vaccine administrations in 2021. We find that the presence of a participating retail pharmacy vaccination site in a county leads to an approximately 26% increase in the per-capita number of doses administered, possibly indicating that proximity and familiarity play a substantial role in vaccine take-up decisions. Increases in county-level per capita participating retail pharmacies lead to an increase in COVID-19 vaccination rates and a decline in the number of new COVID-19 cases, hospitalizations, and deaths, with substantial heterogeneity based on county rurality, political leanings, income, and race composition. The relationship we estimate suggests that averting one COVID-19 case, hospitalization, and death requires approximately 25, 200, and 1,500 county-level vaccine total doses, respectively. These results imply a 9,500% to 22,500% economic return on the full costs of COVID-19 vaccination. Overall, our findings add to understanding vaccine take-up decisions for the design of COVID era and other public health interventions.
    JEL: I0
    Date: 2022–09
  14. By: Florian Bonnet (INED - Institut national d'études démographiques); Hippolyte d'Albis (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Influenza mortality has dramatically decreased in France since the 1950s. Annual death rates peaked during two pandemics: the Asian flu (1956-57) and the Hong-Kong flu (1969-1970). This study's objective is to evaluate whether the second pandemic created a structural change in the dynamics of influenza mortality in France. We employ a new database on influenza mortality since 1950 at the subnational level (90 geographic areas) to estimate statistical models to find whether a structural change happened and to explain the differences in mortality rates across geographic areas. Influenza mortality increased between 1950 and 1969, and decreased from 1970 onward. The Hong-Kong flu is identified as the event of a structural break. After the break, geographical differences are less explained by regional characteristics such as income, density or aging ratio. Hong Kong flu was found to be associated with a major change in influenza mortality in France. Change in health practices and policies induced a decline in mortality that started in 1970, just after the pandemics. The health benefits are notably important for senior citizens and for the poorest regions.
    Date: 2022–08
  15. By: Fuchs, Andreas; Kaplan, Lennart; Kis-Katos, Krisztina; Schmidt, Sebastian S.; Turbanisch, Felix; Wang, Feicheng
    Abstract: Since the outbreak of the COVID-19 pandemic, China's mask and vaccine diplomacy have been widely discussed, but the debate relies on a few stylized data points. This article introduces a systematic way to measure China's foreign aid in almost real-time through official customs records of exported aid goods. Our results show significant shifts in China's aid after the outbreak of the COVID-19 pandemic. First, medical aid skyrocketed after the outbreak. It was initially dominated by face masks and other protective equipment and later by vaccines. This came at the expense of non-medical aid, which was 16.3 percent below its pre-pandemic level. Second, China's aid became global, clearly extending beyond the Global South. Third, in the aftermath of the initial outbreak in March 2020, China's aid became less responsive to both recipient need and political friendship, which can be mainly attributed to the rise of aid through non-government sources. However, in the vaccine diplomacy period of 2021, economic needs and political factors have regained their original importance.
    Keywords: official development assistance,aid exports,China,COVID-19,mask diplomacy,vaccine diplomacy,Health Silk Road
    JEL: F35 F59 H12 H84 I15 I18 P33
    Date: 2022
  16. By: Fatima Arib (Innovation, Responsabilités et Développement Durable (INREDD) - UCA - Université Cadi Ayyad [Marrakech], UCA - Université Cadi Ayyad [Marrakech]); Najat Khaldi (Innovation, Responsabilités et Développement Durable (INREDD) - UCA - Université Cadi Ayyad [Marrakech], UCA - Université Cadi Ayyad [Marrakech])
    Abstract: Health economics is a sub-discipline of economic science concerned with the economic treatment of health. From a socio-economic point of view, health is not an isolated field. It comes from medicine, but it is also related to socio-economic and political factors. Being considered as a superior good and which has particular characteristics, it conditions the ability of individuals to produce and consume. In this paper, we will highlight the interdependencies between the economy and health, then we will analyze the main theories in health economics and finally we will show how the Economy will shape health in its image. The results of our literature review show that the main issues addressed by the health economy revolve around the economic analysis of the interrelationships between economic and social development on the one hand, and population health on the other. Our theoretical analysis shows that the main theoretical approaches in health economics (the neoclassical model, agency theory, conventional theory) are based on two hypotheses: the hypothesis of the individual rationality of actors and the hypothesis of the mode of coordination of their decisions. According to the neoclassical theory, the decisions of individuals, considered as rational, are controlled by market exchange, while the agency theory allows for the presentation of elements that help in economic policy-making. The development of medical sciences and the respect of professional ethics are thus the main contributions of the theory of conventions. These different theoretical approaches complement each other in explaining the functioning of the health care system. However, the theoretical advances made in the field of health economics are still insufficient in terms of the production of new knowledge by research, which mainly concerns the regulation and organization of the health care system.
    Abstract: L'économie de santé est une sous discipline de la science économique s'intéressant à traiter économiquement la santé. D'un point de vue socio-économique, la santé n'est pas un domaine isolé. Elle est issue de la médecine, mais elle est également liée à des facteurs socio-économiques et politiques. Étant considéré la santé comme un bien supérieur et qui a des caractéristiques particulières, elle conditionne la capacité des individus à produire et à consommer. Dans ce papier, nous allons mettre en évidence les interdépendances entre l'économie et la santé, ensuite, nous allons analyser les principales théories en économie de santé et enfin nous allons montrer commet l'Economique va façonner la santé à son image. Les résultats de notre revue de littérature montrent que les principales problématiques traitées par l'économie de santé s'articulent autour l'analyse économique des interrelations entre le développement économique et social, d'une part, et santé de la population d'autre part. Notre analyse théorique démontre que les principales approches théoriques en économie de santé (le modèle néoclassique, théorie de l'agence, théorie conventionnaliste) reposent sur deux hypothèses : l'hypothèse de rationalité individuelle des acteurs et l'hypothèse du mode de coordination de leurs décisions. Selon la théorie néoclassique, les décisions des individus, considérés comme rationnels, sont contrôlées par l'échange marchand, tandis que la théorie de l'agence permet de présenter des éléments aidant à la prise de décision en politique économique. Le développement des sciences médicales et le respect de l'éthique professionnelle constituent ainsi les principaux apports de la théorie des conventions. Ces différentes approches théoriques se complètent pour expliquer le fonctionnement du système de santé. Cependant, les avancées théoriques réalisées dans le domaine de l'économie de santé connaissent encore des insuffisances en termes de production de nouvelles connaissances par la recherche et qui portent principalement sur la régulation et l'organisation du système de soins.
    Keywords: Economics,health,health economics,Health care system,Economie,Santé,Economie de santé,Système de soins
    Date: 2022–08–07

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