nep-hea New Economics Papers
on Health Economics
Issue of 2023‒06‒26
thirteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Child Health, Parental Well-Being, and the Social Safety Net By Achyuta Adhvaryu; N. Meltem Daysal; Snaebjorn Gunnsteinsson; Teresa Molina; Herdis Steingrimsdottir
  2. At Home versus in a Nursing Home: Long-term Care Settings and Marginal Utility By Bertrand Achou; Philippe De Donder; Franca Glenzer; Minjoon Lee; Marie-Louise Leroux
  3. Machine learning and physician prescribing: a path to reduced antibiotic use By Michael Allan Ribers; Hannes Ullrich
  4. Improving Health and Safety in the Informal Sector: Evidence from a Randomized Trial in Bangladesh By Islam, Asad; Lee, Wang-Sheng; Triyana, Margaret; Xia, Xing
  5. Entitled to Property: How Breaking the Gender Barrier Improves Child Health in India By Hossain, Md Shahadath; Nikolov, Plamen
  6. Prenatal Exposure to PM2.5 and Infant Birth Outcomes: Evidence from a Population-Wide Database By Jahanshahi, Babak; Johnston, Brian; McVicar, Duncan; McGovern, Mark; O'Reilly, Dermot; Rowland, Neil; Vlachos, Stavros
  7. The Effects of the 2010 Haiti Earthquake on Children's Nutrition and Education By Dodlova, Marina; Carias, Michelle Escobar; Grimm, Michael
  8. Health Impacts of Public Pawnshops in Industrializing Tokyo By Tatsuki Inoue
  9. Valuing a reduction in the risk and severity of asthma: A large scale multi-country stated preference approach By Damien Dussaux; Gildas Appéré; Alan Krupnick; Muriel Travers
  10. Pandemic Consumption By Ruediger Bachmann; Christian Bayer; Martin Kornejew
  11. The Impact of COVID-19 on Access to Mental Healthcare Services By Harrell, Benjamin; Fumarco, Luca; Button, Patrick; Schwegman, David J.; Denwood, Kyla
  12. Housing Prices, Airport Noise and an Unforeseeable Event of Silence By Breidenbach, Philipp; Thiel, Patrick
  13. Rational social distancing in epidemics with uncertain vaccination timing By Simon K. Schnyder; John J. Molina; Ryoichi Yamamoto; Matthew S. Turner

  1. By: Achyuta Adhvaryu; N. Meltem Daysal; Snaebjorn Gunnsteinsson; Teresa Molina; Herdis Steingrimsdottir
    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
  2. By: Bertrand Achou; Philippe De Donder; Franca Glenzer; Minjoon Lee; Marie-Louise Leroux
    Abstract: Marginal utility of financial resources when needing long-term care, and the related incentives for precautionary savings and insurance, may vary significantly by whether one receives care at home or in a nursing home. In this paper, we develop strategic survey questions to estimate those differences. All else equal, we find that the marginal utility is significantly higher when receiving care at home rather than in a nursing home. We then use these estimates within a quantitative life cycle model to evaluate the impact of the expected choice of care setting (home versus nursing home) on precautionary savings and insurance valuation. The estimated marginal utility differences imply a significant increase in the incentives to save when expecting to receive care at home. Larger incentives to self-insure also translate to a higher valuation of additional subsidies for home care than for nursing homes, shedding light on an efficient way to expand public long-term care subsidies. We also examine how the magnitude of our results quantitatively vary with the existing public long-term care subsidies.
    Keywords: Long-term Care, Marginal Utility, Home Care, Nursing Home, Savings.
    JEL: D14 E21 G51 I10
    Date: 2023
  3. By: Michael Allan Ribers; Hannes Ullrich
    Abstract: Inefficient human decisions are driven by biases and limited information. Health care is one leading example where machine learning is hoped to deliver efficiency gains. Antibiotic resistance constitutes a major challenge to health care systems due to human antibiotic overuse. We investigate how a policy leveraging the strengths of a machine learning algorithm and physicians can provide new opportunities to reduce antibiotic use. We focus on urinary tract infections in primary care, a leading cause for antibiotic use, where physicians often prescribe prior to attaining diagnostic certainty. Symptom assessment and rapid testing provide diagnostic information with limited accuracy, while laboratory testing can diagnose bacterial infections with considerable delay. Linking Danish administrative and laboratory data, we optimize policy rules which base initial prescription decisions on machine learning predictions and delegate decisions to physicians where these benefit most from private information at the point-of-care. The policy shows a potential to reduce antibiotic prescribing by 8.1 percent and overprescribing by 20.3 percent without assigning fewer prescriptions to patients with bacterial infections. We find human-algorithm complementarity is essential to achieve efficiency gains.
    Date: 2023–06–05
  4. By: Islam, Asad (Monash University); Lee, Wang-Sheng (Monash University); Triyana, Margaret (Nanyang Technological University, Singapore); Xia, Xing (affiliation not available)
    Abstract: Workers in small businesses in low- and middle-income countries are exposed to significant risks of occupational accidents and illnesses. A safe and healthy workplace could improve the productivity and sustainability of the business. In this paper, we conduct a randomized controlled trial in Bangladesh that provides informal firms with information on occupational health and safety (OHS) to improve their workplace practices. The intervention comprised two treatment arms: one focused solely on OHS training (the OHS arm), while the other offered business training and access to financing in addition to OHS training (the OHS+Biz arm). After two years, treated firms showed improvements in business practices, particularly those related to safety and a decent work environment. Moreover, both treatment arms experienced increased output and sales revenue. The OHS+Biz arm generally had no additional impact on firm outcomes compared to the OHS arm, suggesting that OHS information is the primary factor driving safer and healthier workplaces, which consequently can lead to better firm outcomes.
    Keywords: occupational health and safety, enterprise training, randomized controlled trial, informal economy, information, credit access
    JEL: J28 C93 J81 I15 M53 J24 O14
    Date: 2023–05
  5. By: Hossain, Md Shahadath (University of Houston); Nikolov, Plamen (Harvard Institute for Quantitative Social Science)
    Abstract: Non-unitary household models suggest that enhancing women's bargaining power can influence child health, a crucial determinant of human capital and economic standing throughout adulthood. We examine the effects of a policy shift, the Hindu Succession Act Amendment (HSAA), which granted inheritance rights to unmarried women in India, on child health. Our findings indicate that the HSAA improved children's height and weight. Furthermore, we uncover evidence supporting a mechanism whereby the policy bolstered women's intra-household bargaining power, resulting in downstream benefits through enhanced parental care for children and improved child health. These results emphasize that children fare better when mothers control a larger share of family resources. Policies empowering women can yield additional positive externalities for children's human capital
    Keywords: human capital, height, bargaining, parental investments, developing countries, India
    JEL: D13 I12 I13 J13 J16 J18 K13 O12 O15 Z12 Z13
    Date: 2023–05
  6. By: Jahanshahi, Babak; Johnston, Brian; McVicar, Duncan; McGovern, Mark; O'Reilly, Dermot; Rowland, Neil; Vlachos, Stavros
    Abstract: There are growing concerns about the impact of pollution on maternal and infant health. In the UK in 2018, 36% of local authorities had levels of PM2.5 where exposure exceeded the annual level recommended by the World Health Organisation at the time. Using a population database of births in Northern Ireland linked to localised geographic information on pollution in mothers' postcodes (zip codes) of residence during pregnancy, we examine whether prenatal exposure to PM2.5 is associated with a comprehensive range of birth outcomes. Overall, we find little evidence that particulate matter is related to worse infant outcomes once we implement a fixed effects approach that accounts for time-invariant factors common to mothers. While reducing pollution remains an urgent public health priority, our results imply that improvements in short-run levels of prenatal PM2.5 exposure are unlikely to be sufficient by themselves to reduce disparities in birth outcomes.
    Keywords: Pollution, PM2.5, infant outcomes, sibling fixed-effects, birth weight
    JEL: I10 J10 Q53
    Date: 2022
  7. By: Dodlova, Marina (University of Passau); Carias, Michelle Escobar (Monash University); Grimm, Michael (University of Passau)
    Abstract: We assess the impact of the 2010 Haiti earthquake on children’s nutrition and education. We combine geo-coded shaking intensity data with four waves of the Haiti Demographic Health Survey, two administered before and two after the earthquake. We find lasting negative impacts of the earthquake on children's stunting and wasting as well as on school enrolment and attendance. A one standard deviation increase in shaking intensity raises infant stunting by 0.08 standard deviations and wasting by 0.04 standard deviations. Our estimates account for the millions in aid funds allocated by the World Bank to overcome the earthquake's aftermath. This aid mitigated but could not fully prevent the adverse effects on children's health and education. The results are robust to alternative specifications and different measures of exposure to the earthquake. Our results highlight the need for aid in poor areas affected by natural disasters to prevent infant malnutrition and poor education. Reduced children's health and education will have lasting private and social costs, which could easily exceed the necessary costs to counter these effects.
    Keywords: natural disasters, earthquake, nutrition, education, school attendance, Haiti
    JEL: I15 I25 Q54 O10
    Date: 2023–05
  8. By: Tatsuki Inoue
    Abstract: This study is the first to investigate whether financial institutions for low-income populations have contributed to the historical decline in mortality rates. Using ward-level panel data from prewar Tokyo City, we found that public pawn loans were associated with reductions in infant and fetal death rates, potentially through improved nutrition and hygiene measures. Simple calculations suggest that popularizing public pawnshops led to a 6% and 8% decrease in infant mortality and fetal death rates, respectively, from 1927 to 1935. Contrarily, private pawnshops showed no significant association with health improvements. Our findings enrich the expanding literature on demographics and financial histories.
    Date: 2023–05
  9. By: Damien Dussaux; Gildas Appéré; Alan Krupnick; Muriel Travers
    Abstract: Asthma is a non-communicable and non-curable lung disease that is associated with an array of environmental contaminants and chemicals. Many of these hazards are subject to regulation, or may be considered for regulation, in order to reduce exposures and prevent human health risks. However, the available information on willingness-to-pay (WTP) to avoid asthma or reduce its severity is scarce, incomplete and does not provide estimates compatible with welfare economic theory that can be used in cost-benefit analysis. This paper is part of the series of large scale willingness to pay (WTP) studies resulting from the Surveys to elicit Willingness to pay to Avoid Chemicals related negative Health Effects (SWACHE) project that intends to improve the basis for doing cost-benefit analyses of chemicals management options and environmental policies in general. The present paper offers values suitable for use in cost-benefit analyses of the WTP for reduced severity of asthma attacks in adults and children and in reduced probability of getting asthma for these two population groups, all in the context of reducing chemical exposures, and covering populations in seven OECD countries: Canada, Czech Republic, France, Poland, Sweden, the United Kingdom and the United States. The context for such WTP elicitations was a set of household products that contain fewer hazardous chemicals than what is currently available in supermarkets but are more expensive.
    Keywords: asthma, chemicals regulation, economic valuation, health risk, health valuation, monetised benefits, morbidity valuation, non-market valuation, stated preferences, surveys, value of a statistical case, willingness-to-pay
    JEL: D61 I18 J17 K32 Q51 Q53 Q58
    Date: 2023–06–05
  10. By: Ruediger 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
  11. By: Harrell, Benjamin (Vanderbilt University); Fumarco, Luca (Masaryk University); Button, Patrick (Tulane University); Schwegman, David J. (American University); Denwood, Kyla (Carnegie Endowment for International Peace)
    Abstract: The COVID-19 pandemic increased the rate of mental health disorders, as well as demand for mental health services. It remains unclear, however, the extent to which the pandemic impacted access to mental health services. Using data from an audit field experiment, we examine the impact of COVID-19 on access to mental health care appointments in the United States. This experiment ran from January to May 2020 and overlapped with the initial onset of the COVID-19 pandemic. We find that increased intensity of COVID-19—measured by daily cases, daily fatalities, and weekly excess deaths—is associated with decreased access to mental health care appointments.
    Keywords: mental health care, audit, COVID-19
    JEL: C93 I14 J16 I11 I18 J15
    Date: 2023–05
  12. By: Breidenbach, Philipp; Thiel, Patrick
    Abstract: To evaluate the causal impact of noise exposure on housing prices, we exploit a sudden and massive reduction in flight traffic that occurred with the onset of the Covid-19 measures in Germany. Comparing locations differently exposed to pre-pandemic noise with a differencein-difference approach, we detect a 2.3% increase in prices for apartments that experienced a noise reduction. Disentangling temporal dynamics, we find a peak effect in mid-2021 (up to 6%), which does not yet allow a statement on whether effects remain persistently. In contrast to most evaluations showing that the erection of a disamenity affects prices negatively, we show that lifting the burden enables neighborhoods to catch up again immediately. The immediate catch-up contradicts a stickiness of housing prices regarding (temporal) local factors. The temporal pattern shows a clear peak of the effects during the pandemic, which potentially hints at information asymmetries since buyers may not know the non-pandemic noise level during the pandemic.
    Keywords: Covid pandemic, aircraft noise, housing prices, hedonic function
    JEL: O18 Q53
    Date: 2023
  13. By: Simon K. Schnyder; John J. Molina; Ryoichi Yamamoto; Matthew S. Turner
    Abstract: During epidemics people reduce their social and economic activity to lower their risk of infection. Such social distancing strategies will depend on information about the course of the epidemic but also on when they expect the epidemic to end, for instance due to vaccination. Typically it is difficult to make optimal decisions, because the available information is incomplete and uncertain. Here, we show how optimal decision making depends on knowledge about vaccination timing in a differential game in which individual decision making gives rise to Nash equilibria, and the arrival of the vaccine is described by a probability distribution. We show that the earlier the vaccination is expected to happen and the more precisely the timing of the vaccination is known, the stronger is the incentive to socially distance. In particular, equilibrium social distancing only meaningfully deviates from the no-vaccination equilibrium course if the vaccine is expected to arrive before the epidemic would have run its course. We demonstrate how the probability distribution of the vaccination time acts as a generalised form of discounting, with the special case of an exponential vaccination time distribution directly corresponding to regular exponential discounting.
    Date: 2023–05

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