nep-hea New Economics Papers
on Health Economics
Issue of 2023‒02‒13
fifteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Predicting and Preventing Gun Violence: An Experimental Evaluation of READI Chicago By Monica P. Bhatt; Sara B. Heller; Max Kapustin; Marianne Bertrand; Christopher Blattman
  2. Political adverse selection By Bursztyn, Leonardo; Kolstad, Jonathan T.; Rao, Aakaash; Tebaldi, Pietro; Yuchtman, Noam
  3. Labour supply, service intensity, and contracts: Theory and evidence on physicians By Bernard Fortin; Nicolas Jacquemet; Bruce Shearer
  4. The anatomy of a hospital system merger: the patient did not respond well to treatment By Gaynor, Martin; Sacarny, Adam; Sadun, Raffaella; Syverson, Chad; Venkatesh, Shruthi
  5. Prescription Behavior of Physicians in the Public and Private Sector By Elina Jussila; Kaisa Kotakorpi; Jouko Verho
  6. Optimal Intertemporal Curative Drug Expenses: The Case of Hepatitis C in France By Magnac, Thierry; Dubois, Pierre
  7. The Value of a Life-Year and the Intuition of Universality By Marc Fleurbaey; Gregory Ponthiere
  8. Enhancing health information infrastructures in Asia: an economic impact study By Johansen, Elias
  9. Comparing the impact of targeted subsidies and health prompts on choice process variables and food choice: The case of dietary fiber By Gustafson, Christopher R.
  10. Human wellbeing and machine learning By Oparina, Ekaterina; Kaiser, Caspar; Gentile, Niccoló; Tkatchenko, Alexandre; Clark, Andrew E.; De Neve, Jan-Emmanuel; D'Ambrosio, Conchita
  11. The effects of telework on employees’ health By Stefan, Bruno
  12. Religion, beliefs, trust, and COVID vaccination behavior among rural people in Malawi? By Holden, Stein T.; Tione, Sarah; Tilahun, Mesfin; Katengeza, Samson
  13. Covid-19 Full-Dose Vaccination across Uninsured Populations: Evidence across Counties in the United States By Rajeev K. Goel; Michael A. Nelson
  14. Equitable Access to Vaccines: Myth or Reality? By Jiaxiong Yao; Shushanik Hakobyan; Henry Rawlings
  15. Beliefs about Social Norms and (the Polarization of) Covid-19 Vaccination Readiness By Silvia Angerer; Daniela Glätzle-Rützler; Philipp Lergetporer; Thomas Rittmannsberger

  1. By: Monica P. Bhatt; Sara B. Heller; Max Kapustin; Marianne Bertrand; Christopher Blattman
    Abstract: Gun violence is the most pressing public safety problem in American cities. We report results from a randomized controlled trial (N=2, 456) of a community-researcher partnership—the Rapid Employment and Development Initiative (READI Chicago)—which provided 18 months of a supported job alongside cognitive behavioral therapy and other social supports. Algorithmic and human referral methods identified men with strikingly high scope for gun violence reduction: for every 100 people in the control group, there were over 11 shooting and homicide victimizations during the 20-month outcome period. Take-up and retention rates were comparable to programs for people facing far lower mortality risk. There is no statistically significant change in an index combining three measures of serious violence, the study's primary outcome. But one component, shooting and homicide arrests, shows a suggestive decline of 64 percent (p=0.15). Because shootings are so costly, READI generates social savings between $174, 000 and $858, 000 per participant, implying a benefit-cost ratio between 3.8 and 18.8 to 1. Moreover, participants referred by outreach workers—a pre-specified subgroup—show enormous declines in both arrests and victimizations for shootings and homicides that remain statistically significant even after multiple testing adjustments. These declines are concentrated among outreach referrals with high predicted risk, suggesting that human and algorithmic targeting may work better together.
    JEL: C53 C93 I38 J08 K42
    Date: 2023–01
  2. By: Bursztyn, Leonardo; Kolstad, Jonathan T.; Rao, Aakaash; Tebaldi, Pietro; Yuchtman, Noam
    Abstract: We study how the politicization of policies designed to correct market failures can undermine their effectiveness. The Patient Protection and Affordable Care Act (ACA) was among the most politically divisive expansions of the US government. We examine whether partisanship distorted enrollment and market outcomes in the ACA insurance marketplaces. Controlling for observable characteristics and holding fixed plans and premiums available, Republicans enrolled less than Democrats and independents in ACA marketplace plans. Selection out of the ACA marketplaces was strongest among Republicans with lower expected healthcare costs, generating adverse selection. Computing enrollment and average cost with and without partisan differences, we find that this political adverse selection reduced enrollment by around three million people and raised average costs in the marketplaces, increasing the level of public spending necessary to provide subsidies to low-income enrollees by around $105 per enrollee per year. Lower enrollments and higher costs are concentrated in more Republican areas, potentially contributing to polarized views of the ACA.
    JEL: J1
    Date: 2022–07–12
  3. By: Bernard Fortin (Département d'Economique, Université Laval - ULaval - Université Laval [Québec], CRREP - Centre de recherche sur les risques, les enjeux économiques, et les politiques publiques - ULaval - Université Laval [Québec], CIRANO - Centre interuniversitaire de recherche en analyse des organisations - UQAM - Université du Québec à Montréal = University of Québec in Montréal); Nicolas Jacquemet (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, CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique); Bruce Shearer (Département d'Economique, Université Laval - ULaval - Université Laval [Québec], CRREP - Centre de recherche sur les risques, les enjeux économiques, et les politiques publiques - ULaval - Université Laval [Québec], CIRANO - Centre interuniversitaire de recherche en analyse des organisations - UQAM - Université du Québec à Montréal = University of Québec in Montréal)
    Abstract: Based on linked administrative and survey panel data, we analyze the labour supply behaviour of physicians who could adopt either a standard fee-for-service contract or a mixed remuneration (MR) contract. Under MR, physicians received a per diem and a reduced fee for services provided. We present estimates of a structural discrete choice model that incorporates service intensity (services provided per hour) and contract choice into a labour supply framework. We use our estimates to predict (ex ante) the effects of contracts on physician behaviour and welfare, as measured by average equivalent variations. The supply of services is reduced under a MR contract, suggesting incentives matter. Hours spent seeing patients is less sensitive to incentives than the supply of services. Our results suggest that a reform forcing all physicians to adopt the MR system would have substantially larger effects on physician behaviour than were measured under the observed reform. A pure salary (per diem) reform would sharply reduce services but would increase time spent seeing patients.
    Keywords: Practice Patterns of Physicians, Labour Supply, Service Intensity, Fee-for-Service Contract, Mixed Remuneration Contract, Discrete Choice Models
    Date: 2021–09
  4. By: Gaynor, Martin; Sacarny, Adam; Sadun, Raffaella; Syverson, Chad; Venkatesh, Shruthi
    Abstract: Despite the continuing US hospital merger wave, it remains unclear how mergers change, or fail to change, hospital behavior and performance. We open the "black box" of hospital practices through a mega-merger between two for-profit chains. Benchmarking the merger's effects against the acquirer's stated aims, we show they achieved some of their goals, harmonizing electronic medical records and sending managers to target hospitals. Post-acquisition managerial processes were similar across the merged chain. However, these interventions failed to drive detectable gains in performance. Our findings demonstrate the importance of organizations for merger research in health care and the economy more generally.
    Keywords: management
    JEL: I10 M12
    Date: 2022–04–07
  5. By: Elina Jussila; Kaisa Kotakorpi; Jouko Verho
    Abstract: We analyze prescription behavior of physicians in the public and private sector. We study two major diseases for which an effective, widely accepted low-cost treatment and alternative, more expensive treatments are available. We find that private sector physicians are more likely to prescribe the expensive medication. The result holds after controlling for individual-level factors including health indicators based on detailed administrative data, and patient fixed effects. In one of our cases, we further find that the same physicians prescribe different medication when working in different sectors. These results are consistent with higher 2nd degree moral hazard in the private sector.
    Keywords: healthcare, prescription behaviour, public sector, private sector, moral hazard
    JEL: I11 H42 I18
    Date: 2022
  6. By: Magnac, Thierry; Dubois, Pierre
    Abstract: We study intertemporal trade-offs that health authorities (HAs) face when considering the control of an epidemy using innovative curative medical treatments. We set up a dynamically controlled Susceptibles-Infected-Recovered (SIR) model for an epidemy in which patients can be asymptomatic, and we analyze in a simple model, the optimality conditions of the sequence of cure expenses decided by HAs at the onset of the drug innovation. We show that analytical conclusions are ambiguous because of their dependence on parameter values. As an application, we focus on the case-study of Hepatitis C whose treatment underwent a major up-heaval when curative drugs were introduced in 2014. We calibrate our controlled SIR model using French data and simulate optimal policies. We show that the optimal policy entails some front loading of the intertemporal budget compared to fixed annual ones. The analysis demonstrates how beneficial the intertemporal budgeting can be compared to non forward looking constant budget allocation.
    Keywords: pharmacy; SIR model; controlled epidemy dynamics; optimal intertemporal poli-; cies; hepatitis C
    JEL: I12 I18
    Date: 2023–01–25
  7. By: Marc Fleurbaey (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); Gregory Ponthiere (UCL - Université Catholique de Louvain = Catholic University of Louvain)
    Abstract: When considering the social valuation of a life-year, there is a conflict between two basic intuitions: on the one hand, the intuition of universality, according to which the value of an additional life-year should be universal, and, as such, should be invariant to the context considered; on the other hand, the intuition of complementarity, according to which the value of a life-year should depend on what this extra-life-year allows for, and, hence, on the quality of that life-year, because the quantity of life and the quality of life are complement to each other. This paper proposes three distinct accounts of the intuition of universality, and shows that those accounts either conflict with a basic monotonicity property, or lead to indifference with respect to how life-years are distributed within the population. Those results support the abandon of the intuition of universality. But abandoning the intuition of universality does not prevent a social evaluator from giving priority, when allocating life-years, to individuals with the lowest quality of life.
    Date: 2022
  8. By: Johansen, Elias
    Abstract: Throughout Asia, low- and middle-income countries are experiencing a rapid growth of health information systems. Interoperability is being made a priority and steps are being taken to reduce fragmentation and ensure interoperability. There are several approaches to determining economic well being based on the use of a master facility list. This represents a standard list of health facilities that are associated with economic well being. Considering the many socioeconomic complexities that exist within our society today, the development and deployment of such an initiative represents a formidable issue. Information infrastructure theory gives guidance on how to approach complex, large-scale, and distributed information systems from a theoretical point of view. An integral part of the process of integrating health information technology into primary care can be found in the use of a variety of electronic methods for managing information regarding people's health and health care, both individually and in group settings. These methods include the use of a variety of electronic methods for managing patient information. Health information technology can significantly reduce the cost of providing health care as well as ensure that the quality of the care is maintained. Through the use of health information technology, the quality of healthcare can be improved.
    Keywords: Economic development and health infrastructure, economic impact and health issues, asian health infrastructure, economic fragmentation and health infrastructure
    JEL: I1 I11 I12 I14 I15 I18 K32 P36
    Date: 2021–06–15
  9. By: Gustafson, Christopher R.
    Abstract: Fiscal tools—taxes and/or subsidies—are increasingly used to address diet-related health problems. However, some studies have found that these tools are markedly more effective if attention is draw to the tax or subsidy, suggesting that the price change alone may go unnoticed in the complex food environments that consumers face. Interventions that prompt individuals to consider health during choice show promise for promoting healthy food choices in both simple laboratory settings and complex, real-world markets. In this pre-registered study, I examine the impact of dietary fiber health prompts and/or dietary fiber subsidies on the per-serving fiber content of foods chosen, the documented set of products considered, and (self-reported) nutrition information use by participants in an online supermarket setting. Participants were randomized to one of four conditions: 1) control, 2) subsidy, 3) fiber prompt, and 4) fiber prompt + subsidy. Results show that both the prompt and prompt + subsidy conditions significantly increase fiber content of foods chosen (with the latter having a larger effect). While all three interventions influence the probability of using nutrition information during food choice and affect the set of products that respondents consider relative to the control condition, the effects were larger for the prompt and prompt + subsidy conditions. A multiple mediation analysis illustrates that both direct and indirect (through the set of products considered and the use of fiber information during choice) pathways lead to the significant overall increase in fiber content of selected foods.
    Keywords: Agricultural and Food Policy, Consumer/Household Economics, Health Economics and Policy
    Date: 2023–01–26
  10. By: Oparina, Ekaterina; Kaiser, Caspar; Gentile, Niccoló; Tkatchenko, Alexandre; Clark, Andrew E.; De Neve, Jan-Emmanuel; D'Ambrosio, Conchita
    Abstract: There is a vast literature on the determinants of subjective wellbeing. International organisations and statistical offices are now collecting such survey data at scale. However, standard regression models explain surprisingly little of the variation in wellbeing, limiting our ability to predict it. In response, we here assess the potential of Machine Learning (ML) to help us better understand wellbeing. We analyse wellbeing data on over a million respondents from Germany, the UK, and the United States. In terms of predictive power, our ML approaches perform better than traditional models. Although the size of the improvement is small in absolute terms, it is substantial when compared to that of key variables like health. We moreover find that drastically expanding the set of explanatory variables doubles the predictive power of both OLS and the ML approaches on unseen data. The variables identified as important by our ML algorithms - i.e. material conditions, health, and meaningful social relations - are similar to those that have already been identified in the literature. In that sense, our data-driven ML results validate the findings from conventional approaches.
    Keywords: subjective wellbeing; prediction methods; machine learning
    JEL: C63 C53 I31
    Date: 2022–07–20
  11. By: Stefan, Bruno
    Abstract: The COVID-19 pandemic forced a large number of people into telework. The change of working conditions was not done with the help of specialists or with the support from employers, resulting in improvisations that had negative consequences for employee health. The survey conducted by the Bureau of Social Research at the end of 2020 measured the impact of work from home on various health problems and body organs. The results clearly show a deterioration of the bones, muscles and joints, the mental system, the stomach, the eyes and the heart for an important segment of the employees. The most vulnerable people were those aged 40-60, PhD graduates, domiciled in medium and small cities, employed by the state in areas that had the greatest difficulties in adapting to digitization and working on online platforms: culture, education, public administration. As experts say that working from home will continue in the coming years even after the pandemic disappears, the deterioration of employees' health will intensify.
    Keywords: telework, health, stress, sedentary behavior, COVID-19.
    JEL: I12 J50 Z13
    Date: 2021–11
  12. By: Holden, Stein T. (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Tione, Sarah (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Tilahun, Mesfin (Centre for Land Tenure Studies, Norwegian University of Life Sciences); Katengeza, Samson (Centre for Land Tenure Studies, Norwegian University of Life Sciences)
    Abstract: This study investigates the religious and other beliefs related to the corona/COVID-19 pandemic and how they are related to covid risk perceptions, trust in COVID vaccines, and how these are affected by the religious beliefs, religious affiliations, trust in authorities, generalized trust, and how these affect vaccine demand/vaccine hesitancy. The study took place in rural areas in six districts in Central and Southern Regions of Malawi during April-May 2022 towards the end of the fourth wave of the pandemic that was dominated by the omicron variant of the virus, through personal interviews of 835 subjects. The study revealed five religious beliefs associated with the pandemic and one non-religious belief that vaccination would lead to infertility in women. This belief (14% of the sample) and the belief that vaccination leads to a triple-six mark from the Devil (33% of the sample) were strongly negatively associated with trust in the vaccine and the trust in the vaccine had a strong impact on the demand for vaccine/vaccine hesitancy. In addition, certain religious groups were associated with more of these pandemic-related beliefs, lower trust in the vaccines, and lower vaccine demand/stronger vaccine hesitancy. Trust in politicians, health personnel, and generalized trust contributed to stronger trust in vaccines. It may be important to address both the beliefs and some of the religious groups and their leaders to promote vaccine demand and reduce vaccine hesitancy.
    Keywords: COVID-19; rural population; religion; beliefs; trust; vaccination behavior
    JEL: I12 I15 I18
    Date: 2023–01–28
  13. By: Rajeev K. Goel; Michael A. Nelson
    Abstract: This paper studies the propensities of the U.S. population to seek a full dose of vaccinations against the COVID-19 pandemic. Beyond the consideration of vaccine dissemination at the disaggregated or the local level, the main focus of this study is on determining whether a lack of health insurance significantly impacted vaccination propensities. If it is indeed the case that a lack of health insurance mattered, this would be informative for policymakers since they tried to address this aspect in the vaccine rollout by subsidizing and offering vaccines at a zero price. Our results show that the uninsured were less likely to be fully vaccinated against the pandemic and this finding holds across different modeling formulations. However, there were differences in the responses of the different population subgroups. The findings with respect to the vaccination propensities of the unvaccinated are noteworthy, especially significant given the fact the COVID-19 vaccines were made available free of cost to the public in the United States, irrespective of their insurance status. A policy lesson from these results is that perhaps a better outreach to communities of the uninsured to inform them about the costs and availability of the coronavirus vaccines would have been better. Interestingly, new covid cases did not significantly impact decisions to fully vaccinate, while greater prosperity made full vaccination more likely. We did not find robust evidence of the elderly having a greater propensity to be fully vaccinated. Finally, accounting for the political dimension, counties housing the seats of the state government had greater full vaccination rates, ceteris paribus.
    Keywords: Covid-19, vaccination, pandemic, insurance, elderly, county, United States
    JEL: I18 I13 I11 H75 G22
    Date: 2022
  14. By: Jiaxiong Yao; Shushanik Hakobyan; Henry Rawlings
    Abstract: Fighting the COVID-19 pandemic required vaccinations; however, ending it requires vaccination equality. The progress in vaccinations varies greatly across countries, with low- and middle-income countries having much lower vaccination rates than advanced countries. Initially, the limited vaccine supply was in part to blame for slow pace of vaccinations in low-income countries. But as the supply constraints eased toward the end of 2021, the focus has shifted to in-country distribution challenges and vaccine hesitancy. This paper quantifies the importance of various factors in driving vaccination rates across countries, including vaccine deliveries, demographic structure, health and transport infrastructure and development level. It then estimates the contribution of these factors to vaccination inequality. We show that much of the vaccination inequality in 2021-22 was driven by the lack of access to vaccines which is beyond countries’ control. And although vaccination inequality declined over time, access to vaccines remains the dominant driver of vaccination inequality.
    Keywords: COVID-19; vaccination; access; inequality; vaccination inequality; vaccination rate; vaccine hesitancy; vaccination equality; country distribution challenge; Income inequality; Global; Sub-Saharan Africa
    Date: 2022–12–16
  15. By: Silvia Angerer; Daniela Glätzle-Rützler; Philipp Lergetporer; Thomas Rittmannsberger
    Abstract: Social norms affect a wide range of behaviors in society. We conducted a representative experiment to study how beliefs about the existing social norm regarding COVID-19 vaccination affect vaccination readiness. Beliefs about the norm are on average downward biased, and widely dispersed. Randomly providing information about the existing descriptive norm succeeds in correcting biased beliefs, thereby reducing belief dispersion. The information has no effect on vaccination readiness on average, which is due to opposite effects among women (positive) and men (negative). Fundamental differences in how women and men process the same information are likely the cause for these contrasting information effects. Control-group vaccination intentions are lower among women than men, so the information reduces polarization by gender. Additionally, the information reduces gendered polarization in policy preferences related to COVID-19 vaccination.
    Keywords: social norms, vaccination, Covid-19
    JEL: C93 D90 I12
    Date: 2022

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