nep-hea New Economics Papers
on Health Economics
Issue of 2023‒05‒08
nineteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Investigating the Complexity of Naloxone Distribution: Which Policies Matter for Pharmacies and Potential Recipients By Rosanna Smart; David Powell; Rosalie Liccardo Pacula; Evan D. Peet; Rahi Abouk; Corey S. Davis
  2. Religious Barriers to Birth Control Access By Marie, Olivier; Zwiers, Esmée
  3. Exposure to War and Its Labor Market Consequences over the Life Cycle By Sebastian T. Braun; Jan Stuhler
  4. Partial Outsourcing of Public Programs: Evidence on Determinants of Choice in Medicare By Marika Cabral; Colleen Carey; Jinyeong Son
  5. Optimal self-protection and health risk perception: bridging the gap between risk theory and the Health Belief Model By Emmanuelle Augeraud-Véron; Marc Leandri
  6. Trends in the Female Longevity Advantage of 19th-Century Birth Cohorts: Exploring the Role of Place and Fertility By Fletcher, Jason M.; Topping, Michael; Joo, Won-tak
  7. The infant health effects of starting universal child benefits in pregnancy: evidence from England and Wales By Reader, Mary
  8. Not Just for Kids: Child and Dependent Care Credit Benefits for Adult Care By Gabrielle Pepin; Yulya Truskinovsky
  9. Immigrant assimilation in health care utilisation in Spain By Zuleika Ferre; Patricia Triunfo; Jos\'e-Ignacio Ant\'on
  10. Early Child Care and Labor Supply of Lower-SES Mothers: A Randomized Controlled Trial By Henning Hermes; Marina Krauss; Philipp Lergetporer; Frauke Peter; Simon Wiederhold
  11. Distributionally Sensitive Measurement and Valuation of Population Health By Shaun Da Costa; Owen O'Donnell; Raf Van Gestel
  12. The Average Uneven Mortality index: Building on the "e-dagger" measure of lifespan inequality By Bonetti, Marco; Basellini, Ugofilippo; NIGRI, ANDREA
  13. Mismatch in Preferences for Working from Home – Evidence from Discrete Choice Experiments with Workers and Employers By Lewandowski, Piotr; Lipowska, Katarzyna; Smoter, Mateusz
  14. Projected Health Benefits and Health Care Savings from the United States National Hepatitis C Elimination Initiative By Jagpreet Chhatwal; Alec Aaron; Huaiyang Zhong; Neeraj Sood; Risha Irvin; Harvey J. Alter; Yueran Zhuo; Joshua M. Sharfstein; John W. Ward
  15. Impact of Retirement on Health: Evidence from 35 Countries By Koryu Sato; Haruko Noguchi
  16. Domestic burdens amid COVID-19 and women's mental health in middle-income Africa By Mueller, Valerie; Grépin, Karen A.; Rabbani, Atonu; Ngunjiri, Anne; Oyekunle, Amy; Wenham, Clare
  17. Crisis Experience and the Deep Roots of Covid-19 Vaccination Preferences By Ekaterina Borisova; Klaus Gründler; Armin Hackenberger; Anina Harter; Niklas Potrafke; Koen Schoors
  18. Fertility in the Heart of the COVID-19 Storm By Daniel L. Dench; Wenhui Li; Theodore J. Joyce; Howard Minkoff; Gretchen Van Wye
  19. Working from Home, COVID-19 and Job Satisfaction By Laß, Inga; Vera-Toscano, Esperanza; Wooden, Mark

  1. By: Rosanna Smart; David Powell; Rosalie Liccardo Pacula; Evan D. Peet; Rahi Abouk; Corey S. Davis
    Abstract: Despite efforts to address the opioid crisis, opioid-related overdoses remain a significant contributor to mortality. State efforts to reduce overdose deaths by removing barriers to naloxone have recently focused on pharmacy channels, but the specifics of these laws and the contexts in which they are implemented vary widely. In this paper, we use novel methods robust to heterogeneous effects across states and time-varying policy effects to estimate the effects on naloxone pharmacy distribution of two types of laws: laws authorizing non-patient-specific prescription distribution of naloxone and laws granting pharmacists prescriptive authority for naloxone. We find that both types of laws significantly increase the volume of naloxone dispensed through pharmacies. However, relative to laws authorizing non-patient-specific prescription distribution, effects are significantly larger for pharmacist prescriptive authority laws. These larger effects only partially derive from increased naloxone prescribing by pharmacists. We also estimate large, significant increases in pharmacy dispensation of naloxone prescribed by non-pharmacist prescribers, with particularly large increases among family medicine physicians, with particularly large increases among family medicine physicians. The relative benefits of pharmacist prescriptive authority laws versus non-patient-specific distribution are larger among Non-Hispanic Black individuals, suggesting an important role of these policies for reducing disparities in access to naloxone.
    JEL: H75 I18 K32
    Date: 2023–04
  2. By: Marie, Olivier (Erasmus University Rotterdam); Zwiers, Esmée (University of Amsterdam)
    Abstract: This paper presents new causal evidence on the "power" of oral contraceptives in shaping women's lives, leveraging the 1970 liberalization of the Pill for minors in the Netherlands and demand- and supply-side religious preferences that affected Pill take-up. We analyze administrative data to demonstrate that, after Pill liberalization, minors from less conservative areas were more likely to delay fertility/marriage and to accumulate human capital in the long run. We then show how these large effects were eliminated for women facing a higher share of gatekeepers – general practitioners and pharmacists – who were opposed to providing the Pill on religious grounds.
    Keywords: birth control, religion, fertility, marriage, human capital, the Netherlands
    JEL: I18 J12 J13 Z12
    Date: 2023–03
  3. By: Sebastian T. Braun; Jan Stuhler
    Abstract: With 70 million dead, World War II remains the most devastating conflict in history. Of the survivors, millions were displaced, returned maimed from the battlefield, or spent years in captivity. We examine the impact of such wartime experiences on labor market careers and show that they often become apparent only at certain life stages. While war injuries reduced employment in old age, former prisoners of war postponed their retirement. Many displaced workers, particularly women, never returned to employment. These responses are in line with standard life-cycle theory and thus likely extend to other conflicts.
    Date: 2023–03
  4. By: Marika Cabral; Colleen Carey; Jinyeong Son
    Abstract: Many public programs let individuals choose between publicly provided benefits and a subsidized private alternative. We investigate the determinants of health insurance choice in Medicare—a setting with vast geographic variation in the share of individuals selecting the public option versus private alternative. We analyze insurance decisions among individuals who move to quantify the relative importance of individual-specific factors (such as preferences or income) and place-specific factors (such as local health insurance options) on insurance decisions. We find roughly 40% of the geographic variation in the share selecting private coverage is due to place-based factors, while the remainder is explained by individuals. Our findings highlight the importance of individual factors in these decisions and may inform discussions about the use of policy to address geographic disparities.
    JEL: H51 I11 I13
    Date: 2023–04
  5. By: Emmanuelle Augeraud-Véron; Marc Leandri
    Abstract: In this contribution to the longstanding risk theory debate on optimal self-protection, we aim to bridge the gap between the microeconomic modeling of self-protection, in the wake of Ehrlich and Becker (1972), and the Health Belief Model, a conceptual framework extremely influential in Public Health studies (Janz and Becker, 1984). In doing so, we highlight the crucial role of risk perception in the individual decision to adopt a preventive behavior towards a generic health risk. We discuss the optimal prevention effort engaged by an agent displaying either imperfect knowledge of the susceptibility (probability of occurrence) or the severity (magnitude of the loss) of a health hazard, or facing uncertainty on these risk components. We assess the impact of risk aversion and prudence on the optimal level of self-protection, an issue at the core of the risk and insurance economic literature. Our results also pave the way for the design of efficient information instruments to improve health prevention when risk perceptions are biased.
    Keywords: Prevention, Self-protection, Health Belief Model, Risk perception, Risk aversion, Prudence
    JEL: D81 I12 D9
    Date: 2023
  6. By: Fletcher, Jason M. (University of Wisconsin-Madison); Topping, Michael (University of Wisconsin-Madison); Joo, Won-tak (University of Wisconsin-Madison)
    Abstract: This paper uses massive online genealogy data from the United States over the 19th century to estimate period and cohort-based sex differences in longevity. Following previous work, we find a longevity reversal in the mid-19th century that expanded rapidly for at least a half century. For measures of conditional survival past childbearing age, females enjoyed a longevity advantage for the whole century. Unlike most mortality databases of this period, genealogical data allows analysis of spatial patterns and of the impacts of fertility on longevity. Our results suggest very limited evidence of spatial (state) variation in these patterns. We do, however, find evidence that the associations between fertility and longevity partially explain the trends.
    Keywords: longevity, sex differences, US, genealogy
    JEL: J11
    Date: 2023–03
  7. By: Reader, Mary
    Abstract: Child benefits are typically paid from birth. This paper asks whether starting universal child benefits in pregnancy leads to improvements in infant health. Leveraging administrative birth registry and hospital microdata from England and Wales, I study the effects of the Health in Pregnancy Grant, a universal conditional cash transfer equivalent to three months of child benefit (190 GBP) as a lump sum to pregnant mothers from 2009 to 2011. I exploit quasi-experimental variation in eligibility with a regression discontinuity design in the date of birth of the baby. I find that the policy increased birth weight by 8–12 grams on average, reduced low birth weight (
    Keywords: birth weight; infant health; cash transfer; child benefit; STICERD; Department of Social Policy Titmuss Meinhardt research fund; Elsevier deal
    JEL: I38
    Date: 2023–03–01
  8. By: Gabrielle Pepin (W.E. Upjohn Institute for Employment Research); Yulya Truskinovsky (Wayne State University)
    Abstract: The Child and Dependent Care Credit (CDCC) allows households to receive tax credits for certain expenses associated with the care of a spouse or adult dependent who is incapable of self care, but very few childless households claim the credit. We examine the value of the CDCC for qualifying households caring for adults. We find that, as of 2016, more than 10 percent of individuals aged 50 to 65 had a coresident spouse or parent likely to be a qualifying individual for the CDCC. We document how state and federal CDCC benefits decrease post-tax costs of typical caregiving services, such as hiring a home health aide, across states. We find that a temporary expansion during 2021 led to substantial decreases in post-tax care costs but generated considerable differences in benefits across households with spouse and nonspouse qualifying individuals. We discuss expected effects on taxpayers’ behavior of permanently expanding the CDCC and find that making the credit refundable would nearly double the number of eligible spousal caregivers aged 50 to 65, with eligibility rates increasing substantially among female, nonwhite, and low-income caregivers.
    Keywords: Adult care, Child and Dependent Care Credit, American Rescue Plan Act of 2021, participation, eligibility
    JEL: H24 J14
    Date: 2023–03
  9. By: Zuleika Ferre; Patricia Triunfo; Jos\'e-Ignacio Ant\'on
    Abstract: Abundant evidence has tracked the labour market and health assimilation of immigrants, including static analyses of differences in how foreign-born and native-born residents consume health care services. However, we know much less about how migrants' patterns of health care usage evolve with time of residence, especially in countries providing universal or quasi-universal coverage. We investigate this process in Spain by combining all the available waves of the local health survey, which allows us to separately identify period, cohort, and assimilation effects. We find that the evidence of health assimilation is limited and solely applies to migrant females' visits to general practitioners. Nevertheless, the differential effects of ageing on health care use between foreign-born and native-born populations contributes to the convergence of utilisation patterns in most health services after 20 years in Spain. Substantial heterogeneity over time and by region of origin both suggest that studies modelling future welfare state finances would benefit from a more thorough assessment of migration.
    Date: 2023–04
  10. By: Henning Hermes (University of Düsseldorf, Institute for Competition Economics); Marina Krauss (University of Augsburg, Department of Economics); Philipp Lergetporer (Technical University of Munich, School of Management); Frauke Peter (Deutsches Zentrum für Hochschul- und Wissenschaftsforschung); Simon Wiederhold (University of Ingolstadt, D-85049 Ingolstadt)
    Abstract: We present experimental evidence that enabling access to universal early child care for families with lower socioeconomic status (SES) increases maternal labor supply. Our intervention provides families with customized help for child care applications, resulting in a large increase in enrollment among lower-SES families. The treatment increases lower-SES mothers' full-time employment rates by 9 percentage points (+160%), household income by 10%, and mothers' earnings by 22%. The effect on full-time employment is largely driven by increased care hours provided by child care centers and fathers. Overall, the treatment substantially improves intra-household gender equality in terms of child care duties and earnings.
    Keywords: Child care, maternal employment, gender equality, randomized controlled trial
    JEL: D90 J13 J18 J22 C93
    Date: 2023–04
  11. By: Shaun Da Costa (Paris School of Economics); Owen O'Donnell (Erasmus University Rotterdam); Raf Van Gestel (Erasmus University Rotterdam)
    Abstract: We introduce a measure of population health that is sensitive to dispersion in both age-specific health and lifespan. The measure generalises health-adjusted life expectancy without requiring more data. A transformation of change in the measure gives a distributionally sensitive monetary valuation of change in population health and disease burden. Application to Sub-Saharan Africa between 1990 and 2019 reveals that the change in population health is sensitive to allowing for lifespan dispersion but is less sensitive to age-specific health dispersion. Distributional sensitivity changes relative burdens of diseases, reduces convergence between the burdens of communicable and non-communicable diseases, and so could influence disease prioritisation. It increases the value of health improvements relative to GDP.
    Keywords: Health, Lifespan, Life Expectancy, Inequality, Global Burden of Disease, Sub-Saharan Africa
    JEL: I14 I15 J11 J17 O15
    Date: 2023–03–24
  12. By: Bonetti, Marco; Basellini, Ugofilippo; NIGRI, ANDREA
    Abstract: In recent years, lifespan inequality has become an important indicator of population health, alongside more established longevity measures. Uncovering the statistical properties of lifespan inequality measures can provide novel insights on the study of mortality developments. We revisit the "e-dagger" measure of lifespan inequality, introduced in Vaupel and Canudas-Romo (2003). We note that, conditioning on surviving at least until age a, e-dagger(a) is equal to the covariance between the conditional lifespan random variable Ta and its transformation through its own cumulative hazard function (hence generalizing a result first noted in Schmertmann, 2020). We then derive an upper bound for e-dagger(a). Leveraging this result, we introduce the "Average Uneven Mortality" (AUM) index, a novel relative mortality index that can be used to analyze mortality patterns. We discuss some general features of the index, including its relationship with a constant ("even") force of mortality, and we study how it changes over time. The use of the AUM index is illustrated through an application to observed period and cohort death rates as well as to period life-table death rates from the Human Mortality Database. We explore the behavior of the index across age and over time, and we study its relationship with life expectancy. The AUM index at birth declined over time until the 1950s, when it reverted its trend. The index generally increases over age and reduces with increasing values of life expectancy, with differences between the period and cohort perspectives. We elaborate on Vaupel and Canudas-Romo’s e-dagger measure, deriving its upper bound. We exploit this result to introduce a novel mortality indicator, which enlarges the toolbox of available methods for the study of mortality dynamics. We also develop some new routines to compute e-dagger(a) and σ_Ta from death rates, and show that they have higher precision when compared to conventional and available functions, particularly for calculations involving older ages.
    Date: 2023–04–06
  13. By: Lewandowski, Piotr (Institute for Structural Research (IBS)); Lipowska, Katarzyna (Institute for Structural Research (IBS)); Smoter, Mateusz (Institute for Structural Research (IBS))
    Abstract: We study workers' and employers' preferences for remote work, estimating the willingness to pay for working from home (WFH) using discrete choice experiments with more than 10, 000 workers and more than 1, 500 employers in Poland. We selected occupations that can be done remotely and randomised wage differences between otherwise identical home- and office-based jobs, and between otherwise identical job candidates, respectively. We find that demand for remote work was substantially higher among workers than among employers. On average, workers would sacrifice 2.9% of their earnings for the option of remote work, especially hybrid WFH for 2-3 days a week (5.1%) rather than five days a week (0.6%). However, employers, on average, expect a wage cut of 21.0% from candidates who want to work remotely. This 18 pp gap in the valuations of WFH reflects employers' assessments of productivity loss associated with WFH (14 pp), and the additional effort required to manage remote workers (4 pp). Employers' and workers' valuations of WFH align only in 25-36% of firms with managers who think that WFH is as productive as on-site work.
    Keywords: working from home, remote work, discrete choice experiment, willingness to pay
    JEL: J21 J31 J81
    Date: 2023–03
  14. By: Jagpreet Chhatwal; Alec Aaron; Huaiyang Zhong; Neeraj Sood; Risha Irvin; Harvey J. Alter; Yueran Zhuo; Joshua M. Sharfstein; John W. Ward
    Abstract: The national hepatitis C elimination initiative provides an opportunity to dramatically expand access to hepatitis C virus (HCV) treatment and put the US on a path to eliminating hepatitis C. Our objective was to project the health benefits and cost savings of this initiative. A previously developed mathematical model was updated to simulate trends in HCV disease burden and cost of care in the US for the next 20 years under status quo and national hepatitis C elimination initiative. Within five years, the initiative will diagnose 92.5% of all persons with HCV and cure 89.6% of HCV infection. Over 10 years, compared with the status quo, the initiative will avert 20, 000 cases of hepatocellular carcinoma, 49, 100 cases of diabetes, and 25, 000 cases of chronic kidney disease. The initiative will also avert 24, 000 deaths adding 220, 000 life years. These benefits in improved health will save $18.1 billion in direct healthcare spending, of which $13.3 billion would accrue to the federal government. Over 20 years, the health benefits would increase by more than 2-fold and cost savings by 3-fold. The cost savings would further increase if the HCV incidence rate decreases because of rapid decline in HCV prevalence. In conclusion, the national hepatitis C elimination initiative would substantially reduce HCV-related morbidity and mortality and would reduce healthcare spending at 10 years and beyond.
    JEL: I1 I13 I18
    Date: 2023–04
  15. By: Koryu Sato (Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University); Haruko Noguchi (Graduate School of Economics, Waseda University)
    Abstract: This study aimed to explore the impact of retirement on health through the application of a fixed effects instrumental variable model to harmonized longitudinal data obtained from 35 countries. Women exhibited improved cognitive function, physical independence, and self-rated health after retirement. Consistently, retirement was associated with reduced physical inactivity and smoking among women, which was not observed among men. Sex differences in post-retirement health behaviors may induce heterogeneous effects on health. Given the current global trend of increasing state pension age, the promotion of healthy behaviors could mitigate potential adverse effects of delayed retirement on health.
    JEL: I10 J26 C26
    Date: 2023–04
  16. By: Mueller, Valerie; Grépin, Karen A.; Rabbani, Atonu; Ngunjiri, Anne; Oyekunle, Amy; Wenham, Clare
    Abstract: This article analyzes two longitudinal datasets (October – December 2020; April 2021) of 1, 000 and 900 women in Kenya and Nigeria, respectively, alongside in-depth qualitative interviews with women at risk of changes to time use, to study two pandemic issues: women’s substitution of paid for unpaid work and how these shifts compromise their mental health. Women devote more time to domestic care (30–38 percent), less time to employment (29–46 percent), and become unemployed (12–17 percent). A rise in domestic work is correlated with depressive (Nigeria) and anxiety symptoms (Kenya and Nigeria). Women with greater agency (Kenya) and fewer children (Nigeria) are less likely to report a domestic burden or loss in paid activities. Social protection programs may fill the void of assistance traditionally provided by informal networks in the short term, while campaigns shifting norms around household work may preserve women’s economic participation in the long term.
    Keywords: agency; domestic work; mental health; women; Kenya; Nigeria
    JEL: D13 I00 J16
    Date: 2023–03–20
  17. By: Ekaterina Borisova; Klaus Gründler; Armin Hackenberger; Anina Harter; Niklas Potrafke; Koen Schoors
    Abstract: We examine the deep roots of preferences for vaccination against COVID-19, moving beyond proximate factors which can only account for part of the observable heterogeneity in the willingness to get vaccinated. Our model on experience-based learning predicts that exposure to past disruptive crises increases individuals’ willingness to acquire and take a promising remedy when new crises occur. Using micro-level data on vaccination preferences for individuals from 19 countries, we find strong evidence for our prediction. We investigate the role of competing vaccines exploiting original geocoded survey data from Russia. Consistent with our theory, past crisis experience decreases vaccination willingness when individuals have learned to distrust the effectiveness of government administered remedies.
    Keywords: Covid-19 vaccination, vaccination preferences, crisis experience, experience effects, survey data, geocoded data
    JEL: H12 H51 I12 I15 I18
    Date: 2023
  18. By: Daniel L. Dench; Wenhui Li; Theodore J. Joyce; Howard Minkoff; Gretchen Van Wye
    Abstract: We describe how the COVID-19 pandemic affected reproductive choices in New York City, the most acutely impacted area of the United States. We contrast changes in New York City with reproductive outcomes in the rest of the US. We find that births to New York City residents fell 8.4% more between March, 2020 and February 2021 than that would have been expected given trends leading up to the pandemic. Births to US-born residents of New York City fell 5.5% over the same year, triple the observed decline in the rest of the US. Births to foreign-born New York City residents fell 11.4%, twice the decline observed in the rest of the US. Reported induced abortions to New York City residents fell precipitously whereas induced abortions nation-wide rose slightly. The acute downturn and robust recovery in births in New York City maps closely with the spike in mortality and its equally rapid decline three months later. We conclude that the fear and uncertainty in the early months of the pandemic is the best explanation for the sudden, but brief drop in births in New York City.
    JEL: I12 J10
    Date: 2023–03
  19. By: Laß, Inga (Bundesinstitut für Bevölkerungsforschung (BiB)); Vera-Toscano, Esperanza (University of Melbourne); Wooden, Mark (Melbourne Institute of Applied Economic and Social Research)
    Abstract: This paper examines the impact of the growth in the incidence of working from home during the COVID-19 pandemic on workers' job satisfaction. Using longitudinal data collected in 2019 and 2021 as part of the Household, Income and Labour Dynamics in Australia (HILDA) Survey, fixed-effects models of job satisfaction are estimated. Changes in the share of total weekly work hours usually worked from home are not found to have any significant association with changes in job satisfaction for men. In contrast, a strong significant positive (but non-linear) association is found for women, and this relationship is concentrated on women with children. These findings suggest the main benefit of working from home for workers arises from the improved ability to combine work and family responsibilities, something that matters more to women given they continue to shoulder most of the responsibility for house and care work.
    Keywords: working from home, telework, job satisfaction, COVID-19, HILDA Survey, gender, work-family balance
    JEL: J22 J28
    Date: 2023–03

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