nep-hea New Economics Papers
on Health Economics
Issue of 2023‒02‒20
28 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Achieving Universal Health Insurance Coverage in the United States: Addressing Market Failures or Providing a Social Floor? By Katherine Baicker; Amitabh Chandra; Mark Shepard
  2. Reducing Administrative Barriers Increases Take-up of Subsidized Health Insurance Coverage: Evidence from a Field Experiment By Keith Marzilli Ericson; Timothy J. Layton; Adrianna McIntyre; Adam Sacarny
  3. Rationing Medicine Through Bureaucracy: Authorization Restrictions in Medicare By Zarek C. Brot-Goldberg; Samantha Burn; Timothy Layton; Boris Vabson
  4. European pharmaceutical research and development. Could a public infrastructure overcome market failures? By Massimo Florio; Chiara Pancotti
  5. Harm Reduction: When Does It Improve Health, and When Does it Backfire? By John Cawley; Davide Dragone
  6. Mandatory Seatbelt Laws and Traffic Fatalities: A Reassessment By D. Mark Anderson; Yang Liang; Joseph J. Sabia
  7. Prenatal Sugar Consumption and Late-Life Human Capital and Health: Analyses Based on Postwar Rationing and Polygenic Scores By Gerard J. van den Berg; Stephanie von Hinke; R. Adele H. Wang
  8. The Cost of Curbing Externalities with Market Power: Alcohol Regulations and Tax Alternatives By Christopher Conlon; Nirupama L. Rao
  9. Information Technology, Improved Access, and Use of Prescription Drugs By Petri Bockerman; Mika Kortelainen; Liisa T. Laine; Mikko Nurminen; Tanja Saxell
  10. Beyond Burnout: from Measuring to Forecasting By Bart Blackburn; Tiffany Chan; Elizabeth Cherot; Richard B. Freeman; Xi Hu; Eric Matt; C. Aubrey Rhodes
  11. Opiates of the Masses? Deaths of Despair and the Decline of American Religion By Tyler Giles; Daniel M. Hungerman; Tamar Oostrom
  12. Health Effects of Fuel Transitions in India: Evidence from Panel Data By Azam, Mehtabul
  13. The kids are not alright: differential trends in mental ill-health in Australia By Ferdi Botha; Richard W. Morris; Peter Butterworth; Nick Glozier
  14. Social networks and mental health: the experience of Cape-Verdean migrants in Portugal By Catia Batista; Rita Neves
  15. Does Less Education Harm Health? Evidence from a Natural Experiment in a Developing Country By Mallick, Debdulal; Khalil, Islam; Nicholas, Aaron
  16. The price of cost-effectiveness thresholds By Kurt R. Brekke; Dag Morten Dalen; Odd Rune Straume
  17. QALYs, DALYs, and HALYs: a unifying framework for the evaluation of population health By Juan D. Moreno-Ternero; Trine T. Platz; Lars P. Østerdal
  18. Follow the leader: community-based health insurance in West Africa By Rute M. Caeiro; Alexander Coutts; Teresa Molina-Millan; Pedro C. Vicente
  19. Hospital competition when patients learn through experience By Luís Sá; Odd Rune Straume
  20. Quality discrimination in healthcare markets By Rosa-Branca Esteves; Ziad Ghandour; Odd Rune Straume
  21. When do Default Nudges Work? By Carl Bonander; Mats Ekman; Niklas Jakobsson
  22. Healthcare assimilation of immigrants By Catia Batista; Ana Beatriz Gomes
  23. The Intergenerational Consequences of Economic Distress: In-Utero Exposure to Financial Crises and Birth Outcomes By Mevlude Akbulut-Yuksel; Seyit M. Cilasun; Erdal Tekin; Belgi Turan
  24. Wildfire Influence on Recent US Pollution Trends By Marshall Burke; Marissa L. Childs; Brandon De la Cuesta; Minghao Qiu; Jessica Li; Carlos F. Gould; Sam Heft-Neal; Michael Wara
  25. Emotional responses to COVID-19 stressors increase avoidance of health information and access to care By Gustafson, Christopher R.; Brooks, Kathleen R.; Meerza, Syed Imran Ali; Yiannaka, Amalia
  26. Comparing the impact of subsidies and health prompts on choice process variables and food choice: The case of dietary fiber By Gustafson, Christopher R.
  27. The effect of primary school education on preventive behaviours during COVID-19 in Japan By Eiji Yamamura; Yoshiro Tsutsui; Fumio Ohtake
  28. What Drives (Gaps in) Scientific Study Participation? Evidence from a COVID-19 Antibody Survey By Deniz Dutz; Michael Greenstone; Ali Hortaçsu; Santiago Lacouture; Magne Mogstad; Azeem M. Shaikh; Alexander Torgovitsky; Winnie van Dijk

  1. By: Katherine Baicker; Amitabh Chandra; Mark Shepard
    Abstract: The United States spends substantially more on health care than most developed countries, yet leaves a greater share of the population uninsured. We suggest that incremental insurance expansions focused on addressing market failures will propagate inefficiencies and are not likely to facilitate active policy decisions that align with societal coverage goals. By instead defining a basic bundle of services that is publicly financed for all, while allowing individuals to purchase additional coverage, policymakers could both expand coverage and maintain incentives for innovation, fostering universal access to innovative care in an affordable system.
    JEL: H4 H51 I13
    Date: 2023–01
  2. By: Keith Marzilli Ericson; Timothy J. Layton; Adrianna McIntyre; Adam Sacarny
    Abstract: Administrative barriers to social insurance program take-up are pervasive, including in subsidized health insurance. We conducted a randomized controlled trial with Massachusetts’ Affordable Care Act marketplace to reduce these barriers and other behavioral frictions. We find that a “check the box” streamlined enrollment intervention raises enrollment by 11%, more than personalized reminder letters (7.9% increase) or generic reminder letters (4.5% increase). Effects are concentrated among individuals eligible for zero-premium plans, who faced no further administrative burdens of setting up payments. Producing this enrollment effect through premium reduction would cost about $6 million in subsidies, highlighting the importance of these burdens.
    JEL: D73 I13
    Date: 2023–01
  3. By: Zarek C. Brot-Goldberg; Samantha Burn; Timothy Layton; Boris Vabson
    Abstract: High administrative costs in U.S. health care have provoked concern among policymakers over potential waste, but many of these costs are generated by managed care policies that trade off bureaucratic costs against reductions in moral hazard. We study this trade-off for prior authorization restriction policies in Medicare Part D, where low-income beneficiaries are randomly assigned to default plans. Beneficiaries who face restrictions on a drug reduce their use of it by 26.8%. Approximately half of marginal beneficiaries are diverted to another related drug, while the other half are diverted to no drug. These policies generated net financial savings, reducing drug spending by $96 per beneficiary-year (3.6% of drug spending), while only generating approximately $10 in paperwork costs. Revealed preference approaches suggest that the cost savings likely exceed beneficiaries’ willingness to pay for foregone drugs.
    JEL: H0 I1 I13
    Date: 2023–01
  4. By: Massimo Florio (DEMM, Universita' di Milano); Chiara Pancotti (CSIL Centre for Industrial Studies)
    Abstract: With a focus on research and development in innovative medicines, this working paper discusses a new European approach to pharmaceutical policy. After examining the European pharmaceutical sector's features, and the strengths and weaknesses of the current research and business model, the study explores the need for and the concept of a European infrastructure with a long-term transboundary mission. Any European medicines infrastructure should focus on threats and research and development areas underinvested under the current business model. More specifically, the study uses an extensive literature review to investigate the feasibility of different options in terms of the scope of the mission and legal, organisational and financial arrangements for establishing such a European infrastructure. Based on their research, the authors present a range of policy options. The most ambitious of these considers a Europe-wide public infrastructure with budgetary autonomy and home-grown research and development capacity. This organisation would be tasked with building a portfolio of new medicines and related biomedical technologies up to the delivery stage over 30 years, in partnership with third-party research centres at the national or European level and with companies. It would be the world's most important global player in biomedical innovationClassification-JEL: H42, D61
    Keywords: coronavirus disease, epidemic, medical research, pharmaceutical expenses, pharmaceutical industry, pharmacy, public health, technology assessment
    Date: 2022–09–01
  5. By: John Cawley; Davide Dragone
    Abstract: Some harm reduction strategies encourage individuals to switch from a harmful addictive good to a less harmful addictive good. This approach is controversial, with advocates claiming it helps switching to a less harmful substance, and opponents claiming it may lead to new substance abuse. This paper builds on theories of addiction to model the introduction of a harm reduction method, and it demonstrates when each side is correct, depending on the enjoyableness of the harm reduction method, the addictiveness of the harm reduction method, and the substitutability with the original addictive good.
    JEL: I12 I18 D11
    Date: 2023–02
  6. By: D. Mark Anderson; Yang Liang; Joseph J. Sabia
    Abstract: Using data from the Fatality Analysis Reporting System for the period 1983-1997, Cohen and Einav (Review of Economics and Statistics 2003; 85(4): 828–843) found that mandatory seatbelt laws were associated with a 4 to 6 percent reduction in traffic fatalities among motor vehicle occupants. After successfully replicating their two-way fixed effects estimates, we (1) add 22 years of data (1998-2019) to capture additional seatbelt policy variation and observe a longer post-treatment period, (2) employ the interaction-weighted estimator proposed by Sun and Abraham (2021) to address potential bias due to heterogeneous and dynamic treatment effects, and (3) estimate event-study models to investigate pre-treatment trends and explore lagged post-treatment effects. Consistent with Cohen and Einav (2003), our updated estimates show that primary seatbelt laws are associated with a 5 to 9 percent reduction in fatalities among motor vehicle occupants. Estimated effects of secondary seatbelt laws are smaller in magnitude and sensitive to model choice.
    JEL: I12 K32 K42
    Date: 2023–01
  7. By: Gerard J. van den Berg; Stephanie von Hinke; R. Adele H. Wang
    Abstract: Maternal sugar consumption in utero may have a variety of effects on offspring. We exploit the abolishment of the rationing of sweet confectionery in the UK on April 24, 1949, and its subsequent reintroduction some months later, in an era of otherwise uninterrupted rationing of confectionery (1942-1953), sugar (1940-1953) and many other foods, and we consider effects on late-life cardiovascular disease, BMI, height, type-2 diabetes and the intake of sugar, fat and carbohydrates, as well as cognitive outcomes and birth weight. We use individual-level data from the UK Biobank for cohorts born between April 1947-May 1952. We also explore whether one's genetic "predisposition" to the outcome can moderate the effects of prenatal sugar exposure. We find that prenatal exposure to derationing increases education and reduces BMI and sugar consumption at higher ages, in line with the "developmental origins" explanatory framework, and that the sugar effects are stronger for those who are genetically "predisposed" to sugar consumption.
    Date: 2023–01
  8. By: Christopher Conlon; Nirupama L. Rao
    Abstract: Products with negative externalities are often subject to regulations that limit competition. The single-product case may suggest that it is irrelevant for aggregate welfare whether output is restricted via corrective taxes or limiting competition. However, when products are differentiated curbing consumption through market power can be costly. Firms with market power may not only reduce total quantity, but distort the purchase decisions of inframarginal consumers. We examine a common regulation known as post-and-hold (PH) used by a dozen states for the sale of alcoholic beverages. Theoretically, PH eliminates competitive incentives among wholesalers selling identical products. We assemble unique data on distilled spirits from Connecticut, including matched manufacturer and wholesaler prices, to evaluate the welfare consequences of PH. For similar levels of ethanol consumption, PH leads to substantially lower consumer welfare (and government revenue) compared to excise, sales or Ramsey taxes by distorting consumption choices away from high-quality/premium brands and towards low-quality brands. Replacing PH with volumetric or ethanol-based taxes could reduce consumption by over 9% without reducing consumer surplus, and increase tax revenues by over 300%.
    JEL: D6 H21 H23 L13 L5 L66
    Date: 2023–01
  9. By: Petri Bockerman (University of Jyvaskyla, Labour Institute for Economic Research LABORE and IZA Institute of Labor Economics); Mika Kortelainen (University of Turku and VATT Institute for Economic Research); Liisa T. Laine (University of Missouri); Mikko Nurminen (The Social Insurance Institution of Finland); Tanja Saxell (VATT Institute for Economic Research and Helsinki GSE)
    Abstract: We estimate the effects of information technology designed to improve access to medication while limiting overuse. We focus on benzodiazepines, commonly prescribed and effective but addictive medications. We study the staggered rollout of a nationwide electronic prescribing system over four years in Finland and use population-wide, individual-level administrative data sets. We find an increase in benzodiazepine use on average due to increased prescription renewals. The effect is most pronounced among younger patients. We find little evidence of improvement in their general health outcomes but observe substantial increases in diagnoses of prescription drug abuse disorders and poisonings. Our results show robust evidence that easier access may lead to medication overuse.
    Keywords: Information technology, electronic prescribing, medication access, overuse, repeat prescribing
    JEL: H51 H75 I12 I18
    Date: 2023–01
  10. By: Bart Blackburn; Tiffany Chan; Elizabeth Cherot; Richard B. Freeman; Xi Hu; Eric Matt; C. Aubrey Rhodes
    Abstract: Burnout of physicians and other medical personnel is a major problem in the economics of healthcare systems, potentially costing billions of dollars. Knowledge of the determinants and costs of burnout at the organization level is sparse, making it difficult to assess the net benefits of interventions to reduce burnout at the level where arguably the greatest change can be affected. In this paper, we use data from a midsize healthcare organization with about 500 clinicians in 2021-22 to advance analysis of clinical burnout in two ways. First, we estimate the costs of clinician burnout beyond the widely studied losses due to turnover. Including hard-to-measure and potentially long-term costs that arise from reduced patient satisfaction and lower productivity of burnt-out clinicians at work, our analysis suggests a much higher cost of burnout per clinician than previous estimates that exclude these costs. Second, we use standard medical billing and administrative operating data to forecast turnover and productivity of clinicians to serve as an early warning system. Accurate estimates of both the cost of burnout now and of likely future costs should help decision-makers be proactive in their approach to solving the burnout crisis currently affecting the healthcare industry. While our empirical analysis relates to a particular healthcare organization, the framework for quantifying the costs of burnout can be used by other organizations to assess the cost-effectiveness of ameliorative policies.
    JEL: I1 I19 I3 I30 I31
    Date: 2023–01
  11. By: Tyler Giles; Daniel M. Hungerman; Tamar Oostrom
    Abstract: In recent decades, death rates from poisonings, suicides, and alcoholic liver disease have dramatically increased in the United States. We show that these "deaths of despair" began to increase relative to trend in the early 1990s, that this increase was preceded by a decline in religious participation, and that both trends were driven by middle-aged white Americans. Using repeals of blue laws as a shock to religiosity, we confirm that religious practice has significant effects on these mortality rates. Our findings show that social factors such as organized religion can play an important role in understanding deaths of despair.
    JEL: I18 J11 Z12
    Date: 2023–01
  12. By: Azam, Mehtabul (Oklahoma State University)
    Abstract: We use a nationally representative panel data and combine difference-in-differences methodology with multivalued treatments to look at the impact of cooking fuel switch towards LPG on the probability of short-term adverse respiratory health outcomes such as cough and cough with breathing issues. We find that a switch by households from polluting fuels to LPG reduces the probability of any household member reporting adverse short-term respiratory issues. However, a switch from polluting fuels to a fuel stacking strategy has no impact on the adverse respiratory health issues. A reverse switch by households from LPG to polluting fuels increases the probability of household members reporting adverse health outcomes. Importantly, the clean switch to LPG has a much larger impact for women in reducing the incidence of short-term adverse respiratory outcomes.
    Keywords: fuel switching, difference-in-differences, multivalued treatments
    JEL: I1 O12
    Date: 2023–01
  13. By: Ferdi Botha (Melbourne Institute: Applied Economic & Social Research, The University of Melbourne); Richard W. Morris (Central Clinical School, Faculty of Medicine and Health, University of Sydney; School of Psychology, Faculty of Science, University of Sydney); Peter Butterworth (Melbourne Institute: Applied Economic & Social Research, The University of Melbourne; National Centre for Epidemiology and Population Health, The Australian National University); Nick Glozier (Central Clinical School, Faculty of Medicine and Health, University of Sydney)
    Abstract: Given the observed deterioration in mental health among Australians over the past decade, this study investigates to what extent this differs in people born in different decades – i.e., possible cohort differences in the mental health of Australians. Using 20 years of data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we find strong evidence that cohort effects are driving the increase in population level mental ill-health. Deteriorating mental health is particularly pronounced among people born in the 1990s and seen to a lesser extent among the 1980s cohort. There is little evidence that mental health is worsening with age for people born prior to the 1980s. The findings from this study highlight that it is the poorer mental health of Millennials that is driving the apparent deterioration in population-level mental health. Understanding the context and changes in society that have differentially affected younger people may inform efforts to ameliorate this trend and prevent it continuing for emerging cohorts.
    Keywords: mental ill-health, cohort effects, trajectories, Australia
    JEL: I18
    Date: 2023–03
  14. By: Catia Batista; Rita Neves
    Abstract: Immigrant integration is an inherently stressful process that implies psychological challenges. To moderate the impact of the post-migration stressors, social support may play an important role. Using survey data on recently arrived Cape-Verdean migrants in the Lisbon Metropolitan Area, we analyse the role of both destination and home social networks on migrants’ mental health. We find that destination networks significantly reduce overall anxiety and female migrants’ emotional distress. However, larger home networks lead to an increase in overall anxiety and are associated with poorer mental health indicators for female migrants, who may be subject to larger pressure to send financial remittances back home. However, home networks have a positive effect in reducing male migrants’ emotional distress.
    Keywords: International migration, Immigration, Mental health, Social networks, Gender, Cape-Verde, Portugal
    Date: 2022
  15. By: Mallick, Debdulal; Khalil, Islam; Nicholas, Aaron
    Abstract: We investigate the effects on health outcomes resulting from a reduction in years of schooling in Egypt in 1988, a policy change that moves in the opposite direction in relation to the extant literature. We exploit this policy change as a natural experiment and employ a fuzzy regression discontinuity design to investigate a wide range of objectively measured health outcomes and behaviors. Despite the policy’s adverse effect on years of schooling and students’ ability to complete educational milestones, there is no effect on any of the health outcomes. Our results (or lack thereof) add to the complexity and nuance of the findings in the literature that is focused on the effect of increasing compulsory schooling (or school leaving age), particularly in developing countries.
    Keywords: Education; Health; Natural experiment; Fuzzy regression discontinuity
    JEL: C99 I12 I20
    Date: 2023–01
  16. By: Kurt R. Brekke (Norwegian School of Economics (NHH), Department of Economics); Dag Morten Dalen (BI Norwegian Business School); Odd Rune Straume (NIPE/Center for Research in Economics and Management, University of Minho, Portugal; and Department of Economics, University of Bergen, Norway)
    Abstract: Health systems around world are increasingly adopting cost-effectiveness (CE) analysis to inform decisions about access and reimbursement. We study how CE thresholds imposed by a health plan for granting reimbursement affect drug producers´ pricing incentives and patients´access to new drugs. Analysing a sequential pricing game between an incumbent drug producer and a potential entrant with a new drug, we show that CE thresholds may have adverse effects for payers and patients. A stricter CE threshold may induce the incumbent to switch pricing strategy from entry accommodation to entry deterrence, limiting patients´ access to the new drug. Otherwise, irrespective of whether entry is deterred or accommodated, a stricter CE threshold is never pro-competitive and may in fact facilitate a collusive outcome with higher prices of both drugs. Compared to a laissez-faire policy, the use of CE thresholds can only increase the surplus of a health plan if it leads to entry deterrence in which the price reduction by the incumbent necessary to deter entry outweighs the health loss to patients not getting access to the new drug.
    Keywords: Pharmaceuticals; Health Plans; Cost-effectiveness analysis; ICER; Therapeutic competition
    JEL: I11 I18 L13 L65
    Date: 2022
  17. By: Juan D. Moreno-Ternero (Department of Economics, Universidad Pablo de Olavide); Trine T. Platz (Department of Food and Resource Economics, University of Copenhagen); Lars P. Østerdal (Department of Economics, Copenhagen Business School)
    Abstract: We provide a unifying framework for the evaluation of population health. We formalize several axioms for social preferences over distributions of health. We show that a specific combination of those axioms characterizes a large class of population health evaluation functions combining concerns for quality of life, quantity of life and health shortfalls. We refer to the class as (unweighted) aggregations of health-adjusted life years (HALYs). Two focal (and polar) members of this family are the (unweighted) aggregations of quality-adjusted life years (QALYs), and of disability-adjusted life years (DALYs). We also provide new characterization results for these focal members that enable us to scrutinize their normative foundations and shed new light on their similarities and differences.
    Keywords: population health, QALYs, DALYs, HYEs, axioms.
    JEL: D63 I10
    Date: 2023
  18. By: Rute M. Caeiro; Alexander Coutts; Teresa Molina-Millan; Pedro C. Vicente
    Abstract: In this study, we analyze the role of social networks in health insurance adoption in rural Guinea-Bissau. Using detailed social network data, and exploiting the mobilization of local female leaders to promote the insurance scheme, we find that, following the promoters’ intervention, households’ probability of take-up increased by 22 percentage points. Looking at effects along social networks, we find that households well connected to insurance promoters are more likely to adopt if promoters adopt as well. Lastly, our results show that distribution of insurance promotional material by the promoters has a positive effect in households’ adoption and payment of health insurance.
    Keywords: Health insurance, Social networks, Africa
    JEL: O12 I13 D83
    Date: 2022
  19. By: Luís Sá (NIPE/Center for Research in Economics and Management, University of Minho, Portugal); Odd Rune Straume (NIPE/Center for Research in Economics and Management, University of Minho, Portugal; and Department of Economics, University of Bergen, Norway)
    Abstract: We study competing hospitals' incentives for quality provision in a dynamic setting where healthcare is an experience good. In our model, the utility a patient derives from choosing a particular provider depends on a subjective component specifi c to the match between the patient and the provider, which can only be learned through experience. We find that the experience-good nature of healthcare can either reinforce or dampen the demand responsiveness to quality and the hospitals' incentives for quality provision, depending on two key factors: (i) the shape of the distribution of match-specific utilities, and (ii) the cost relationship between quality provision and treatment volume. Our analysis helps identify and understand the conditions required for the market-based provision of healthcare to deliver improved quality.
    Keywords: Hospital competition; experience goods; forward-looking consumers; expectations; quality.
    JEL: I11 I18 L13 L51
    Date: 2022
  20. By: Rosa-Branca Esteves (NIPE/Center for Research in Economics and Management, University of Minho, Portugal); Ziad Ghandour (NIPE/Center for Research in Economics and Management, University of Minho, Portugal); Odd Rune Straume (NIPE/Center for Research in Economics and Management, University of Minho, Portugal; and Department of Economics, University of Bergen, Norway)
    Abstract: Recent advances in healthcare information technologies allow healthcare providers to more accurately track patient characteristics and predict the future treatment costs of previously treated patients, which increases the scope for providers to quality discriminate across different patient types. We theoretically analyse the potential implications of such quality discrimination in a duopoly setting with profit-maximising hospitals, fixed prices and heterogeneous patients. Our analysis shows that the ability to quality discriminate tends to intensify competition and lead to higher quality provision, which benefits patients but makes the hospitals less profitable. Nevertheless, the effect on social welfare is a priori ambiguous, since quality discrimination also leads to an inefficient allocation of patients across hospitals.
    Keywords: Quality discrimination; Hospital competition; Patient heterogeneity
    JEL: I11 I14 L13
    Date: 2022
  21. By: Carl Bonander; Mats Ekman; Niklas Jakobsson
    Abstract: Nudging is a burgeoning topic in science and in policy, but evidence on the effectiveness of nudges among differentially-incentivized groups is lacking. This paper exploits regional variations in the roll-out of the Covid-19 vaccine in Sweden to examine the effect of a nudge on groups whose intrinsic incentives are different: 16-17-year-olds, for whom Covid-19 is not dangerous, and 50-59-year-olds, who face a substantial risk of death or severe disease. The response is strong in the younger but absent in the older age group, consistent with the theory that nudges work best for choices that are not meaningful to the individual.
    Date: 2023–01
  22. By: Catia Batista; Ana Beatriz Gomes
    Abstract: Full access to healthcare is an important driver of immigrant integration. Existing literature shows that there are multiple de facto barriers for migrants to access healthcare even when they are legally entitled to them. This paper examines how time since arrival impacts immigrants’ access to healthcare, a novel research question adding to the existing literature on migrant assimilation. We use survey data collected from about 800 Cape Verdean immigrants in the Lisbon Metropolitan Area. The findings show that immigrants do assimilate in terms of access to healthcare. These results are robust when controlling for sample selection.
    Keywords: Migration, Integration, Assimilation, Healthcare, Cape Verde, Portugal
    JEL: O15 F22 J61 I15
    Date: 2022
  23. By: Mevlude Akbulut-Yuksel; Seyit M. Cilasun; Erdal Tekin; Belgi Turan
    Abstract: This paper uses the severe economic crisis in Turkey in 2008 as a quasi-experiment to evaluate the impact of worsening economic conditions during pregnancy on birth outcomes. Exploiting the temporal and spatial variations in economic hardship across provinces, we show that the deep economic downturn led to significantly lower birth weight. Furthermore, these effects are mainly observed in children born to mothers with low socioeconomic status, suggesting that credit constraints may be a significant factor in the impact of economic crises on birth outcomes in Turkey. Our study also demonstrates that mothers residing in provinces significantly hit by the economic recession are more likely to have premature babies and shorter gestational lengths, both of which elevate the prevalence of lower birth weight newborns. Finally, our analysis illustrates that selective fertility, abortion, and neonatal mortality are more common during an economic downturn, and play a significant role in explaining the impact on birth outcomes in our context.
    JEL: I14 I15 J13
    Date: 2023–01
  24. By: Marshall Burke; Marissa L. Childs; Brandon De la Cuesta; Minghao Qiu; Jessica Li; Carlos F. Gould; Sam Heft-Neal; Michael Wara
    Abstract: Steady improvements in ambient air quality in the US over the past several decades have led to large public health benefits, and the policies that helped drive these improvements are considered landmarks in successful environmental policymaking. However, recent trends in PM2.5 concentrations, a key pollutant, have stagnated or begun to reverse throughout much of the US. We quantify the contribution of wildfire smoke to these trends and find that since 2016, wildfire smoke has significantly slowed or reversed previous improvements in average annual PM2.5 concentrations in two-thirds of US states, eroding 23% of previous gains on average in those states (equivalent to 3.6 years of air quality progress) and over 50% in multiple western states. Smoke influence on trends in extreme PM2.5 concentrations is detectable by 2010 and is concentrated in a dozen western states. Wildfire-driven increases in ambient PM2.5 concentrations are unregulated under current air pollution law, and, absent additional intervention, wildfire's contribution to regional and national air quality trends is likely to grow as the climate continues to warm.
    JEL: Q5 Q53 Q54
    Date: 2023–01
  25. By: Gustafson, Christopher R. (University of Nebraska-Lincoln); Brooks, Kathleen R.; Meerza, Syed Imran Ali; Yiannaka, Amalia
    Abstract: The COVID-19 pandemic, like other crises, has had direct and indirect impacts on people’s lives, many of which have been negative. However, there is little evidence about how COVID-19 affects decision-making. Emotional responses to COVID-19- related stressors, such as local cases and income loss, provide a pathway for these stressors to affect decision-making. In this study, we examine linkages between exposure to COVID-19-related stressors—focusing on temporally specific local case counts and loss of income due to the pandemic—and behaviors for important health decisions with both individual (accessing health care) and societal (accessing information about antimicrobial resistance (AMR)) relevance. In the analysis of two health behaviors that use data from 1) a custom AMR survey and 2) the U.S. Census’s Household Pulse Survey, which asked about accessing healthcare, we find that exposure to COVID-19 stressors significantly increases feelings of hopelessness. Higher levels of hopelessness are associated with an increased probability of avoiding health information about AMR and foregoing or delaying needed medical care. Mediation analysis confirms that hopelessness is an important pathway through which COVID-19-related stressors affect avoidance behaviors. Our results suggest that large- scale crises may diminish action on other important personal and societal health issues facing humanity through emotion-mediated changes in decision-making.
    Date: 2023–01–27
  26. By: Gustafson, Christopher R. (University of Nebraska-Lincoln)
    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.
    Date: 2023–01–27
  27. By: Eiji Yamamura; Yoshiro Tsutsui; Fumio Ohtake
    Abstract: Education plays a critical role on promoting preventive behaviours against the spread of pandemics. In Japan, hand-washing education in primary schools was positively correlated with preventive behaviours against COVID-19 transmission for adults in 2020 during the early stages of COVID-19 [1]. The following year, the Tokyo Olympics were held in Japan, and a state of emergency was declared several times. Public perceptions of and risks associated with the pandemic changed drastically with the emergence of COVID-19 vaccines. We re-examine whether effect of hand-washing education on preventive behaviours persisted by covering a longer period of the COVID-19 pandemic than previous studies. 26 surveys were conducted nearly once a month for 30 months from March 2020 (the early stage of COVID-19) to September 2022 in Japan. By corresponding with the same individuals across surveys, we comprehensively gathered data on preventive behaviours during this period. In addition, we asked about hand-washing education they had received in their primary school. We used the data to investigate how and the degree to which school education is associated with pandemic mitigating preventive behaviours. We found that hand-washing education in primary school is positively associated with behaviours such as hand washing and mask wearing as a COVID-19 preventive measure, but not related to staying at home. We observed a statistically significant difference in hand washing between adults who received childhood hand-washing education and those who did not. This difference persisted throughout the study period. In comparison, the difference in mask wearing between the two groups was smaller, but still statistically significant. Furthermore, there was no difference in staying at home between them.
    Date: 2023–01
  28. By: Deniz Dutz; Michael Greenstone; Ali Hortaçsu; Santiago Lacouture; Magne Mogstad; Azeem M. Shaikh; Alexander Torgovitsky; Winnie van Dijk
    Abstract: Underrepresentation of minority and poor households in scientific studies undermines policy decisions and public health. We study data from a serological study that randomized participation incentives. Participation is low (6% at $0, 17% at $100, 29% at $500) and unequal: minority and poor households are underrepresented at low incentive levels. We develop a framework for disentangling non-contact and ``participation hesitancy'' in explaining non-participation. We find that underrepresentation occurs because poor and minority households are more hesitant, not because they are harder to contact. The $500 incentive appears to overcome differences in hesitancy and restore representativeness along observable dimensions.
    JEL: C40 C42 C83 I1 I14 I30 O31
    Date: 2023–01

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