nep-hea New Economics Papers
on Health Economics
Issue of 2023‒02‒27
seventeen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Early life exposure to measles and later-life outcomes: Evidence from the introduction of a vaccine By Gerard J. van den Berg; Stephanie von Hinke; Nicolai Vitt
  2. Activating the Long-Term Inactive: Labor Market and Mental Health Effects By Mareen Bastiaans; Robert Dur; Anne C. Gielen
  3. Overseas GPs and Prescription Behaviour in England By Nicodemo, Catia; Orso, Cristina E.; Tealdi, Cristina
  4. Improved menstrual health and the workplace: an RCT with female Bangladeshi garment workers By Czura, Kristina; Menzel, Andreas; Miotto, Martina
  5. The pricing of physicians' services with distant medicine and health insurance By Emilie Dargaud; Izabela Jelovac
  6. Rationalizing Pharmaceutical Spending By Manuel García-Goñi
  7. Multivariate risk preferences in the quality-adjusted life year model By Arthur E. Attema; Jona J. Frasch; Olivier L’haridon
  8. Measurement of Social Welfare and Inequality in Presence of Partially-ordered Variables By Mohammad Abu-Zaineh; Sameera Awawda
  9. The political economy of consulting firms in reform processes: the case of the World Health Organization By Eckl, Julian; Hanrieder, Tine
  10. Impacts of the Great Green Wall projects on children’s health: Evidence from Nigeria By Pauline Castaing; Antoine Leblois
  11. Locust Infestations and Individual School Dropout: Evidence from Africa By Abigial O. Asare; Bernhard Christopher Dannemann; Erkan Goeren
  12. Let them Eat Cake? The Net Consumer Welfare Impact of Sin Taxes By Di Cosmo, Valeria; Tiezzi, Silvia
  13. The Value of a Life-Year and the Intuition of Universality By Marc Fleurbaey; Gregory Ponthiere
  14. The impacts of the pandemic on the health and well-being of children in Latin America and the Caribbean and its effect on child-sensitive social protection systems By Castillo, Claudio; Marinho, Maria Luisa
  15. Turning worries into cognitive performance: Results from an online experiment during Covid By Timothée Demont; Daniela Horta Sáenz; Eva Raiber
  16. Trust and social preferences in times of acute health crisis By Fortuna Casoria; Fabio Galeotti; Marie Claire Villeval
  17. Who Gets Vaccinated? Cognitive and Non-cognitive Predictors of Individual Behavior in Pandemics By Andor, Mark A.; Bauer, Thomas K.; Eßer, Jana; Schmidt, Christoph M.; Tomberg, Lukas

  1. By: Gerard J. van den Berg; Stephanie von Hinke; Nicolai Vitt
    Abstract: Until the mid 1960s, the UK experienced regular measles epidemics, with the vast majority of children being infected in early childhood. The introduction of a measles vaccine substantially reduced its incidence. The first part of this paper examines the long-term human capital and health effects of this change in the early childhood disease environment. The second part investigates interactions between the vaccination campaign and individuals' endowments as captured using molecular genetic data, shedding light on complementarities between public health investments and individual endowments. We use two identification approaches, based on the nationwide introduction of the vaccine in 1968 and local vaccination trials in 1966. Our results show that exposure to the vaccination in early childhood positively affects adult height, but only among those with high genetic endowments for height. We find no effects on years of education; neither a direct effect, nor evidence of complementarities.
    Date: 2023–01
  2. By: Mareen Bastiaans (Erasmus University Rotterdam); Robert Dur (Erasmus University Rotterdam); Anne C. Gielen (Erasmus University Rotterdam)
    Abstract: In many Western countries, a sizeable group of people live on welfare benefits for a long time. Many of them suffer from mental health issues. This paper studies the labor market and mental health effects of an activation program targeting these long-term inactive people. We exploit the staggered implementation of the program in a difference-in-differences design. We find that the activation program hardly affects labor market outcomes. However, for those on mental health medication prior to the start of the program, the use of mental health medication substantially drops in the years following the start of the program. This effect is particularly pronounced for men. We also study spillover effects on the children of those targeted by the program, finding some suggestive evidence for improved learning and mental health outcomes.
    Keywords: Activation program, long-term inactive, welfare beneficiaries, mental health, intergenerational spillovers
    JEL: H53 I19 I38 J68
    Date: 2023–01–20
  3. By: Nicodemo, Catia (University of Oxford); Orso, Cristina E. (University of Insubria); Tealdi, Cristina (Heriot-Watt University, Edinburgh)
    Abstract: The UK imports many doctors from abroad, where medical training and experience might be different. This study attempts to understand how drug prescription behaviour differs in English GP practices which have larger or smaller numbers of foreign-trained GPs. Results show that in general practices with a high share of GPs trained outside the UK, prescriptions for antibiotics, mental health medication, analgesics and antacids are higher, controlling for the characteristics of the patients and the practices. However, we find no evidence of any significant impact of such different prescribing behaviour neither on patients' satisfaction nor on unplanned hospitalisations, pointing to this behaviour being due to over-prescribing. Identifying differences in prescribing habits among GPs is paramount to identifying the policies best able to guarantee consistent services across GP practices and the consequent reduction of health inequalities.
    Keywords: GPs, immigration, prescriptions, NHS England
    JEL: I1 C01 C55 C8
    Date: 2023–01
  4. By: Czura, Kristina (University of Groningen); Menzel, Andreas (CERGE-EI, Prague); Miotto, Martina (CERGE-EI, Prague, and CAGE)
    Abstract: Menstruation can limit female labor force participation, especially in low-income countries, where menstrual hygiene practices are constrained by lack of finances and information. In a randomized controlled trial with around 1, 900 female workers from four Bangladeshi garment factories, we relax both constraints individually and jointly by providing free sanitary pads and information. Both access to sanitary pads and information improve menstrual practices, either by the adoption of new technologies, or by knowledge gains and improved use of traditional materials, and both interventions improve health outcomes. However, these positive effects do not translate to better labor outcomes, such as earnings and work attendance.
    Keywords: Menstrual Health, Health Behavior, Labor Force Participation, Export Manufacturing JEL Classification: O14, O15, O35, M54, J32, J81
    Date: 2023
  5. By: Emilie Dargaud (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet - Saint-Étienne - Université de Lyon - CNRS - Centre National de la Recherche Scientifique); Izabela Jelovac (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet - Saint-Étienne - Université de Lyon - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Telemedicine is often put forward as a solution to medical deserts. Recently, telemedicine has allowed to limit physical contacts during a pandemic. We analyze within a theoretical model the setting of physicians' fees in the presence of distant medicine and public health insurance, as well as the resulting patients' surplus, access and public expenses. Concretely, we consider that distant medicine is provided either by the same physician as in-person medicine or by another one specialized in distant medicine. We compare the outcomes of these two market structures with each other and with a benchmark monopoly with no distant medicine. This comparison allows to discuss the effects of a recent French reform concerning insurance reimbursements for distant medicine, as well as those of cross-border high-quality remote health services.
    Keywords: Distant medicine pricing insurance medical deserts I11 I13 L13, Distant medicine, pricing, insurance, medical deserts I11, I13, L13
    Date: 2023–01–06
  6. By: Manuel García-Goñi
    Abstract: Pharmaceutical spending accounts for a large share of health spending worldwide. While pharmaceuticals are an indispensable component of effective modern health systems, and their benefits in terms of increasing life expectancy and improving quality of life are unquestionable, the large variation in pharmaceutical spending across countries suggests that there may be large efficiency gains to be realized. This paper reviews the existing literature and databases on the level and composition of pharmaceutical spending and estimates potential efficiency gains from increased use of generics. It also reviews how countries organize the procurement and tendering of pharmaceuticals and the implications for spending. Finally, the paper identifies the various channels through which spending inefficiencies can arise and identifies reform options for reducing pharmaceutical spending while ensuring quality health outcomes.
    Keywords: Pharmaceutical spending; pharmaceutical policy; generics; biosimilar; procurement; economic evaluation; volume share; percentage value share; share of generic; efficiency gain; Health care; Health care spending; Consumption; Global; Europe
    Date: 2022–09–16
  7. By: Arthur E. Attema (Erasmus School of Health Policy and Management |Rotterdam]); Jona J. Frasch (Erasmus School of Health Policy and Management |Rotterdam]); Olivier L’haridon (CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR1 - Université de Rennes 1 - UNIV-RENNES - Université de Rennes - CNRS - Centre National de la Recherche Scientifique)
    Abstract: The interest in multivariate and higher-order risk preferences has increased. A growing body of literature has demonstrated the relevance and impact of these preferences, but for health the evidence is lacking. We measure multivariate and higher-order risk preferences for quality of life (QoL) and longevity, the two attributes of the Quality-Adjusted Life Year (QALY) model. We observe preferences for a positive correlation between these attributes and for pooling together a fixed loss in one of the attributes and a mean-zero risk in the other, and for pooling together mean-zero risks in QoL and longevity. The findings indicate that higher-order risk preferences are stronger for health than for money. Furthermore, we test if preferences for a risky treatment for a disease affecting only QoL, depend on life expectancy. We find no such a relation, but there is a positive relation between riskiness of a comorbidity affecting life expectancy and risk aversion for a QoL treatment. We therefore observe no definitive deviation from the QALY model, although the model is more robust when expected longevity is high. Our findings suggest that the current practice of cost-effectiveness analysis should be generalized to account for risk aversion in QoL and longevity, and higher-order preferences.
    Keywords: comorbidities, correlation attitude, prudence, QALYs, risk apportionment, risk aversion, temperance, treatment intensity
    Date: 2022–02
  8. By: Mohammad Abu-Zaineh (Aix Marseille Univ, CNRS, AMSE, Marseille, France.); Sameera Awawda (Economics Department and the Institute of Community and Public Health, Birzeit University, Birzeit, Palestine)
    Abstract: We address the question of the measurement of social welfare and inequalities in the context of partially-ordered health variables. We propose a general framework based on the assumption that the distribution of well-being states forms an m-dimensional Boolean lattice. To this end, the distribution of well-being states is constructed based on the prevalence of a finite number of illnesses where each state represents the number of illnesses an individual may suffer from. The implementation of the framework involves breaking down the Boolean lattice into a set of linear extensions where all health states become fully ordered. The linear extensions account for all possible ordering of the health states based on the depth of health problems (i.e., the severity of health conditions). Having constructed these linear extensions, we then proceed on ranking distributions in terms of welfare by applying appropriate dominance criteria and employ aggregate metrics to provide a numerical representation of the social welfare and inequality associated with each distribution. An illustrative application of the methodology is provided.
    Keywords: boolean lattice, Hammond dominance, ordinal inequality, partially-ordered variables, stochastic dominance, welfare function
    JEL: D63 I14 I15 O5
    Date: 2022–12
  9. By: Eckl, Julian; Hanrieder, Tine
    Abstract: Existing research interprets the rise of consulting firms in intergovernmental organizations (IGOs) primarily as evidence of the global spread of managerialism. We highlight that consultants are not merely carriers of business-like world cultural norms, but also part of contentious IGO politics and governance. We unpack the consulting black box and reconstruct how consulting firms are hired and active in IGOs. Analyzing the experiences of the World Health Organization (WHO), we show how IGOs have been informally ‘opened up’ to consulting firms (and to their funders) and we investigate what the consequences of their privileged access are in practice. Consultants curate voices and input (including their own) into reform packages, promote certain contents, and engage in self-effacement practices that undermine accountability to stakeholders. The pivotal position of the consultants can have a disempowering effect on actors excluded from the consulting agreement or marginalized through consulting practices. We illustrate our general discussion by zooming in on the consultant-mediated reform of WHO’s Roll Back Malaria partnership in 2015. Our analysis is based on primary documents, key informant interviews, informal conversations, and participant observation.
    Keywords: global governance; consulting firms; informal governance; private authority; institutional reform; World Health Organization; Gates Foundation; McKinsey; T&F deal
    JEL: J1
    Date: 2023–01–10
  10. By: Pauline Castaing (CERDI - Centre d'Études et de Recherches sur le Développement International - CNRS - Centre National de la Recherche Scientifique - UCA - Université Clermont Auvergne); Antoine Leblois (CEE-M - Centre d'Economie de l'Environnement - Montpellier - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - Institut Agro Montpellier - Institut Agro - Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement - UM - Université de Montpellier)
    Abstract: The Great Green Wall is a crosscountry initiative to improve the environment of desertification areas in Sub-Saharan Africa. This paper refers to the implementation of Great Green Wall projects in Nigeria to document the local impact of environmental restoration on children's food security and health. Our identification strategy uses two types of variation to capture these effects. The spatial variation comes from the heterogeneous exposure of the children to these new environmental restoration programs. The temporal variation comes from sudden changes between 2013 and 2016. Taking the height-to-age z-score as main outcome of interest, we find a significant and robust health improvement for children living next to community-based orchards whereas proximity to shelterbelts generates mixed impacts. Gains in health (+0.5 standard deviation in the height index) coexist with higher dietary diversity score for children living near orchards.
    Keywords: Environmental Restoration, Food security, Nigeria, Nutrition, Impact evaluation
    Date: 2023–01–26
  11. By: Abigial O. Asare (University of Oldenburg, Department of Economics); Bernhard Christopher Dannemann (University of Oldenburg, Department of Economics); Erkan Goeren (University of Oldenburg, Department of Economics)
    Abstract: This paper examines the effect of desert locust infestations on school enrollment of children and young adults between 3 and 24 years of age. We combine individual and household survey data from the 2005-2019 Demographic and Health Surveys (DHS) Program with data on the spatial distribution of locust events in Africa. We show that months of exposure to locust infestations have a negative and statistically significant impact on individual schooling status. We find that individuals from farming households are affected more negatively by locust infestations than individuals from non-farming households. We also find that individuals from poorer farming households have a higher school dropout rate than individuals from wealthier farming households, highlighting the role of negative income shocks as a possible transmission mechanism for the effects of desert locust events. Our results also show that the estimated effect is amplified by the household’s head educational status. A series of additional robustness tests further corroborate our main findings. We provide a quantitative assessment of the impact of a permanent 1.5 C rise in global temperature on the frequency of locust events and possible implications for schooling outcomes over time. The results show that a 1.5 C rise in temperature will decrease accumulated years of schooling by about 1.2 years over a period of 10 years.
    Keywords: Desert Locust; Demographic and Health Surveys (DHS) Program; School Enrollment;Income Shocks; Current Schooling; Farmers; Africa
    Date: 2023–02
  12. By: Di Cosmo, Valeria; Tiezzi, Silvia
    Abstract: When judging the distributional impact of a sin tax, what matters is not just how much low income people would pay but how much the tax would benefit or harm them overall. In this paper we assess the consumer welfare impact of a fat tax net of its expected benefits computed as savings from averted internalities. Using data on Italian consumers we estimate a censored Exact Affine Stone Index (EASI) incomplete demand system for food groups and simulate changes in purchases, calorie intake, consumers’ welfare and the monetary value of health benefits after the tax. Our results suggest costs from taxation larger than benefits at all income levels. As a fraction of income, the net impact would be regressively distributed.
    Keywords: sin taxes; internality benefits; welfare costs; exact affine stone index demand system; demand elasticities; micronutrients intake
    JEL: C3 H22 H23 I3 I39
    Date: 2023–01–10
  13. 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
  14. By: Castillo, Claudio; Marinho, Maria Luisa
    Abstract: The coronavirus disease (COVID-19) pandemic has had a profound impact on health, economic and social conditions in the countries of Latin America and the Caribbean, affecting different population groups in various ways. While children have not been among the main direct victims of the virus, the crisis triggered by the pandemic has placed children in a situation where they face obstacles to exercising their rights to health and education, social security, a standard of living that allows for their full development and protection from all forms of violence. These challenges are compounded by the fact that in 2020, one in two children was living in poverty. The public health measures most countries have implemented to contain the spread of the virus have also hampered children’s access to routine feeding and vaccination programmes, health check-ups and food and nutrition monitoring, timely diagnosis and medical referrals, and opportunities for free play or camaraderie with peers, all of which are fundamental to achieving their developmental potential.
    Date: 2022–12–05
  15. By: Timothée Demont (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Daniela Horta Sáenz (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Eva Raiber (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique, CEPR - Center for Economic Policy Research - CEPR)
    Abstract: Worrisome topics, such as climate change, economic crises, or the Covid-19 pandemic, are increasingly present and pervasive due to digital media and social networks. Do such worries affect cognitive performance? The effect of a distressing topic might be very different depending on whether people have the scope and means to cope with the consequences. It can also differ by how performance is rewarded, for instance, if is there a goal that people can focus on. In an online experiment during the Covid-19 pandemic, we test how the cognitive performance of university students responds to topics discussing (i) current mental health issues related to social restrictions or (ii) future labor market uncertainties linked to the economic contraction. Moreover, we study how the response is affected by a performance goal by conditioning payout on reaching a minimum level. We find that the labor market topic increases cognitive performance when performance is motivated by a goal. Conversely, there is no such effect after the mental health topic. We even find a weak negative effect among those mentally vulnerable when payout is not based on reaching a goal. The positive effect is driven by students with larger financial and social resources, pointing at an inequality-widening mechanism.
    Keywords: cognitive performance, financial worries, Covid-19, financial incentives, anxiety, coping behaviors
    Date: 2023–01–16
  16. By: Fortuna Casoria (CEREN EA 7477, Burgundy School of Business, Université Bourgogne Franche-Comté, Dijon, France); Fabio Galeotti (Univ Lyon, CNRS, GATE UMR 5824, 93 Chemin des Mouilles F-69130 Ecully, France); Marie Claire Villeval (Univ Lyon, CNRS, GATE UMR 5824, 93 Chemin des Mouilles F-69130 Ecully, France)
    Abstract: We combined a natural experiment (the occurrence of the COVID-19 pandemic in 2020) with the tools of laboratory experiments to study whether and how an unprecedented shock on social interactions (the introduction and abrogation of a nationwide lockdown) affected the evolution of individuals’ social preferences, and willingness to trust others. In a longitudinal online incentivized experiment during the first lockdown in France, we elicited the same participants’ preferences for prosociality, trust and trustworthiness every week for three months. Despite the exposure to long-lasting social distancing, prosocial preferences and the willingness to reciprocate the trust of others remained stable during the whole period under study. In contrast, the lockdown had an immediate negative effect on trust, which remained at lower levels til after the lifting of such measures but recovered its initial level nine months later. The decline in trust was mainly driven by individuals who experienced financial hardship, a lack of outward exposure, and higher anxiety during the lockdown.
    Keywords: Social preferences, Trust, Trustworthiness, Pandemic, COVID-19, Social distancing
    JEL: C92 D91 I18
    Date: 2023
  17. By: Andor, Mark A. (RWI); Bauer, Thomas K. (RWI); Eßer, Jana (RWI); Schmidt, Christoph M. (RWI); Tomberg, Lukas (RWI)
    Abstract: This study investigates the different cognitive and non-cognitive characteristics associated with individuals' willingness to get vaccinated against Covid-19 and their actual vaccination status. Our empirical analysis is based on data obtained from three survey waves of about 2, 000 individuals living in the German state of North Rhine-Westphalia. We find that individuals with a high level of trait reactance display a significantly lower willingness to get vaccinated. They also tend to get inoculated later or never. Moreover, neuroticism, locus of control, and risk literacy appear to be associated with the willingness to get vaccinated, but these results are less pronounced and less robust. Our results indicate that vaccination campaigns and policies could be improved by specifically addressing those with a high level of trait reactance.
    Keywords: COVID-19, vaccination, psychological traits, risk literacy, health literacy
    JEL: D91 H0 I12 I18
    Date: 2023–01

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