|
on Health Economics |
| By: | Hunt Allcott; Daniel Cohen; William Morrison; Dmitry Taubinsky |
| Abstract: | Policymakers are increasingly interested in non-standard policy instruments (NPIs), or “nudges,” such as simplified information disclosure and warning labels. We characterize the welfare effects of NPIs using public finance sufficient statistic approaches, allowing for endogenous prices, market power, and optimal or suboptimal taxes. While many empirical evaluations have focused on whether NPIs increase ostensibly beneficial behaviors on average, we show that this can be a poor guide to welfare. Welfare also depends on whether the NPI reduces the variance of distortions from heterogenous biases and externalities, and the average effect becomes irrelevant with zero pass-through or optimal taxes. We apply our framework to randomized experiments evaluating automotive fuel economy labels and sugary drink health labels. In both experiments, the labels increase ostensibly beneficial behaviors but also may decrease welfare in our model, because they increase the variance of distortions. |
| JEL: | D90 H0 |
| Date: | 2022–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30740&r=hea |
| By: | Kennedy-Moulton, Kate (Columbia University); Miller, Sarah (University of Michigan); Persson, Petra (Stanford University); Rossin-Slater, Maya (Stanford University); Wherry, Laura R. (New York University); Aldana, Gloria (US Census Bureau) |
| Abstract: | We use linked administrative data on the universe of California births to provide novel evidence on economic inequality in infant and maternal health. Infants and mothers at the top of the income distribution have worse birth and morbidity outcomes than their lowest-income counterparts, but are nevertheless the least likely to die in the year following birth. Racial disparities swamp these income disparities, with no racial convergence in health outcomes as income rises. A comparison with Sweden shows that infant and maternal health is worse in California at virtually all income levels. |
| Keywords: | maternal and infant health, health disparities, administrative data |
| JEL: | I14 |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15745&r=hea |
| By: | Madia, Joan Eliel; Präg, Patrick; Monden, Christiaan Willem Simon (University of Oxford) |
| Abstract: | Parents of better-educated children are healthier and live longer. Is this a non-monetary return to education which crosses generational boundaries, or is this the consequence of unobserved factors (e.g. shared genes or living conditions) driving both children’s education and parental health? Using data from the English Longitudinal Study of Aging (ELSA) and two educational reforms that raised the mandatory school-leaving age from age 14 to 15 years in 1947 and from age 15 to 16 years in 1972, we investigate the causal effect of children’s education on parental longevity. Results suggest that both one-year increases in school-leaving age significantly reduced the hazard of dying for fathers as well as for mothers. We do not find a consistent pattern when comparing differences in the effects of daughters’ and sons’ education. Lower class parents benefitted more from the 1972 reform than higher class parents. We discuss these results against the backdrop of generational conflict and the specific English context. |
| Date: | 2022–12–06 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:9n8q5&r=hea |
| By: | Gunes, Pinar Mine (University of Alberta); Tsaneva, Magda (Clark University) |
| Abstract: | This paper examines the effect of Brazil's Family Health Program (Programa Saude da Familia, FHP) on cognitive skills of fifth-grade students. We use biennial data from national exams between 2007 and 2015, and variation in the FHP implementation date across municipalities, birth cohort, and test year to identify the effect of the program on language and mathematics test scores. We find that, in northern municipalities, students exposed to FHP at or prior to birth have 0.88 points higher language and 1.30 points higher mathematics test scores compared to those exposed to FHP in childhood. The estimated effects are intent-to-treat effects and correspond to increases of 0.021sd and 0.030sd in language and mathematics test scores. We use an event-study analysis demonstrating that the largest effects of FHP on cognitive skills are for those students exposed at or prior to birth, with trivial effects if exposed after birth. We do not find evidence for changes in parental investment behavior or child school attendance, which suggests that the effects are likely due to the direct impact of the program on child cognitive development. |
| Keywords: | early life interventions, cognitive skills, community healthcare, Brazil |
| JEL: | I15 I18 I21 |
| Date: | 2022–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15784&r=hea |
| By: | Joan Costa-Font (London Scool of Economics, IZA and CESifo); Sarah Flèche (CNRS-Sorbonne Economics Centre, University Paris1 Pantheon-Sorbonne and CEP, London School of Economics); Ricardo Pagan (University of Malaga) |
| Abstract: | The proportion of people sleeping less than the daily-recommended hours has increased. Yet, we know little about the labour market returns to sleep. We use longitudinal data from Germany and exploit exogenous variation in sleep duration induced by time and local variations in sunset time. We find that a 1-hour increase in weekly sleep increases employment by 1.6 percentage points and weekly earnings by 3.4%. Most of this earnings effect comes from productivity improvements, while the number of working hours decreases with sleep time. We identify one mechanism driving these effects, namely the better mental health workers experience from sleeping more hours |
| Keywords: | sleep; employment; productivity; mental health; sunset times |
| JEL: | I18 J12 J13 |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:mse:cesdoc:22023&r=hea |
| By: | Alex Hollingsworth; Krzysztof Karbownik; Melissa A. Thomasson; Anthony Wray |
| Abstract: | The past century witnessed a dramatic improvement in public health, the rise of modern medicine, and the transformation of the hospital from a fringe institution to one essential to the practice of medicine. Despite the central role of medicine in contemporary society, little is known about how hospitals and modern medicine contributed to this health transition. In this paper, we explore how access to the hospital and modern medicine affects mortality. We do so by leveraging a combination of novel data and a unique quasi-experiment: a large-scale hospital modernization program introduced by The Duke Endowment in the early twentieth century. The Endowment helped communities build and expand hospitals, obtain state-of-the-art medical technology, attract qualified medical personnel, and refine management practices. We find that access to a Duke-supported hospital reduced infant mortality by 10%, saving one life for every $20,000 (2017 dollars) spent. Effects were larger for Black infants (16%) than for White infants (7%), implying a reduction in the Black-White infant mortality gap by one-third. We show that the effect of Duke support persisted into later life with a 9% reduction in mortality between the ages of 56 and 65. We further provide evidence on the mechanisms that enabled these effects, finding that Endowment-supported hospitals attracted higher-quality physicians and were better able to take advantage of new medical innovations. |
| Keywords: | modern medicine, hospitals, mortality, infant health, hospital funding, physician labor supply, medical innovation, health care complementarities, charitable giving |
| JEL: | J13 N32 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10097&r=hea |
| By: | Neidell, Matthew; Graff Zivin, Joshua; Sheahan, Megan; Willwerth, Jacqueline; Fant, Charles; Sarofim, Marcus; Martinich, Jeremy |
| Abstract: | Workers in climate exposed industries such as agriculture, construction, and manufacturing face increased health risks of working on high temperature days and may make decisions to reduce work on high-heat days to mitigate this risk. Utilizing the American Time Use Survey (ATUS) for the period 2003 through 2018 and historical weather data, we model the relationship between daily temperature and time allocation, focusing on hours worked by high-risk laborers. The results indicate that labor allocation decisions are context specific and likely driven by supply-side factors. We do not find a significant relationship between temperature and hours worked during the Great Recession (2008-2014), perhaps due to high competition for employment, however during periods of economic growth (2003-2007, 2015-2018) we find a significant reduction in hours worked on high-heat days. During periods of economic growth, for every degree above 90 on a particular day, the average high-risk worker reduces their time devoted to work by about 2.6 minutes relative to a 90-degree day. This effect is expected to intensify in the future as temperatures rise. Applying the modeled relationships to climate projections through the end of century, we find that annual lost wages resulting from decreased time spent working on days over 90 degrees across the United States range from $36.7 to $80.0 billion in 2090 under intermediate and high emission futures, respectively. |
| Keywords: | Humans, Models, Economic, Climate, Agriculture, Employment, Salaries and Fringe Benefits, United States, Hot Temperature, Basic Behavioral and Social Science, Behavioral and Social Science, Climate Action, Decent Work and Economic Growth, General Science & Technology |
| Date: | 2021–01–01 |
| URL: | http://d.repec.org/n?u=RePEc:cdl:ucsdec:qt8031v4f4&r=hea |
| By: | Borbely, Daniel (University of Dundee); Lenhart, Otto (University of Strathclyde); Norris, Jonathan (University of Strathclyde); Romiti, Agnese (University of Strathclyde) |
| Abstract: | This study examines the effects of U.S. state-level marijuana policies on mental health. Using data from three nationally representative data sets and estimating difference-in-differences models that account for the staggered implementation of both medical and recreational marijuana legislation, we evaluate the impact on marijuana use as well as two measures of mental distress. We show that marijuana laws have positive effects on marijuana use, but find no evidence for any effect on mental health on average. Nonetheless, null aggregate effects mask sharp heterogeneities across the age distribution. Our findings show that elderly individuals (age 60 and older) benefit from medical marijuana legalization in terms of better mental health, whereas legalizing recreational marijuana produces negative mental health effects for younger individuals (below age 35). The effects of medical marijuana legislation are driven by elderly people with pre-existing chronic health conditions, whereas those of recreational marijuana legislation are driven by younger and relatively healthy individuals. Furthermore, results are stronger for women than for men. |
| Keywords: | marijuana legalization, recreational marijuana, medical marijuana, mental health |
| JEL: | I18 I10 K32 |
| Date: | 2022–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15803&r=hea |
| By: | Nguyen, Ha Trong; Le, Huong Thu; Connelly, Luke; Mitrou, Francis |
| Abstract: | Studies on health insurance coverage often rely on measures self-reported by respondents, but the accuracy of such measures has not been thoroughly validated. This paper is the first to use linked Australian National Health Survey and administrative population tax data to explore the accuracy of self-reported private health insurance (PHI) coverage in survey data. We find that 9% of individuals misreport their PHI coverage status, with 5% of true PHI holders reporting that they are uninsured and 16% of true non-insured persons self-identifying as insured. Our results show reporting errors are systematically correlated with individual and household characteristics. Our evidence on the determinants of errors is supportive of common reasons for misreporting. We directly investigate biases in the determinants of PHI enrolment using survey data. We find that, as compared to administrative data, survey data depict a quantitatively different picture of PHI enrolment determinants, especially those capturing age, language proficiency, labour force status or the number of children. We also show that PHI coverage misreporting is subsequently associated with misreporting of reasons for purchasing PHI, type of cover and length of cover. |
| Keywords: | Health Insurance, Measurement Error, Administrative Data, Survey Misreporting, Linked Data, Australia |
| JEL: | C81 I13 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1215&r=hea |
| By: | Alberto Cavaliere (University of Pavia); Ashin Moayedizadeh (University of Pavia) |
| Abstract: | This paper explores different aspects of competition in the U.S. pharmaceutical industry in order to broaden our insight into price competition in the pharmaceutical market. The main focus is on the effects of patent expiry and generic entry on the brand and generic name drug prices. Using an unbalanced panel dataset of 19 branded and corresponding generic drugs, which faced their first generic entry between 2010 and 2014, we discovered that the Generic Competition Paradox does not arise according to the results obtained with our dataset. Though prices of brand-name drugs are continuously rising, each new generic entrant is associated with an average 2.6 percent decrease in the brand-name drug price. Moreover, the empirical findings in this study fully support the idea of market segmentation based on insurance coverage. We can state that after generic entry, the originator firms appear to demand higher prices in order to exercise price discrimination and exploit the market segment that is less price sensitive. |
| Keywords: | Pharmaceutical industry, Generic entry, Brand drug price, Generic Competition Paradox, Market segmentation theory |
| JEL: | I11 L11 L65 D4 |
| Date: | 2022–12 |
| URL: | http://d.repec.org/n?u=RePEc:pav:demwpp:demwp0209&r=hea |
| By: | Ayşe İmrohoroğlu (University of Southern California); Kai Zhao (University of Connecticut) |
| Abstract: | This paper examines the effectiveness of several policies in reducing the aggregate share of homeless in a dynamic general equilibrium model. The model economy is calibrated to capture the most at-risk groups and generates a diverse population of homeless with a significant fraction becoming homeless for short spells due to labor market shocks and a smaller fraction experiencing chronic homelessness due to health shocks. Our policy experiments show housing subsidies to be more effective in reducing the aggregate homeless share, mostly by helping those with short spells, than non-housing policies. For the chronically homeless population, a means-tested expansion of disability income proves to be effective. We also find that some policies that result in higher exit rates from homelessness, such as relaxation of borrowing constraints, help the currently homeless population but lead to a larger homeless share at the steady state by increasing the entry rate. |
| Keywords: | Inequality, Housing, Income Shock, Health Shock, General Equilibrium |
| JEL: | E20 H20 |
| Date: | 2022–12 |
| URL: | http://d.repec.org/n?u=RePEc:uct:uconnp:2022-17&r=hea |
| By: | NISHITATENO Shuhei |
| Abstract: | During the early 2000s, five prefectures in Japan introduced a Low Emission Zone (LEZ) policy that banned highly polluting diesel trucks and buses from entering. This paper analyzes effects of this policy intervention on air quality, new vehicle registrations, and birthweights. To do so we use a matching approach to construct a control group that is comparable to the designated areas in terms of pollution levels and road traffic volumes of regulated vehicles and apply a difference-in-differences (DD) design. We find that the LEZs led to a reduction in hourly suspended particulate matter concentrations and to reduced incidence of low birthweights in the treated prefectures relative to the control group, holding the gestational period and other controls constant. Evidence also suggests that the LEZs led to an increase in new registrations of trucks and buses, but not of passenger cars, which were exempt from the regulations. Our paper is the first to study such a large-scale LEZ intervention and to provide evidence linking LEZs to reduced incidence of low birthweights. |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:eti:dpaper:22109&r=hea |
| By: | Alfano, Marco (Lancaster University); Cornelissen, Thomas (University of Essex) |
| Abstract: | Due to economic interconnectedness across regions, locally confined violent conflict may have welfare effects far beyond directly affected areas. This paper focuses on Somalia's al-Shabaab insurgency and investigates whether the food transportation network propagates the effects of violent conflict to distant locations. Combining granular geospatial information on agricultural areas, roads, and itineraries, we show that conflict along transportation routes significantly increases food prices at markets located hundreds of kilometers away. Standardized estimates amount to up to half the magnitude of the effect of rainfall. Negative effects of conflict on road traffic as measured by satellite images of light emissions point towards decreases in food transportation. Moreover, conflict decreases food security, nutrition, health, and education for households living in far-away market areas. This suggests that food prices act as a propagating mechanism that links – among others – human capital to far-away conflict. Back-of-the-envelope calculations suggest that spatial spillovers add an additional 30% to the welfare cost of local conflict. |
| Keywords: | conflict, spillover effects, food security, health, education |
| JEL: | D74 I15 I25 Q18 |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15761&r=hea |
| By: | Last, Briana Shiri; Wuest, Joanna |
| Abstract: | Industry-funded religious liberty litigation groups have sought to undermine healthcare policy and law while simultaneously attacking the rights of sexual and gender minorities. Whereas past scholarship has tracked religiously-affiliated healthcare providers’ growing political power and attendant transformations to legal doctrine, our account emphasizes the political donors and visionaries who have leveraged religious providers and the U.S. healthcare system’s delegated structure to transform social policy and bureaucratic agencies more generally. We collect and analyze industry-funded litigation briefs, track statutory and constitutional developments in federal courts, and employ a historical institutionalist analysis of the U.S. healthcare system. Case studies include: 1) the Affordable Care Act’s implementation, 2) Department of Health and Human Services (HHS) interpretations of its rules and relevant congressional statutes, 3) the professional civil service, and 4) state and federal COVID-19 public health policies. We find that industry-funded religious liberty legal organizations have successfully limited the rights of sexual and gender minorities and access to reproductive healthcare while also curtailing the administrative authority of agencies including HHS. Our case studies highlight the threat that industry-funded religious liberty legal organizations pose for effective healthcare regulation, reproductive healthcare access, and civil rights enforcement for sexual and gender minorities. |
| Date: | 2022–11–28 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:vx5dz&r=hea |
| By: | Florian Dorn; Berit Lange; Martin Braml; David Gstrein; John L.Z. Nyirenda; Patrizio Vanella; Joachim Winter; Clemens Fuest; Gérard Krause |
| Abstract: | Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks. |
| Keywords: | Covid-19, pandemics, health outcomes, disease burden, non-pharmaceutical interventions, economic decline, social distancing, healthcare access, integrated approach |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10085&r=hea |
| By: | Rui Esteves; Kris James Mitchener; Peter Nencka; Melissa A. Thomasson |
| Abstract: | Using newly digitized U.S. city-level data on hospitals, we explore how pandemics alter preferences for healthcare. We find that cities with higher levels of mortality during the Great Influenza of 1918-1919 subsequently expanded hospital capacity by more than cities experiencing less influenza mortality: cities in the top half of the mortality distribution increased their count of hospitals by 8-10 percent in the years after the pandemic. This effect persisted to 1960 and was driven by increases in non-governmental hospitals. Growth responded most in richer cities, exacerbating existing inequalities in access to healthcare. We do not find evidence that government-run hospitals or other types of city-level spending related to healthcare responded to pandemic intensity, suggesting that large health shocks do not necessarily lead to increased public provision of health services. |
| Keywords: | hospitals, healthcare, influenza, pandemics, local public goods |
| JEL: | I11 I14 J10 N32 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10089&r=hea |
| By: | Chauvin, Juan Pablo |
| Abstract: | This paper presents an overview of how health outcomes vary across cities in Latin America and discusses some of the known drivers of this variation. There are large disparities in outcomes across cities and across neighborhoods of the same city. Because health is closely related to the socioeconomic conditions of individuals, part of the spatial variation reflects residential segregation by income. Local characteristics also have a direct effect on health outcomes, shaping individuals' access to health services and the prevalence of unhealthy lifestyles. In addition, urban environments affect health through natural atmospheric conditions, through local infrastructure in particular water, sanitation, and urban transit and through the presence of urban externalities such as traffic congestion, pollution, crime, and the spread of transmissible diseases. The COVID-19 pandemic illustrates many of these patterns, since the impact of the disease has differed sharply across cities, and much of this variation can be explained by observable local characteristics particularly population, connectivity with other cities and countries, income levels, and residential overcrowding. |
| Keywords: | Latin America;COVID-19 |
| JEL: | I18 R10 O18 |
| Date: | 2021–10 |
| URL: | http://d.repec.org/n?u=RePEc:idb:brikps:11663&r=hea |
| By: | Blackman, Allen; Bonilla, Jorge Alexander; Villalobos, Laura |
| Abstract: | In cities around the world, Covid-19 lockdowns have improved outdoor air quality, in some cases dramatically. Even if only temporary, these improvements could have longer-lasting effects on policy by making chronic air pollution more salient and boosting political pressure for change. To that end, it is important to develop objective estimates of both the air quality improvements associated with Covid-19 lockdowns and the benefits these improvements generate. We use panel data econometric models to estimate the effect of Bogotás lockdown on fine particulate pollution, epidemiological models to simulate the effect of reductions in that pollution on long-term and short-term mortality, and benefit transfer methods to estimate the monetary value of the avoided mortality. We find that in its first year of implementation, on average, Bogotás lockdown cut fine particulate pollution by more than one-fifth. However, the magnitude of that effect varied considerably over the course of the year and across the citys neighborhoods. Equivalent permanent reductions in fine particulate pollution would reduce long-term premature deaths by more than one-quarter each year, a benefit valued at $670 million per year. Finally, we estimate that in 2020-2021, the lockdown reduced short-term deaths by 31 percent, a benefit valued at $180 million. |
| Keywords: | Pollution; COVID-19; lockdown; Colombia; panel data; integrated exposure-response model; benefit transfer |
| JEL: | Q51 Q52 Q53 Q56 Q58 I15 |
| Date: | 2021–11 |
| URL: | http://d.repec.org/n?u=RePEc:idb:brikps:11768&r=hea |
| By: | Martin, Thomas (University of Warwick); Sgroi, Daniel (Univertsity of Warwick & IZA Bonn) |
| Abstract: | Does imagining what life could have been in the absence of a shock change current satisfaction? To answer this we collect field data through a survey that covers the period before, during and after the COVID-19 lockdown, exploiting the features of a natural experiment combined with induced variation stemming from a randomized control trial (RCT). Our data covers first year students studying before the COVID-19 pandemic, during the full COVID-19 lockdown period, and during the partial COVID-19 lockdown period. The RCT directs a subset of students to imagine how satisfied they could have been in the absence of COVID-19. The control group are instead asked about their current satisfaction. We find that imagining life in the absence of a shock (COVID-19) can impact current satisfaction : the higher individuals think their satisfaction would have been in the absence of the shock, the lower their current satisfaction. However, the natural experiment component of our study suggests that counterfactual reasoning may mislead. By comparing the satisfaction of COVID-19 students asked to imagine university life without COVID-19, with the reported satisfaction of equivalent students just before the arrival of COVID-19, we show students typically over-exaggerate how satisfied they would have been if a negative shock had not happened. |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:wrk:warwec:1443&r=hea |
| By: | C. Biliotti; F. J. Bargagli-Stoffi; N. Fraccaroli; M. Puliga; M. Riccaboni |
| Abstract: | We study the causal effects of lockdown measures on uncertainty and sentiments on Twitter. By exploiting the quasi-experimental setting induced by the first Western COVID-19 lockdown - the unexpected lockdown implemented in Northern Italy in February 2020 - we measure changes in public uncertainty and sentiment expressed on daily pre and post-lockdown tweets geolocalized inside and in the proximity of the lockdown areas. Using natural language processing, including dictionary-based methods and deep learning models, we classify each tweet across four categories - economics, health, politics and lockdown policy - to identify in which areas uncertainty and sentiments concentrate. Using a Difference-in-Difference analysis, we show that areas under lockdown depict lower uncertainty around the economy and the stay-at-home mandate itself. This surprising result likely stems from an informational asymmetry channel, for which treated individuals adjusts their expectations once the policy is in place, while uncertainty persists around the untreated. However, we also find that the lockdown comes at a cost as political sentiments worsen. |
| Date: | 2022–12 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2212.01705&r=hea |