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on Health Economics |
| By: | Charles F. Manski |
| Abstract: | In medical treatment and elsewhere, it has become standard to base treatment intensity (dosage) on evidence in randomized trials. Yet it has been rare to study how outcomes vary with dosage. In trials to obtain drug approval, the norm has been to specify some dose of a new drug and compare it with an established therapy or placebo. Design-based trial analysis views each trial arm as qualitatively different, but it may be highly credible to assume that efficacy and adverse effects (AEs) weakly increase with dosage. Optimization of patient care requires joint attention to both, as well as to treatment cost. This paper develops methodology to credibly use limited trial evidence to choose dosage when efficacy and AEs weakly increase with dose. I suppose that dosage is an integer choice t ∊ (0, 1, . . . , T), T being a specified maximum dose. I study dosage choice when trial evidence on outcomes is available for only K dose levels, where K |
| JEL: | C44 I1 |
| Date: | 2023–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31305&r=hea |
| By: | Juan Pablo Atal (University of Pennsylvania); Jose Ignacio Cuesta (Stanford University and NBER); Felipe Gonzalez (Queen Mary University of London); Cristobal Otero (University of California Berkeley) |
| Abstract: | We study the effects of competition by state-owned firms, leveraging the decentralized entry of public pharmacies to local markets in Chile. Public pharmacies sell the same drugs at a third of private pharmacy prices, because of stronger upstream bargaining and market power in the private sector, but are of lower quality. Public pharmacies induced market segmentation and price increases in the private sector, which benefited the switchers to the public option but harmed the stayers. The countrywide entry of public pharmacies would reduce yearly consumer drug expenditure by 1.6 percent. |
| JEL: | D72 H4 L3 |
| Date: | 2023–06–21 |
| URL: | http://d.repec.org/n?u=RePEc:qmw:qmwecw:951&r=hea |
| By: | Jeffrey Clemens; Jonathan M. Leganza; Alex Masucci |
| Abstract: | Over the last decade, the U.S. Medicare program has added new billing codes to enhance the financial rewards for Chronic Care Management and Transitional Care Management. We analyze the effects of introducing these new billing codes. First, we provide evidence on the adoption of the new codes by primary care physicians. We show that take-up of the new billing codes occurs gradually and exhibits substantial variation across space and across physician characteristics. Second, we provide evidence on how the new billing codes can both complement and substitute for the billing or provision of other services. We focus on two case studies. As a case of code substitution, we show that Transitional Care Management services partially crowd out traditional office visits following hospital discharges. As a case of code complementarity, we show that both Transitional Care Management and Chronic Care Management services predict increases in annual wellness visits. Overall, our analysis highlights how both new code take-up frictions and the impact of new code billing on existing code billing can be important for assessing the total costs and benefits of payment reforms. |
| JEL: | H57 I11 |
| Date: | 2023–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31336&r=hea |
| By: | Ejrnæs, Mette (University of Copenhagen); García-Miralles, Esteban (Bank of Spain); Gørtz, Mette (University of Copenhagen); Lundborg, Petter (Lund University) |
| Abstract: | Longer life expectancy can affect individuals' incentives to work, save, and marry, net of any changes in their underlying health. We test this hypothesis by using the sudden arrival of a new treatment in 1995 that dramatically increased life expectancy for HIV-infected individuals. We compare the behavioral responses of HIV-infected individuals who were still in good health but who differed in their access to the new treatment. Those with access to treatment work substantially more, marry later, but do not save more. Our results highlight the importance of accounting for such incentive effects when valuing increases in life expectancy. |
| Keywords: | life expectancy, labor supply, marriage, HIV |
| JEL: | D84 I12 J12 J21 |
| Date: | 2023–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16228&r=hea |
| By: | Filomena, Mattia (Marche Polytechnic University); Picchio, Matteo (Università Politecnica delle Marche, Ancona) |
| 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: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16169&r=hea |
| By: | Luca Lindner; Arthur Hayen |
| Abstract: | The Menzis Shared Savings Program was initiated in 2014 by the Dutch insurer Menzis and the national primary care organisation Arts en Zorg, and is among the first value-based payment models for primary care in Europe. It runs as a complement to the current – volume-driven – primary care payment system. This paper reviews the evidence of the impact of this programme against its stated objectives. The Menzis Shared Savings Program led to a lower volume of care, particularly in terms of referrals to specialist care, laboratory care and general practitioners care. Main facilitating factors were the advanced data infrastructure in place, communication and transparency about the programme’s parameters, and the programme’s focus on mitigating financial risk and uncertainty for providers. Shared savings models – even when added as a mere complement to existing volume-driven payment methods – could enhance value in health systems. |
| Date: | 2023–06–27 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:158-en&r=hea |
| By: | Galizzi, Matteo M (Department of Psychological and Behavioural Science, and LSE Behavioural Lab, London School of Economics and Political Science, UK); Godager, Geir (Department of Health Management and Health Economics); Li, Jing (School of Pharmacy, University of Washington, USA); Linnosmaa, Ismo (Department of Health and Social Management, University of Eastern Finland and Finnish Institute for Health and Welfare (THL), Finland); Tammi, Timo (Faculty of Social Sciences and Business Studies, University of Eastern Finland, Joensuu, Finland); Wiesen, Daniel (Department of Healthcare Management, and Center for Social and Economic Behavior (C-SEB), University of Cologne, Germany) |
| Abstract: | We propose a comprehensive overview of the main theoretical notions and empirical findings on altruism among physicians and other healthcare providers. While altruism in the behavioral and experimental economics literature is typically defined as a deviation from purely self-interested behavior, the theoretical health economics literature embeds the notion of physician altruism within the doctor–patient relationship. The altruism of physicians is typically defined as the weight in the doctor’s utility function attached to patient’s health benefits, besides the self-interested monetary considerations. We broadly group the empirical evidence into three main categories of evidence: evidence from (i) survey and interview data, (ii) prescriptions records, and (iii) behavioral experiments. Across each of those groups of studies and different methods, the evidence generally supports the theoretical notion that physicians behave ‘altruistically’ in their healthcare decisions. Some studies indicate, however, considerable heterogeneity in physicians’ altruistic preferences. |
| Keywords: | Altruism; healthcare providers; experimental evidence; structural estimation |
| JEL: | C91 D03 I10 |
| Date: | 2023–06–23 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2023_004&r=hea |
| By: | Godager , Geir (Department of Health Management and Health Economics); Scott, Anthony (Melbourne Institute: Applied Economic and Social Research, The University of Melbourne) |
| Abstract: | There is increasing empirical evidence of patient harm and resource waste from over-diagnosis, over-treatment, medical errors, and the underuse of effective care. This chapter reviews recent literature on physician behavior and health outcomes. Research on the economics of physician behavior takes a classical economic perspective based on using financial incentives to solve information problems in healthcare markets. The evidence on payment methods, competition and market organization, and information interventions is summarized. Incentives matter, but may matter less in the presence of altruistic motives amongst most physicians, as well as the presence of complex multi-tasking decision environments. More contemporary research on physician behavior has taken a behavioral perspective where it is acknowledged that physician decision making can be biased even in cases where incentive and information problems are absent. The large health services research literature on professional behavior change incorporates behavioral and psychological perspectives yet integration into economic models of physician behavior is still in its early stages. Though research on incentives continues to dominate the health economics literature, evidence suggests that behavioral approaches are important not only in understanding incentives, but in changing physicians’ behavior using non-pecuniary interventions |
| Keywords: | Physician behavior; Physician payment; Health outcomes; Market organization |
| JEL: | D47 D82 I11 I19 J33 |
| Date: | 2023–06–12 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2023_003&r=hea |
| By: | Bjørnshagen, Vegar (Norwegian Social Research Nova); Rooth, Dan-Olof (Stockholm University); Ugreninov, Elisabeth (Norwegian Social Research Nova) |
| Abstract: | This article examines disability discrimination in the hiring process and explores variation in how the intersection of disability and gender shapes employers' hiring behavior by occupational context and gender segregation. We use data from a field experiment in which approximately 2, 000 job applications with randomly assigned information about disability were sent to Swedish employers with vacancies. We find that nondisabled applicants receive 33 percent more callbacks than similarly qualified wheelchair users despite applying for jobs where the impairment should not interfere with performance. The results indicate no heterogeneity in levels of disability discrimination against men and women on average across occupations or by occupational gender segregation. However, levels of discrimination differ considerably among occupations, varying from no evidence of disability discrimination to discrimination against both disabled men and disabled women as well as cases where disability discrimination is found only against women or only against men. The results thus indicate that disability and gender interact and shape discrimination in distinct ways within particular contexts, which we relate to intersectional stereotyping and norms of gender equality influencing hiring practices but not to declared ambitions for diversity or gender equality legislation. |
| Keywords: | disability, hiring discrimination, gender, field experiment, correspondence study |
| JEL: | I14 J14 J23 J64 J71 |
| Date: | 2023–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16217&r=hea |
| By: | De Donder, Philippe; Achou, Bertrand; Glenzer, Franca; Lee, Minjoon; Leroux, Marie-Louise |
| 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 varies with the existing public long-term care subsidies |
| Keywords: | Long-term Care; Marginal Utility; Home Care; Nursing Home; Savings |
| JEL: | D14 E21 G51 I0 |
| Date: | 2023–06–06 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:128135&r=hea |
| By: | Philippe de Donder (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - UT - Université de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, CNRS - Centre National de la Recherche Scientifique); Marie-Louise Leroux (Département des Sciences Economiques, ESG-UQAM, Montréal, Canada); François Salanié (TSE-R - Toulouse School of Economics - UT Capitole - Université Toulouse Capitole - UT - Université de Toulouse - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement) |
| Abstract: | Advantageous selection occurs when the agents most eager to buy insurance are also the cheapest ones to insure. Hemenway (1990) links it to differences in risk-aversion among agents, implying different prevention efforts, and finally different riskinesses. We argue that it may also appear when agents share the same attitude towards risk, and in the absence of moral hazard. Using a standard asymmetric information setting satisfying a single-crossing property, we show that advantageous selection may occur when several contracts are offered, or when agents also face a non-insurable background risk, or when agents face two mutually exclusive risks that are bundled together. We illustrate this last effect in the context of life care annuities, a product bundling long-term care insurance and annuities, by constructing a numerical example based on Canadian survey data. |
| Keywords: | Propitious selection, Positive or negative correlation property, Contract bundling, Long-term care insurance, Annuity |
| Date: | 2023–05–26 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04120555&r=hea |
| By: | Vanessa Cirulli (Italian Agency for Development Cooperation and Sapienza University of Rome); Giorgia Marini (Department of Juridical and Economic Studies (DSGE), Sapienza University of Rome); Marco A. Marini (Department of Social Sciences and Economics, Sapienza University of Rome); Odd Rune Straume (Department of Economics/NIPE, University of Minho) |
| Abstract: | We analyse – theoretically and empirically – the effect of hospital mergers on waiting times in healthcare markets where prices are fixed. Using a spatial modelling framework where patients choose provider based on travelling distance and waiting times, we show that the effect is theoretically ambiguous. In the presence of cost synergies, the scope for lower waiting times as a result of the merger is larger if the hospitals are more profit-oriented. This result is arguably confirmed by our empirical analysis, which is based on a conditional flexible difference-indifferences methodology applied to a long panel of data on hospital mergers in the English NHS, where we find that the effects of a merger on waiting times crucially rely on a legal status that can reasonably be linked to the degree of profit-orientation. Whereas hospital mergers involving Foundation Trusts tend to reduce waiting times, the corresponding effect of mergers involving hospitals without this legal status tends to go in the opposite direction. |
| Keywords: | Hospital merger, waiting times, profit-orientation |
| JEL: | I11 I18 L21 L41 |
| Date: | 2023–07 |
| URL: | http://d.repec.org/n?u=RePEc:fem:femwpa:2023.14&r=hea |
| By: | Carmen Camacho (PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Fernanda Estevan (EESP - Sao Paulo School of Economics - FGV - Fundacao Getulio Vargas [Rio de Janeiro]) |
| Abstract: | We use an overlapping generations model to investigate the role of parental health investment and children's schooling on the aggregate level of human capital and inequality. In our model, parental longevity affects children's human capital since it impacts human capital transmission. When poor parents cannot afford to invest in health, poverty traps may arise as human capital levels remain low in the long run. Both health costs and public school quality are crucial in determining whether households fall into the poverty trap. We demonstrate that high-quality schools ensure that successive generations become more educated, eventually attaining a higher human capital steady state. However, public health investments are particularly effective, as they affect household income and schooling and allow for human capital transmission through generations. We calibrate our model for Brazil and Chile and show that our model predicts that a poverty trap will arise in Brazil but not in Chile. |
| Keywords: | Poverty trap, Human capital, School quality, Intergenerational transmission, Longevity |
| Date: | 2023–04 |
| URL: | http://d.repec.org/n?u=RePEc:hal:psewpa:halshs-04075431&r=hea |
| By: | Andersson, Henrik; Scholtz, Henrik; Zheng, Jiakun |
| Abstract: | This paper applies an experimental design developed by Bleichrodt et al. (2010) to test the key assumption of original regret theory (Loomes and Sugden, 1982): convexity of the regret function. We elicit preferences for financial and health outcomes for about 1, 000 subjects, yielding some evidence of minor dierences between financial domain and health domain. While aggregate results seem to support regret theory at first sight, individual-level analyses show that the majority of subjects violate the predictions of regret theory with a convex regret function. Our results thus challenge the predictive accuracy of regret theory as a descriptive theory of decision-making under risk. |
| Keywords: | Original regret theory; Decision under uncertainty; Utility measurement; Online experiments |
| JEL: | C91 D81 |
| Date: | 2023–06–22 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:128169&r=hea |
| By: | Grossbard, Shoshana (San Diego State University) |
| Abstract: | This paper presents a model of consumption and household production that takes into account substitution between health-related goods that are produced at home and those produced commercially as well as substitution between goods produced at home by oneself and those produced by one's spouse or partner. New insights are offered that help interpret heterogeneity analysis in data for couples, when individuals differ by gender, age, weight and education. The model also identifies new variables related to marriage markets that could help explain consumption, including demand for medical care and good nutrition. These variables include sex ratios (and exogenous parameters that influence sex ratios) as well as legal changes related to marriage and divorce. A reexamination of the determinants of the price elasticity of demand includes an explanation for gender gaps in such elasticity. |
| Keywords: | health, caregiving, marriage, consumption, household production |
| JEL: | D1 D11 D13 I1 I12 J12 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16182&r=hea |
| By: | Patricia Palffy; Patrick Lehnert; Uschi Backes-Gellner |
| Abstract: | To foster gender equality and diversity in the workplace, firms and policymakers strive to attract women and men to gender-atypical occupations. However, particularly for men, such attempts have been of limited success. We theorize (a) that identity threat-related barriers hinder gender-atypical occupational choices, (b) that these barriers differ for women and men, and (c) that therefore the success of policy interventions aiming to encourage gender-atypical occupational choices differs for women and men. We conduct a large-scale field experiment with young women and men choosing their occupations when applying for their first job. We find that a brief intervention featuring counter-stereotypical framing and female role models in typically male jobs in STEM substantially increases women's applications for STEM jobs. However, an equivalent intervention featuring counter-stereotypical framing and male role models in typically female jobs in health and care does not increase men's applications for those jobs. Thus, strategies that work for women - such as portraying role models - do not necessarily work for men. To foster full gender equality in the workplace, firms and policymakers should not only continue investing in interventions aiming to attract women to male-dominated occupations but also develop interventions particularly focused at encouraging men to consider female-dominated occupations. |
| Keywords: | occupational choice, gender typicality, occupational gender segregation, field experiment |
| JEL: | J24 J16 I24 M59 |
| Date: | 2022–05 |
| URL: | http://d.repec.org/n?u=RePEc:iso:educat:0207&r=hea |
| By: | Kantorowicz-Reznichenko, Elena (Erasmus University Rotterdam); Dabrowska, Justyna; Kantorowicz, Jaroslaw |
| Abstract: | The COVID-19 pandemic posed new challenges for leaders. It required behavior change and self-compliance of the public. Stereotypically feminine qualities such as compassion and good approach to people may have helped achieving such goals, thus rendering this pandemic as a "feminine crisis". The special nature of this crisis, and the saliency in the media of female-led countries successfully managing the pandemic, raises the question whether female leaders would be perceived as more competent to manage such a crisis? Using an experimental study on a representative sample in Poland, we assess whether female prime minister candidates, or candidates with feminine traits, are advantaged when their competence to manage a large-scale pandemic is assessed. We find that contrary to a national security and an economic cri-sis, where male or masculine candidates are advantaged, women, or feminine candidates, have no advantage in managing a COVID-19 type crisis. Furthermore, conservative partici-pants seem to perceive male candidates as more competent, even in the pandemic context. All differences are small in magnitude, and yet suggest that even when assessed in a potentially “feminine crisis” women do not fare better than men, whereas men still fare better in typically male crisis. |
| Date: | 2023–06–05 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:3xp9z&r=hea |
| By: | Donehower, Gretchen (University of California at Berkeley) |
| Abstract: | In Asia, aging countries with slow population growth worry about a lack of workers in the future and see older people’s labor as a potential solution. However, this leaves out the work that many older people already do—unpaid care work. Drawing on data from Bangladesh, India, Mongolia, and Thailand, the estimates in this paper show that older people, especially older women, are doing a great deal of work caring for others. In this case, policies that aim to increase overall market labor force effort by increasing the market labor of older people may underachieve their goals if they do not account for the older people’s unpaid care work responsibilities. Finally, we use the estimates of the older people’s unpaid care work to think about investments in the paid care economy that might be needed to replace unpaid care work of the older people if they increase labor market effort but not total work. These simple calculations indicate that the scale of investment required is manageable. |
| Keywords: | older workers; unpaid care work; care economy; labor supply |
| JEL: | J13 J14 J22 |
| Date: | 2023–06–23 |
| URL: | http://d.repec.org/n?u=RePEc:ris:adbewp:0687&r=hea |
| By: | Laura Dague; Benjamin D. Ukert |
| Abstract: | The COVID-19 related public health emergency led to federal legislation that changed the landscape of Medicaid coverage for low-income people in the United States. Beginning in 2020, policy responses led to a surge in Medicaid enrollment due to federal rules preventing Medicaid disenrollment, and total Medicaid enrollment increased more from January 2020-2023 than the net increase in insurance coverage from 2013-2017 following the Affordable Care Act’s implementation. As these policies come to an end, it is crucial to understand their implications for the future of Medicaid. This paper provides an overview of Medicaid’s enrollment, renewal and funding policies, highlighting how these policies changed during and immediately following the acute phases of the COVID-19 pandemic, describes enrollment increases and their composition, reviews literature relevant to the policy and its unwinding, and identifies key areas for research. By examining this unprecedented period of Medicaid policy, we can inform future policy decisions and optimize safety net programs to be effective in a broad set of circumstances. |
| JEL: | H7 I13 I18 I38 |
| Date: | 2023–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31342&r=hea |
| By: | Bäckström, Peter (Department of Economics, Umeå University); Hanes, Niklas (Department of Economics, Umeå University) |
| Abstract: | We study the effect of peacekeeping on post-deployment earnings for military veterans. Using Swedish administrative data, we follow a sample of more than 11, 000 veterans who were deployed for the first time during the period 1993-2010 for up to nine years after returning home. To deal with selection bias, we use difference-in-differences propensity score matching based on a rich set of covariates, including measures of individual ability, health and pre-deployment labour market attachment. We find that, overall, veterans’ post-deployment earnings are largely unaffected by their service. Even though Swedish veterans in the studied period tend to outperform their birthcohort peers who did not serve, we show that this advantage in earnings disappears once we adjust for non-random selection into service. |
| Keywords: | Military veterans; peacekeeping; earnings |
| JEL: | H56 J01 J20 J45 |
| Date: | 2023–06–14 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:umnees:1010&r=hea |
| By: | Bostwick, Valerie (Kansas State University); Severen, Christopher (Federal Reserve Bank of Philadelphia) |
| Abstract: | We provide evidence that graduated driver licensing (GDL) laws, originally intended to improve public safety, impact human capital accumulation. Many teens use automobiles to access both school and employment. Because school and work decisions are interrelated, the effects of automobile-specific mobility restrictions are ambiguous. Using a novel triple-difference research design, we find that restricting mobility significantly reduces high school dropout rates and teen employment. We develop a multiple discrete choice model that rationalizes unintended consequences and reveals that school and work are weak complements. Thus, improved educational outcomes reflect decreased access to leisure activities rather than reduced labor market access. |
| Keywords: | mobility restrictions, human capital, teen employment, graduated driver licensing, multiple discreteness |
| JEL: | I20 J24 J22 C35 R48 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16183&r=hea |
| By: | Kumar, Chetan; K.B., Rangappa |
| Abstract: | Education is seen as the best mechanism to achieve upward economic and social mobility by vulnerable masses. Even by the government, education is regarded as a proactive initiative through which it can hope to address the problem of regional imbalance in a sustainable manner. Many prior studies have identified various factors which have played significant role in depriving education for masses. However, studies which have identified magnitude of the factors impact in depriving of education are scarce. The present study identifies the causal factors which have deprived school attendance of students among households across Indian districts along with the magnitude of their impact. Through present study we were able to infer that nutrition of children, maternal health, years of schooling and financial inclusion of household played a significant role in affecting their school attendance. Through predictive probability, we were able to assess the magnitude of the impact of the following factors and their implications on public expenditure. |
| Keywords: | Socio-Economic Factors, Horizontal spread, School attendance, Indian Districts, Binomial Logistic Regression, Predictive Probability |
| JEL: | I24 I25 I28 |
| Date: | 2022–06–22 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:117599&r=hea |
| By: | Brücker, Herbert (Institute for Employment Research (IAB), Nuremberg, Germany ; Humboldt Univ.); Ette, Andreas (BiB); Grabka, Markus M. (SOEP); Kosyakova, Yuliya (Institute for Employment Research (IAB), Nuremberg, Germany ; Univ. Bamberg); Niehues, Wenke (BAMF-FZ); Rother, Nina (BAMF-FZ); Spieß, C. Katharina (BiB); Zinn, Sabine (SOEP); Bujard, Martin (BiB); Cardozo, Adriana (SOEP); Décieux, Jean Philippe (BiB); Maddox, Amrei (BAMF-FZ); Milewski, Nadja (BiB); Naderi, Robert (BiB); Sauer, Lenore (BiB); Schmitz, Sophia (BiB); Schwanhäuser, Silvia (Institute for Employment Research (IAB), Nuremberg, Germany); Siegert, Manuel (BAMF-FZ); Tanis, Kerstin (BAMF-FZ) |
| Abstract: | "The Institute for Employment Research (IAB), the Federal Institute for Population Research (BiB), the Research Centre of the Federal Office for Migration and Refugees, and the Socio-Economic Panel at DIW Berlin have surveyed 11, 225 Ukrainian refugees in Germany from August to October 2022. The survey can be extrapolated to the refuge population who has arrived since the beginning of the war at February 24, 2022, to June 8, 2022, in Germany. The results show that the majority of refugees from Ukraine report war as the main flight motive, while personal contacts and respect of human rights were the main reasons to choose Germany as a destination. Roughly 80 percent of adult refugees are women. About the half lives together with minor-aged children, about 80 percent without a partner. Some 70 percent have tertiary education degrees. Yet, only 4 percent report good or very good, another 14 percent fair German language proficiency. About 50 percent visits or has already completed a German language class. 17 percent are employed, with some 70 percent of those performing qualified jobs. The health status of the refugee population is good, but life satisfaction well below the German population average. Above one-third of the refugees plans to stay in Germany forever or for several years, about one-third aim to leave Germany by the end of war, while 27 percent are not yet certain about their staying perspectives." (Author's abstract, IAB-Doku) ((en)) |
| Keywords: | Bundesrepublik Deutschland ; Ukraine ; Aufenthaltsdauer ; IAB-Open-Access-Publikation ; IAB-BiB/FReDA-BAMF-SOEP-Befragung ; berufliche Integration ; Bildungsniveau ; Deutsch als Fremdsprache ; Geflüchtete ; Frauen ; Geschlechterverteilung ; Gesundheitszustand ; Herkunftsland ; Lebenssituation ; Rückwanderungsbereitschaft ; Spracherwerb ; Sprachkenntnisse ; Wanderungsmotivation ; Wohnsituation ; Zufriedenheit ; Zukunftsperspektive ; 2022-2022 |
| Date: | 2023–06–12 |
| URL: | http://d.repec.org/n?u=RePEc:iab:iabfob:202224(en)&r=hea |
| By: | Pier Basaglia; Sophie M. Behr; Moritz A. Drupp |
| Abstract: | This paper is the first to investigate the effectiveness of fuel taxation to jointly deliver climate and health benefits in a quasi-experimental setting. Using the synthetic control method, we compare carbon and air pollutant emissions of the actual and synthetic German transport sector following the 1999-2003 German eco tax reform. We demonstrate sizable average reductions in CO2 (12%), PM2.5 (10%) and NOX (6%) emissions between 1999 and 2009 across a range of specifications. Using official cost estimates, we find that the eco-tax saved more than 40 billion euros of external damages. More than half of the reductions in external damages are health benefits, highlighting the importance of accounting for co-pollution impacts of carbon pricing. Our fuel and emission specific tax elasticity estimates suggest much stronger demand responses to eco tax increases than to market price movements, primarily due to increases in tax salience, which we measure using textual analysis of newspapers. We further show that gasoline-to-diesel substitution substantially mediates the trade-off between climate and health benefits. Our results highlight the key roles of tax salience and fuel-substitution in mediating the effectiveness of fuel taxes to reduce climate and health externalities. |
| Keywords: | environmental policy, carbon tax, eco tax, tax elasticity, tax salience, fuel consumption, fuel substitution, externalities, climate, pollution, health |
| JEL: | Q51 Q58 Q41 H23 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10508&r=hea |
| By: | Nathan Kettlewell (University of Technology Sydney); Yuting Zhang (Melbourne Institute: Applied Economic & Social Research, The University of Melbourne) |
| Abstract: | In countries with dual public and private healthcare systems, individuals are often incentivised to purchase private health insurance through subsidies and penalty. We use administrative data from Australia to study how high-income earners respond on both the intensive and extensive margins to the simultaneous withdrawal of a premium subsidy, and the increase of a tax penalty. We estimate regression discontinuity models by exploiting discontinuous changes in the penalty and subsidy rates. Our setting is particularly interesting because means testing creates different incentives at the extensive and intensive margins. Specifically, we could expect to see higher take-up of insurance coupled with downgrading to less expensive plans. We find evidence that the penalty – despite being large in value – only has a modest effect on take-up. Our results show little evidence of downgrading, which is consistent with a low price elasticity for the high-income earners we study. |
| Keywords: | health insurance, tax penalty, regression discontinuity, Australia |
| JEL: | I13 I18 I12 |
| Date: | 2023–05 |
| URL: | http://d.repec.org/n?u=RePEc:iae:iaewps:wp2023n08&r=hea |
| By: | Marina Dodlova; Michelle Escobar Carias; Michael Grimm |
| 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 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10505&r=hea |
| By: | Schmitz, Hendrik; Tawiah, Beatrice Baaba |
| Abstract: | We study the effect of education on health (hospital stays, number of diagnosed conditions, self-rated poor health, and obesity) over the life-cycle in Germany, using compulsory schooling reforms as a source of exogenous variation. Our results suggest a positive correlation of health and education which increases over the life-cycle. We do not, however, find any positive local average treatment effects of an additional year of schooling on health or health care utilization for individuals up to age 79. An exception is obesity, where positive effects of schooling start to be visible around age 60 and become very large in age group 75-79. The results in age group 75-79 need to be interpreted with caution, however, due to small sample size and possible problems of attrition. |
| Keywords: | Education, health, life-cycle effects, compulsory schooling |
| JEL: | I10 I12 I21 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:rwirep:1006&r=hea |
| By: | Pietrangelo de Biase; Sean Dougherty |
| Abstract: | This study provides an in-depth examination of the fiscal and governance decentralisation of long-term care (LTC) across OECD countries, offering projections of future fiscal burdens of LTC spending across levels of government. With rapid population ageing and a decrease in the supply of informal care, LTC spending has increased significantly. The paper introduces a novel methodology to estimate LTC expenditures across different government levels, including central and subnational governments. By analysing country cases, it explores the responsibilities assigned to each government level and the implications for service delivery and intergovernmental coordination. The study also discusses the overall anticipated increase of LTC expenditure to 2.3% of GDP by 2040, identifying the most impacted countries. This research contributes to our understanding of LTC systems, highlights the challenges of increasing LTC costs and provides insights for optimising governance and fiscal expenditure. |
| Keywords: | fiscal federalism, health accounts, long-term care, population ageing, social care |
| JEL: | H51 H77 I18 J11 |
| Date: | 2023–07–05 |
| URL: | http://d.repec.org/n?u=RePEc:oec:ctpaab:45-en&r=hea |
| By: | Permanyer, Iñaki; Vigezzi, Serena |
| Abstract: | We propose a novel decomposition approach that breaks down the levels and trends of lifespan inequality as the sum of cause-of-death contributions. The suggested method shows whether the levels and changes in lifespan inequality are attributable to the levels and changes in (1) the extent of inequality in the cause-specific age-at-death distribution (the ‘Inequality’ component), (2) the total share of deaths attributable to each cause (the ‘Proportion’ component), and (3) the cause-specific mean age at death (the ‘Mean’ component). This is the so-called ‘Inequality-Proportion-Mean’ (or IPM) method. We apply the IPM method to 10 low-mortality countries in Europe. Our findings suggest that the most prevalent causes of death (in our setting ‘Circulatory system’ and ‘Neoplasms’) do not necessarily contribute the most to overall levels of lifespan inequality. In turn, ‘Perinatal and congenital’ causes are the strongest drivers of lifespan inequality declines. The contribution of the IPM components to changes in lifespan inequality varies considerably across causes, sexes and countries. Among the three, the ‘Proportion’ component is the one that explains the least lifespan inequality dynamics – suggesting that shifts in the structure of causes of death alone contributed little to change lifespan inequality. |
| Date: | 2023–06–08 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:t3kzy&r=hea |
| By: | Folbre, Nancy; Fremstad, Shawn (Center for Economic and Policy Research); Gonalons-Pons, Pilar; Coan, Victoria |
| Abstract: | Understanding care provision requires a holistic approach with attention to care needs and responsibilities, transfers of time and money to meet care needs, access to services and supports, care service quality, and paid and unpaid caregivers’ well-being. Existing data sources typically focus on one specific site of care provision or one form of care, making it challenging to see interconnections important to the bigger picture. Overall, the current data infrastructure makes it very difficult, if not impossible, to answer fundamental questions about the size of the care sector, the distribution of the costs and benefits of care provision, or the extent of unmet care needs. This working paper takes a step toward addressing this problem. It provides an overview of empirical research, identifies strengths, weaknesses, and gaps in existing data resources, and considers possible improvements and synergies. |
| Date: | 2023–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:bue34&r=hea |
| By: | Lelys I. Dinarte Diaz; Saravana Ravindran; Manisha Shah; Shawn M. Powers; Helen Baker-Henningham |
| Abstract: | Approximately 75% of children aged 2 to 4 worldwide are regularly subjected to violent discipline across the globe. We study the impact of a virtually-delivered intervention on positive parenting practices in Jamaica. We find the intervention improves caregiver knowledge (0.52 SD) and attitudes around violence (0.2 SD) and leads to meaningful changes in caregiver disciplining behaviors, with a 0.12 SD reduction in violence against children. Treatment children also experience fewer emotional problems (0.17 SD). When we return nine months later, we also find reductions in caregiver depression (0.12 SD), anxiety (0.16 SD), and parental stress (0.16 SD) for treatment caregivers. The virtual delivery has important scalable policy implications which could help decrease violence against children across the globe. |
| JEL: | I25 J12 J13 J16 |
| Date: | 2023–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31338&r=hea |
| By: | Jonathan Gruber (MIT); Kristiina Huttunen (Aalto University, Helsinki GSE, VATT and IZA); Tuomas Kosonen (VATT Institute for Economic Research and Finnish Centre of Excellence in Tax Systems Research) |
| Abstract: | We study the impacts of a policy designed to reward mothers who stay at home rather than join the labor force when their children are under age three. We use regional and over time variation in child home care allowance to show that home care allowance decreases maternal employment in both the short and long term, with almost three-quarters of the supplement amount offset by lost labor income. The effects are large enough for the existence of home care benefit system to explain the higher child penalty in Finland than comparable nations. Home care benefits also negatively affect the early childhood cognitive test results of children at the age of five, increase the likelihood of choosing vocational rather than academic secondary education track, and increase youth crimes. We confirm that the mechanism of action is changing work/home care arrangements by studying a a day care fee (DCF) reform had the opposite effect of raising incentives to work. We find that this policy increased the labor force participation of mothers and participation of children to day care, and improved child early test and schooling outcomes. This parallel set of findings suggests that on average in Finland, shifting child care from the home to the market increases labor force participation and improves child outcomes. |
| Keywords: | home care allowance, employment, child development, schooling |
| JEL: | J13 J21 J38 |
| Date: | 2022–11 |
| URL: | http://d.repec.org/n?u=RePEc:fit:wpaper:4&r=hea |
| By: | Chowdhury, Shyamal (University of Sydney); Singh, Prachi (University of Aberdeen) |
| Abstract: | Unintended consequences of public policies, while common, are under-studied and often unaccounted for in economic analysis. In this paper we study the unintended consequences of a public information campaign on water quality on the marriage market in rural Bangladesh. Despite being heavily contaminated with arsenic, groundwater was the main source of drinking water for rural dwellers in Bangladesh since the 1970s. This created a major health emergency in the country as arsenic exposure causes multiple health problems, ranging from skin lessons to various types of cancer. However, until the mid 1990s, the contamination remained largely unknown and became public knowledge only later through a nationwide information campaign. We study the impact of the campaign on marriage patterns in rural Bangladesh. Using a difference-in-difference model, we analyse the age at marriage, bride price agreed at the time of marriage and find that both of them decreased in arsenic affected areas compared to areas unaffected by arsenic contamination. The effect on age at marriage is primarily driven by younger cohorts who got married earlier. Additionally, we find an increase in the likelihood of females having their first child at an early age (between 16 to 20 years). These are important social consequences, however, often ignored in most analyses. |
| Keywords: | arsenic contamination, health shock, information campaign, age at first marriage, bride price, age at first birth, Bangladesh |
| JEL: | I12 J12 R11 |
| Date: | 2023–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp16214&r=hea |
| By: | Daniel Borbely (Department of Economics, University of Strathclyde); Otto Lenhart (Department of Economics, University of Strathclyde); Jonathan Norris (Department of Economics, University of Strathclyde); Agnese Romiti (Department of Economics, University of Strathclyde) |
| Abstract: | This study examines the effects of marijuana legalization on mental health. We use a difference-in-differences approach that leverages the staggered implementation of both medical and recreational marijuana legislation across U.S. states. We find that marijuana laws have a positive effect on marijuana use but have no effect on mental health overall. Nonetheless, null aggregate effects mask sharp heterogeneities across the age distribution. We show that elderly individuals, especially those with pre-existing health conditions, benefit from medical marijuana legalization in terms of better mental health, whereas legalizing recreational marijuana produces the opposite effect for younger individuals, especially if relatively healthy. |
| Keywords: | marijuana legalization, recreational marijuana, medical marijuana, mental health |
| JEL: | I18 I10 K32 |
| Date: | 2023–03 |
| URL: | http://d.repec.org/n?u=RePEc:str:wpaper:2302&r=hea |
| By: | Monks, Thomas; Harper, Alison |
| Abstract: | Objectives: Discrete-event simulation is a widely used computational method in health services and health economic studies. This systematic scoping review investigates to what extent authors share computer models, and audits if sharing adheres to best practice. Data sources: The Web of Science, Scopus, PubMed, and ACM Digital Library databases were searched between 1st January 2019 till 31st December 2022. Eligibility criteria for selecting studies: Cost-effectiveness, Health service research and methodology studies in a health context were included. Data extraction and synthesis: The data extraction and best practice audit were performed by two reviewers. We developed best practice audit criteria based on the Turing Way and other published reproducibility guides. Main outcomes and measures: We measured the proportion of literature that shared models; we report analyses by publication type, year of publication, Covid-19 application; and free and open source versus commercial software. Results: 47 (8.3\%) of the 564 studies included cited a published DES computer model; rising to 9.0\% in 2022. Studies were more likely to share models if they had been developed using free and open source tools. Studies rarely followed best practice when sharing computer models. Conclusions: Although still in the minority, there is evidence that healthcare DES authors are increasingly sharing their computer model artifacts. Although commercial software dominates the DES literature, free and open source software plays a crucial role in sharing. The DES community can adopt many simple best practices to improve the quality of sharing. |
| Date: | 2023–06–05 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:c4ytf&r=hea |
| By: | Marc d’Elbée (BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale, CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPCité - Université Paris Cité, LSHTM - London School of Hygiene and Tropical Medicine); Fern Terris-Prestholt (LSHTM - London School of Hygiene and Tropical Medicine); Andrew Briggs (LSHTM - London School of Hygiene and Tropical Medicine); Ulla Kou Griffiths (LSHTM - London School of Hygiene and Tropical Medicine , UNICEF Headquarters); Joseph Larmarange (CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPCité - Université Paris Cité); Graham Francis Medley (LSHTM - London School of Hygiene and Tropical Medicine); Gabriella Beatriz Gomez (LSHTM - London School of Hygiene and Tropical Medicine , IAVI Global Headquarters [New-York, NY, USA]) |
| Abstract: | Appropriate costing and economic modeling are major factors for the successful scale-up of health interventions. Various cost functions are currently being used to estimate costs of health interventions at scale in low- and middle-income countries (LMICs) potentially resulting in disparate cost projections. The aim of this study is to gain understanding of current methods used and provide guidance to inform the use of cost functions that is fit for purpose. We reviewed seven databases covering the economic and global health literature to identify studies reporting a quantitative analysis of costs informing the projected scale-up of a health intervention in LMICs between 2003 and 2019. Of the 8725 articles identified, 40 met the inclusion criteria. We classified studies according to the type of cost functions applied-accounting or econometric-and described the intended use of cost projections. Based on these findings, we developed new mathematical notations and cost function frameworks for the analysis of healthcare costs at scale in LMICs setting. These notations estimate variable returns to scale in cost projection methods, which is currently ignored in most studies. The frameworks help to balance simplicity versus accuracy and increase the overall transparency in reporting of methods. |
| Keywords: | cost functions, econometrics, health economics, low- and middle-income countries, microeconomics, production costs |
| Date: | 2023–06–18 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-04133193&r=hea |
| By: | Catalina Herrera-Almanza; Maria Rosales-Rueda |
| Abstract: | Vaccinations are a cost-effective tool to prevent child mortality and morbidity; however, their access and take-up remain low in developing countries. We analyze the effects on child vaccinations of a large-scale community-based health worker program that aimed to reach remote areas distant from public health facilities in Madagascar. We identify these effects using a triple-difference design that leverages the time and geographic variation in the program rollout and the geocoded household distance to the closest health facility. Our findings indicate that, on average, the program did not improve the vaccination uptake in treated areas; however, the community health workers component had an additional effect on children’s vaccinations in the most remote areas from the closest health facility. Despite this improvement, we find that mothers’ religious affiliation might constitute a barrier for the vaccination uptake of the most remote and vulnerable children. |
| JEL: | I12 I15 J13 O15 |
| Date: | 2023–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:31340&r=hea |
| By: | Doruska, Molly; Barrett, Christopher B.; Rohr, Jason R. |
| Keywords: | International Development, Resource/Energy Economics and Policy, Health Economics and Policy |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:ags:aaea22:335555&r=hea |
| By: | Croissant, Aurel; Kühn, David; Macias-Weller, Ariam; Pion-Berlin, David |
| Abstract: | This paper examines the relationship between the militarisation of COVID-19 state responses and autocratisation in eight Asian and Latin American countries. Using a conceptual framework of COVID-19-related military missions and operations, our findings for each country over the first two pandemic years show that although military engagements in the COVID-19 response profiles considerably varied, all governments deployed their military, especially in the provision of health services, logistics, and the production of COVID19 goods. Meanwhile, soldiers were generally less involved in health bureaucracy and public security. Based on two rounds of an expert survey, we then evaluated whether military pandemic deployments negatively affected democratic standards. This was the case where soldiers routinely conducted public-security operations autonomous of effective civilian oversight. Our study concludes that the pandemic did not induce autocratisation; rather, it exacerbated pre-existing conditions and problems in the democratic governance of the security sector. This "acceleration effect" was visible in democracies and autocracies experiencing autocratisation already prior to the pandemic. |
| Keywords: | COVID-19, civil-military relations, militarisation, democratic backsliding, disaster response |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:gigawp:334&r=hea |
| By: | Pierre van der Eng |
| Abstract: | This paper discusses existing estimates of the number of deaths due to the 1918 Spanish influenza pandemic in Indonesia, particularly in the core island of Java. Chandra (2013) estimated these deaths to be 4.26 to 4.37 million. The paper substantiates that these estimates are the result of a methodology that relies on an overestimated annual average population growth rate of 1.75% during 1880-1930. Using a more realistic growth rate of 1.1% per year reduces the estimate to a still considerable 1.47 million deaths in 1918. A rough estimate of excess mortality among the non-Indonesian population in Java and the whole population in the outer islands of Indonesia suggest a total of 2 million excess deaths related to the Spanish flu in 1918-19. The paper also briefly scrutinises the available vital statistics obtained from the village registers in Java. Correcting these as much as possible for under-recording confirms the impression that the estimates in Chandra (2013) are too high. The paper identifies opportunities for further historical demography research related to the 1918 flu pandemic in Indonesia. |
| Keywords: | Spanish flu, epidemic, influenza pandemic, mortality, Java, Indonesia |
| JEL: | I19 J11 N35 |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:pas:papers:2023-06&r=hea |
| By: | Katz, Lindsay; Chong, Michael; Alexander, Monica |
| Abstract: | Patterns and trends in short-term mobility are important to understand, but data required to measure such movements are often not available from traditional sources. We collected daily data from Facebook’s Advertising Platform to measure short-term mobility across all states and provinces in the United States and Canada. We show that rates of short-term travel vary substantially over geographic area, but also by age and sex, with the highest rates of travel generally for males. Strong seasonal patterns are apparent in travel to many areas, with different regions experiencing either increased travel or decreased travel over winter, depending on climate. Further, some areas appear to show marked changes in mobility patterns since the onset of the pandemic. We used the traveler rates constructed from Facebook to adjust Covid-19 mortality rates over the period July 2020 to July 2021, and showed that accounting for travelers leads to on average a 3 per cent difference in implied mortality rates, with substantial variation across demographic groups and regions. |
| Date: | 2023–06–16 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:bev4p&r=hea |