nep-hea New Economics Papers
on Health Economics
Issue of 2022‒11‒07
28 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Multidimensional Screening and Menu Design in Health Insurance Markets By Hector Chade; Victoria R. Marone; Amanda Starc; Jeroen Swinkels
  2. The Downward Spiral By Greenwood, Jeremy; Guner, Nezih; Kopecky, Karen A.
  3. The Effect of Removing Early Retirement on Mortality By Bellés Obrero, Cristina; Jimenez-Martin, Sergi; Ye, Han
  4. Information, Loss Framing, and Spillovers in Pay-for-Performance Contracts By Bauhoff,Sebastian Peter Alexander; Kandpal,Eeshani
  5. Staff Engagement, Coworkers' Complementarity and Employee Retention: Evidence from English NHS Hospitals By Moscelli, Giuseppe; Sayli, Melisa; Mello, Marco
  6. Does Population Sorting through Internal Migration Increase Healthcare Costs and Needs in Peripheral Regions? By Kulshreshtha, Shobhit; Salm, Martin; Wübker, Ansgar
  7. Revisiting the Effects of Cigarette Taxes on Smoking Outcomes By Vinish Shrestha
  8. Does the Gender Wage Gap Influence Intimate Partner Violence in Brazil ? Evidence from Administrative Health Data By Perova,Elizaveta; Reynolds,Sarah Anne; Schmutte,Ian
  9. Dust to Feed, Dust to Grey: The Effect of In-Utero Exposure to the Dust Bowl on Old-Age Longevity By Hamid Noghanibehambari; Jason Fletcher
  10. The Impact of Early Childhood Development Interventions on Children’s Health in Developing Countries: A Systematic Review and Meta-analysis By McWay, Ryan; Prabhakar, Pallavi; Ellis, Ayo
  11. Health Shocks and Housing Downsizing: How Persistent Is 'Ageing in Place'? By Costa-Font, Joan; Vilaplana-Prieto, Cristina
  12. Financial Incentives to Increase Utilization of Reproductive, Maternal, and Child Health Services in Low- and Middle-Income Countries : A Systematic Review and Meta-Analysis By Neelsen,Sven,De Walque,Damien B. C. M.,Friedman,Jed,Wagstaff, Adam
  13. The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme By Lin, Lin; Zai, Xianhua
  14. Estimating the Impact of Improved Roads on Access to Health Care : Evidence from Mozambique By Iimi,Atsushi
  15. Multimorbid life expectancy across race, socioeconomic status, and gender in South Africa By Anastasia Lam; Katherine Keenan; Mikko Myrskylä; Hill Kulu
  16. Financial Incentives, Fertility, and Son Preference in Armenia By Pinto,Maria Florencia; Posadas,Josefina; Shapira,Gil
  17. Modeling to Inform Economy-Wide Pandemic Policy: Bringing Epidemiologists and Economists Together By Sumit Agarwal; Michael Darden; David Dowdy; Lauren Gardner; Barton Hamilton; Karen A. Kopecky; Melissa Marx; Nicholas Papageorge; Daniel Polsky; Kimberly Powers; Elizabeth Stuart; Matthew Zahn
  18. Social Isolation, Health Dynamics, and Mortality: Evidence across 21 European Countries By Fawaz, Yarine; Mira, Pedro
  19. Nursing homes and mortality in Europe: Uncertain causality By Xavier Flawinne; Mathieu Lefebvre; Sergio Perelman; Pierre Pestieau; Jérôme Schoenmaeckers
  20. Conflict and Girl Child Marriage: Global Evidence By Caroline Krafft; Diana Jimena Arango; Amalia Hadas Rubin; Jocelyn Kelly
  21. Predicting COVID-19 Vaccine Uptake By Pronkina, Elizaveta; Rees, Daniel I.
  22. Mass Messaging and Health Risk Reduction : Evidence from COVID-19 Text Messages in Tajikistan By Seitz,William Hutchins
  23. Addressing Vaccine Hesitancy : Survey and Experimental Evidence from Papua New Guinea By Hoy,Christopher Alexander; Wood,Terence; Moscoe,Ellen Elizabeth
  24. Acceptance of COVID-19 Vaccines in Sub-Saharan Africa : Evidence from Six National Phone Surveys By Kanyanda,Shelton Sofiel Elisa; Markhof,Yannick Valentin; Wollburg,Philip Randolph; Zezza,Alberto
  25. Death and Destitution : The Global Distribution of Welfare Losses from the COVID-19 Pandemic By Ferreira,Francisco H. G.; Sterck,Olivier Christian Brigitte; Mahler,Daniel Gerszon; Decerf,Benoit Marie A
  26. Cities in a Pandemic: Evidence from China By Badi H. Baltagi; Ying Deng; Jing Li; Zhenlin Yang
  27. Gender and COVID-19 : What have we learnt, one year later ? By De Paz Nieves,Carmen; Gaddis,Isis; Muller,Miriam
  28. Gender, Loneliness and Happiness during COVID-19 By Lepinteur, Anthony; Clark, Andrew E.; Ferrer-i-Carbonell, Ada; Piper, Alan; Schröder, Carsten; D’Ambrosio, Conchita

  1. By: Hector Chade; Victoria R. Marone; Amanda Starc; Jeroen Swinkels
    Abstract: We study a general screening model that encompasses a health insurance market in which consumers have multiple dimensions of private information and a price-setting insurer (e.g., a monopolist or a social planner) offers vertically differentiated contracts. We combine theory and empirics to provide three novel results: (i) optimal menus satisfy intuitive conditions that generalize the literature on multidimensional screening and shed light on insurer incentives; (ii) the insurer's problem with an unlimited number of contracts is well-approximated with only a small set of contracts; and (iii) under an additional assumption, the problem becomes dramatically simpler and can be solved using familiar graphical analysis. Calibrated numerical simulations validate assumptions, quantify the differential incentives of a monopolist and a social planner, and evaluate common policy interventions in a monopoly market.
    JEL: I11
    Date: 2022–10
  2. By: Greenwood, Jeremy (University of Pennsylvania); Guner, Nezih (Universitat Autònoma de Barcelona); Kopecky, Karen A. (Federal Reserve Bank of Atlanta)
    Abstract: There have been more than 500,000 opioid overdose deaths since 2000. To analyze the opioid epidemic, a model is constructed where individuals choose whether to use opioids recreationally, knowing the probabilities of addiction and dying. These odds are functions of recreational opioid usage. Markov chains are estimated from the US data for the college and non-college educated that summarize the transitions into and out of opioid addiction as well as to a deadly overdose. The structural model is constructed to match the estimated Markov chains. The epidemic's drivers and the impact of medical interventions are examined.
    Keywords: addiction, college/non-college educated, deaths, fentanyl, Markov chain, medical interventions, opioids, OxyContin, pain, prices, state-contingent preferences, structural model, subjective and objective beliefs
    JEL: D11 D12 E13 I12 I14 I31 J11 J17
    Date: 2022–09
  3. By: Bellés Obrero, Cristina (University of Mannheim); Jimenez-Martin, Sergi (Universitat Pompeu Fabra); Ye, Han (University of Mannheim)
    Abstract: This paper sheds new light on the mortality effect of delaying retirement by investigating the impacts of the 1967 Spanish pension reform. This reform exogenously changed the early retirement age, depending on the date individuals started contributing to the Social Security system. Those contributing before 1 January 1967 maintained the right to voluntarily retire early (at age 60), while individuals who started contributing after that date could not voluntarily claim a pension until the age of 65. Using the Spanish administrative Social Security data, we find that the reform delayed the individuals' labour market exit by around half a year and increased the probability that individuals take up disability pensions, partial pensions, and no pensions. We show evidence that delaying exiting employment increases the hazard of dying between the ages of 60 and 69, for almost all individuals. Heterogeneous analysis indicates that the increase in mortality is stronger for those employed in low-skilled, physically and psychosocially demanding jobs. Moreover, we show that allowing for flexible retirement schemes, such as partial retirement, mitigates the detrimental effect of delaying retirement on mortality.
    Keywords: delaying retirement, mortality, heterogeneity, flexible retirement
    JEL: I10 I12 J14 J26
    Date: 2022–09
  4. By: Bauhoff,Sebastian Peter Alexander; Kandpal,Eeshani
    Abstract: Do incentives matter beyond the information conveyed by pay-for-performance contracts? Does loss framing matter? And do incomplete contracts generate spillovers on unincentivized tasks? This study reports on a framed field experiment with 1,363 maternity care workers in 691 primary health facilities in Nigeria to answer these questions. Participants were randomized into three study arms—(1) information with a flat participation fee, (2) performance-based rewards, and (3) performance-based penalties. In each arm, participants had to identify correct clinical actions based on the records of hypothetical patients receiving maternity care. Five of fifteen possible actions were incentivized but performance was measured on all fifteen. Compared to information alone, both rewards and penalties increase time on task by 11 percent, correct overall performance by 6 to 8 percent, and directly incentivized performance by 20 percent. Incentives also generate positive spillovers of 14 percent on unincentivized tasks. Loss framing does not affect performance. Results suggest that improving health worker effort by 8 percent would have an impact on neonatal mortality at par with the short run effect of adding a physician to a health facility. Finally, findings show that a small incentive captures most of the impact, implying that incentives work by making information more effective and that pay-for-performance contracts can be made significantly more cost-effective.
    Keywords: Health Care Services Industry,Reproductive Health,Health Economics&Finance,Health Service Management and Delivery
    Date: 2021–06–02
  5. By: Moscelli, Giuseppe (University of Surrey); Sayli, Melisa (University of Surrey); Mello, Marco (University of Surrey)
    Abstract: Retention of skilled workers is essential for labour-intensive organisations like hospitals, where an excessive turnover of doctors and nurses can reduce the quality and quantity of services to patients. In the public sector, where salaries are often not negotiable at individual level, workers increasingly care about the non-pecuniary aspects of their jobs. We empirically investigate the role played by two such aspects, staff engagement and the retention of complementary coworkers, in affecting employee retention within the public hospital sector. We exploit a unique and rich panel dataset based on employee-level payroll and staff survey records from the universe of English NHS hospitals, and estimate dynamic panel data models to deal with the bias due to reverse causality. We find that nurses' retention is positively associated with their engagement, whereas doctors' retention is positively associated with nurses' retention. This heterogeneous response of employee retention can be explained by the hierarchy of workers' professional roles within the organisation.
    Keywords: employee retention, staff engagement, job complementarities, coworkers, hospitals, endogeneity
    JEL: C33 C36 I11 J22 J28 J63
    Date: 2022–10
  6. By: Kulshreshtha, Shobhit (Tilburg University); Salm, Martin (Tilburg University); Wübker, Ansgar (RWI)
    Abstract: Large regional disparities in health and healthcare costs prevail in many countries, but our understanding of the underlying causes is still limited. This study shows for the case of the Netherlands that population sorting through internal migration can explain a substantial share, around 28%, of regional variation in healthcare costs. Internal migration during the 1998-2018 period increases average healthcare costs in peripheral provinces by up to 3%. Most of this effect can be attributed to selective migration. We find similar results for risk scores, a measure of healthcare needs. The Dutch risk equalization scheme compensates only partially for these effects.
    Keywords: regional variation in healthcare costs, internal migration, movers approach, regional disparities
    JEL: H51 I14 R23
    Date: 2022–09
  7. By: Vinish Shrestha (Department of Economics, Towson University)
    Abstract: This study re-evaluates the efficacy of cigarette taxation in curtailing smoking. I use recent advancements in the difference-in-differences (DiD) literature to account for heterogeneous treatment effects and compare the findings to the two-way-fixed effect (TWFE) estimates. Using data from the Behavioral Risk Factor Survelliance System Selected Metropolitan/Micropolitan Area Risk Trend (BRFSS SMART) for sample periods 2004-2010 and 2015-2020, the study presents three main findings. First, the results for 2004-2010 sample show that the TWFE estimate is only about 65% of the size of the overall average treatment effect on the treated (ATT) estimate obtained using DiD framework. Second, the event-study type estimates increase gradually in magnitude following the treatment year, thus demonstrating dynamic treatment effects ignored by the TWFE estimate. Third, the ATT estimate pertaining to 2015-2020 sample is only about 63% of the ATT estimate for 2004-2010 sample. Overall, the findings point out that relying on TWFE models to obtain elasticity estimates may bias the estimates towards zero.
    Keywords: Cigarette taxation, Difference-in-Differences, Treatment heterogeneity, Dynamic treatment effects, Elasticity.
    JEL: I10 I18 D00 B23 H20
    Date: 2022–10
  8. By: Perova,Elizaveta; Reynolds,Sarah Anne; Schmutte,Ian
    Abstract: Improving women’s economic status has been presented in theory as a protective mechanism against intimate partner violence. Using panel data from 2011–16 for the most populous 20 percent of municipalities in Brazil, the analysis tests if the gender wage gap is causally associated with three administrative measures of violence against women: homicides, overnight hospitalizations for assault, and incidents of domestic violence reported by attending health workers about patients. The analysis finds that a narrowing in the gender wage gap leads to a reduction of homicides of women, especially among younger women and in municipalities with a low Human Development Index. The impact on less severe forms of violence, also captured in medical reports, depends on the context. A reduction in the gender wage ratio triggers a decrease in reports in municipalities that have police stations specifically designed to address crimes against women, but it has the opposite impact in the absence of such services. The results suggest that while improvements in gender equality in the labor market curtail the most severe forms of violence against women, they need to be complemented by policies directly focused on women’s safety to reduce less severe violence effectively.
    Keywords: Gender and Development,Crime and Society,Health Care Services Industry,Social Conflict and Violence,Wages, Compensation&Benefits
    Date: 2021–05–11
  9. By: Hamid Noghanibehambari; Jason Fletcher
    Abstract: Intensive agriculture and deep plowing resulted in top-soil erosion and dust storms during the 1930s. These effects have been shown to affect agricultural income and land values that persisted for years. Given the growing literature on the relevance of in-utero and early-life exposures, it is surprising that studies focusing on links between the Dust Bowl and later-life health find inconclusive and mixed results. This paper re-evaluates this literature and studies the long-term effects of in-utero and early-life exposure to top-soil erosion caused by the Dust Bowl of the 1930s on old-age longevity. Specifically, we employ Social Security Administration death records linked with the full-count 1940 census and implement event studies and difference-in-difference designs to compare the longevity of individuals in high/medium versus low top-soil erosion counties post-1930 versus pre-1930. We find intent-to-treat reductions in longevity of about 0.9 months for those born in high erosion counties post-1930. We show that these effects are not an artifact of preexisting trends in longevity. Additional analyses suggest the effects are more pronounced among children raised in farm households, females, and those with lower maternal education. We also provide suggestive evidence that reductions in adulthood income are a likely mechanism channel.
    JEL: I12 I15 J0
    Date: 2022–10
  10. By: McWay, Ryan (Population Studies Center, University of Michigan); Prabhakar, Pallavi (Dept. of Economics, Norwegian School of Economics and Business Administration); Ellis, Ayo (Federal Reserve Bank of Cleveland)
    Abstract: Investing in a child’s early years reduces incidences of stunting, wasting, worm infections, and anemia among young children. Yet, 250 million children are at risk of not reaching their full development potential in low-and-middle income countries (LMIC) due to inadequate nutrition and lack of early stimulation. Multiple early childhood health interventions such as growth monitoring, nutrition supplementation, cash transfers, handwashing, and deworming have been tested to evaluate their impact on improving child health outcomes in LMIC. However, there is limited evidence assessing the relative benefits of implementing one type of intervention over another. This review is among the first to identify the interventions which have comparatively outperformed others in improving children’s physical health since the year 2000 and the gaps in the quality of existing evidence. Upon a comprehensive review of the impact from 39 early childhood interventions, we find that interventions including nutrition or cash based assistance outperform interventions offering information based support or growth monitoring. Further examination of the long term impacts, cost-effectiveness, and extended exposure of these interventions is needed to understand what works in improving child health during early years.
    Keywords: Early Childhood Development (ECD); Systematic Review; Meta-analysis; Health; Lower-and-Middle Income Countries (LMIC)
    JEL: I15 I31 J13
    Date: 2022–10–07
  11. By: Costa-Font, Joan (London School of Economics); Vilaplana-Prieto, Cristina (Universidad de Murcia)
    Abstract: Individual preferences for 'ageing in place' (AIP) in old age are not well understood. One way to test the strength of AIP preference is to investigate the effect of health shocks on residential mobility to smaller size or value dwellings, which we refer to as 'housing downsizing'. This paper exploits more than a decade worth of longitudinal data to study older people's housing decisions across a wide range of European countries. We estimate the effect of health shocks on the probability of different proxies for housing downsizing (residential mobility, differences in home value, home value to wealth ratio), considering the potential endogeneity of the health shock to examine the persistence of AIP preferences. Our findings suggest that consistently with the AIP hypothesis, every decade of life, the likelihood of downsizing decreases by two percentage points (pp). However, the experience of a health shock partially reverts such culturally embedded preference for AIP by a non- negligible magnitude on residential mobility (9pp increase after the onset of a degenerative illness, 9.3pp for other mental disorders and 6.5pp for ADL), home value to wealth ratio and the new dwelling's size (0.6 and 1.2 fewer rooms after the onset of a degenerative illness or a mental disorder). Such estimates are larger in northern and central European countries.
    Keywords: ageing in place, housing downsizing, health shocks at old age, Europe, residential mobility, mental degenerative mental illness, mental disorder
    JEL: I18 G51 J61 R31
    Date: 2022–10
  12. By: Neelsen,Sven,De Walque,Damien B. C. M.,Friedman,Jed,Wagstaff, Adam
    Abstract: Financial incentives for health providers and households are increasingly used to improve reproductive, maternal, and child health service coverage in low- and middle-income countries. This study provides a quantitative synthesis of their effectiveness. A systematic review was conducted of the effects of performance-based financing, voucher, and conditional cash transfer programs on six reproductive, maternal, and child health service indicators, with eligible evidence coming from randomized controlled trials and studies using double-difference, instrumental variables, and regression discontinuity designs. Four literature searches were conducted between September 2016 and March 2021 using seven academic databases, Google Scholar, development agency and think tank websites, and previous systematic reviews. Random effects meta-analysis was used to obtain mean effect sizes. From 58 eligible references 212 impact estimates were extracted, which were synthesized into 130 program-specific effect sizes. Financial incentives increase coverage of all considered reproductive, maternal, and child health indicators, but mean effects sizes are of modest magnitude. Effect size heterogeneity is typically low to moderate, and there is no indication that study bias risk, baseline indicator levels, or a combination of provider- and household-level incentives impact effect sizes. There is, however, weak evidence that mean effect sizes are somewhat smaller for performance-based financing than for voucher and conditional cash transfer programs, and that the increase in income, rather than the incentive itself, drives coverage improvements. Financial incentives improve reproductive, maternal, and child health service coverage. If future research confirms the preliminary finding that performance-based financing has smaller effects, voucher and conditional cash transfer programs are the preferred policy option among incentive interventions to achieve higher reproductive, maternal, and child health service coverage. The relative effectiveness and efficiency of incentives compared with unconditional increases of provider and household incomes, however, need to be studied further.
    Keywords: Health Care Services Industry,Health Service Management and Delivery,Taxation&Subsidies,Reproductive Health,Early Child and Children's Health
    Date: 2021–10–04
  13. By: Lin, Lin; Zai, Xianhua
    Abstract: Low-income people in low- and middle-income countries (LMICs) have limited access to healthcare when they are sick. To address this issue, the governments of LMICs have initiated health insurance programs that target these poor populations. However, the health benefits these programs provide are often limited due to resource constraints in LMICs. In this paper, we study the New Cooperative Medical Scheme (NCMS), a limited coverage insurance program for rural residents in China, to explore its effectiveness, and the mechanisms that contribute to its successes, if any. In a plausibly random design, we exploit the variation in provincial NCMS enrollment rate 2004-2011 to identify its average treatment effect. We find that although the NCMS' coverage is limited, its effect on inpatient care use increases significantly. This increase is mainly driven by inpatient care delivered by primary care providers, which has the most generous reimbursement rates. In addition, we show that half of the increase in inpatient care use is attributable to the NCMS' healthcare investment in rural providers. For outpatient services, while the total effect is not statistically significant, we find that the utilization pattern across providers is consistent with the differential payment design of the NCMS: rural residents use more outpatient care provided by primary care institutions where they can get higher reimbursement rates. In addition, we show evidence that rural residents substitute outpatient services in hospitals for that in township health centers. Lastly, results on health expenditure and health outcomes indicate that the introduction of the NCMS does not affect out-of-pocket medical expense or all-cause mortality rates among rural residents, but it does reduce mortality for specific diseases such as AIDS and infectious disease.
    Keywords: Healthcare Utilization,NCMS,Health Insurance,Poor Populations
    JEL: H51 I12 I13 I18
    Date: 2022
  14. By: Iimi,Atsushi
    Abstract: The paper recasts light on the linkage between transport infrastructure and human capital development. Health care access is an important challenge in many developing countries. In particular in remote rural areas, it is not easy to access good quality health care services. Among others, transport connectivity is often an important constraint. The paper estimates the impact of transport connectivity on access to health care services in Mozambique, especially focused on people’s decision about whether they visit and ask for advice at a health facility if they have a fever. This is a critical question in Mozambique where malaria is still a life-threatening disease. About three-quarters of the total population does not have access to health facilities by walking. The paper shows that transport connectivity to health facilities is a significant determinant of people’s health care access. Owning transport means, such as a bike or a motorcycle, is also instrumental to promoting people’s access to health care. The rich are more likely to benefit from health care services, suggesting a need for other complementary policies, such as a health care subsidy and insurance, to improve health care accessibility.
    Keywords: Health Care Services Industry,Transport Services,Leprosy,Communicable Diseases,Cholera,Malaria,Health Service Management and Delivery
    Date: 2021–07–02
  15. By: Anastasia Lam (Max Planck Institute for Demographic Research, Rostock, Germany); Katherine Keenan; Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany); Hill Kulu (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: The burden of multimorbidity is increasing globally as populations age. However, it is unclear how many years someone is expected to live with multimorbidity, and how it varies by social and economic factors particularly in low- and middle-income countries. We investigate this in South Africa, where its apartheid history further complicates the roles of race, socioeconomic, and gender inequalities in society. This underlines the importance of taking an intersectional perspective when trying to understand the interplay of these factors and how they influence health and mortality. We introduce the term ‘multimorbid life expectancy’ to describe the years lived with multimorbidity. Using an incidence-based multistate Markov modeling approach, we find that females had higher multimorbid life expectancy than males (17.7 years vs 9.9 years), and this disparity was consistent across all race and education groups. Asian/Indians and the post-secondary educated had the highest multimorbid life expectancy relative to other groups. White males seemed to benefit the most from having more education, while African males and females seemed to benefit the least. This suggests associations between structural inequalities and multimorbid life expectancy, highlighting the need for health system and educational policy changes that are proportionate to each group’s level of need.
    Keywords: South Africa, adult mortality, apartheid, chronic diseases, education, gender, infectious diseases, life expectancy, morbidity, races, socio-economic status
    JEL: J1 Z0
    Date: 2022
  16. By: Pinto,Maria Florencia; Posadas,Josefina; Shapira,Gil
    Abstract: Armenia experienced dramatic demographic changes in the past three decades: the share of adults age 65 and over nearly doubled, the total fertility rate reduced by more than 30 percent, and the male-to-female sex ratio at birth increased to one of the world’s highest. Like other middle-income countries concerned with the implications of an aging population for long-term growth and fiscal sustainability, Armenia introduced financial incentives to promote fertility. This paper estimates the effect of the 2009 reform of the universal Childbirth Benefit Program, which increased the amounts of lump sum transfers conditional on birth. The analysis relies on a quasi-experimental strategy exploiting the timing of the policy change and eligibility rule—women get a larger transfer for third and higher-order births. The findings show that the annual probability of an additional birth among women with at least two other children increased between 1.4 and 1.6 percentage points in the five years following the policy change. These effects are equivalent to 58 and 64 percent of the pre-reform birth probability for women who had at least two children. Given the previously demonstrated relationship between fertility level and sex ratio in societies with strong son preference, the reform may potentially alleviate the sex imbalance without directly targeting it. Parents who already have at least one son and are less likely to engage in sex selection and more likely to have additional births; however, the findings do not indicate a significant increase in the likelihood of having daughters.
    Keywords: Educational Sciences,Demographics,Health Care Services Industry,Adolescent Health
    Date: 2021–06–22
  17. By: Sumit Agarwal; Michael Darden; David Dowdy; Lauren Gardner; Barton Hamilton; Karen A. Kopecky; Melissa Marx; Nicholas Papageorge; Daniel Polsky; Kimberly Powers; Elizabeth Stuart; Matthew Zahn
    Abstract: Facing unprecedented uncertainty and drastic trade-offs between public health and other forms of human well-being, policymakers during the Covid-19 pandemic have sought the guidance of epidemiologists and economists. Unfortunately, while both groups of scientists use many of the same basic mathematical tools, the models they develop to inform policy tend to rely on different sets of assumptions and, thus, often lead to different policy conclusions. This divergence in policy recommendations can lead to uncertainty and confusion, opening the door to disinformation, distrust of institutions, and politicization of scientific facts. Unfortunately, to date, there have not been widespread efforts to build bridges and find consensus or even to clarify sources of differences across these fields, members of whom often continue to work within their traditional academic silos. In response to this "crisis of communication," we convened a group of scholars from epidemiology, economics, and related fields (such as statistics, engineering, and health policy) to discuss approaches to modeling economy-wide pandemics. We summarize these conversations by providing a consensus view of disciplinary differences (including critiques) and working through a specific policy example. Thereafter, we chart a path forward for more effective synergy among disciplines, which we hope will lead to better policies as the current pandemic evolves and future pandemics emerge.
    Keywords: economics; epidemiology; public health; Covid-19; behavior modeling; health outcomes; health-wealth tradeoffs
    JEL: C8 H0 I1 J0
    Date: 2021–11–16
  18. By: Fawaz, Yarine (CEMFI, Madrid); Mira, Pedro
    Abstract: We provide a comprehensive picture of the health effects of social isolation using longitudinal data over 21 European countries (SHARE). First, using Cox regressions, we find a significant, strong and robust association between our social isolation index and mortality, which is much stronger in Eastern countries. While all of our pooled countries estimates ranged between a 20 to 30% increase in the mortality hazard for the socially isolated, that number jumps to 45% for the Eastern countries. We then estimate linear regressions to study the dynamic "value added" effects of SI on health and other mediator outcomes, and find that social isolation at baseline leads to worsening health in the next waves along all the dimensions we observe. Up to 13 percent of the effect of baseline social isolation on mortality can be imputed to the combined one-wave-ahead impact of social isolation on increased frailty, reduced cognitive function and increased smoking.
    Keywords: social isolation, loneliness, health, mortality, SHARE
    JEL: I10 C41
    Date: 2022–10
  19. By: Xavier Flawinne (Université de Liège); Mathieu Lefebvre (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Sergio Perelman (Université de Liège); Pierre Pestieau (Université de Liège, 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); Jérôme Schoenmaeckers (Université de Liège, CIRIEC-Belgium)
    Abstract: The current health crisis has particularly affected the elderly population. Nursing homes have unfortunately experienced a relatively large number of deaths. On the basis of this observation and working with European data (from SHARE), we want to check whether nursing homes were lending themselves to excess mortality even before the pandemic. Controlling for a number of important characteristics of the elderly population in and outside nursing homes, we conjecture that the difference in mortality between those two samples is to be attributed to the way nursing homes are designed and organized. Using matching methods, we observe excess mortality in Sweden, Belgium, Germany, Switzerland, Czech Republic and Estonia but not in the Netherlands, Denmark, Austria, France, Luxembourg, Italy and Spain. This raises the question of the organization and management of these nursing homes, but also of their design and financing.
    Keywords: mortality,nursing homes,propensity score matching,SHARE
    Date: 2022
  20. By: Caroline Krafft (St. Catherine University); Diana Jimena Arango (World Bank Group); Amalia Hadas Rubin (International Republican Institute); Jocelyn Kelly (Harvard Humanitarian Initiative)
    Abstract: Child marriage has lasting negative health, human capital, and welfare consequences. Conflict settings are characterized by a number of complex changes that can potentially increase the risk of child marriage, but there has been limited population-based research directly estimating the relationship between conflict and child marriage. Using Demographic and Health Survey data from 19 conflict-affected countries, this paper estimates the relationship between conflict and child marriage. It identifies the relationship based on variation over space and time in conflict intensity. The findings are mixed; in some countries conflict is associated with an increase in child marriage, in others it is associated with a decrease in child marriage, and in some cases there is not a statistically significant relationship. This overall pattern is robust to a variety of approaches to measuring conflict. These findings underscore how efforts to reduce child marriage need to consider conflict as a potential risk factor, but also one that is likely to interact with local economic, social, and demographic environments.
    Keywords: Conflict; Child marriage; Humanitarian settings; Gender-based violence
    JEL: D74 J12 J13 J16
    Date: 2022–08
  21. By: Pronkina, Elizaveta (Université Paris-Dauphine); Rees, Daniel I. (Universidad Carlos III de Madrid)
    Abstract: Although COVID-19 vaccines are safe and effective, many adults are hesitant or unwilling to use them. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona survey, we examine the correlates of vaccine uptake among Europeans ages 50 and older. We find that self-reported trust and risk aversion are good predictors of COVID-19 vaccine uptake. By contrast, there is little evidence that either excess mortality during the pandemic or official case counts influenced whether SHARE Corona respondents were vaccinated against COVID-19.
    Keywords: vaccination, COVID-19, flu, SHARE
    JEL: I12 I18
    Date: 2022–10
  22. By: Seitz,William Hutchins
    Abstract: Can mass public health messages change behavior during a crisis? This paper assesses the impact of a COVID-19 focused text-messaging campaign launched in May 2020 with the Ministry of Health and Social Protection of Tajikistan to encourage compliance with risk reduction measures. The initiative sent a series of informational messages to about 5.5 million mobile phone subscribers and reached at least one member of more than 90 percent of the country’s households. An individual fixed effects estimator is used to measure changes in reported behavior after a respondent lists text messages as a primary source of information about COVID-19, or alternatively when reporting an official text message in the past week. Listing text messaging as a primary source of information increased the number of reported behaviors by 0.15 units (p = 0.000) and receiving an official text message in the past week increased the number by 0.47 units (p = 0.000). These effects were driven by more positive responses for wearing masks, reducing visits with friends and relatives, reducing travel, practicing safer greetings (such as fewer handshakes), and safety-related changes at work. The results suggest that text messaging–based public health messaging was a cost-effective means of increasing awareness in a large and geographically dispersed audience during the COVID-19 pandemic and that the program led to an increase in self-reported risk reducing behaviors.
    Keywords: Health Care Services Industry,Telecommunications Infrastructure,Public Health Promotion,ICT Applications
    Date: 2021–08–23
  23. By: Hoy,Christopher Alexander; Wood,Terence; Moscoe,Ellen Elizabeth
    Abstract: This paper examines the drivers of COVID-19 vaccine hesitancy and tests various means ofincreasing people’s willingness to receive a COVID-19 vaccine. The study draws on data collected through a broadlyrepresentative phone survey with 2,533 respondents and an online randomized survey experiment with 2,392 participantsin Papua New Guinea. Both surveys show that less than 20 percent of the respondents who were aware a vaccine existedwere willing to be vaccinated. The main reason respondents stated for their hesitancy regarding the vaccine was concernabout side effects; however, the majority also said health workers could change their mind, particularly if informationwas communicated in person. The phone survey illustrated that people’s level of trust in the vaccine and theirbeliefs about the behavior of others are strongly associated with their intention to get a COVID-19 vaccine. In contrast,people’s concern about COVID-19, most trusted source of information (including social media), and vaccinationhistory were unrelated to their intention to get vaccinated. The online experiment showed that a message that emphasizedthe relative safety of the vaccine by highlighting that severe side effects are rare, while also emphasizing thedangers of COVID-19, increased intention to get vaccinated by around 50 percent. Collectively, these results suggestthat policy makers would be well placed to direct their efforts to boosting the general population’s trust thatgetting vaccinated substantially reduces the risk of severe illness or death from COVID-19.
    Keywords: Early Child and Children's Health,Public Health Promotion,Immunizations,Disease Control & Prevention,Reproductive Health,Health Care Services Industry,ICT Applications,Educational Sciences
    Date: 2021–11–05
  24. By: Kanyanda,Shelton Sofiel Elisa; Markhof,Yannick Valentin; Wollburg,Philip Randolph; Zezza,Alberto
    Abstract: Recent debates surrounding the lagging COVID-19 vaccination campaigns in low-income countries center around vaccine supply and financing. Yet, relatively little is known about attitudes toward COVID-19 vaccines in these countries and in Africa in particular. This paper provides cross-country comparable estimates of the willingness to accept a COVID-19 vaccine in six Sub-Saharan African countries. It uses data from six national high-frequency phone surveys in countries representing 38 percent of the Sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria, and Uganda). Samples were drawn from large, nationally representative sampling frames providing a rich set of demographic and socioeconomic characteristics which are used to disaggregate the analysis. The findings show acceptance rates to be generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9 percent) to below what would likely be required for herd immunity in Mali (64.5 percent). Safety concerns about the vaccine in general and its side effects emerge as the primary reservations toward a COVID-19 vaccine across countries. These findings suggest that limited supply, not inadequate demand, likely presents the key bottleneck to reaching high COVID-19 vaccine coverage in Sub-Saharan Africa.
    Keywords: Educational Sciences,Public Health Promotion,Early Child and Children's Health,Reproductive Health,Immunizations,Disease Control&Prevention,Labor&Employment Law,Financial Sector Policy
    Date: 2021–07–28
  25. By: Ferreira,Francisco H. G.; Sterck,Olivier Christian Brigitte; Mahler,Daniel Gerszon; Decerf,Benoit Marie A
    Abstract: The COVID-19 pandemic has brought about massive declines in well-being around the world. This paper seeks to quantify and compare two important components of those losses—increased mortality and higher poverty—using years of human life as a common metric. The paper estimates that almost 20 million life-years were lost to COVID-19 by December 2020. Over the same period and by the most conservative definition, more than 120 million additional years were spent in poverty because of the pandemic. The mortality burden, whether estimated in lives or years of life lost, increases sharply with gross domestic product per capita. By contrast, the poverty burden declines with per capita national income when a constant absolute poverty line is used, or is uncorrelated with national income when a more relative approach is taken to poverty lines. In both cases, the poverty burden of the pandemic, relative to the mortality burden, is much higher for poor countries. The distribution of aggregate welfare losses—combining mortality and poverty and expressed in terms of life-years —depends on the choice of poverty line(s) and the relative weights placed on mortality and poverty. With a constant absolute poverty line and a relatively low welfare weight on mortality, poorer countries are found to bear a greater welfare loss from the pandemic. When poverty lines are set differently for poor, middle-income, and high-income countries and/or a greater welfare weight is placed on mortality, upper-middle-income and rich countries suffer the most.
    Keywords: Inequality,Law and Justice Institutions,Population&Development,Health Care Services Industry
    Date: 2021–05–24
  26. By: Badi H. Baltagi (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Ying Deng (School of International Trade and Economics, University of International Business and Economics, No. 10 Huixin East Street, Chaoyang District, Beijing 100029, China); Jing Li (School of Economics, Singapore Management University, 90 Stamford Road, Singapore 178903); Zhenlin Yang (School of Economics, Singapore Management University, 90 Stamford Road, Singapore 178903)
    Abstract: This paper studies the impact of urban density, city government efficiency, and medical resources on COVID-19 infection and death outcomes in China. We adopt a simultaneous spatial dynamic panel data model to account for (i) the simultaneity of infection and death outcomes, (ii) the spatial pattern of the transmission, (iii) the inter-temporal dynamics of the disease, and (iv) the unobserved city- and time-specific effects. We find that, while population density increases the level of infections, government efficiency significantly mitigates the negative impact of urban density. We also find that the availability of medical resources improves public health outcomes conditional on lagged infections. Moreover, there exists significant heterogeneity at different phases of the epidemiological cycle.
    Keywords: COVID-19, Urban Density, Government Efficiency Cities
    JEL: R1 R5 I18
    Date: 2022–10
  27. By: De Paz Nieves,Carmen; Gaddis,Isis; Muller,Miriam
    Abstract: One year into the COVID-19 pandemic, this paper takes stock of new data and analysis to provide an up-to date picture of how women and men have been affected differently in terms of endowments, economic conditions, and agency. With regards to health outcomes, men have suffered a disproportionate burden of COVID-19 mortality, and more men than women were diagnosed with COVID-19. On the other hand, the disruptions in service provision have worsened reproductive health outcomes in several countries. In terms of education, data is scarce but there is no evidence for the hypothesis that families redirected scarce resources to prioritize education of boys over girls. However, girls report having taken on the additional care burden to a larger extent than boys, with potential impacts on their learning time. In terms of labor market consequences, women were more likely than men to stop working and have borne the brunt of the increase in the demand for care work. Businesses with female top managers have also experienced disproportionately more negative impacts. Finally, with respect to voice and agency, the risk of violence has increased for women and girls, especially intimate partner violence. In addition, women have been under-represented in decision-making on COVID-19 and, in some contexts, disadvantaged in access to critical information. The paper concludes with highlighting the importance of collecting sex-disaggregated data to understand the gender-differentiated impacts of the pandemic.
    Keywords: Gender and Development,Health Care Services Industry,Educational Sciences,Labor Markets
    Date: 2021–06–22
  28. By: Lepinteur, Anthony; Clark, Andrew E.; Ferrer-i-Carbonell, Ada; Piper, Alan; Schröder, Carsten; D’Ambrosio, Conchita
    Abstract: We analyse a measure of loneliness from a representative sample of German individuals interviewed in both 2017 and at the beginning of the COVID-19 pandemic in 2020. Both men and women felt lonelier during the COVID-19 pandemic than they did in 2017. The pandemic more than doubled the gender loneliness gap: women were lonelier than men in 2017, and the 2017-2020 rise in loneliness was far larger for women. This rise is mirrored in life-satisfaction scores. Men’s life satisfaction changed only little between 2017 and 2020; yet that of women fell dramatically, and sufficiently so to produce a female penalty in life satisfaction. We estimate that almost all of this female penalty is explained by the disproportionate rise in loneliness for women during the COVID-19 pandemic.
    Keywords: Loneliness, Life Satisfaction, Gender, COVID-19, SOEP
    Date: 2022–10

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