nep-hea New Economics Papers
on Health Economics
Issue of 2023‒05‒15
sixteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Intergenerational Child Mortality Impacts of Deworming: Experimental Evidence from Two Decades of the Kenya Life Panel Survey By Michael W. Walker; Alice H. Huang; Suleiman Asman; Sarah J. Baird; Lia Fernald; Joan Hamory Hicks; Fernando Hoces de la Guardia; Satoshi Koiso; Michael Kremer; Matthew N. Krupoff; Michelle Layvant; Eric Ochieng; Pooja Suri; Edward Miguel
  2. From Drought to Distress: Examining the Mental Health Consequences of Water Scarcity in Ethiopia By Richard Freund
  3. Inciting Family Healthy Eating: Taxation and Nudging By Moustapha Sarr
  4. Excise Tax Incidence: The Inequity of Taxing Obesity and Beauty By Osaid Alshamleh; Glenn Jenkins; Tufan Ekici
  5. Provider Responses to the Expansion of Public Subsidies in Healthcare: The Case of Oral Chemotherapy Treatment in Australia By Naghsh Nejad, Maryam; Yu, Serena; Haywood, Philip
  6. The causal impact of maternal educational curricula on infant health at birth By Cristina Borra; Pilar Cuevas-Ruiz; Almudena Sevilla
  7. When Health Trumps Money: Economic Incentives and Health Equity in the Provision of Nursing Homes By Øystein Hernæs; Snorre Kverndokk; Simen Markussen; Henning Øien
  8. On a tendency in health economics to dwell on income inequality and underestimate social stress By Stark, Oded
  9. COVAX – Time to reconsider the strategy and its target By David Bell; Garrett Wallace Brown; Wellington Oyibo; Samiratou Ouédraogo; Blagovesta Tacheva; Elena Barbaud; Andreas Kalk; Valéry Ridde; Elisabeth Paul
  10. The balance of risks and benefits in the COVID-19 “vaccine hesitancy” literature: An umbrella review By Chaufan, Claudia; Heredia, Camila; McDonald, Jennifer; Hemsing, Natalie
  11. Risk Aversion and COVID-19 Vaccine Hesitancy By Lepinteur, Anthony; Borga, Liyousew G.; Clark, Andrew E.; Vögele, Claus; D'Ambrosio, Conchita
  12. The economic costs of childhood socio-economic disadvantage in European OECD countries By Chris Clarke; Julien Bonnet; Manuel Flores; Olivier Thévenon
  13. La Notte della Taranta under the shadow of Covid-19 By Giuseppe Attanasi; Marta Ballatore; Michela Chessa; Carlo Ciucani; Sara Gil-Gallen
  14. Synthetic Controls with Multiple Outcomes: Estimating the Effects of Non-Pharmaceutical Interventions in the COVID-19 Pandemic By Wei Tian; Seojeong Lee; Valentyn Panchenko
  15. A parsimonious model of optimal social distancing and vaccination during an outbreak By Luca Gori; Piero Manfredi; Simone Marsiglio; Mauro Sodini
  16. Permanent Instability of Preferences after COVID-19 Crisis: A Natural Experiment from Urban Burkina Faso By Boutin, Delphine; Petifour, Laurene; Megzari, Haris

  1. By: Michael W. Walker; Alice H. Huang; Suleiman Asman; Sarah J. Baird; Lia Fernald; Joan Hamory Hicks; Fernando Hoces de la Guardia; Satoshi Koiso; Michael Kremer; Matthew N. Krupoff; Michelle Layvant; Eric Ochieng; Pooja Suri; Edward Miguel
    Abstract: We assess the impacts of a randomized school-based deworming intervention in Kenya on the mortality of recipients’ children using a 23-year longitudinal data set of over 6, 500 original participants and their offspring. The under-5 mortality rate fell by 22% (17 deaths per 1000 live births) for children of treatment group individuals. We find that a combination of improved health, education and living standards, increased urban residence, delayed fertility, and greater use of health care in the parent generation contributed to the reduction. The results provide evidence for meaningful intergenerational benefits of child health investments.
    JEL: H51 I15 I25
    Date: 2023–04
  2. By: Richard Freund (University of Cape Town, School of Economics)
    Abstract: In 2021, Ethiopia experienced a prolonged drought after two consecutive failed rainy seasons. This paper investigates the effect of the drought on young adults’ experiences of anxiety and depression by applying a difference-in-differences strategy to this event, in a natural experiment. I construct a Standardised Precipitation Index using 40 years of satellite rainfall data to exogenously measure local drought intensity and combine with unique longitudinal data. I find that exposure to the drought increases the probability of young adults experiencing symptoms consistent with either mild or severe anxiety (depression) by nearly 12 (10) percentage points. This represents a 63% and 55% increase relative to the pre-drought sample averages, respectively. These results are robust across alternative model specifications and a variety of sensitivity checks. The impact on depression is driven by those who were severely exposed to the drought, while both mild and severe exposure affect anxiety. The drought has a greater impact on individuals in rural households, those working in agriculture, and on individuals born into the poorest households. According to the mediation model estimated, the increase in mental health issues may partly be explained by the drought’s impact on inflation, perceived household poverty, and physical illness.
    Date: 2023
  3. By: Moustapha Sarr
    Abstract: This paper examines whether a tax on unhealthy food and a nudge are suitable to promote families healthy eating. We consider, in a theoretical model, an economy composed of two types of family that differ in their income and their nutritional knowledge, which reflects their degree of misperception of the future health effects of diet, and choose their consumption according to their perceived utility. We find that the decentralized solution of taxation on unhealthy good achieves the first-best optimum if and only if it is possible for the central planner to implement a targeted tax policy. Investigating the case of a mixed policy, we find that taxation of unhealthy food and nudge are probably complementary public policy instruments to promote family healthy eating. The mixed policy reduces both the perception and income gaps between the two family types.
    Keywords: tax, healthy eating, nudge, perception, family environment, nutritional knowledge
    JEL: D83 H21 I18
    Date: 2023
  4. By: Osaid Alshamleh (Department of Accounting and Finance, Cyprus International University, Hespolat, Mersin 10, Turkey); Glenn Jenkins (Queen's University); Tufan Ekici (Department of Economics, Ramapo College of New Jersey, Mahwah, N.J. USA)
    Abstract: The estimation and analysis of the distribution of the negative health impacts of certain commodities subject to excise taxes in Belize and the distribution of the burdens of the excise taxes across households of different income levels are the focus of this article. Particular attention is given to the taxation of soft drinks and cosmetics. We examine the income distribution and tax revenue impacts using the commodity data from the household expenditure survey by and the effective tax rates expressed as a percentage of the value of the final consumption of each item. As in many developing countries, taxes on alcoholic beverages and tobacco products are found to be regressive. The most regressive excise taxes are on soft drinks and cosmetics. Households across the economy pay more in excise taxes on cosmetics than they do on either alcoholic beverages or tobacco products. Relative to the level of household expenditures, the burden of the excise taxes on cosmetics is highest for households in the lowest quintile of total expenditures. The impact of soft drinks in creating obesity is likely to be much greater for high income households whose total consumption per household is twice that of low-income households.
    Keywords: excise tax, tax incidence, cosmetics, soft drinks, obesity, regressivity, Belize
    JEL: H22 L66
    Date: 2023–04
  5. By: Naghsh Nejad, Maryam (University of Technology, Sydney); Yu, Serena (University of Technology, Sydney); Haywood, Philip (University of Technology, Sydney)
    Abstract: We examine provider responses to the expansion of public subsidies in 2015 for oral chemotherapy treatment, in a health system where providers were free to determine their own prices. Oral chemotherapy treatment was known to have similar efficacy to its traditional intravenous alternative and was preferred by patients for its at-home administration. However, from a policymaker's perspective, the potential for misalignment between patient and provider preferences was significant given the shift to full reimbursement for the oral chemotherapy medication but no change in fee-for-service payments for associated chemotherapy services. Under this scenario, a shift away from traditional intravenous chemotherapy may entail reduced activity and revenues associated with infusions for providers, and we hypothesise that it may result in unintended policy consequences such as reduced take-up of oral chemotherapy or higher prices. We implement a difference-in-difference model using national administrative data on services provided, and chemotherapy medications prescribed, by providers to 1850 patients in New South Wales, Australia. Our estimates indicate that the subsidies expanded access to oral chemotherapy for newly eligible patients by 15 percentage points. However, prices charged by providers for an episode of care rose by 23 percent, driven mostly by increases in service volumes. The results illustrate the importance of understanding differential provider responses to policy changes in financial incentives.
    Keywords: provider behavior, financial incentives, applied microeconomics
    JEL: I11 I13 D04
    Date: 2023–04
  6. By: Cristina Borra; Pilar Cuevas-Ruiz; Almudena Sevilla
    Abstract: We provide the first causal evidence of the returns to maternal educational curricula on offspring's health at birth. Educational programs that aim to deliver more general knowledge may potentially improve women's earning potential and maternal prenatal investment by increasing the portability of skills across occupations and improving women's ability to make informed decisions about fertility options and health behavior. We study the impacts of a comprehensive educational reform that postponed students' curriculum choices and integrated more general education into the high school system on infant health outcomes. Using a dose-response difference-in-differences (DiD) model research design applied to linked population registries, we find that the reform led to a significant reduction in the incidence of very low birth weight (less than 1, 500 grams) and very preterm birth (less than 33 gestation weeks). Overall, the reform's positive effects on infant health at birth seem to be driven by increased mothers' labor market opportunities and better family planning, rather than increased ability to avoid risky behaviours or increased women's earnings via different occupational choices or assortative mating.
    Keywords: health at birth, educational curricula, vocational education, academic education, comprehensive educational reform
    Date: 2023–04–18
  7. By: Øystein Hernæs; Snorre Kverndokk; Simen Markussen; Henning Øien
    Abstract: The allocation of public care services should be determined by individual needs but can be influenced by economic factors. This paper examines the impact of economic incentives on the allocation of nursing home care in the Norwegian long-term care system. The study uses a theoretical model and empirical data from the municipality of Oslo to determine if nursing home spots are allocated based on income, which would be financially advantageous for the provider. We do not find evidence that the economic incentives of the care provider play a role in the allocation of nursing homes. Thus, in this setting, needs seems to be the dominant factor for allocation of nursing home care, while economic incentives seem to play no significant role.
    Keywords: long-term care, economic incentives in health care, health care equity
    JEL: I14 I18 H51
    Date: 2023
  8. By: Stark, Oded
    Abstract: Social stress can cause physical and mental harm. It is therefore not surprising that public health policy makers have sought to identify and implement policies aimed at tackling this social ill. A frequently prescribed remedy is to reduce social stress by reducing income inequality, which is typically measured by the Gini coefficient. Decomposing the coefficient into a measure of a population’s social stress and a population’s income makes it possible to show that steps taken to lower the coefficient can actually exacerbate social stress. We formulate conditions under which lowering the Gini coefficient coincides with increasing social stress. If the aim of public policy is to improve public health and increase social welfare, and if social welfare is reduced by social stress, then lowering the Gini coefficient may not be the right course of action.
    Keywords: Health Economics and Policy, Public Economics
    Date: 2023–04–24
  9. By: David Bell; Garrett Wallace Brown; Wellington Oyibo; Samiratou Ouédraogo; Blagovesta Tacheva; Elena Barbaud; Andreas Kalk; Valéry Ridde; Elisabeth Paul
    Abstract: COVAX, the international initiative supporting COVID-19 vaccination campaigns globally, is budgeted to be the costliest public health initiative in low- and middle-income countries, with over 16 billion US dollars already committed. While some claim that the target of vaccinating 70% of people worldwide is justified on equity grounds, we argue that this rationale is wrong for two reasons. First, mass COVID-19 vaccination campaigns do not meet standard public health requirements for clear expected benefit, based on costs, disease burden and intervention effectiveness. Second, it constitutes a diversion of resources from more cost-effective and impactful public health programmes, thus reducing health equity. We conclude that the COVAX initiative warrants urgent review.
    Date: 2023–04
  10. By: Chaufan, Claudia (York University); Heredia, Camila; McDonald, Jennifer; Hemsing, Natalie
    Abstract: Background: “Vaccine hesitancy” (VH) has been described as a “threat to global health”, especially in the COVID-19 era. Research on VH indicates that the concerns of vaccine recipients with the balance of risks and benefits of COVID-19 vaccination, which involve safety and effectiveness considerations (hereafter “safety concerns”), are a leading driver of VH. However, what explains these concerns is underexplored. Goal: We conducted a qualitative umbrella review following PRISMA guidelines and informed by a critical perspective to examine how the safety concerns of COVID-19 vaccine recipients are addressed in the VH literature. Methods: We searched PubMed, the Epistemonikos COVID-19 platform (COVID-19 L. OVE), and the WHO Global Research on COVID-19 Database. We included 49 refereed reviews examining VH in any population involved with COVID-19 vaccination decisions for themselves or as caretakers, with no methodological, quality, temporal, or geographic restrictions, and were published in English, excluding those that authors did not identify as “systematic”. Two reviewers completed article screening and data extraction and synthesis. Thematic synthesis was used to identify themes and frequencies were calculated to assess the strength of support for themes. Disagreements were resolved through full team discussion. The protocol was registered with PROSPERO (ID CRD42022351489) and partially funded by a SSHRC grant (# 435-2022-0959). Findings: All reviews assumed that VH was a major barrier to ending the COVID-19 crisis. With vaccines assumed to be “safe and effective”, recipients’ safety concerns were downplayed. Evidence incompatible with “VH-as-a-problem”, whenever mentioned, was dismissed as “misinformation”. Informed consent was either not discussed or was presented as a potential threat to “vaccine confidence”. We observed no differences regardless of study population, methodology, or other study characteristics. Limitations are discussed. Conclusions: Neglecting or dismissing vaccine recipients’ safety concerns contributes to the problem that research on COVID-19 VH purports to address. It also undermines the implementation of informed consent, critical to ethical medical and public health research, policy, and practice. The scant attention to bioethical considerations in current COVID-19 VH research is concerning.
    Date: 2023–04–14
  11. By: Lepinteur, Anthony (University of Luxembourg); Borga, Liyousew G. (Luxembourg Institute of Health); Clark, Andrew E. (Paris School of Economics); Vögele, Claus (University of Luxembourg); D'Ambrosio, Conchita (University of Luxembourg)
    Abstract: We here investigate the role of risk aversion in COVID-19 vaccine hesitancy. The theoretical effect is ambiguous, as both COVID-19 infection and vaccination side-effects involve probabilistic elements. In large-scale data covering five European countries, we find that vaccine hesitancy falls with risk aversion, so that COVID-19 infection is perceived as involving greater risk than is vaccination.
    Keywords: risk aversion, COVID-19, vaccine hesitancy
    JEL: I12 D81
    Date: 2023–04
  12. By: Chris Clarke; Julien Bonnet; Manuel Flores; Olivier Thévenon (OECD)
    Abstract: Growing up in socio-economic disadvantage has important and long-lasting effects on children’s lives. Children from disadvantaged households often fall behind in many areas of well-being and development, with effects that continue to limit their opportunities and outcomes – including their health and labour market outcomes – long after they reach adulthood. Drawing on Europe-wide survey data from 27 countries, this paper explores how childhood socio-economic disadvantage affects later adult labour market and health outcomes, and evaluates the country-level GDP-equivalent cost of childhood disadvantage due to lost employment, lost earnings, and lost health, as well as the costs of lost government revenue and benefit spending. Results point to large costs for societies from childhood socio-economic disadvantage, totalling on average the equivalent of 3.4% of GDP annually.
    Keywords: children, education, families, health, inequality
    JEL: I31 I32 J13
    Date: 2022–11–25
  13. By: Giuseppe Attanasi (Sapienza University of Rome, Italy; BETA, University of Strasbourg, France; Université Côte d'Azur, CNRS, GREDEG, France); Marta Ballatore (Université Bourgogne Franche-Comté, CEREN EA 7477, Burgundy School of Business, Dijon, France; Université Côte d'Azur, CNRS, GREDEG, France); Michela Chessa (Université Côte d'Azur, France; GREDEG CNRS); Carlo Ciucani (University G. D'Annunzio of Chieti-Pescara, Italy); Sara Gil-Gallen (Author-Workplace-Name: BETA, University of Strasbourg, France)
    Abstract: During Covid-19 pandemic, the tourism and leisure industry faced one of the hardest-hit. Among the targets of the restrictions, most summer gatherings and cultural events were canceled, postponed, or adjusted to the health situation. Little is known about hosts' perception regarding extraordinary changes in the value proposition, as a consequence of such contingencies. To shed light on this aspect, we collected data at the dates and places of the 2020 and 2021 La Notte della Taranta, one of the most notable European festivals of folk music. This event was partially canceled in 2020 and adjusted to the health situation in 2021. Our analysis explores the role of generic behavioral traits and festival-specific features in determining hosts' attitudes on the matter. More precisely, we focus on two main perspectives of hosts: the agreement with the measures taken by organizers in 2020 and 2021; and the perception of tourists' behavior in the last regular edition of 2019. Findings highlight the role of the objective danger of Covid-19. Interestingly, preferences toward ambiguity arise as a consistent and significant determinant for both research questions. This shows that leveraging on generic behavioral traits appears relevant when making extraordinary organizational decisions during an unexpected contingency.
    Keywords: Cultural festival, Covid-19 pandemic, Hosts' perception, Ambiguity aversion
    Date: 2022–09
  14. By: Wei Tian; Seojeong Lee; Valentyn Panchenko
    Abstract: We propose a generalization of the synthetic control method to a multiple-outcome framework, which improves the reliability of treatment effect estimation. This is done by supplementing the conventional pre-treatment time dimension with the extra dimension of related outcomes in computing the synthetic control weights. Our generalization can be particularly useful for studies evaluating the effect of a treatment on multiple outcome variables. To illustrate our method, we estimate the effects of non-pharmaceutical interventions (NPIs) on various outcomes in Sweden in the first 3 quarters of 2020. Our results suggest that if Sweden had implemented stricter NPIs like the other European countries by March, then there would have been about 70% fewer cumulative COVID-19 infection cases and deaths by July, and 20% fewer deaths from all causes in early May, whereas the impacts of the NPIs were relatively mild on the labor market and economic outcomes.
    Date: 2023–04
  15. By: Luca Gori; Piero Manfredi; Simone Marsiglio; Mauro Sodini
    Abstract: Motivated by the complicated control issues of COVID-19, this article aims at investigating the optimal control of an epidemic of a Susceptible-Infective-Removed-Susceptible (SIRS) infection, where social distancing is the only control action in a first stage, whereas a combination of social distancing and vaccination is available in a second stage. The resulting two-control optimal problem is set within a parsimonious economic framework in which a social planner minimises an objective function weighting epidemiological and economic costs by choosing the strength of social distancing in the first stage and both social distancing and the extent of an income tax to finance vaccination in the second stage. The article shows (i) how to mix social distancing and vaccination depending on the planner's degree of rationality; (ii) the importance of the planner's expectation about the date of vaccine arrival, and how the actual efficacy of the vaccine against the infection can affect the optimal social distancing policy in the pre-vaccination period, and (iii) the use of the social distancing instrument as the only optimal control under vaccine rationing.
    Keywords: Infectious diseases, COVID-19 transmission dynamics and interventions, Social distancing, Vaccination
    JEL: C61 C62 J1 J22 O41 O47
    Date: 2023–04–01
  16. By: Boutin, Delphine (University of Bordeaux); Petifour, Laurene (Heidelberg University); Megzari, Haris (University of Bordeaux)
    Abstract: The salience of the first Covid-19 crisis over a well-identified period makes it an unexpected and abrupt change in the environment. This study uses the onset of the Covid-19 crisis to empirically examine whether risk and time preferences change in response to this exogenous shock, and whether those variations are temporary or durable. We use an original panel dataset conducted in January 2020 (before any event), in June 2020 (just after the removal of strong economic measures) and in January 2022 among women working in the informal sector in Ouagadougou, Burkina Faso. We use individual fixed effects on the balanced panel to isolate the specific causal effect of the Covid-19 crisis on variation in attitudes toward risk and time. Two time horizons are analyzed: immediately at the end of the economic restrictions (short-term effect), then two years later (medium-term effect). We demonstrate strong preference instability: immediately after the shock of the Covid-19, risk aversion changed over the 6-month period in both the gain (12%) and loss (-47%) domains, while impatience increased by 20%. Eighteen months later, preferences have not returned to their pre-shock level, suggesting an abrupt and permanent effect of Covid-19 on individual preferences. We also show that risk aversion (in both domains) is non-sensitive to actual impacts, but appears to be driven by economic fears and concerns related to the Covid-19 crisis.
    Keywords: COVID-19, risk attitudes, impatience, emotions, media exposure
    JEL: D8 D9 C93 I18 O55
    Date: 2023–04

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