nep-hea New Economics Papers
on Health Economics
Issue of 2023‒07‒10
twelve papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Incentives, Health, and Retirement - Evidence from a Finnish Pension Reform By Joonas Ollonqvist; Kaisa Kotakorpi; Mikko Laaksonen; Pekka Martikainen; Jukka Pirttilä; Lasse Tarkiainen
  2. Child Health, Parental Well-Being, and the Social Safety Net By Achyuta Adhvaryu; N. Meltem Daysal; Snaebjorn Gunnsteinsson; Teresa Molina; Herdis Steingrimsdottir
  3. Trends in the School Lunch Program: Changes in Selection, Nutrition & Health By Therese Bonomo; Diane Whitmore Schanzenbach
  4. Prescription behavior of physicians in the public and private sector By Elina Jussila; Kaisa Kotakorpi; Jouko Verho
  5. Socioemotional Development during Adolescence: Evidence from a Large Macro Shock By Azmat, Ghazala; Kaufmann, Katja Maria; Özdemir, Yasemin
  6. The Unintended Consequence of Stringent Immigration Enforcement on Staffing in Nursing Homes: Evidence from Secure Communities By Gunadi, Christian
  7. Air Pollution, Smoky Days and Hours Worked By Ron Chan; Martino Pelli; Veronica Vienne
  8. City Shape and Air Pollution By Gallé, Johannes
  9. Why do urban people in India succumb to Covid 19 more? Investigating the Role of Lifestyle Disorder Disease By Parantap Basu; Susmita Das; Arnab Dutta Choudhury; Ritwik Mazumder
  10. The spread of COVID-19 in London: network effects and optimal lockdowns By Julliard, Christian; Shi, Ran; Yuan, Kathy
  11. Working from home after COVID-19: Firms expect a persistent and intensive shift By Erdsiek, Daniel; Rost, Vincent
  12. Policy Packages and Policy Space: Lessons from COVID-19 By Katharina Bergant; Kristin Forbes

  1. By: Joonas Ollonqvist (Finnish Institute for Health and Welfare); Kaisa Kotakorpi (Tampere University, Finnish Centre of Excellence in Tax Systems Research); Mikko Laaksonen (Finnish Centre for Pensions); Pekka Martikainen (University of Helsinki, Max Planck Institute for Demographic Research, and Max Planck â University of Helsinki Center for Social Inequalities in Population Health); Jukka Pirttilä (University of Helsinki, VATT Institute for Economic Research, and Finnish Centre of Excellence in Tax Systems Research); Lasse Tarkiainen (University of Helsinki)
    Abstract: We analyse the effects of changes in retirement incentives on retirement behaviour, utilising a Finnish pension reform implemented in 2005. The reform generated financial incentives to postpone retirement for some groups of individuals. Using detailed administrative data on individual health, we focus on whether individual reactions to incentives vary according to health status, and analyse whether individuals with poor health are also able to take advantage of the potential monetary benefits associated with the reform. We find that many types of individuals react to retirement incentives, and the reaction does not vary according to health status in a systematic way. Hence there does not seem to be a trade-off between providing incentives to postpone retirement and equal treatment of individuals with different health status.
    Keywords: Pension reform, retirement incentives, health
    JEL: H55 J26
    Date: 2023–05
  2. 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.
    JEL: I10 J13 J22
    Date: 2023–05
  3. By: Therese Bonomo; Diane Whitmore Schanzenbach
    Abstract: There has been significant media attention on the issue of childhood obesity, leading policymakers to reform the National School Lunch Program (NSLP) to include stricter nutritional requirements. We use data on school lunch menus to document improvements in the nutritional quality of school meals between 1991 and 2010. We then evaluate how this change in nutritional content maps into obesity outcomes, using panel data on a nationally representative cohort of children, tracking them from kindergarten entry in fall 2010 through the end of fifth grade in spring 2016. We find little evidence that participation in the school lunch program leads to weight gain, as measured by changes in obesity, overweight, and BMI. These results suggest that improvements in the nutritional content of school lunches have been largely successful in reversing the previously negative relationship between school lunches and childhood obesity. Unrelated to school lunch participation, we find a strong relationship between mother’s obesity status and both the level and growth of children’s obesity, especially for girls and among high-SES families.
    JEL: I14 I18 I21
    Date: 2023–05
  4. By: Elina Jussila (Tampere University and Finnish Centre of Excellence in Tax Systems Research (FIT)); Kaisa Kotakorpi (Tampere University, Finnish Centre of Excellence in Tax Systems Research (FIT), VATT Institute for Economic Research and CESifo); Jouko Verho (VATT Institute for Economic Research, Finnish Centre of Excellence in Tax Systems Research (FIT) and CESifo)
    Abstract: We analyze prescription behavior of physicians in the public and private sector. We study two major diseases for which an effective, widely accepted low-cost treatment and alternative, more expensive treatments are available. We find that private sector physicians are more likely to prescribe the expensive medication. The result holds after controlling for individual-level factors including health indicators based on detailed administrative data, and patient fixed effects. In one of our cases, we further find that the same physicians prescribe different medication when working in different sectors. These results are consistent with higher 2nd degree moral hazard in the private sector.
    Keywords: taxation, emigration
    JEL: I11 H42 I18
    Date: 2022–12
  5. By: Azmat, Ghazala (Sciences Po, Paris); Kaufmann, Katja Maria (University of Bayreuth); Özdemir, Yasemin (University of Bayreuth)
    Abstract: We exploit a large quasi-exogenous shock to study the development of socioemotional skills during adolescence and the consequences for long-term behavior and labor market outlook. Using novel, longitudinal, microdata on cohorts of East German adolescents before and after a large macro shock (the German Reunification), we causally estimate the impact on socioemotional skills, finding substantial negative effects in the short run. These effects are substantially larger among those affected by the shock in their early adolescence (13-14 years old), relative to older adolescents (16-17 years old). Changes in socioemotional skills have a lasting (negative) impact on them as adults, especially among those affected early in their adolescence, in terms of their expressions of externalizing behavior (e.g., physical fighting) and behavioral control problems (i.e., substance abuse), as well as internalizing behavior (i.e., mental health) and in their (labor-market) optimism and expectations. This study highlights the permanent effects of uncertainty on socioemotional skills during formative years.
    Keywords: socioemotional development, youths, behavior, health, education
    JEL: D91 I12 I31 J13 J16 J24
    Date: 2023–05
  6. By: Gunadi, Christian
    Abstract: The provision of healthcare in the United States is increasingly more reliant on immigrant workers. In this paper, I examine the impact of Secure Communities, a major immigration enforcement program that was designed to check the immigration status of all individuals arrested by local police, on staffing in nursing homes. Using difference-in-differences strategy that exploits staggered activation of Secure Communities across U.S counties, I found that the program reduced direct-care staff hours per resident day by 0.082, an approximately 2.2% decline relative to the mean of treatment counties in the baseline period. This finding suggests that stringent immigration enforcement may exacerbate the healthcare worker shortage in the United States.
    Keywords: Staffing, Nursing Homes, Secure Communities, Immigration
    JEL: K37 J61 I11 J2 J15
    Date: 2023
  7. By: Ron Chan; Martino Pelli; Veronica Vienne
    Abstract: The current literature on the economic cost of air pollution in the labor market primarily focuses on labor productivity, leaving the impact on working hours relatively unexplored. In this paper, we investigate the effects of air pollution on work hours using a nationally representative sample for Chile. To address the potential endogeneity of air pollution, we leverage the exogenous occurrence of wildfires between 2010 and 2018. We construct the smoke plumes originating from each wildfire to identify the causal impact of air pollution on hours worked. Our analysis reveals that an exogenous increase in fine particulate matter resulting from an extra smoky day leads to a 2% reduction in work hours for the average Chilean worker. The impact is more pronounced for male workers engaged in outdoor tasks, such as agriculture, and for economically disadvantaged households, where the negative effects of air pollution can be up to four times larger. Our findings imply that earlier studies focusing only on labor productivity may be underestimating the effect of air pollution on economic output by 11-13%. La littérature actuelle sur le coût économique de la pollution de l'air sur le marché du travail se concentre principalement sur la productivité du travail, laissant l'impact sur les heures de travail relativement inexploré. Dans cet article, nous étudions les effets de la pollution de l'air sur les heures de travail en utilisant un échantillon national représentatif du Chili. Pour traiter l'endogénéité potentielle de la pollution de l'air, nous tirons parti de l'occurrence exogène des incendies de forêt entre 2010 et 2018. Nous construisons les panaches de fumée provenant de chaque incendie afin d'identifier l'impact causal de la pollution de l'air sur les heures travaillées. Notre analyse révèle qu'une augmentation exogène des particules fines résultant d'une journée de fumée supplémentaire entraîne une réduction de 2 % des heures de travail pour le travailleur chilien moyen. L'impact est plus prononcé pour les hommes qui travaillent à l'extérieur, comme dans l'agriculture, et pour les ménages économiquement défavorisés, où les effets négatifs de la pollution de l'air peuvent être jusqu'à quatre fois plus importants. Nos résultats impliquent que les études antérieures axées uniquement sur la productivité du travail pourraient sous-estimer de 11 à 13 % l'effet de la pollution de l'air sur la production économique.
    Keywords: air pollution, hours worked, wildfires, Chile, pollution de l'air, heures travaillées, incendies de forêt, Chili
    JEL: Q53 J20 J22 O13 I15
    Date: 2023–06–12
  8. By: Gallé, Johannes
    Abstract: Air pollution has become an increasing health threat for the local population in many cities around the world. Using high resolution remote sensing data on nightlights and fine particulate matter (PM2.5) for the years 1998-2013, I study the contemporary nexus between city shape and air pollution in India. I find that the compactness of a city has statistically significant and negative effects on local air quality. The results are more pronounced in larger cities and robust with respect to different compactness measures. While geographic dispersion allows for more fresh air corridors, differences in commuting patterns could serve as an additional explanation. People in less compact cities are more likely to use public transport and thereby reducing the overall road traffic within cities translating into less pollution. However, the statistically significant effects do not translate into substantial changes in the relative risk of PM2.5-induced diseases.
    Keywords: Urbanization, air pollution, commuting, India
    JEL: R10 R41 Q53
    Date: 2023
  9. By: Parantap Basu (Durham University); Susmita Das (Assam University, Silchar India); Arnab Dutta Choudhury (Assam University, Silchar India); Ritwik Mazumder (Assam University, Silchar India)
    Abstract: Using data on weekly COVID infections and fatalities at the district level for 23 states and union territories of India, we investigate the determinants of COVID-19 deaths focusing exclusively on the second wave of infections. We include several macroeconomic and structural indicators for districts namely, per capita district domestic product, the degree of urbanization, population density, percentage of aged population, share of agriculture, poverty, amongst several others. Our findings suggest that fatalities have a clear rural-urban divide. Rural agricultural districts with more poor people have experienced less cases and fatalities. Fatalities are more clustered in prosperous and dense industrial and districts. Regions having higher COVID fatalities also have a higher proportion of ageing population with urban life-style disorder related diseases such as obesity, diabetes and hypertension.
    Date: 2023–05
  10. By: Julliard, Christian; Shi, Ran; Yuan, Kathy
    Abstract: We generalise a stochastic version of the workhorse SIR (Susceptible-Infectious-Removed) epidemiological model to account for spatial dynamics generated by network interactions. Using the London metropolitan area as a salient case study, we show that commuter network externalities account for about 47% of the propagation of COVID-19. We find that the UK lockdown measure reduced total propagation by 44%, with more than one third of the effect coming from the reduction in network externalities. Counterfactual analyses suggest that: the lockdown was somehow late, but further delay would have had more extreme consequences; a targeted lockdown of a small number of highly connected geographic regions would have been equally effective, arguably with significantly lower economic costs; targeted lockdowns based on threshold number of cases are not effective, since they fail to account for network externalities.
    Keywords: COVID-19; networks; key players; spatial modelling; SIR model; Elsevier deal
    JEL: I18 C51 D85
    Date: 2023–08–01
  11. By: Erdsiek, Daniel; Rost, Vincent
    Abstract: This study exploits fine-grained survey data to elicit firms' long-term expectations about the use of working from home (WFH) arrangements after the COVID-19 pandemic. From December 2021 until January 2022, the representative survey was conducted among more than 1, 000 managers from the manufacturing industry and the information economy, which includes the ICT sector, media service providers and knowledge-intensive service providers. Firms were asked about their previous use and expected use of five different hybrid and fully remote working models ranging from 1 to 5 WFH days per week. For each model, firms indicated the share of employees who had been using this schedule before the pandemic and the share of employees who are expected to use this schedule after COVID-19.
    Date: 2022
  12. By: Katharina Bergant; Kristin Forbes
    Abstract: This paper uses the onset of COVID-19 to examine how countries construct their policy packages in response to a severe negative shock. We use several new datasets to track the use of a large variety of policy tools: announced fiscal stimulus (both above- and below-the-line), monetary policy (through interest rates, asset purchases, liquidity support and swap lines), foreign currency intervention, adjustments to macroprudential regulations (including the countercyclical capital buffer) and changes in capital controls (on inflows and outflows). The results suggest that pre-existing policy space was usually more important than other country characteristics and the extent of “stress” (in economic, financial, and health measures) in determining how a country responded to COVID-19. The notable exception is for fiscal stimulus, for which existing policy space did not act as a significant constraint in advanced economies. This is a sharp contrast to results for earlier episodes—although advanced economies with higher debt levels may have been constrained in how they provided stimulus (with more below-the-line commitments). Moreover, the use of (and space available) for each policy tool usually did not affect a country’s use of other policies. This suggests that countries are not coordinating their tools optimally in an integrated framework, especially when policy space is limited for certain tools.
    JEL: E5 E6 F3 H5 H6
    Date: 2023–05

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