nep-hea New Economics Papers
on Health Economics
Issue of 2023‒02‒06
seventeen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Impact of Privatization: Evidence from the Hospital Sector By Mark Duggan; Atul Gupta; Emilie Jackson; Zachary S. Templeton
  2. Disability Insurance Screening and Worker Outcomes By Alexander Ahammer; Analisa Packham
  3. Reducing Bullying: Evidence from a Parental Involvement Program on Empathy Education By Flavio Cunha; Qinyou Hu; Yiming Xia; Naibao Zhao
  4. Schools as Safety Nets: Break-Downs and Recovery in Reporting of Violence against Children By Clarke, Damian; Larroulet, Pilar; Pailañir, Daniel; Quintana, Daniela
  5. The effect of reducing welfare access on employment, health, and children's long-run outcomes By Hicks, Jeffrey; Simard-Duplain, Gaëlle; Green, David A.; Warburton, William
  6. Pension Reforms, Longer Working Horizons and Absence from Work By Brunello, Giorgio; De Paola, Maria; Rocco, Lorenzo
  7. International Spillover Effects of Air Pollution: Evidence from Mortality and Health Data By Seonmin Will Heo; Koichiro Ito; Rao Kotamarthi
  8. Health Wearables, Gamification, and Healthful Activity By Muhammad Zia Hydari; Idris Adjerid; Aaron D. Striegel
  9. The Health-Consumption Effects of Increasing Retirement Age Late in the Game By Eve Caroli; Catherine Pollak; Muriel Roger
  10. Water Treatment And Child Mortality: A Meta-Analysis And Cost-effectiveness Analysis By Michael Kremer; Stephen P. Luby; Ricardo Maertens; Brandon Tan; Witold Więcek
  11. Child Gender and Subjective Well-being of Older Parents in China By Lei, Lei; Wu, Fengyu; Xia, Yiming
  12. Digital remote monitoring plus usual care versus usual care in patients treated with oral anticancer agents: the randomized phase 3 CAPRI trial By Olivier Mir; Marie Ferrua; Aude Fourcade; Delphine Mathivon; Adeline Duflot-Boukobza; Sarah Dumont; Eric Baudin; Suzette Delaloge; David Malka; Laurence Albiges; Patricia Pautier; Caroline Robert; David Planchard; Stéphane de Botton; Florian Scotté; François Lemare; May Abbas; Marilène Guillet; Vanessa Puglisi; Mario Di Palma; Etienne Minvielle
  13. Local Conditions of Sexism During Adolescence and Women’s Longer Term Outcomes By Fletcher, Jason
  14. Partial Fertility Recuperation in Spain Two Years After the Onset of the COVID-19 Pandemic By Fallesen, Peter; Cozzani, Marco
  15. Effects of the COVID-19 crisis on household food consumption and child nutrition in Mozambique By Margherita Squarcina; Eva-Maria Egger
  16. What is expected for China's SARS-CoV-2 epidemic? By Carlos Hernandez-Suarez; Efren Murillo-Zamora
  17. How effective are covid-19 vaccine health messages in reducing vaccine skepticism? Heterogeneity in messages effectiveness by just world beliefs By Juliane Wiese; Nattavudh Powdthavee

  1. By: Mark Duggan; Atul Gupta; Emilie Jackson; Zachary S. Templeton
    Abstract: Privatization has been shown to increase growth and profitability of public firms. However, effects on consumers are understudied. We study potential trade-offs in the US hospital sector where public control declined by 42% over 1983–2019. Private operators may improve hospitals’ financial performance, but a focus on profitability may adversely affect access to care for certain patients. Using national data across all hospitals and patients, we study 258 hospital privatizations over the 2000–2018 period. Private operators improve profitability so that hospitals generate a modest surplus, primarily by increasing mean revenue per patient. However, this is partly achieved by differentially reducing the intake of low-income Medicaid patients, who are typically less profitable than other groups due to lower reimbursement rates. While other patients appear to be absorbed by neighboring hospitals, Medicaid patients experience an aggregate decline in utilization at the market-level, which we interpret as a decline in access to care. Hospital privatization therefore partially offsets the benefits of providing publicly funded health insurance through Medicaid, and our estimates imply it is quantitatively important. The aggregate decline in Medicaid volume is detected only in more concentrated hospital markets, suggesting market power is a key driver.
    JEL: H11 I11 I13 I18
    Date: 2023–01
  2. By: Alexander Ahammer; Analisa Packham
    Abstract: We estimate the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze workers after an acute workplace injury that experience differential levels of application screening. We find that when workers face stricter 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. Our findings imply that imposing stricter DI screening 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: 2023–01
  3. By: Flavio Cunha; Qinyou Hu; Yiming Xia; Naibao Zhao
    Abstract: According to UNESCO, one-third of the world’s youths are victims of bullying, which deteriorates academic performance and mental health, and increases suicide ideation and the risk of committing suicide. This paper analyzes a four-month parent-directed intervention designed to foster empathy in middle schoolers in China. Our implementation and evaluation study enrolled 2, 246 seventh and eighth graders and their parents, whom we assigned, at the classroom level, to the control or intervention condition randomly. We measured, before and after the intervention, parental investments, children’s empathy, and self-reported bullying perpetration and victimization incidents. Our analyses show that the intervention increased investments and empathy and reduced bullying incidents. In addition, we measured costs and found that it costs $12.50 for our intervention to reduce one bullying incident. Our study offers a scalable and low-cost strategy that can inform public policy on bullying prevention in other similar settings.
    JEL: I10 I20 J24 O10
    Date: 2023–01
  4. By: Clarke, Damian (University of Chile); Larroulet, Pilar (Pontificia Universidad Catolica de Chile); Pailañir, Daniel (University of Chile); Quintana, Daniela (Central Bank of Chile)
    Abstract: Schools are a key channel in formal reporting of violence against children, but this channel broke down with the onset of the COVID-19 pandemic. We study how widespread such reporting declines are, and to what extent they were recovered once re-openings begin. Examining the universe of all criminal reports of violence against children in Chile, we observe sharp declines in reporting of all types of violence (psychological, physical, and sexual), and that full recovery in reporting had not occurred, even nearly 2 years following initial school closures. Our estimates suggest that school closure and incomplete re-opening resulted in around 2, 800 'missing' reports of intra-family violence against children, 2, 000 missing reports of sexual assault, and 230 missing reports of rape against children, equivalent to between 10-25 weeks of reporting at baseline. In the post-school closure period, we find that greater school attendance encourages faster and more complete recovery in reporting of violence against children, pointing to important non-cognitive costs of both school closure, and school absence.
    Keywords: violence against children, reporting, school closure, school attendance, COVID-19
    JEL: D10 I28 I18 K42
    Date: 2023–01
  5. By: Hicks, Jeffrey; Simard-Duplain, Gaëlle; Green, David A.; Warburton, William
    Abstract: How does welfare affect the prosperity of mothers and their children? We study this question using a Canadian welfare reform and by linking administrative welfare records to tax returns, nearly all medical spending, and children's educational attainment. Eighty percent of mothers in the complier group found employment within a year, and for many, total income rose despite reduced transfers. We find precise zero effects on total health expenditures for both mothers and children. However, composition changes, including fewer family physician visits, indicate that mothers had less time to seek health care. We find precise zero effects on children's test scores and graduation, but modest reductions of intergenerational transmission of welfare.
    Keywords: welfare, health, public
    JEL: H23 H31 I38
    Date: 2022
  6. By: Brunello, Giorgio (University of Padova); De Paola, Maria; Rocco, Lorenzo (University of Padova)
    Abstract: Using matched employer-employee data for Italy and newly available information on sick leaves certificates, we study the effect of an exogenous increase in the length of the residual work horizon – triggered by a pension reform that increased minimum retirement age - on middle-aged employees' absence from work due to sick leaves. We find that this effect is positive for females and negative for males. After excluding health as a plausible mechanism, we argue that the intertemporal substitution of leisure prevailed on the fear of job loss for females, while the opposite happened to males. Sick leaves increased only for females working in firms paying smaller wage premia to female than to male workers, suggesting that, in these firms, females exchange lower pay with higher flexibility in their work schedule.
    Keywords: absences from work, retirement, Italy
    JEL: J22 J26
    Date: 2023–01
  7. By: Seonmin Will Heo; Koichiro Ito; Rao Kotamarthi
    Abstract: We study the international spillover effects of air pollution by developing a framework that integrates recent advances in atmospheric science into econometric estimation with microdata on mortality and health. Combining transboundary particle trajectory data with the universe of individual-level mortality and emergency room visit data in South Korea, we find that transboundary air pollution from China significantly increases mortality and morbidity in South Korea. Using these estimates, we show that a recent Chinese environmental policy “war on pollution” generated a substantial international spillover benefit. Finally, we examine China’s strategic pollution reductions and provide their implications for the potential Coasian bargaining.
    JEL: Q53
    Date: 2023–01
  8. By: Muhammad Zia Hydari; Idris Adjerid; Aaron D. Striegel
    Abstract: Health wearables in combination with gamification enable interventions that have the potential to increase physical activity -- a key determinant of health. However, the extant literature does not provide conclusive evidence on the benefits of gamification, and there are persistent concerns that competition-based gamification approaches will only benefit those who are highly active at the expense of those who are sedentary. We investigate the effect of Fitbit leaderboards on the number of steps taken by the user. Using a unique data set of Fitbit wearable users, some of whom participate in a leaderboard, we find that leaderboards lead to a 370 (3.5%) step increase in the users' daily physical activity. However, we find that the benefits of leaderboards are highly heterogeneous. Surprisingly, we find that those who were highly active prior to adoption are hurt by leaderboards and walk 630 fewer steps daily after adoption (a 5% relative decrease). In contrast, those who were sedentary prior to adoption benefited substantially from leaderboards and walked an additional 1, 300 steps daily after adoption (a 15% relative increase). We find that these effects emerge because sedentary individuals benefit even when leaderboards are small and when they do not rank first on them. In contrast, highly active individuals are harmed by smaller leaderboards and only see benefit when they rank highly on large leaderboards. We posit that this unexpected divergence in effects could be due to the underappreciated potential of noncompetition dynamics (e.g., changes in expectations for exercise) to benefit sedentary users, but harm more active ones.
    Date: 2023–01
  9. By: Eve Caroli (Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres, LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres - CNRS - Centre National de la Recherche Scientifique); Catherine Pollak (DREES - Centre de Recherche du DREES - Ministère de l'Emploi et de la Solidarité, LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres - CNRS - Centre National de la Recherche Scientifique); Muriel Roger (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Using the differentiated increase in retirement age across cohorts introduced by the 2010 French pension reform, we estimate the health-consumption effects of a 4-month increase in retirement age. We focus on individuals who were close to retirement age but not retired yet by the time the reform was passed. Using administrative data on individual sick-leave claims and nonhospital health-care expenses, we show that the probability of having at least one sickness absence increases for all treated groups, while the duration of sick leaves remains unchanged.Delaying retirement does not increase the probability of seeing a GP, except for men in the younger cohorts. In contrast, it raises the probability of having a visit with a specialist physician for all individuals, except men in the older cohorts. Delaying retirement also increases the probability of seeing a physiotherapist among women from the older cohorts. Overall, itincreases health expense claims, in particular in the lower part of the expenditure distribution.
    Keywords: Pension reform, Retirement age, Health, Health-care consumption
    Date: 2022–12–15
  10. By: Michael Kremer; Stephen P. Luby; Ricardo Maertens; Brandon Tan; Witold Więcek
    Abstract: Randomized controlled trials (RCTs) of water treatment are typically powered to detect effects on caregiver-reported diarrhea but not child mortality, as detecting mortality effects requires prohibitively large sample sizes. Consequently, water treatment is seldom included in lists of cost-effective, evidence-backed child health interventions which are prioritized in health funding decisions. To increase statistical power, we conducted a systematic review and meta-analysis. We replicated search and selection criteria from previous meta-analyses of RCTs aimed at improving water quality to prevent diarrhea in low- or middle-income countries which included children under 5 years old. We identified 52 RCTs and then obtained child mortality data from each study for which these data were collected and available, contacting authors of the study where necessary; this resulted in 15 studies.Frequentist and Bayesian methods were used to estimate the effect of water treatment on child mortality among included studies. We estimated a mean cross-study reduction in the odds of all-cause under-5 mortality of about 30% (Peto odds ratio, OR, 0.72; 95% CI 0.55 to 0.92; Bayes OR 0.70; 95% CrI 0.49 to 0.93). The results were qualitatively similar under alternative modeling and data inclusion choices. Taking into account heterogeneity across studies, the expected reduction in a new implementation is 25%. We used the results to examine the cost-effectiveness of investing in water treatment for point-of-collection chlorine dispensers or a large-scale program providing coupons for free chlorine solution. We estimate a cost per expected DALY averted due to water treatment of around USD 40 for both, accounting for delivery costs. This is approximately 45 times lower than the widely used threshold of 1x GDP per capita per DALY averted.
    JEL: I1
    Date: 2023–01
  11. By: Lei, Lei; Wu, Fengyu; Xia, Yiming
    Abstract: In many societies, parents prefer sons over daughters, but the well-being effects of child gender, especially in later life, are less studied. Using the latest two waves of the China Health and Retirement Longitudinal Study (CHARLS), this paper evaluates the impacts of having daughters on older parents' subjective well-being (SWB) in China, which has a rapidly aging population and the traditional preference for sons. Studying the cohort of parents whose child gender is as good as random, we find that having more daughters promotes older parents' SWB, especially overall life satisfaction, satisfaction with health, and satisfaction with children. Our results suggest that the increase in SWB is achieved through better health, more financial support from daughters, more spending on leisure and a lower probability of working. The positive SWB effects of daughters are found to be more salient among more vulnerable groups, including those who are older, less educated, and with fewer children.
    Keywords: Subjective Well-being, Child Gender, Older Parents, China, Life Satisfaction, Domain Satisfaction
    JEL: I31 J14 J16
    Date: 2023
  12. By: Olivier Mir (DIOPP - Département interdisciplinaire d’organisation des parcours patients - IGR - Institut Gustave Roussy); Marie Ferrua (IGR - Institut Gustave Roussy); Aude Fourcade (IGR - Institut Gustave Roussy); Delphine Mathivon (DIOPP - Département interdisciplinaire d’organisation des parcours patients - IGR - Institut Gustave Roussy); Adeline Duflot-Boukobza (IGR - Institut Gustave Roussy); Sarah Dumont (IGR - Institut Gustave Roussy); Eric Baudin (IGR - Institut Gustave Roussy); Suzette Delaloge (IGR - Institut Gustave Roussy); David Malka (IGR - Institut Gustave Roussy); Laurence Albiges (IGR - Institut Gustave Roussy); Patricia Pautier (IGR - Institut Gustave Roussy); Caroline Robert (IGR - Institut Gustave Roussy); David Planchard (IGR - Institut Gustave Roussy); Stéphane de Botton (IGR - Institut Gustave Roussy); Florian Scotté (DIOPP - Département interdisciplinaire d’organisation des parcours patients - IGR - Institut Gustave Roussy); François Lemare (IGR - Institut Gustave Roussy); May Abbas (DIOPP - Département interdisciplinaire d’organisation des parcours patients - IGR - Institut Gustave Roussy); Marilène Guillet (IGR - Institut Gustave Roussy); Vanessa Puglisi (DIOPP - Département interdisciplinaire d’organisation des parcours patients - IGR - Institut Gustave Roussy); Mario Di Palma (DIOPP - Département interdisciplinaire d’organisation des parcours patients - IGR - Institut Gustave Roussy); Etienne Minvielle (DIOPP - Département interdisciplinaire d’organisation des parcours patients - IGR - Institut Gustave Roussy, i3-CRG - Centre de recherche en gestion i3 - X - École polytechnique - Université Paris-Saclay - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Strategies that individualize the care of cancer patients receiving oral anticancer agents offer opportunities to improve treatment adherence and patient care. However, the impact of digital remote monitoring systems in this setting has not been evaluated. Here, we report the results of a phase 3 trial (CAPRI, NCT02828462) to assess the impact of a nurse navigator-led program on treatment delivery for patients with metastatic cancer. Patients receiving approved oral anticancer agents were randomized (1:1) to an intervention combining a nurse navigator-led follow-up system and a web portal–smartphone application on top of usual care, or to usual symptom monitoring at the discretion of the treating oncologist, for a duration of 6 months. The primary objective included optimization of the treatment dose. Secondary objectives were grade ≥3 toxicities, patient experience, rates and duration of hospitalization, response and survival, and quality of life. In 559 evaluable patients the relative dose intensity was higher in the experimental arm (93.4% versus 89.4%, P = 0.04). The intervention improved the patient experience (Patient Assessment of Chronic Illness Care score, 2.94 versus 2.67, P = 0.01), reduced the days of hospitalization (2.82 versus 4.44 days, P = 0.02), and decreased treatment-related grade ≥3 toxicities (27.6% versus 36.9%, P = 0.02). These findings show that patient-centered care through remote monitoring of symptoms and treatment may improve patient outcomes and experience.
    Date: 2022
  13. By: Fletcher, Jason
    Abstract: This short report uses a representative school-based sample (Add Health) to characterize local measures of (classmates’) beliefs about traditional sex roles in examining short and long term outcomes for women and men through age 30. Regression analyses suggest several key findings. First, women who attended high school with “traditionalist” classmates have much worse labor market outcomes. Second, the penalty for women’s outcomes is higher if the “traditionalist” classmates are women (vs. men). Third, a large share (typically >50%) of the labor market impacts may be due to reductions in educational outcomes (test scores and completed schooling). Fourth, males also have some reductions in human capital and earnings whose high school classmates were “traditionalist”.
    Date: 2023–01–11
  14. By: Fallesen, Peter (ROCKWOOL Foundation); Cozzani, Marco (European University Institute)
    Abstract: Following the onset COVID-19 pandemic’s, a host of countries saw drastic fertility declines. Yet so far it remains unclear whether affected populations subsequently have recuperated the fertility declines, and if so, if the recuperation is equally distributed. We use vital statistics on Spain, the European country experiencing the most severe fertility decline of the pandemic, to examine these questions. By December 2021, Spain had only seen a partial recuperation of the fertility with large heterogeneity. Mothers at the beginning and the end of the reproductive age and those transitioning to first child have not yet recuperated, whereas mother in the middle of the fertility window and higher order births have fully recuperated. The findings suggest large consequences for population structure and ultimate childlessness in Spain.
    Date: 2023–01–10
  15. By: Margherita Squarcina; Eva-Maria Egger
    Abstract: This study investigates the short-term impacts of an aggregate socioeconomic shock on household food consumption and children's nutrition using the case of the COVID-19 pandemic in Mozambique. In response to the economic downturn, households are expected to adjust their food choices both in terms of quality, towards cheaper and unhealthier food, and quantity, reducing diet diversification and increasing the exposure to malnutrition, mainly for children. Empirical evidence on such immediate effects is still scarce, mainly due to a lack of data.
    Keywords: COVID-19, Food, Child nutrition, Stunting, Mozambique, Nutrition
    Date: 2022
  16. By: Carlos Hernandez-Suarez; Efren Murillo-Zamora
    Abstract: Recently, China announced that its "zero-covid" policy would end, which will bring serious challenges to the country's health system. In here we provide simple calculations that allows us to provide an estimate of what is expected as an outcome in terms of fatalities, using the fact that it is a highly contagious disease that will expose most of a highly vaccinated population to the virus. We use recent findings regarding the amount of reduction in the risk of severe outcome achieved by vaccination and arrive to an estimate of 1.1 m deaths, 60% of these are males. In our model, 84% percent of deaths occur in individuals with age 55 years or older. In a scenario in which this protection is completely lost due to waning and the infection fatality rate of the prevalent strain reaches similar levels to the observed in the beginning of the epidemic, the death toll could reach 2.4 m, 93% in 55 years or older.
    Date: 2022–12
  17. By: Juliane Wiese; Nattavudh Powdthavee
    Abstract: To end the COVID-19 pandemic, policymakers have relied on various public health messages to boost vaccine take-up rates amongst people across wide political spectra, backgrounds, and worldviews. However, much less is understood about whether these messages affect different people in the same way. One source of heterogeneity is the belief in a just world (BJW), which is the belief that in general, good things happen to good people, and bad things happen to bad people. This study investigates the effectiveness of two common messages of the COVID-19 pandemic: vaccinate to protect yourself and vaccinate to protect others in your community. We then examine whether BJW moderates the effectiveness of these messages. We hypothesize that just-world believers react negatively to the prosocial pro-vaccine message, as it charges individuals with the responsibility to care for others around them. Using an unvaccinated sample of UK residents before vaccines were made widely available (N=526), we demonstrate that the individual-focused message significantly reduces overall vaccine skepticism, and that this effect is more robust for individuals with a low BJW, whereas the community-focused message does not. Our findings highlight the importance of individual differences in the reception of public health messages to reduce COVID-19 vaccine skepticism.
    Date: 2023–01

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