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on Health Economics |
| By: | Jonathan Gruber; Tuomas Kosonen; Kristiina Huttunen |
| Abstract: | We study the impacts of a policy designed to reward mothers who stay at home rather than join the labor force when their children are under age three. We use regional and over time variation to show that the Finnish Home Care Allowance (HCA) decreases maternal employment in both the short and long term. The effects are large enough for the existence of home care benefit system to explain the higher short-term child penalty in Finland than comparable nations. Home care benefits also negatively affect the early childhood cognitive test results of children, decrease the likelihood of choosing academic high school, and increase youth crimes. We confirm that the mechanism of action is changing work/home care arrangements by studying a day care fee reform that had the opposite effect of raising incentives to work – with corresponding opposite effects on mothers and children compared to HCA. Our findings suggest that shifting child care from the home to the market increases labor force participation and improves child outcomes. |
| JEL: | H31 J13 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30931&r=hea |
| By: | Laura Grigolon; Laura Lasio |
| Abstract: | Lung cancer is associated with smoking and is characterized by low treatment rates and research funds. We estimate a model of treatment choice where patients internalize societally biased beliefs on the effectiveness of treatment and stigma, basing their treatment decision on the treatment decisions of their reference group. Identification rests on the exogenous variation in the treatment propensity of physicians. Placing all patients in a neighborhood characterized by low social discrimination increases treatment rates by 4% and the use of innovative therapies by 3%. Social effects account for around 2% of the gap in research funding for lung cancer. |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2021_277v2&r=hea |
| By: | Naoki Aizawa; Ami Ko |
| Abstract: | While the traditional role of insurers is to provide protection against idiosyncratic risks of individuals, insurers themselves face substantial uncertainties due to aggregate shocks. To prevent insurers from passing through aggregate risks to consumers, governments have increasingly adopted dynamic pricing regulations that limit insurers' ability to change premiums over time. This paper develops and estimates an equilibrium model with dynamic pricing and firm entry and uses it to evaluate the design of dynamic pricing regulations in the U.S. long-term care insurance (LTCI) market. We find that stricter dynamic pricing regulation lowers social welfare as the benefit from improved premium stability is outweighed by the cost of reduced insurer participation. The welfare loss from stricter dynamic pricing regulation could be mitigated if the government also expands public LTCI through Medicaid. |
| JEL: | D14 G22 I13 L11 L51 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30952&r=hea |
| By: | Sam Heft-Neal; Carlos F. Gould; Marissa Childs; Mathew V. Kiang; Kari Nadeau; Mark Duggan; Eran Bendavid; Marshall Burke |
| Abstract: | Air pollution is known to negatively affect a range of health outcomes. Wildfire smoke is an increasingly important contributor to air pollution, yet extreme smoke events are highly salient and could induce behavioral responses that alter health impacts. We combine geolocated data covering the near universe of 127 million emergency department (ED) visits in California with estimates of daily surface wildfire smoke PM2.5 concentrations and quantify how increasingly acute wildfire smoke events affect ED visits. Low or moderate levels of ambient smoke increase total visits by 1-1.5% in the week following exposure, but extreme smoke days reduce total visits by 6-9%, relative to a day with no smoke. Reductions persist for at least a month. Declines during extreme exposures are driven by diagnoses not thought to be acutely impacted by pollution, including accidental injuries, and come disproportionately from less insured populations. In contrast, health outcomes with the strongest physiological link to short-term air pollution increase dramatically: ED visits for asthma, COPD, and cough all increase by 30-110% in the week after one extreme smoke day. Because low and moderate smoke days vastly outweigh extreme smoke days in our sample, we estimate that smoke exposure was responsible for roughly 3, 000 additional ED visits per year in CA from 2006-2017. |
| JEL: | Q5 Q53 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30969&r=hea |
| By: | Domenico Depalo (Bank of Italy, Labor Market Department); Alessandro Palma (Gran Sasso Science Institute (GSSI) & CEIS, Università di Roma ‘Tor Vergata’) |
| Abstract: | We estimate the effect of air pollution on work-related accidents using administrative data from Italy in a setting characterized by strict air pollution and work safety regulations. To address the potential endogeneity due to unobserved productivity shifts and firm-specific pollution sources, we use winter heating rules in highly urbanized areas as a exogenous sources of variation in pollution exposure. We find that a one unit increase in PM10 causes 0.014 additional accidents and 0.0013 additional disabilities. We also explore the theoretical implications of these findings in a setting where firms are risk carriers and fully bear the compensation costs of less severe accidents. We empirically confirm that firms have an incentive to deploy defensive investments also when the risk of accidents derives from external factors, as in the case of air quality. Our back-of-the-enveloped calculation shows that each additional unit in PM10 concentration would increase the total cost of an accident by about 1.7%. |
| Keywords: | air pollution, workplace safety, work accidents, IV, winter heating |
| JEL: | I18 J28 J81 Q51 Q53 |
| Date: | 2023–02–25 |
| URL: | http://d.repec.org/n?u=RePEc:rtv:ceisrp:554&r=hea |
| By: | Liu, Ziheng (University of Wisconsin-Madison); Chen, Xi (Yale University); Lu, Qinan (University of Wisconsin-Madison) |
| Abstract: | In light of the low public awareness of ozone pollution and the potential health threats posed by long-term ozone exposure, this study estimates the causal effect of long-term ozone exposure on respiratory mortality. By employing an instrumental variable based on the long-distance transmission of ozone from upwind neighbor counties, we discover that an increase of one standard deviation in the average concentrations of ozone in the preceding five years increases respiratory mortality by 0.062–0.066 standard deviations. The findings indicate that long-term ozone exposure increases mortality from both acute and chronic respiratory diseases and has significant adverse effects on vulnerable groups. Furthermore, we discover that the respiratory mortality rate responds to long-term ozone exposure nonlinearly, and that there is a critical threshold at which the adverse effects of ozone exposure commence. Our bootstrap simulation results suggest that if ozone concentrations in the preceding five years decrease by 10 percent, 11, 391 deaths from respiratory diseases could be avoided in the United States annually, with resulting health benefits valued at around $106.85–113.67 billion. Our further estimates suggest that, consistent with general respiratory diseases, long-term ozone exposure also contributes to deaths from COVID-19 during the pandemic. |
| Keywords: | long-term exposure, ozone, respiratory diseases, nonlinear responses, health benefits, COVID-19 |
| JEL: | I15 J14 Q51 Q53 |
| Date: | 2023–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15981&r=hea |
| By: | Mara Barschkett |
| Abstract: | Over the past decades, the share of very young children in daycare has increased significantly in many OECD countries, including Germany. Despite the relevance of child health for child development and later life success, the effect of early daycare attendance on health has received little attention in the economic literature. In this study, I investigate the impact of a large daycare expansion in Germany on children’s age-specific mental and physical health outcomes. Based on a unique set of administrative health records covering 90% of the German population over a period of ten years, I exploit exogenous variation in daycare attendance induced by the expansion. My results provide evidence for the substitution of illness spells from the first years of elementary school to the first years of daycare. Specifically, I find that early daycare attendance increases the prevalence of respiratory and infectious diseases and healthcare consumption when entering daycare (1–2 years) by 5–6 percent. At elementary school age (6–10 years), the prevalence decreases by similar magnitudes. I do not find evidence for an effect of daycare attendance on mental disorders, obesity, injuries, vision problems, or healthcare costs. Heterogeneity analysis indicates more pronounced effects for children from disadvantaged areas, earlier detection of vision problems, and a reduction in obesity in these children. |
| Keywords: | Child care, daycare expansion, physical health, mental health, education, administrative health records, difference-in-differences, event study |
| JEL: | I10 I12 J13 C23 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwwpp:dp2028&r=hea |
| By: | Martina Björkman-Nyqvist; Seema Jayachandran; Celine P. Zipfel |
| Abstract: | Building on prior evidence that mothers often have a stronger preference for spending on children than fathers do, we use a randomized experiment to evaluate the impacts of a communication training program for mothers on child health in Uganda. The hypothesis is that the training will enable women to better convey their knowledge and preferences to their husbands and, thereby, boost investments in children's health. We find that the program increases spousal discussion about the family's health, nutrition, and finances. However, this does not increase overall adoption of health-promoting behaviors or improve child anthropometrics. One exception is that the communication training increases women's and children’s intake of protein-rich foods as well as household spending on these foods. |
| JEL: | D10 I12 O12 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30962&r=hea |
| By: | Vincenzo Bove (University of Warwick); Jessica Di Salvtore (University of Warwick); Lenadro Elia (Marche Polytechnic University.); Roberto Nisticò (Università di Napoli Federico II, CSEF and IZA) |
| Abstract: | A considerable body of empirical evidence indicates that conflict affects reproductive behaviour, often resulting in an increased fertility rate due to higher child mortality and limited access to healthcare services. Yet, we know much less about the effect of peace in a post-conflict setting. This study explores how the external provision of security affects fertility rates by focusing on the UN intervention in Liberia. By combining birth history data from three rounds of the Demographic and Health Survey with information on road distance to UN military compounds, we find that women who live in the proximity of peacekeepers have lower fertility rates in the deployment period. We find that this is due to parents prioritizing quality over quantity as peacekeepers improve maternal and child health and encourages family planning by (i) enabling donors and humanitarian actor to deliver infrastructures and services, and (ii) facilitating citizens’ access to such services. |
| Keywords: | conflict; fertility; maternal health; child health; UN operations. |
| JEL: | J16 J24 D74 F50 |
| Date: | 2023–02–22 |
| URL: | http://d.repec.org/n?u=RePEc:sef:csefwp:670&r=hea |
| By: | Goncalves, Judite (Universidade Nova de Lisboa); Merenda, Roxanne (Universidade Nova de Lisboa); Pereira dos Santos, João (RWI) |
| Abstract: | Portugal introduced a sugar-sweetened beverages (SSB) tax in 2017. This study uses unique administrative accounting data for all SSB producers/importers in Portugal, and an event study design with bottled water firms as the primary comparison group, to assess the causal impacts of the tax on multiple firm-level outcomes. We find a 6.8% average decrease in domestic SSB sales, vis-à-vis bottled water. The soda tax hindered SSB firms' financial health, namely net income, ability to convert receivables into cash, and liabilities. SSB producers/importers did not decrease wages, cut jobs, or modify their workforce towards higher R&D capacity. Forgone corporate income tax appears negligible compared to the government revenue generated by the tax itself. |
| Keywords: | sugar tax, soda tax, firm-level, sin taxes |
| JEL: | H25 H51 I18 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15968&r=hea |
| By: | David C. Grabowski; Jonathan Gruber; Brian McGarry |
| Abstract: | Although debates over immigration remain contentious, one important sector served heavily by immigrants faces a critical labor shortage: nursing homes. We merge a variety of data sets on immigration and nursing homes and use a shift-share instrumental variables analysis to assess the impact of increased immigration on nursing home staffing and care quality. We show that increased immigration significantly raises the staffing levels of nursing homes in the U.S., particularly in full time positions. We then show that this has an associated very positive effect on patient outcomes, particularly for those who are short stayers at nursing homes, and particularly for immigration of Hispanic staff. |
| JEL: | I11 I18 J61 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30960&r=hea |
| By: | Walker, Brigham (Tulane University); Wisniewski, Janna (Tulane University); Tinkler, Sarah (Portland State University); Stano, Miron (Oakland University); Sharma, Rajiv (Portland State University) |
| Abstract: | Roughly a quarter of physicians in the United States are either international medical graduates (IMGs) or foreign-born physicians (FBPs). We propose a theoretical model where patient preferences that disfavor IMGs and FBPs may result in those physicians offering better access to their services compared with non-IMGs/FBPs in equilibrium. We use data from two field experiments to test the predictions from the model: one concerning patient preferences and the other concerning physician availability. In the patient preferences field experiment, we find that patients strongly prefer doctors educated in the United States to IMGs by about 2-to-1. In the physician availability field experiment, we find that US-born physicians generally have lower levels of availability including offering fewer appointments and longer wait times. These results indicate a substantial underutilization of FBPs relative to US-born physicians and suggest that a sizable share of the US healthcare provider base is unfairly disadvantaged based on nativity. |
| Keywords: | patient preferences, physician availability, foreign doctors, International Medical Graduates (IMGs), Foreign-Born Physicians (FBPs) |
| JEL: | I11 C93 J7 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp15951&r=hea |
| By: | Boyan Zheng; Qiongshi Lu; Jason Fletcher |
| Abstract: | The causal effects of fertility are a central focus in the social sciences, but the analysis is challenged by the endogeneity of fertility choices. Earlier work has proposed several “natural experiments” from twin births or gender composition of earlier births to assess whether having more children affects adults’ outcomes, though there are limitations to using rare (twins) and weak (gender composition) instrumental variables for fertility. This paper proposes a new “natural experiment” approach to assessing the causal effects of fertility by measuring the combination of couples’ genetics in predicting fertility—a dyadic genetic instrumental variable, where the key idea (exclusion restriction) is that the interactions of the couple’s genetics that shift the likelihood of fertility is unknown to the couples. We use a nationally representative sample of couples to examine the long-lasting effects of fertility on older adults’ life outcomes, including labor market outcomes, personality traits, and subjective wellbeing. We find that fertility reduces females’ extraversion and years of working and some evidence indicates that fertility reduces both males’ and females’ lifetime number of jobs worked. |
| JEL: | J10 J13 J22 J29 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30955&r=hea |
| By: | Nguyen, Cuong Viet; Nguyen, Quynh Ngoc |
| Abstract: | In this study, we study disability among older people (aged 60 or older) using the 2016 Viet Nam National Disability Survey. We find that 31% and 12% of older people are living with low and high disabilities, respectively. These rates are remarkably higher than the disability rate identified by local authorities. Disability is found to be more prevalent in older people and women. There is a strong and negative association between education and disability, as well as between wealth and disability. Next, we analyze the need for care among older people with disabilities. We find that around 10% of older people need care, which is equivalent to around 1.2 million people. The proportion of people in need of care is 29% for older people with disabilities and 53.8% for older people with severe disabilities. |
| Keywords: | Disability, older people, care need, unmet care, Vietnam |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1244&r=hea |
| By: | Lisa J. Dettling; Melissa Schettini Kearney |
| Abstract: | We revisit the cyclical nature of birth rates and infant health and investigate to what extent the relationship between aggregate labor market conditions and birth outcomes is mitigated by the consumption smoothing income assistance delivered through unemployment insurance (UI). We introduce a novel empirical test of standard neoclassical models of fertility that directly tests the prediction of opposite-signed income and intertemporal substitution effects of business cycles by examining the interaction of the aggregate unemployment rate with a measure of potential income replacement from UI. Our results show that as UI benefit generosity reaches 100 percent income replacement, there is no effect of the unemployment rate on fertility rates. This implies that the well-documented cyclical nature of fertility rates is about access to liquidity. We also provide novel evidence that infant health is countercyclical based on timing of conception, but procyclical based on time in utero. The negative relationship between the in utero aggregate unemployment rate and infant health also disappears when potential UI replacement rates reach 100 percent. Our results indicate that the social insurance provided by UI has a pro-natalist effect and improves babies’ health. |
| JEL: | H51 I18 J11 J13 J18 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30937&r=hea |
| By: | Ulep, Valerie Gilbert T.; Uy, Jhanna; Casas, Lyle Daryll D.; Capanzana, Mario V.; Nkoroi, Alice; Galera, Rene Gerard Jr.; Carpio, Maria Evelyn; Tan, Frederich |
| Abstract: | About a third of Filipino children are stunted or chronically malnourished. However, there is a paucity of evidence on the socioeconomic inequalities of stunting in the Philippines. This study has two objectives. First, it discusses various determinants of the large socioeconomic disparity in stunting. Second, it models the trajectory of stunting until 2030 should the country expand the coverage of key nutrition and health interventions. Based on the authors’ previous decomposition analysis, maternal nutritional status and education factors, quality of prenatal care, and child diet are significant drivers of the disparity. Furthermore, using a compartment-based model, it finds a 10-percentage point reduction in the prevalence of stunting, with the expansive promotion of infant and young child feeding (IYCF) practices and complementary food interventions. Lastly, the authors note that addressing the socioeconomic disparity in child stunting and universal provision of nutrition and health interventions puts the country on track to its 2030 Sustainable Development Goal (SDG) target. Comments to this paper are welcome within 60 days from the date of posting. Email publications@pids.gov.ph. |
| Keywords: | undernutrition;child stunting;stunting projection;Philippines;stunting |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2023-04&r=hea |
| By: | Anna Choi; Arnab K. Basu; Nancy H. Chau; T.V. Sekher |
| Abstract: | This paper studies the education gradient associated with health reporting errors for two highly prevalent non-communicable diseases among older adults in India. We leverage a novel data set—the Longitudinal Aging Study in India (2017-18) panel survey—to unpack the sources of health reporting error in a developing-country context for the first time. |
| Keywords: | Education, Health, Panel survey |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:unu:wpaper:wp-2023-27&r=hea |
| By: | Abieyuwa Ohonba (College of Business and Economics, School of Economics, University of Johannesburg); Frederich Kirsten (College of Business and Economics, School of Economics, University of Johannesburg); Bongiwe Mkhize (College of Business and Economics, School of Economics, University of Johannesburg) |
| Abstract: | Unmet healthcare needs are significant public health concerns worldwide. In South Africa, this is especially prevalent with high healthcare inequities. Issues about availability, acceptability and accessibility are central to the healthcare inequities in South Africa. Yet, little information exists on how people in different sociodemographic groups perceive these issues and their perceptions about overall unmet healthcare needs. This study assesses the dynamics behind perceived unmet healthcare needs in South Africa. We use the International Social Survey Programme (ISSP) data from the 2010 Health and Healthcare module. For the empirical analysis, logistical regressions were used to assess the sociodemographic determinants behind perceived unmet healthcare needs among South Africans. In addition, a composite index was constructed based on the three main themes, while three separate logistic regressions were also conducted based on each of the three dimensions. Overall, the results show that income, race, age, and regional factors influence people's view of unmet healthcare needs in South Africa. The findings point to the fact that perceived issues about unmet healthcare needs are clustered around those most vulnerable in society. Driven mainly by availability issues, reasons like waiting lists or queues too long and living too far from healthcare facilities are some of the primary reasons why the vulnerable still feel their healthcare needs are unmet. The needs of the socioeconomically disadvantaged population should be addressed by the government so that they can endure the effects of crises when they occur. In addition, South African policymakers should concentrate on the socio-disadvantaged population when designing the National Health Insurance (NHI) system. |
| Keywords: | Social determinants of health, public health, perceived unmet needs, health inequity, South Africa |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ady:wpaper:edwrg-05-2023&r=hea |
| By: | Jishnu Das; Quy-Toan Do |
| Abstract: | Governments in many low- and middle-income countries are developing health insurance products as a complement to tax-funded, subsidized provision of health care through publicly operated facilities. This paper discusses two rationales for this transition. First, health insurance would boost fiscal revenues for health care, as post-treatment out-of-pocket payments to providers would be replaced by pre-treatment insurance premia to health ministries. Second, increased patient choice and carefully designed physician reimbursements would increase quality in the health care sector. This essay shows that, at best, these objectives have only been partially met. Despite evidence that health insurance has provided financial protection, consumers are not willing to pay for unsubsidized premia. Health outcomes have not improved despite an increase in utilization. We argue that this is not because there was no room to improve the quality of care but because behavioral responses among health care providers have systematically undermined the objectives of these insurance schemes. |
| JEL: | I11 I12 I13 I15 O12 |
| Date: | 2023–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30996&r=hea |
| By: | Opiniano, Gina A.; Abrigo, Michael R.M.; Tam, Zhandra C. |
| Abstract: | We assess the short-term impacts of the Doctors-to-the-Barrios (DTTB), a national physician deployment program in the Philippines that augments the supply of rural healthcare workers in underserved areas, on several health sector outcomes. Using regression discontinuity design, we find that the DTTB program doubles modern contraceptive-use prevalence and reduces child underweight prevalence in poor municipalities, coinciding with an increased propensity of having rural health physicians in the community. We estimated an internal program rate of return of 15.9%, which is likely to be severely understated. Comments to this paper are welcome within 60 days from the date of posting. Email publications@pids.gov.ph. |
| Keywords: | rural health physician;doctors-to-the-barrios program;maternal and child health;healthcare workers |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2023-03&r=hea |
| By: | Caroline Berchet; José Bijlholt; Mariko Ando |
| Abstract: | The COVID 19 pandemic has disproportionately hit some vulnerable population groups. Those living in deprived areas, migrant population, and ethnic minorities are at higher risk of catching and dying from the virus than other groups, and they also face significant indirect health impacts of the COVID-19 pandemic - both mental health impacts and disruption of routine care. The working paper gathers evidence on the direct and indirect health impacts of the COVID-19 on the poor population and the ethnic minorities. It reviews factors underlying these inequalities, and maps policy interventions adopted by OECD countries to help address the disproportionate impacts of the COVID-19 pandemic on vulnerable population groups. |
| JEL: | I14 I30 I10 |
| Date: | 2023–03–09 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:153-en&r=hea |
| By: | Wong, John Q.; Co, Stephanie Anne L.; Modina, Cheyenne Ariana Erika; Fowler, Krizelle Cleo; Tarroc, Mary Gil; Mallari, Eunice U.; Abigail L. Tan; Carlo Yao |
| Abstract: | The passage of the UHC law in 2019 mandated the creation of the Health Technology Assessment (HTA) Program to identify and recommend the most cost-effective health technologies for the Philippine government to procure. Since its inception, the HTA has mainly assessed COVID-19-related technologies. But with changing demands, current HTA processes must be evaluated for their relevance and usefulness post-pandemic and performance relative to international best practices. More importantly, there is a need to assess the far-reaching impacts of pricing and procurement on end users. Given these criteria, this study reviewed HTA policies and assessed end-user outcomes. Special attention was given to the utilization, assessment, and satisfaction with the processes, reports, and recommendations of the HTA by end users. Multiple factors, including changes in leadership and the COVID-19 pandemic, have delayed the HTA roadmap. However, end users still utilize HTA assessments and recommendations in agenda setting, policy formulation, decisionmaking, and procurement. This was especially apparent for technologies related to COVID-19. But despite these achievements, much can be improved. The HTA must navigate through the challenges of inadequate local data. It must also consider adopting international best practices and adding human resources to increase assessment capacity and improve current processes. Finally, the program must transition to essential medicine and technologies for high-burden diseases and widen its scope, given its value to agencies involved in improving public health. Comments to this paper are welcome within 60 days from the date of posting. Email publications@pids.gov.ph. |
| Keywords: | health technology assessment;evaluation;outcome |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2022-59&r=hea |
| By: | Matias D. Cattaneo; Luke Keele; Rocio Titiunik |
| Abstract: | We present a practical guide for the analysis of regression discontinuity (RD) designs in biomedical contexts. We begin by introducing key concepts, assumptions, and estimands within both the continuity-based framework and the local randomization framework. We then discuss modern estimation and inference methods within both frameworks, including approaches for bandwidth or local neighborhood selection, optimal treatment effect point estimation, and robust bias-corrected inference methods for uncertainty quantification. We also overview empirical falsification tests that can be used to support key assumptions. Our discussion focuses on two particular features that are relevant in biomedical research: (i) fuzzy RD designs, which often arise when therapeutic treatments are based on clinical guidelines, but patients with scores near the cutoff are treated contrary to the assignment rule; and (ii) RD designs with discrete scores, which are ubiquitous in biomedical applications. We illustrate our discussion with three empirical applications: the effect CD4 guidelines for anti-retroviral therapy on retention of HIV patients in South Africa, the effect of genetic guidelines for chemotherapy on breast cancer recurrence in the United States, and the effects of age-based patient cost-sharing on healthcare utilization in Taiwan. Complete replication materials employing publicly available statistical software in Python, R and Stata are provided, offering researchers all necessary tools to conduct an RD analysis. |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2302.07413&r=hea |
| By: | Hema Shah; Lisa A. Gennetian |
| Abstract: | Children represent the largest indirect beneficiaries of the U.S. social welfare system. Yet, many questions remain about the direct benefits of cash aid to children. The current understanding of the impacts of cash aid in the U.S. is drawn primarily from studies of in-kind benefits, tax credits, and conditional cash aid programs. A corresponding economics literature focuses on the labor supply responses of parents and the role of income, parenting skills, and early education as family investment mechanisms that reduce socioeconomic inequality in children’s well-being. In contrast to the U.S., dozens of low- to middle-income nations use direct cash aid—conditional or unconditional—as a central policy strategy, with demonstrated positive effects across a host of economic and health measures and selected aspects of children’s health and schooling. This paper reviews the economic research on U.S. safety net programs and cash aid to families with children and what existing studies reveal about its impacts on family investment mechanisms and children’s outcomes. We specifically highlight gaps in understanding the impacts of unconditional cash aid on children. We then review nine contemporary unconditional cash transfer programs and discuss their promise and limitations in filling the U.S.-based economic evidence gap about the impact of cash aid on children’s development. |
| JEL: | H31 H53 H75 I3 I38 J13 J18 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30965&r=hea |
| By: | Yuting Chen; Patricia Cortés; Gizem Koşar; Jessica Pan; Basit Zafar |
| Abstract: | We study how COVID-19 affected the prevalence, expectations, and attitudes toward remote work using specially designed surveys. The incidence of remote work remains higher than pre-pandemic levels and both men and women expect this to persist post-pandemic. Workers also report increased preference for remote work as a result of the pandemic. These changes are strongly correlated with individuals’ exposure to the pandemic induced work-from-home shock, indicating that experience with remote work during the pandemic likely shaped expectations and preferences toward WFH. The magnitude of the effects on preferences and expectations are similar across gender, marital status, and presence of children. |
| JEL: | J22 |
| Date: | 2023–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:30941&r=hea |
| By: | Zane Varpina (Stockholm School of Economics in Riga; Baltic International Centre for Economic Policy Studies); Kata Fredheim (Stockholm School of Economics in Riga; Baltic International Centre for Economic Policy Studies) |
| Abstract: | The Covid-19 pandemic restricted people’s movement but also changed their course of life. For some migrants, this meant re-evaluating opportunities abroad and back home. This paper uses findings from interviews with those who returned to Latvia during the pandemic to gain insight into the ways the pandemic influenced their decision to return. We find that the pandemic impacted how people think of return. It was both a reason and a catalyst, accelerating life events and leading to decisions to return. For some who contemplated return the pandemic accelerated decision, motivated by missing people, loneliness, and missing community. The pandemic and its immediate consequences also directly affected migrants; livelihood and work; some returned quickly. For some of these migrants, the pandemic also acted as a barrier to leaving again soon after a return. Circular migration journeys of coming back and leaving again feed into the narrative that for many migrants returning is more a stop in their journey than the destination itself. The much anticipated great wave of return, it seems was more like a tide. People moved back and forth between borders, seeking safety and community in times of uncertainty while trying to maintain their work and studies. |
| Date: | 2022–06 |
| URL: | http://d.repec.org/n?u=RePEc:bic:opaper:16&r=hea |
| By: | Bertrand Achou (HEC Montréal - HEC Montréal); Philippe de Donder (TSE-R - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - Université Fédérale Toulouse Midi-Pyrénées - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Franca Glenzer (HEC Montréal - HEC Montréal); Minjoon Lee (Carleton University); Marie-Louise Leroux (Département des Sciences Economiques, ESG-UQAM, Montréal, Canada) |
| Abstract: | COVID-19 outbreaks at nursing homes during the recent pandemic have received ample media coverage and may have lasting negative impacts on individuals' perception of nursing homes. We argue that this could have sizable and persistent implications for savings and long-term care policies. Our theoretical model predicts that higher nursing home aversion should induce higher savings and stronger support for policies subsidizing home care. Based on a survey of Canadians aged 50 to 69, we document that higher nursing home aversion is widespread: 72% of respondents are less inclined to enter a nursing home because of the pandemic. Consistent with our model, we find that these respondents are more likely to have higher intended savings for old age because of the pandemic. We also find that they are more likely to strongly support home care subsidies. |
| Keywords: | Pandemic risk, Nursing home, Long-term care, Savings, Public policy |
| Date: | 2022–09 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03917920&r=hea |