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on Health Economics |
| By: | Bauernschuster, Stefan (University of Passau); Grimm, Michael (University of Passau); Hajo, Cathy M. (Ramapo College of New Jersey) |
| Abstract: | Margaret Sanger established the first birth control clinic in New York in 1916. From the mid-1920s, "Sanger clinics" spread over the entire U.S. Combining newly digitized data on the roll-out of these clinics, full-count Census data, and administrative vital statistics, we find that birth control clinics accounted for 5.0–7.8% of the overall fertility decline until 1940. Moreover, birth control clinics had a significant and meaningful negative effect on the incidence of stillbirths and infant mortality. The effect of birth control clinics on puerperal deaths is consistently negative, yet insignificant. Further suggestive evidence points towards positive effects on female employment. |
| Keywords: | birth control, fertility, mortality, Margaret Sanger, demographic transition |
| JEL: | D10 J13 J23 N32 O12 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16118&r=hea |
| By: | Keivabu, Risto Conte (Max Planck Institute for Demographic Research); Cozzani, Marco (University of Florence); Wilde, Joshua (Max Planck Institute for Demographic Research) |
| Abstract: | In this paper, we combine administrative data for continental Spain from 2010 to 2018 with meteorological data to identify the effect of temperature on fertility. We demonstrate that warm (25-30°C) and hot days (>30°C) decrease total fertility rate (TFR) in Spain, and that the estimated decrease is higher than the effects estimated in previous literature for other countries. Moreover, we show that locations with a colder climate are more vulnerable to the impact of heat. Our results suggest that the global impact of climate change on population dynamics may be understated, especially without adaptation and mitigation measures, and that temperature increases may exacerbate the socio-economic consequences of low fertility such as population ageing. |
| Keywords: | fertility, TFR, temperature, heat, Spain |
| JEL: | J13 J11 J18 I12 Q54 Q56 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16110&r=hea |
| By: | Priyanka Anand; Lisa B. Kahn |
| Abstract: | In this paper, we examine whether a friend or older sibling's teen pregnancy impacts one's own sexual behavior. We exploit high-frequency data on sexual activity from the National Longitudinal Study of Adolescent to Adult Health and the sharp timing of the end of a peer's pregnancy to analyze the evolution of sexual behavior. We find that those who observe a peer's teen pregnancy change their sexual behavior after the event to put themselves at lower risk of their own teen pregnancy; specifically, they are less likely to have unprotected sex and have fewer sexual partners in the months following the end of the teen pregnancy. We find that females are more likely to change their sexual behavior after the end of a peer's teen pregnancy compared to males, and the effects are larger after observing a peer's teen pregnancy that results in a live birth. Our work suggests that connecting youth personally with the experiences of teen parents is a promising avenue for teen pregnancy prevention campaigns. |
| JEL: | I12 J13 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31228&r=hea |
| By: | Filomena, Mattia; Picchio, Matteo |
| Abstract: | We estimate the impact of temperatures on work-related accident rates in Italy by using daily data on weather conditions matched to administrative daily data on work-related accidents. The identification strategy of the causal effect relies on the plausible exogeneity of short-term daily temperature variations in a given spatial unit. We find that both high and cold temperatures impair occupational health by increasing workplace injury rates. The positive effect of warmer weather conditions on work-related accident rates is larger for men, in manufacturing and service sectors, and for workplace injuries. Colder temperatures lead to a substantial increase in commuting accidents, especially during rainy days. |
| Keywords: | climate change, temperatures, weather conditions, work-related accidents, job safety |
| JEL: | J28 J81 Q52 Q54 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1280&r=hea |
| By: | Ketcham, Jonathan; Kuminoff, Nicolai; Saha, Nirman |
| Abstract: | This study provides the first revealed preference evidence on the value of statistical life (VSL) for US seniors aged 67–97 from the rates at which they choose to consume medical care relative to other private goods and by the effects of their choices on their survival probabilities. These effects are estimated from individuals’ survey responses linked with their Medicare records. Instrumental variables estimators provide robust evidence that the mean VSL is below $1 million and that it decreases with age, and, given age, increases with income, education, and health and is higher for women and people who never smoked. |
| Date: | 2023–05–10 |
| URL: | http://d.repec.org/n?u=RePEc:rff:dpaper:dp-23-16&r=hea |
| By: | Korfhage, Thorben (RWI); Fischer, Björn (ZEW Mannheim) |
| Abstract: | We estimate a dynamic structural model of labor supply, retirement, and informal care supply, incorporating labor market frictions and the German tax and benefit system. We find that in the absence of Germany's public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that public long-term care insurance policies are fiscally costly and induce negative labor market effects. But we also show that they can offset the personal costs of caregiving to a large extent and increase welfare for those providing care, especially for low-income individuals. |
| Keywords: | long-term care, informal care, long-term care insurance, labor supply, retirement, pension benefits, dynamic structural model |
| JEL: | I18 I38 J14 J22 J26 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16124&r=hea |
| By: | Kolodziej, Ingo; Coe, Norma B.; Van Houtven, Courtney Harold |
| Abstract: | Informal care reduces work on the intensive and extensive margins; however, we do not know how caregiving affects work productivity. We link two new unique national U.S. data sets to provide the first causal estimates of the effect of providing at least 80 hours of informal care in the past month on work productivity, compared to less intensive caregiving. We control for caregiver selection into work using a Heckman selection model and use instrumental variables to estimate the causal effect of providing at least 80 hours in the past month on work productivity, using the Work Productivity and Activity Impairment (WPAI) instrument, and weekly hours worked. The IV is widowhood status of the care recipient. For both the OLS and IV results, providing at least 80 hours in the past month is associated with a 0.07-0.13 point increase in the WPAI compared to non-intensive caregivers, signifying lower work productivity. This result is mainly driven by presenteeism, or employees being less productive on the job, as opposed to absenteeism, measured by missed days of work. The OLS models are precisely estimated (p |
| Keywords: | Informal care, work productivity, Heckman selection correction, instrumental variables |
| JEL: | C36 I1 J14 J24 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:rwirep:1010&r=hea |
| By: | Johanna Catherine Maclean; D. Sebastian Tello-Trillo; Douglas A. Webber |
| Abstract: | We study the effect of losing insurance on psychiatric – mental health disorder (MHD) and substance use disorder (SUD) – hospital-based care. Psychiatric disorders cost the U.S. over $1T each year and hospitalizations provide important and valuable care for patients with these disorders. We use variation in public insurance coverage (Medicaid) eligibility offered by a large-scale and unexpected disenrollment in the state of Tennessee in 2005 that lead to 190, 000 individuals losing their insurance. Medicaid enrollees are at elevated risk for psychiatric disorders. Following the disenrollment, hospitalizations for SUDs declined by 15.4 percent. Findings suggest that MHD hospitalizations declined by 4.2 percent, but the coefficient estimate is imprecise. The expected financing of hospital care received also changed, with the probability that Medicaid was listed as the expected payer for MHD and SUD hospitalizations declining by 27.5 percent and 30.8 percent respectively post-disenrollment |
| Keywords: | Healthcare; Insurance; Mental health disorders; Substance use disorders |
| JEL: | I10 I11 I18 |
| Date: | 2022–10–20 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedgfe:2022-69&r=hea |
| By: | Dolls, Mathias (Ifo Institute for Economic Research); Krolage, Carla (Ifo Institute for Economic Research) |
| Abstract: | This paper analyzes behavioral responses to a 2014 reform in the German public pension system that lowered the full retirement age (FRA) of individuals with a long contribution history by up to two years and framed the new FRA as reference age for retirement. Using administrative data from public pension insurance accounts, we first document a substantial bunching response at the FRA exceeding the control group's bunching by 83%. Second, we show in a difference-in-difference setting that a 1.0 year decrease in the FRA leads to a reduction in the average pension claiming age by 0.3-0.4 years. Treated individuals neither have poorer health nor are more likely to be liquidity-constrained than individuals in the control group. Our results suggest that the strong responses to the reform are driven both by the new FRA serving as a reference point and by financial incentives. Estimated fiscal costs of the reform are at the upper end of the range of previous back-of-theenvelope calculations. |
| Keywords: | retirement age, early retirement, pension reform |
| JEL: | H55 J14 J18 J26 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16116&r=hea |
| By: | Jäger, Philipp |
| Abstract: | I study the impact of old-age assistance on mortality using the introduction of public pensions in the UK in 1909 as a quasi-natural experiment. Exploiting the newly created pension eligibility age through a difference-in-difference as well as an event-time design, I show that elderly mortality in England and Wales declined after the pension was introduced. The estimated mortality decline is economically relevant, more pronounced in counties with a higher share of pensioners and is driven by fewer deaths from infectious as well as non-infectious diseases. An analysis of full-count individual-level census data points to a reduction in residential crowding and retirement, especially from occupations associated with high mortality rates, as likely channels. |
| Keywords: | Old-age assistance, mortality, retirement |
| JEL: | H55 I12 J14 J26 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:rwirep:995&r=hea |
| By: | Tanya Byker; Elena Patel; Shanthi Ramnath |
| Abstract: | We use employment data from the Current Population Survey to assess the efficacy of state-mandated paid sick leave policies on leave-taking behavior with a focus on any variation by gender. We find that these policies increase leave taking for care-giving for men by 10-20%, and this effect is strongest for men with young children in the household. In addition, we find that Hispanic men and men without a bachelor’s degree, who historically have had low access to paid sick leave, are 20–25% more likely to take care-giving leave. By comparison, we do not find evidence that these policies affect leave taking for own sickness for men or women, nor do we find evidence that these policies affect care-giving leave taking for women. Our evidence highlights the importance of studying care-giving leave within the context of paid leave policies and the importance of considering gender differences in the treatment effect within this context. |
| Keywords: | Paid Sick Leave; care-giving leave; Gender; leave taking; career |
| JEL: | H31 J14 J38 |
| Date: | 2023–04 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedhwp:96037&r=hea |
| By: | Ziegler, Lennart (University of Vienna); Bamieh, Omar (University of Vienna) |
| Abstract: | This study examines the effect of two recent parental leave reforms in Austria that allow parents to choose leave schemes with varying duration. Using a regression discontinuity design, we find that the introduction of more flexible scheme choices led mothers to take, on average, 1-2 months less of leave. This decrease in leave duration, however, was not accompanied by an employment increase of similar magnitude. To understand the absence of labor supply effects, we examine data on work preferences from the Austrian Microcensus. Child care duties are cited as the primary reason for not seeking work but few mothers indicate that they would start working if better access to formal childcare were available. Switching to the more flexible leave system had a minimal effect on the labor market choices of mothers, as the majority continue to prioritize child care responsibilities and do not consider nurseries as a desirable alternative. |
| Keywords: | parental leave, gender differences, child care, financial incentives, labor supply, return to work |
| JEL: | J12 J13 J18 J22 I38 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16172&r=hea |
| By: | Dave E. Marcotte; Benjamin Hansen |
| Abstract: | The suicide rate in the United States has risen nearly 40 percent since 2000. This increase is puzzling because suicide rates had been falling for decades at the end of the 20th Century. In this paper, we review important facts about the changing rate of suicide. General trends miss the story of important differences across groups – suicide rates rose substantially among middle aged persons between 2005 and 2015 but have fallen since. Among young people, suicide rates began a rapid rise after 2010 that has not abated. We review empirical evidence to assess potential causes for recent changes in suicide rates. The economic hardship caused by the Great Recession played an important role in rising suicide among prime-aged Americans. We illustrate that the increase in the prevalence of depression among young people during the 2010s was so large it could explain nearly all the increase in suicide mortality among those under 25. Bullying victimization of LGBTQ youth could also account for part of the rise in suicide. The evidence that access to firearms or opioids are major drivers of recent suicide trends is less clear. We end by summarizing evidence on the most promising policies to reduce suicide mortality. |
| JEL: | I1 I12 I19 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31242&r=hea |
| By: | Jouko Verho (VATT Institute for Economic Research and Finnish Center of Excellence in Tax Systems Research (FIT)); Jarkko Harju (Tampere University, Finnish Centre of Excellence in Tax Systems Research (FIT) and VATT Institute for Economic Research) |
| Abstract: | We study the moral hazard effects of the drug copayment threshold in Finland using detailed prescription drug purchase data. The analysis reveals that the average drug costs increase discontinuously by 17% at the threshold above which out-of-pocket drug costs decrease substantially. Our results suggest an average price elasticity of -0.17, which indicates evident moral hazard costs. Approximately 80% of the overall effect is due to individuals buying drugs in larger quantities rather than purchasing higher-priced drugs. The heterogeneity analysis suggests that the responses are largest for drug categories taken on an as-needed rather than a regular basis. |
| Keywords: | Prescription drugs, Moral hazard, Health insurance |
| JEL: | I10 H51 D12 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:fit:wpaper:12&r=hea |
| By: | Paul Goldsmith-Pinkham; Maxim Pinkovskiy; Jacob Wallace |
| Abstract: | We use a five percent sample of Americans’ credit bureau data, combined with a regression discontinuity approach, to estimate the effect of universal health insurance at age 65—when most Americans become eligible for Medicare—at the national, state, and local level. We find a 30 percent reduction in debt collections—and a two-thirds reduction in the geographic variation in collections—with limited effects on other financial outcomes. The areas that experienced larger reductions in collections debt at age 65 were concentrated in the Southern United States, and had higher shares of black residents, people with disabilities, and for-profit hospitals. |
| JEL: | G5 I13 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31223&r=hea |
| By: | Resul Cesur; Arzu Kibris |
| Abstract: | This research is the first to identify the impact of armed conflict exposure for the average male randomly drawn from the population on subsequent intimate partner violence (IPV). We exploit a population-level natural experiment in service location assignment of draftees under Turkey’s universal conscription system, inducting 90% of all draft-age men for 15-to-18 months, with nearly a quarter of them being deployed to the conflict zone during our analysis period, 1984-to-2011, in the southeast of the country to curb the Kurdistan Workers’ Party (PKK) insurgency. Purging any confounding influence of civilian exposure, the innovative design of our survey captures isolated exposure during military service. Results show that conflict zone deployment increases physical and psychological IPV perpetration from husband to wife. Probing the mechanisms, our analysis first renders the use of violence as an instrumental behavior in intrahousehold bargaining as an unlikely mechanism by eliminating labor market outcomes and economic- and social-controlling behaviors from the list of usual suspects. Moreover, we rule out the possibility of risky health habits exacerbating the unfavorable effects of combat. Then, we show compelling evidence that normalizing violence in everyday life, likely emerging as an expressive behavior when arguments escalate, is the primary mediating pathway. |
| JEL: | I0 O17 Z13 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31227&r=hea |
| By: | Keith Finlay; Michael G. Mueller-Smith; Brittany Street |
| Abstract: | Children's indirect exposure to the justice system through biological parents or co-resident adults is both a marker of their own vulnerability and a measure of the justice system's expansive reach in society. Estimating the size of this population for the United States has historically been hampered by inadequate data resources, including the inability to (1) observe non-incarceration events, (2) follow children throughout their childhood, and (3) measure adult non-biological parent cohabitants. To overcome these challenges, we leverage billions of restricted administrative and survey records linked with Criminal Justice Administrative Records System data, and find substantially larger exposure rates than previously reported: prison - 9% of children born between 1999-2005, felony conviction - 18%, and any criminal charge - 39%. Charge exposure rates exceed 60% for Black, American Indian, and low-income children. While broader definitions reach a more expansive population, strong and consistently negative correlations with childhood well-being suggest these remain valuable predictors of vulnerability. Finally, we document substantial geographic variation in exposure, which we leverage in a movers design to estimate the effect of living in a high-exposure county during childhood. We find that children moving into high-exposure counties are more likely to experience post-move exposure events and exhibit significantly worse outcomes by age 26 on multiple dimensions (earnings, criminal activity, teen parenthood, mortality); impacts are strongest for those who moved at earlier ages. |
| JEL: | I32 J12 K14 K42 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31262&r=hea |
| By: | Abrahamsson, Sara (Norwegian Institute of Public Health); Bütikofer, Aline (Norwegian School of Economics); Karbownik, Krzysztof (Emory University) |
| Abstract: | Using spatial and temporal variation in openings of fast food restaurants in Norway between 1980 and 2007, we study the effects of changes in the supply of high caloric nutrition on the health and cognitive ability of young adult males. Our results indicate that exposure to these establishments during childhood and adolescence increases BMI and has negative effects on cognition. Heterogeneity analysis does not reveal meaningful differences in the effects across groups, including for those with adverse prenatal health or high paternal BMI, an exception being that cognition is only affected by exposure at ages 0–12 and this effect is mediated by paternal education. |
| Keywords: | fast food restaurants, food supply, BMI, obesity, cognitive ability |
| JEL: | I12 I20 J13 L66 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16109&r=hea |
| By: | Collischon, Matthias (Institute for Employment Research (IAB), Nuremberg); Hiesinger, Karolin (Institute for Employment Research (IAB), Nuremberg); Pohlan, Laura (Institute for Employment Research (IAB), Nuremberg) |
| Abstract: | This paper analyzes the individual-level effects of disability onset on labor market outcomes using novel administrative data from Germany. Combining propensity score matching techniques with an event-study design, we find lasting negative impacts on employment and wages. One important mechanism is transitions to nonemployment after disability onset: newly disabled individuals' probability of becoming nonemployed increases by 10 percentage points after one year and by 15 percentage points after five years relative to that of the control group. For those who stay in employment, working part-time and switching to less physically or psychosocially demanding jobs are important adjustment paths. The negative labor market effects of disability onset are more pronounced for severely disabled, older and low-skilled individuals. |
| Keywords: | propensity score matching, labor market outcomes, disability, event study |
| JEL: | I10 J14 J21 J71 |
| Date: | 2023–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16100&r=hea |
| By: | Delgado-Cubillo, Pablo; Martín Román, Ángel L. |
| Abstract: | While the 1995 Occupational Safety and Health Act (OSH) regulation transformed the outlook on workplaces in Spain, characterized by a lack of preventive protection, public statistics have reported an increasing trend in the postregulation workplace accident rates. This study uses microdata from official national statistics to examine the effect of the OSH regulation on the reported accidents while focusing on its severity. Accordingly, we apply a difference-in-difference assessment method where a comparable group is formed by the contemporaneous in itinere accidents (commuting), which are legally and statistically considered work-related accidents but not directly impacted by the OSH regulation, with a focus on the workplace environment. The results reveal that the nonfatal accident rate decreased after the implementation of the regulation. However, when we isolate the effect of the regulation on accidents that usually provoke hard-to-diagnose injuries (dislocations, back pain, sprains, and strains), we obtain a significant increase in the accident rate. Moral hazard mixed effects seem to have played a crucial role in these dynamics through overreporting and/or Peltzman effects, often offsetting accident reduction intended by the OSH regulation. |
| Keywords: | OSH, impact evaluation, moral hazard, difference-in-difference |
| JEL: | K31 I18 D04 H43 J28 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1277&r=hea |
| By: | Adhvaryu, Achyuta (University of San Diego); Daysal, N. Meltem (University of Copenhagen); Gunnsteinsson, Snaebjorn (Independent Researcher); Molina, Teresa (University of Hawaii at Manoa); Steingrimsdottir, Herdis (Copenhagen Business School) |
| Abstract: | How do parents contend with threats to the health and survival of their children? Can the social safety net mitigate negative economic effects through transfers to affected families? We study these questions by combining the universe of cancer diagnoses among Danish children with register data for affected and matched unaffected families. Parental income declines substantially for 3-4 years following a child's cancer diagnosis. Fathers' incomes recover fully, but mothers' incomes remain 3% lower 12 years after diagnosis. Using a policy reform that introduced variation in the generosity of targeted safety net transfers to affected families, we show that such transfers play a crucial role in smoothing income for these households and, importantly, do not generate work disincentive effects. The pattern of results is most consistent with the idea that parents' preferences to personally provide care for their children during the critical years following a severe health shock drive changes in labor supply and income. Mental health and fertility effects are also observed but are likely not mediators for impacts on economic outcomes. |
| Keywords: | child health, income, labor supply, safety net, cash transfers, disincentive effects, long-run effects, mental health, childhood cancers, Denmark |
| JEL: | I10 J13 J22 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16115&r=hea |
| By: | Fraas, Arthur G. (Resources for the Future); Lutter, Randall; Murphy, Joshua; Xiahou, Qinrui (Resources for the Future); Potter, Jeff; Gosling, Samuel D. |
| Abstract: | To assess how early-life exposure to air pollution affects adult personality, we use new annual lead (Pb) vehicle emissions data by county, for 1969 to 1981, and “Big Five” personality data for 130, 000 adults. Models with county and cohort fixed effects show higher Pb exposure during the first five years of life lowers agreeableness and increases openness. Weaker evidence suggests Pb lowers conscientiousness and increases neuroticism but it has no effect on extraversion. We also assess how regulation-induced cuts in total suspended particulates (TSP) levels affect adult personality. We are unable to disentangle early life effects of Pb and TSP. |
| Date: | 2023–05–10 |
| URL: | http://d.repec.org/n?u=RePEc:rff:dpaper:dp-23-17&r=hea |
| By: | Matthew Robson (Erasmus University Rotterdam); Owen O’Donnell (Erasmus University Rotterdam); Tom Van Ourti (Erasmus University Rotterdam) |
| Abstract: | We design a novel experiment to identify aversion to pure (univariate) health inequality separately from aversion to income-related and income-caused health inequality. Participants allocate resources to determine health of individuals. Identification comes from random variation in resource productivity and in information on income and its causal effect. We gather data (26, 286 observations) from a UK representative sample (n=337) and estimate pooled and participant-specific social preferences while accounting for noise. The median person has strong aversion to pure health inequality, challenging the health maximisation objective of economic evaluation. Aversion to health inequality is even stronger when it is related to income. However, the median person prioritises health of poorer individuals less than is assumed in the standard measure of income-related health inequality. On average, aversion to that inequality does not become stronger when low income is known to cause ill-health. There is substantial heterogeneity in all three types of inequality aversion |
| Keywords: | Inequality Aversion, Social Preferences, Health, Income, Experiment |
| JEL: | C90 D30 D63 I14 |
| Date: | 2023–04–12 |
| URL: | http://d.repec.org/n?u=RePEc:tin:wpaper:20230019&r=hea |
| By: | Leuz, Christian; Malani, Anup; Muhn, Maximilian; Jakab, László |
| Abstract: | Financial ties between drug companies and medical researchers are thought to bias results published in medical journals. To enable readers to account for such bias, most medical journals require authors to disclose potential conflicts of interest. For such policies to be effective, conflict disclosure must modify readers' beliefs. We therefore examine whether disclosure of financial ties with industry reduces article citations, indicating a discount. A challenge to estimating this effect is selection as drug companies may seek out higher quality authors as consultants or fund their studies, generating a positive correlation between disclosed conflicts and citations. Our analysis confirms this positive association. Including observable controls for article and author quality attenuates but does not eliminate this relation. To tease out whether other researchers discount articles with conflicts, we perform three tests. First, we show that the positive association is weaker for review articles, which are more susceptible to bias. Second, we examine article recommendations to family physicians by medical experts, who choose from articles that are a priori more homogenous in quality. Here, we find a significantly negative association between disclosure and expert recommendations, consistent with discounting. Third, we conduct an analysis within author and article, exploiting journal policy changes that result in conflict disclosure by an author. We examine the effect of this disclosure on citations to a previously published article by the same author. This analysis reveals a negative citation effect. Overall, we find evidence that disclosures negatively affect citations, consistent with the notion that other researchers discount articles with disclosed conflicts. |
| Keywords: | Financial interests, Bias in medical research, Research and development, Disclosure regulation, Transparency |
| JEL: | D83 D84 G18 K20 L51 M40 O31 |
| Date: | 2022 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:cfswop:702&r=hea |
| By: | Samantha E. Clark; Ruth Etzioni; Jerry Radich; Zachary Marcum; Anirban Basu |
| Abstract: | Objective To assess the price elasticity of branded imatinib in chronic myeloid leukemia (CML) patients on Medicare Part D to determine if high out-of-pocket payments (OOP) are driving the substantial levels of non-adherence observed in this population. Data sources and study setting We use data from the TriNetX Diamond Network (TDN) United States database for the period from first availability in 2011 through the end of patent exclusivity following the introduction of generic imatinib in early 2016. Study design We implement a fuzzy regression discontinuity design to separately estimate the effect of Medicare Part D enrollment at age 65 on adherence and OOP in newly-diagnosed CML patients initiating branded imatinib. The corresponding price elasticity of demand (PED) is estimated and results are assessed across a variety of specifications and robustness checks. Data collection/extraction methods Data from eligible patients following the application of inclusion and exclusion criteria were analyzed. Principal findings Our analysis suggests that there is a significant increase in initial OOP of $232 (95% Confidence interval (CI): $102 to $362) for individuals that enrolled in Part D due to expanded eligibility at age 65. The relatively smaller and non-significant decrease in adherence of only 6 percentage points (95% CI: -0.21 to 0.08) led to a PED of -0.02 (95% CI: -0.056, 0.015). Conclusion This study provides evidence regarding the financial impact of coinsurance-based benefit designs on Medicare-age patients with CML initiating branded imatinib. Results indicate that factors besides high OOP are driving the substantial non-adherence observed in this population and add to the growing literature on PED for specialty drugs. |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2305.06076&r=hea |
| By: | Brun, Martín (Universitat Autònoma de Barcelona); D'Ambrosio, Conchita (University of Luxembourg); Ferrer-i-Carbonell, Ada (CSIC Institute of Public Goods and Policies (IPP)); Ramos, Xavier (Universitat Autònoma de Barcelona) |
| Abstract: | We analyse individuals' preferences vaccine-distribution schemes in the World, the EU, and their country of residence that emphasise circumstances rather than outcomes or effort. We link preferences to previously-measured cognition, and find that high-cognition individuals are 35% more likely to always support such schemes. These preferences are not driven by scheme convenience nor vaccine hesitancy, but appear to be caused by prosociality. We argue that this latter is linked to the perception of less equality of opportunity in society: despite having similar ideals about the role that effort and luck should play in life, high-cognition individuals perceive outcomes to be more determined by luck. |
| Keywords: | social preferences, redistribution, COVID-19, vaccines, cognition, COME-HERE survey |
| JEL: | I14 D91 D71 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16126&r=hea |
| By: | Donata Stonkute (Max Planck Institute for Demographic Research, Rostock, Germany); Angelo Lorenti (Max Planck Institute for Demographic Research, Rostock, Germany); Jeroen Spijker |
| Abstract: | Education plays a crucial role in shaping the health outcomes of adults. This study examines the relationship between educational attainment and health across Europe. Using data from the Survey of Health, Ageing and Retirement in Europe, we estimate educational inequalities in disability-free life expectancy (DFLE) by gender in seven Western European (2004-2019) and three Central and Eastern European (CEE) (2010-2019) countries. We exploit a novel approach that combines the Sullivan method and multivariate life tables to calculate DFLE using SHARE data. We find that educational differences in DFLE favoring the better-educated exist in both CEE and Western European countries, but also that the differences across countries are more pronounced among the low-educated. While the absolute gaps in DFLE between low- and high-educated individuals in CEE and Western European countries are similar, the educational disparities in DFLE impose a more significant burden on the CEE populations due to their overall lower life expectancy. Educational inequalities are larger among women than among men in CEE countries, while the results for Western European countries are mixed. Our findings further highlight the important role of the institutional context in mitigating or exacerbating educational inequalities in health. |
| JEL: | J1 Z0 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:dem:wpaper:wp-2023-028&r=hea |
| By: | David Cho; Alvaro Mezza; Joshua Montes |
| Abstract: | Despite the growth in the literature on the opioid crisis, questions remain on how to best measure the local supply of prescription opioids. We document that measures based on the number of prescriptions largely track hydrocodone, while measures based on morphine-equivalent amounts largely track oxycodone. This choice matters, given the well-documented link between oxycodone and the rise in use of illicit opioids such as heroin, plus the fact that oxycodone and hydrocodone (the two most common prescription opioids) are only weakly correlated. We recommend local measures of the supply of opioids should take into account morphine-equivalent amounts, to avoid understating the health and economic consequences of opioid abuse. |
| Keywords: | Opioid crisis; Labor force; Manufacturing |
| JEL: | J21 I12 I18 |
| Date: | 2022–11–22 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedgfe:2022-78&r=hea |
| By: | Anne Case; Angus Deaton |
| Abstract: | We examine mortality differences between Americans with and without a four-year college degree over the period 1992 to 2021. From 1992 to 2010, both groups saw falling mortality, but with greater improvements for the more educated; from 2010 to 2019, mortality fell for those with a BA and rose for those without; from 2019 to 2021, mortality rose for both groups, but more rapidly for the less educated. In consequence, the mortality gap between the two groups rose in all three periods, unevenly until 2010, faster between 2010 to 2019, and explosively during the pandemic. The overall period saw dramatic changes in patterns of mortality, but gaps rose consistently, not only in all-cause mortality, but in each of thirteen broad classifications of cause of death. Gaps increased for causes of death whose rates have risen in the last thirty years, whose rates have fallen in the last thirty years, and whose rates fell and then rose. Gaps rose for causes where rates were originally higher for those without a BA, and where rates were originally lower for those without a BA. Although mechanisms and stories are different for each cause of death, the widening gap is seen throughout. |
| JEL: | I1 I14 I26 J10 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31236&r=hea |
| By: | Chellai, Fatih |
| Abstract: | The increase in caesarean section (CS) rates across countries has caused several health, social, and economic problems. The objectives are to estimate the prevalence and trend of caesarian sections and to investigate the determinants of such a dynamic. Secondary data from multiple indicator cluster surveys (MICS) were used for a set of countries in Central, Eastern, and Southeastern Europe. A meta-analysis was performed and multivariable logistic models were fitted. The findings showed high heterogeneity of CS rates among the study countries, with rates ranging from 11.1% in Ukraine to 40.4% in the Republic of Macedonia. In terms of the dynamics of C-section use over time, the results showed, within countries, that the rates are increasing sharply for all women. The inequalities between subgroups in these countries have been revealed, notably by area and region. Except for mother’s age and baby size at birth (for specific countries), univariate and multivariate logistic regression revealed that none of the determinants were significantly associated (p>0.05) with the use of C-section. The results show that inequalities in the C-section exist within and between countries. However, considering the rationale for the use of caesarean sections, we need to implement different and flexible approaches with respect to the characteristics of each country in terms of demography, health systems, and economic levels. |
| Keywords: | Caesarean section; Prevalence; Delivery; Maternal Health |
| JEL: | I1 I12 I14 I18 |
| Date: | 2023–05–15 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:117344&r=hea |
| By: | Soetewey, Antoine (Université catholique de Louvain, LIDAM/ISBA, Belgium); Legrand, Catherine (Université catholique de Louvain, LIDAM/ISBA, Belgium); Denuit, Michel (Université catholique de Louvain, LIDAM/ISBA, Belgium); Silversmit, Geert (Belgian Cancer Registry) |
| Abstract: | Over the last decade, the number of years of life lost (YLL) became a popular tool in biostatistics and epidemiology to measure discrepancies in life expectancy or mortality between a cohort of patients and the general population. Its prominence in the literature is primarily due thanks to its ease of interpretation and because information on the cause of death is not required. Multi-state models are a powerful statistical approach to study the evolution of individuals between different “states”, providing a convenient representation for cancer patients. Based on 161, 007 melanoma, thyroid and female breast cancer cases recorded by the Belgian Cancer Registry, a three-state (healthy–cancer–death) illness-death model is used to illustrate how it can be applied to cancer registry data to estimate several types of health indicators, with a focus on the incidence and the number of years of life lost due to cancer. These can be seen as complementary types of health indicators, providing valuable information in different contexts and for different parties. |
| Keywords: | Years of life lost ; Multi-state models ; Critical illness ; Cancer mortality |
| Date: | 2023–04–21 |
| URL: | http://d.repec.org/n?u=RePEc:aiz:louvad:2023013&r=hea |
| By: | Pascaline Dupas; Camille Falezan; Seema Jayachandran; Mark P. Walsh |
| Abstract: | Despite the well-established importance of verbal engagement for infant language and cognitive development, many parents in low-income contexts do not converse with their infants regularly. We report on a randomized field experiment evaluating a low-cost intervention that aims to raise verbal engagement with infants by showing recent or expectant mothers a 3-minute informational video and giving them a themed wall calendar. Six to eight months later, mothers selected for the intervention report greater belief in the benefits of verbally engaging with infants, more frequent parent-infant conversations, and that their infants have more advanced language and cognitive skills. We measure positive but noisy effects on parental verbal inputs in a day-long recording and on surveyor-observed infant cognitive skills. The intervention could be delivered to expectant mothers through existing health clinics at very low marginal cost so could be a highly cost-effective early childhood development policy in low-income contexts. |
| JEL: | D19 I25 O15 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31264&r=hea |
| By: | Zachary Wagner; Corrina Moucheraud; Manisha Shah; Alexandra Wollum; Willa H. Friedman; William H. Dow |
| Abstract: | Bias among health care providers can lead to poor-quality care and poor health outcomes, and it can exacerbate disparities. We use a randomized controlled trial to evaluate an intervention to reduce family planning provider bias towards young women in 227 clinics in Tanzania, Burkina Faso, and Pakistan. The intervention educated providers about bias towards young women, facilitated communication about bias with other providers, and offered non-financial public awards to clinics with the least biased care. After 12 months, the intervention led to less-biased attitudes and beliefs among providers and more comprehensive counseling. Clients also perceived better treatment at intervention clinics compared to control clinics. Despite reductions in reported bias, we find mixed evidence regarding changes in method dispensing |
| JEL: | D12 I11 I12 O12 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31269&r=hea |
| By: | Rüdiger Bachmann; Christian Bayer; Martin Kornejew |
| Abstract: | This paper examines how households adjusted their consumption behavior in response to COVID- 19 infection risk during the early phase of the pandemic. We use a monthly consumption survey specifically designed by the German Statistical Office covering the second wave of COVID-19 infections from September to November 2020. Households reduced their consumption expenditures on durables and social activities by, respectively, 24 percent and 36 percent in response to one hundred extra infections per one hundred thousand inhabitants per week. The effect was concentrated among the elderly, whose mortality risk from COVID-19 infection was arguably the highest. |
| Keywords: | consumption, health risk, pandemic, COVID-19, survey data |
| JEL: | D12 E21 E32 I12 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:bon:boncrc:crctr224_2023_423&r=hea |
| By: | Gabriella Conti (University College London); Pamela Giustinelli (Bocconi University) |
| Abstract: | We provide a framework to disentangle the role of preferences and beliefs in health behavior, and we apply it to compliance behavior during the acute phase of the COVID-19 pandemic. Using rich data on subjective expectations collected during the spring 2020 lockdown in the UK, we estimate a simple model of compliance behavior with uncertain costs and benefits, which we employ to quantify the utility trade-offs underlying compliance, to decompose group differences in compliance plans, and to compute the monetary compensation required for people to comply. We find that, on average, individuals assign the largest disutility to passing away from COVID-19 and being caught transgressing, and the largest utility to preserving their mental health. But we also document substantial heterogeneity in preferences and/or expectations by vulnerability status, gender, and other individual characteristics. In our data, both preferences and expectations matter for explaining gender differences in compliance, whereas compliance differences by vulnerability status are mainly driven by heterogeneity in preferences. We also investigate the relationship between own and others’ compliance. When others fail to comply and trust breaks down, individuals respond heterogeneously depending on their own circumstances and characteristics. When others around them comply less, those with higher risk tolerance and those without prior COVID-19 experience plan to comply less themselves, while the vulnerables plan to comply more. When a high-level public figure breaches the rules, supporters of the opposing political party plan to comply less. These findings emphasize the need for public health policies to account for heterogenous beliefs, preferences, and responses to others in citizens’ health behaviors. |
| Keywords: | health behavior, COVID-19, United Kingdom |
| JEL: | C25 C83 D84 I12 I18 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2023-012&r=hea |
| By: | Monsees, Daniel; Schmitz, Hendrik |
| Abstract: | We study the effect of education on vaccination against COVID-19 and influenza in Germany and Europe. Our identification strategy makes use of changes in compulsory schooling laws and allows to estimate local average treatment effects for individuals between 59 and 91 years of age. We find no significant effect of an additional year of schooling on vaccination status in Germany. Pooling data from Europe, we conclude that schooling increases the likelihood to vaccinate against COVID by an economically negligible effect of one percentage point (zero for influenza). However, we find indications that additional schooling increases fear of side effects from COVID vaccination. |
| Keywords: | COVID, influenza, vaccination, education, compulsory schooling |
| JEL: | I10 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:rwirep:1011&r=hea |
| By: | Bryant G. Hopkins; Katharine O. Strunk; Scott A. Imberman; Adrea J. Truckenmiller; Matthew Guzman; Marisa H. Fisher |
| Abstract: | We use data from Michigan and an interrupted time series (ITS) strategy to show how the COVID-19 pandemic impacted new special education classifications and discontinuations. We find a substantial decrease in K-5 classifications and discontinuations during the 2019-20 and 2020-21 school years. Classifications fell by 19 and 12 percent in these years, respectively, with smaller but still significant reductions in discontinuations. Districts with remote schooling and Black, Asian, and economically disadvantaged students saw larger decreases in classifications. While rates returned to trend in 2021-22, there was little “catch up” beyond that to make up for these delays, suggesting that as of that year many students had not yet gained access to services for which they may be eligible. |
| JEL: | I10 I20 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31261&r=hea |
| By: | Mr. Serhan Cevik |
| Abstract: | The spread of the COVID-19 pandemic and government interventions have reshaped economic activity with abrupt changes in household consumption behavior across the world. This paper provides an empirical investigation of how the COVID-19 vaccine rollout has affected consumer spending at daily frequency using debit and credit card transactions in three European countries. Empirical results show that COVID-19 vaccinations, along with other policy interventions, have mitigated the severe negative impact of the pandemic and boosted consumer spending. First, the vaccination deployment has a statistically and economically significant positive effect on private consumption. Second, other policy responses to the pandemic—designed to contain the spread of the virus and provide support to businesses and households—have significant effects on the amount and composition of debit and credit card transactions. Third, the impact of COVID-19 vaccinations in terms of stimulating consumer spending appears to be more pronounced on contact-intensive sectors such as services than goods. |
| Keywords: | Pandemic; COVID-19; vaccination; household behavior; consumer spending; card transactions; Baltics; Estonia; Latvia; Lithuania; vaccine rollout; credit card transactions; vaccination deployment; government intervention; vaccination effort; Consumer credit; Household consumption |
| Date: | 2023–04–21 |
| URL: | http://d.repec.org/n?u=RePEc:imf:imfwpa:2023/081&r=hea |
| By: | Lorenzo Lucchini; Ollin Langle-Chimal; Lorenzo Candeago; Lucio Melito; Alex Chunet; Aleister Montfort; Bruno Lepri; Nancy Lozano-Gracia; Samuel P. Fraiberger |
| Abstract: | Mobile phone data have played a key role in quantifying human mobility during the COVID-19 pandemic. Existing studies on mobility patterns have primarily focused on regional aggregates in high-income countries, obfuscating the accentuated impact of the pandemic on the most vulnerable populations. By combining geolocation data from mobile phones and population census for 6 middle-income countries across 3 continents between March and December 2020, we uncovered common disparities in the behavioral response to the pandemic across socioeconomic groups. When the pandemic hit, urban users living in low-wealth neighborhoods were less likely to respond by self-isolating at home, relocating to rural areas, or refraining from commuting to work. The gap in the behavioral responses between socioeconomic groups persisted during the entire observation period. Among low-wealth users, those who used to commute to work in high-wealth neighborhoods pre-pandemic were particularly at risk, facing both the reduction in activity in high-wealth neighborhood and being more likely to be affected by public transport closures due to their longer commute. While confinement policies were predominantly country-wide, these results suggest a role for place-based policies informed by mobility data to target aid to the most vulnerable. |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2305.06888&r=hea |
| By: | Lee, Zeewan; Tan, Poh Lin; Tan-Soo, Jie-Sheng |
| Abstract: | The rise of remote work arrangements under the COVID-19 pandemic has generated important benefits, enhancing worker productivity by providing flexibility and reducing commuting costs. Would such positive labor market outcomes enjoyed equally between spouses? Using a longitudinal dataset of married women and their spouses before, during and after the lockdown in Singapore, we examine the effect of the pandemic and the availability of remote work on the respondents’ salary income, while accounting for the moderating roles of gendered differences in time use (e.g., in childcare) and presence of helpers. We find a significant salary income growth among male remote workers, but not among females. While both male and female remote workers experienced an increase in income if they spent less time on household work, women were less likely to face such smaller household responsibilities than men. This study provides empirical evidence that unequal division of household labor leads to unequal gains from remote work. |
| Keywords: | gender, income, COVID-19, remote work, flexible work, time use |
| JEL: | J16 J24 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:esprep:270941&r=hea |