nep-hea New Economics Papers
on Health Economics
Issue of 2023‒01‒02
twenty papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Disability Insurance Screening and Worker Outcomes By Alexander Ahammer; Analisa Packham
  2. Financial Regret at Older Ages and Longevity Awareness By Abigail Hurwitz; Olivia S. Mitchell
  3. Prescription Opioids and Economic Hardship in France By Natali, Ilaria; Dewatripont, Mathias; Ginsburgh, Victor; Goldman, Michel; Legros, Patrick
  4. Online Reviews and Hospital Choices By Ian McCarthy; Kaylyn Sanbower; Leonardo Sánchez Aragón
  5. Maternal Dengue and Health Outcomes of Children By Martin Foureaux Koppensteiner; Lívia Menezes
  6. Evaluating the US pharmaceutical patent policy By Izhak, Olena; Saxell, Tanja; Takalo, Tuomas
  7. Neuroticism and Sport: How Personality affects Lifestyle in the UK By Rowan Cherodian; Adelina Gschwandtner; Sarah L. Jewell; Uma Kambhampati
  8. Are South African Medical Schemes Efficient? A Longitudinal Analysis By Ndlovu, Thabang
  9. Market Structure, Efficiency and Performance: Empirical evidence from South Africa’s Healthcare Insurer Market. By Ndlovu, Thabang
  10. Quantifying Excess Mortality Among Non COVID-19 Patients in Healthcare Settings By Fetzer, T.; Rauh, C.
  11. COVID19: Erroneous Modelling and Its Policy Implications By Yinon Bar-On; Tatiana Baron; Ofer Cornfeld; Ron Milo; Eran Yashiv
  12. Health literacy and the voluntary adoption of the new normal in COVID-19: The case of Japan By Cheng, John W.; Mitomo, Hitoshi; Kamplean, Artima; Seo, Yongkyoung
  13. Revenge of the experts: will COVID-19 renew or diminish public trust in science? By Eichengreen, Barry; Aksoy, Cevat Giray; Saka, Orkun
  14. An Analytical Model of Covid-19 Lockdowns By Łukasz Rachel
  15. Drivers of COVID-19 deaths in the United States: A two-stage modeling approach By Andrés Garcia-Suaza; Miguel Henry; Jesús Otero; Kit Baum
  16. Teleworking and Life Satisfaction during COVID-19: The Importance of Family Structure By Claudia Senik; Andrew E. Clark; Conchita d'Ambrosio; Anthony Lepinteur; Carsten Schröder
  17. Urban Exodus? Understanding Human Mobility in Britain During the COVID-19 Pandemic Using Facebook Data By Rowe, Francisco; Calafiore, Alessia; Arribas-Bel, Dani; Samardzhiev, Krasen; Fleischmann, Martin
  18. "Have Low Emission Zones slowed urban traffic recovery after Covid-19?". By Daniel Albalate; Xavier Fageda
  19. Sectoral Mobility during the COVID-19 Pandemic By Catherine Cox; Osborne Jackson
  20. Gender differences on the labor market transitions during the COVID-19 pandemic in Spain. The role of teleworking. By Maite Blázquez; Ainhoa Herrarte; Ana I. Moro Egido

  1. By: Alexander Ahammer (Johannes Kepler University Linz); Analisa Packham (Vanderbilt University and NBER)
    Abstract: We estimate the returns to more targeted disability insurance (DI) programs in terms of labor force participation and worker health. To do so, we analyze male workers after an acute workplace injury that experience differential levels of application screening. We find that when workers face tighter screening requirements, they are less likely to claim disability and are more likely to remain in the labor force. We observe no differences in any physical or mental health outcomes, including reinjury. Our findings imply that imposing stricter DI screening requirements has large fiscal benefits but does not yield any detectable health costs, on the margin.
    Keywords: disability insurance, retirement, health
    JEL: I38 I18 J18 J16
    Date: 2022–10
  2. By: Abigail Hurwitz; Olivia S. Mitchell
    Abstract: Older people often express regret about financial decisions made earlier in life that left them susceptible to old-age insecurity. Prior work has explored one outcome, saving regret, or peoples’ expressed wish that they had saved more earlier in life. The present paper extends attention to five additional areas regarding financial decisions, examining whether older Americans also regret not having insured better, claimed benefits and quit working too early, and becoming financially dependent on others. Using a controlled randomized experiment conducted on 1,764 respondents age 50+ in the Health and Retirement Study, we show that providing people objective longevity information does alter their self-reported financial regret. Specifically, giving people information about objective survival probabilities more than doubled regret expressed about not having purchased long term care, and it also boosted their regret by 2.4 times for not having purchased lifetime income. We conclude that information provision can be a potent, as well as cost-effective, method of alerting people to retirement risk.
    JEL: D14 D15 D83 G22 G41 G51
    Date: 2022–11
  3. By: Natali, Ilaria; Dewatripont, Mathias; Ginsburgh, Victor; Goldman, Michel; Legros, Patrick
    Abstract: This paper studies how opioid analgesic sales are empirically related to socioeconomic disparities in France, with a focus on poverty. This analysis is made possible using the OpenHealth database, which provides retail sales data for opioid analgesics available on the French market. We exploit firm-level data for each of the 94 departments in Metropolitan France between 2008 and 2017. We show that increases in the poverty rate are associated with increases in sales: a one percentage point increase in poverty is associated with approximately a five percent increase in mild opioid sales. Our analysis further shows that opioid sales are positively related to the share of middle-aged people and individuals with basic education only, while they are negatively related to population density. The granularity and longitudinal nature of these data allow us to control for a large pool of potential confounding factors. Our results suggest that additional interventions should be more intensively addressed towards the most deprived areas. We conclude that a combination of policies aimed at improving economic prospects and strictly monitoring access to opioid medications would be beneficial for reducing opioid-related harm.
    Date: 2022–12–06
  4. By: Ian McCarthy (U.S. Department of Justice); Kaylyn Sanbower (U.S. Department of Justice); Leonardo Sánchez Aragón (U.S. Department of Justice)
    Abstract: Information problems in health care and the multifaceted nature of hospital quality complicate hospital choice. Online reviews provide an accessible, salient means through which researchers and health care decision-makers can gather information about a hospital’s quality of care, and given their increasing popularity, these measures may affect hospital choice and may have implications for hospital prices. Using the universe of hospital Yelp reviews and inpatient claims data for elective procedures in Florida from 2012 through 2017, we exploit exogenous variation in online hospital ratings over time to identify the effect of online reviews on hospital choice. We find that among admissions for elective, inpatient procedures, patients are willing to travel between 5 and 30 percent further to receive care from a hospital with a higher Yelp rating, relative to other hospitals in the market. We also find evidence that higher ratings translate into higher commercial payments from insurers, albeit with relatively modest magnitudes. Our results indicate that novel, accessible sources of quality information have the potential to affect health care decisions, with potential downstream effects on health care prices.
    Date: 2022–12
  5. By: Martin Foureaux Koppensteiner (University of Surrey); Lívia Menezes (University of Birmingham)
    Abstract: We study the effect of maternal dengue infections on birth outcomes using linked administrative records from Brazil estimating maternal fixed-effect specifications. In contrast to previous studies, we find robust evidence for the negative effect of dengue infections on birth weight (BW). The effect is particularly pronounced at lower parts of the BW distribution, with an increase of 15%, 67%, and 133% for low, very low, and extremely low BW, respectively. Maternal dengue also has negative health consequences beyond birth outcomes; we document large increases in children's hospitalisations and medical expenditures for up to three years after birth.
    JEL: I15 I18 J13
    Date: 2022–12
  6. By: Izhak, Olena; Saxell, Tanja; Takalo, Tuomas
    Abstract: The debate on whether COVID-19 vaccine patents are slowing down the pace of vaccination and the recovery from the crisis has brought the optimal design of pharmaceutical patent policy to the fore. In this paper we evaluate patent policy in the US pharmaceutical industry. We estimate the effect of patent length and scope on generic entry prior to the expiration of new drug patents using two quasi-experimental approaches: one based on changes in patent laws and another on the allocation of patent applications to examiners. We find that extending effective patent length increases generic entry whereas broadening protection reduces it. To assess the welfare effects of patent policy, we match these empirical results with a model of new drug development, generic entry, and patent length and scope. Optimal policy calls for shorter but broader pharmaceutical patents.
    Keywords: Patent policy,pharmaceuticals,generic entry,innovation,imitation
    JEL: I18 K20 L13 O34 O31
    Date: 2021
  7. By: Rowan Cherodian; Adelina Gschwandtner; Sarah L. Jewell; Uma Kambhampati
    Abstract: In recent years, researchers have become increasingly aware of the impact that personality traits have on individual lifestyle decisions, both positive and negative. Using longitudinal data from a large household survey as well as genetic information from the UK, the present study unveils the causal relationship between neuroticism as a personality trait and sports activity. Our results suggest that neuroticism leads individuals to perform less sports activities. While this result is intuitive, our method establishes causality and draws attention to the difficulty of policy in this area. In particular, one of the main ways recommended to help improve neuroticism is exercise but our results indicate that neurotic individuals are less likely to take up sporting activity. In this context, tailoring lifestyle recommendations to personality would significantly improve their results and help increase the efficacy of health policy. This is important to reduce the economic burden of ill health.
    Keywords: Big5 Personality Traits; Neuroticism; Exercise; Lifestyle; Personalized Medical Care
    JEL: I12 I14 I31 C18 D91 Z20
    Date: 2022–12
  8. By: Ndlovu, Thabang
    Abstract: This study assessed the efficiencies of South African private medical schemes for the period 2011 to 2017. There are two types of medical schemes in the private medical scheme sector. First, there are open medical schemes which are legally required to accept any individual who would want to join. Second, there are restricted medical schemes which are attached to a specific group such as an employer, industry or union and these schemes are open only to the members of the association. The study estimated efficiency scores using first, the Data Envelope Analysis (DEA) technique which is a non-parametric procedure that uses linear programming in order to formulate efficient frontiers which envelop all input-output combinations of firms within a sample. Second, the study employed the Stochastic Frontier Analysis (SFA) technique which is an econometric technique which postulates a functional relationship amongst outputs and inputs and thus employs statistical procedures in order to determine parameters for the function. The empirical findings of both the DEA and SFA approaches suggest that open medical schemes tend to be more efficient than restricted medical schemes in terms of technical, scale and pure technical efficiency over the sample period.
    Keywords: Healthcare Insurance, DEA, SFA, Efficiency, Technical Efficiency, Pure Technical Efficiency, Scale Efficiency, South Africa
    JEL: L00 L11 L22
    Date: 2022–11–30
  9. By: Ndlovu, Thabang
    Abstract: This study assessed the relationship between market structure, conduct and performance in the South African healthcare insurer market for the period 2011 to 2017 using data obtained from the Council of Medical Schemes. Three hypotheses were tested: the structure-conduct-performance (SCP) paradigm, the relative market power (RMP) paradigm and the efficient structure (ES) hypothesis. The empirical evidence reveals that both the SCP and ES hypotheses can be rejected in relation to South African medical schemes. The empirical evidence reveals support for differing hypotheses for open and restricted medical schemes. Moreover, the empirical results suggest that the market for restricted medical schemes is highly concentrated and operating under a reduced efficiency level which produces less than desirable outcomes. In regard to open medical schemes, the empirical results reveal strong support for the RMP hypothesis which suggests that open medical schemes with more differentiated product and/or service offerings will achieve higher market share, be in a position to exercise market power and thus able to set higher prices and earn higher profit.
    Keywords: Healthcare Insurance, DEA, Competition, Market Structure, Market Conduct, Market Performance, South Africa
    JEL: L00 L11 L22
    Date: 2022–11–30
  10. By: Fetzer, T.; Rauh, C.
    Abstract: COVID-19 drastically increased demand- and supply pressures faced by healthcare systems. Increased pressures may have negative spillovers into non COVID-19 care which can cause preventable excess deaths among patients seeking medical help for reasons unrelated to COVID-19. This paper finds substantial and robust evidence of such non COVID-19 excess deaths among hospital patients leveraging data from an integrated public healthcare system: the NHS in England. We find that there is at least one additional preventable death among hospital patients seeking medical help for reasons unrelated to COVID-19 for every 30 deaths that can be linked to COVID-19. In aggregate, there were 4,003 such excess deaths during the first twelve months of the pandemic. At the healthcare provider level, the increase in non COVID-19 excess deaths is sharply increasing in COVID-19 induced pressures on hospitals.
    Keywords: congestion effects, COVID-19, excess mortality, externalities, pandemic, public health
    Date: 2022–09–09
  11. By: Yinon Bar-On (Weizmann Institute of Science); Tatiana Baron (Ben Gurion University); Ofer Cornfeld (BFI); Ron Milo (Weizmann Institute of Science); Eran Yashiv (Tel Aviv University; Centre for Macroeconomics (CFM); London School of Economics (LSE); Centre for Economic Policy Research (CEPR))
    Abstract: Research in Economics on COVID19 typically posits an economy subject to a model of epidemiological dynamics. We place this model on the foundations of an epidemiological analysis of the SARS-CoV-2 transmission timescales. We formulate a full model with both epidemiologically based and clinically based parameterization. Doing so, we are able to study the dynamic properties of the epidemic. We show that there is often serious mis-specification of the model, erroneously characterizing a relatively slow-moving disease, thereby distorting the policymaker decisions. This leads to a higher death toll and potentially also to higher loss of output.
    Keywords: epidemiological dynamics, COVID19, transmission timescales, optimal policy, public health, disease dynamics and scale, misspecification
    JEL: H12 I12 I18 J17
    Date: 2020–12
  12. By: Cheng, John W.; Mitomo, Hitoshi; Kamplean, Artima; Seo, Yongkyoung
    Abstract: This study quantitatively examines factors behind the Japanese public's high voluntary compliance with the government's 'new normal' advice during COVID-19 from both sociocultural and health communication perspectives. Using survey data collected from 3,100 adults in Japan in October 2021, it is found that social coercion increases people's willingness to comply with government advice while belief in COVID-19 conspiracy theories has the opposite effect. In parallel, it is found that perceived efficacy of the new normal practices also increases the willingness to comply with government advice, and the effect is strengthened by health literacy.
    Date: 2022
  13. By: Eichengreen, Barry; Aksoy, Cevat Giray; Saka, Orkun
    Abstract: It is sometimes said that an effect of the COVID-19 pandemic will be heightened appreciation of the importance of scientific research and expertise. We test this hypothesis by examining how exposure to previous epidemics affected trust in science and scientists. Building on the “impressionable years hypothesis” that attitudes are durably formed during the ages 18–25, we focus on individuals exposed to epidemics in their country of residence at this particular stage of the life course. Combining data from a 2018 Wellcome Trust survey of more than 75,000 individuals in 138 countries with data on global epidemics since 1970, we show that such exposure has no impact on views of science as an endeavor but that it significantly reduces trust in scientists and in the benefits of their work. We also illustrate that the decline in trust is driven by the individuals with little previous training in science subjects. Finally, our evidence suggests that epidemic-induced distrust translates into lower compliance with health-related policies in the form of negative views towards vaccines and lower rates of child vaccination.
    Keywords: epidemics; impressionable years; scientists; trust; coronavirus; Covid-19
    JEL: D83 F50 I19
    Date: 2021–01–01
  14. By: Łukasz Rachel (Bank of England; London School of Economics (LSE))
    Abstract: This paper develops an analytical framework for studying risk mitigation behaviors and policies during an epidemic. The analytics uncover two novel insights. First, individual precautionary behavior dramatically flattens the epidemic curve, so much so that the infection externality leads to too much, not too little, social distancing in equilibrium. Second, the optimal policy does not flatten the curve per se; instead it avoids the second wave of infections and prevents the epidemic overshoot, minimizing cumulative deaths. The optimal policy is almost entirely independent of the economic parameters such as the value of statistical life.
    JEL: E1 I1 H0
    Date: 2020–12
  15. By: Andrés Garcia-Suaza (University del Rosario); Miguel Henry (Greylock McKinnon Associates); Jesús Otero (University del Rosario); Kit Baum (Boston College)
    Abstract: We offer a two-stage (time-series and cross-section) econometric modeling approach to examine the drivers behind the spread of COVID-19 deaths across counties in the United States. Our empirical strategy exploits the availability of two years (January 2020 through January 2022) of daily data on the number of confirmed deaths and cases of COVID-19 in the 3,000 U.S. counties of the 48 contiguous states and the District of Columbia. In the first stage of the analysis, we use daily time-series data on COVID-19 cases and deaths to fit mixed models of deaths against lagged confirmed cases for each county. Because the resulting coefficients are county specific, they relax the homogeneity assumption that is implicit when the analysis is performed using geographically aggregated cross-section units. In the second stage of the analysis, we assume that these county estimates are a function of economic and sociodemographic factors that are taken as fixed over the course of the pandemic. Here we employ the novel one-covariate-at-atime variable-selection algorithm proposed by Chudik et al. (2018) to guide the choice of regressors.
    Date: 2022–11–30
  16. By: Claudia Senik (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, SU - Sorbonne Université); Andrew E. Clark (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); Conchita d'Ambrosio ( - Université du Luxembourg); Anthony Lepinteur ( - Université du Luxembourg); Carsten Schröder (DIW Berlin - Deutsches Institut für Wirtschaftsforschung)
    Abstract: We carry out a difference-indifferences analysis of a representative real-time survey conducted as part of the German SocioEconomic Panel (SOEP) study and show that teleworking had a negative average effect on life satisfaction over the first two years of the COVID-19 pandemic. This average effect hides considerable heterogeneity reflecting genderrole asymmetry: lower life satisfaction is only found for unmarried men and women with school-age children. The negative effect for women with school-age children disappears in 2021, suggesting adaptation to new constraints and/or the adoption of coping strategies.
    Keywords: Life Satisfaction,Teleworking,Work from Home,Gender,Childcare,COVID-19,SOEP
    Date: 2022–11
  17. By: Rowe, Francisco (University of Liverpool); Calafiore, Alessia (University of Liverpool); Arribas-Bel, Dani; Samardzhiev, Krasen; Fleischmann, Martin
    Abstract: Existing empirical work has focused on assessing the effectiveness of non-pharmaceutical interventions on human mobility to contain the spread of COVID-19. Less is known about the ways in which the COVID-19 pandemic has reshaped the spatial patterns of population movement within countries. Anecdotal evidence of an urban exodus from large cities to rural areas emerged during early phases of the pan- demic across western societies. Yet, these claims have not been empirically assessed. Traditional data sources, such as censuses offer coarse temporal frequency to analyse population movement over short-time intervals. Drawing on a data set of 21 million observations from Facebook users, we aim to analyse the extent and evolution of changes in the spatial patterns of population movement across the rural-urban continuum in Britain over an 18-month period from March, 2020 to August, 2021. Our findings show an overall and sustained decline in population movement during periods of high stringency measures, with the most densely populated areas reporting the largest reductions. During these periods, we also find evidence of higher-than-average mobility from highly dense population areas to low densely populated areas, lending some support to claims of large-scale population movements from large cities. Yet, we show that these trends were temporary. Overall mobility levels trended back to pre-coronavirus levels after the easing of non-pharmaceutical interventions. Following these interventions, we also found a reduction in movement to low density areas and a rise in mobility to high density agglomerations. Overall, these findings reveal that while COVID-19 generated shock waves leading to temporary changes in the patterns of population movement in Britain, the resulting vibrations have not significantly reshaped the prevalent structures in the national pattern of population movement.
    Date: 2022–06–03
  18. By: Daniel Albalate ((GiM-IREA). Observatori d’Anàlisi i Avaluació de Polítiques Públiques. Facultat d’Economia i Empresa. Universitat de Barcelona. Departament d’Econometria Estadística i Economia Aplicada. Secció Polítiques públiques. John Maynard Keynes 1-11, Torre 6, planta 3. 08034 Barcelona. Tel: +34.493031131); Xavier Fageda ((GiM-IREA). Observatori d’Anàlisi i Avaluació de Polítiques Públiques. Facultat d’Economia i Empresa. Universitat de Barcelona. Departament d’Econometria Estadística i Economia Aplicada. Secció Polítiques públiques. John Maynard Keynes 1-11, Torre 6, planta 3. 08034 Barcelona. +34.93.4039721)
    Abstract: This paper provides a bridge between the literature on the effects of the pandemic on mobility and the literature on low emission zones (LEZ) impacts. Using data for large European cities in the period 2018-2021, we examine whether LEZ may explain differences in the recovery patterns of traffic in European cities after the covid shock. Controlling for several city attributes, we examine whether LEZ cities are less congested before and after the pandemic in comparison to non-LEZ cities. Our hypothesis is that LEZ may have been more effective in reducing congestion after the pandemics because the fleet renewal process has slowed down. Our results validate the traffic mitigating role of LEZ, which is robust to the lasting effects of Covid-19.
    Keywords: Low Emission Zones, Congestion, Traffic, Access restrictions, Sustainability, Cities. JEL classification: R41, R11, R52.
    Date: 2022–12
  19. By: Catherine Cox; Osborne Jackson
    Abstract: This study uses the longitudinal design of the US Current Population Survey to describe sectoral mobility trends for workers before and after the emergence of COVID-19. We find a small increase in the 15-month rate of workers who switched industries following the onset of the pandemic, likely driven by workers who did not have an unemployment stint following job separation. However, larger changes in sectoral mobility during this time are evident when we examine differences across regions, industries, and individuals who are stratified by characteristics such as sex, age, or education. These results suggest that while the COVID-19 pandemic is not associated with a large aggregate change in sectoral mobility, more considerable disaggregated patterns can be found across markets and people.
    Keywords: sectoral mobility; COVID-19; pandemic; Current Population Survey
    JEL: J63 J24 I18
    Date: 2022–12–07
  20. By: Maite Blázquez (Universidad Autonoma de Madrid.); Ainhoa Herrarte (Universidad Autonoma de Madrid.); Ana I. Moro Egido (Department of Economic Theory and Economic History, University of Granada.)
    Abstract: This paper analyzes gender differences as regards the effect of the COVID-19 pandemic on the labor transitions from employment to unemployment, inactivity and furloughs schemes, and the role that teleworking may have had as a protector of job loss in Spain. Based on more than 2,000 types of jobs, we propose an Evidence-Based Teleworking Index that considers the intensity of telework use in a given job, but also reflects the actual ability of firms to adapt to telework. By means of multinomial probit models with sample selection, our results show that the job loss suffered by women during the pandemic has been greater than that experienced by men. The findings confirm that the ability to telework has been a potential cushion against employment losses, but the effect has been mainly driven by males. The shielding effects of telework have been especially relevant in reducing the transitions from employment to ERTEs, while the power of telework to protect against unemployment and inactivity seems to be insignificant, even during the pandemic.
    Keywords: COVID-19, teleworking, working from home, job loss, gender gap, labor market transitions.
    JEL: J64 J21 J22 J71
    Date: 2022–12–08

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