nep-hea New Economics Papers
on Health Economics
Issue of 2023‒07‒24
thirty-one papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Impact of Pension Reform on Employment, Retirement and Disability Insurance Claims By Hernaes, Erik; Markussen, Simen; Piggott, John; Røed, Knut
  2. Working conditions and disabilities in French workers: a career-long retrospective study By Thomas Barnay; Éric Defebvre
  3. How Culture Shapes Choices Related to Fertility and Mortality: Causal Evidence at the Swiss Language Border By Lisa Faessler; Rafael Lalive; Charles Efferson
  4. Do Hospital Mergers Reduce Waiting Times? Theory and Evidence from the English NHS By Cirulli, Vanessa; Marini, Giorgia; Marini, Marco A.; Straume, Odd Rune
  5. Gaming and Effort in Performance Pay By Luca Bertuzzi; Paul J. Eliason; Benjamin Heebsh; Riley J. League; Ryan C. McDevitt; James W. Roberts
  6. (Breaking) intergenerational transmission of mental health By Bütikofer, Aline; Ginja, Rita; Karbownik, Krzysztof; Landaud, Fanny
  7. Intergeneration Human Capital Transmission and Poverty Traps By Carmen Camacho; Fernanda Estevan
  8. Universal Investments in Toddler Health. Learning from a Large Government Trial By Baker, Jennifer L.; Bjerregaard, Lise G.; Dahl, Christian M.; Johansen, Torben S. D.; Sørensen, Emil N.; Wüst, Miriam
  9. Job Loss, Unemployment Insurance and Health: Evidence from Brazil By Guilherme Amorim; Diogo Britto; Alexandre Fonseca; Breno Sampaio
  10. Resting on Their Laureates? Research Productivity Among Winners of the Nobel Prize in Physiology or Medicine By Jay Bhattacharya; Paul Bollyky; Jeremy D. Goldhaber-Fiebert; Geir H. Holom; Mikko Packalen; David M. Studdert
  11. Financial Incentives and Private Health Insurance Demand on the Extensive and Intensive Margins By Kettlewell, Nathan; Zhang, Yuting
  12. Technology, Skills, and Performance: The Case of Robots in Surgery By Tafti, Elena Ashtari
  13. Moral Hazard in Drug Purchases By Jouko Verho; Jarkko Harju
  14. Decomposing social risk preferences for health and wealth By Arthur E. Attema; Olivier L'Haridon; Gijs van de Kuilen
  15. An experimental investigation of social risk preferences for health By Arthur E. Attema; Olivier L'Haridon; Gijs van de Kuilen
  16. Fatal Errors: The Mortality Value of Accurate Weather Forecasts By Shrader, Jeffrey G.; Bakkensen, Laura; Lemoine, Derek
  17. Health and Wellbeing Spillovers of a Partner's Cancer Diagnosis By Angelini, Viola; Costa-Font, Joan
  18. The Historical Impact of Coal on Cities By Clay, Karen; Lewis, Joshua; Severnini, Edson R.
  19. Household and Individual Economic Responses to Different Health Shocks: The Role of Medical Innovations By Lazuka, Volha
  20. How much is too much? A methodological investigation of the literature on alcohol consumption By Stefano Castriota; Paolo Frumento; Francesco Suppressa
  21. Children’s Time Allocation and the Socioeconomic Gap in Human Capital By Nicole Black; Danusha Jayawardana; Gawain Heckley
  22. Biased Beliefs and Stigma as Barriers to Treatment and Innovation Adoption By Laura Grigolon; Laura Lasio
  23. The Political Effects of the 1918 Influenza Pandemic in Weimar Germany By Stefan Bauernschuster; Matthias Blum; Erik Hornung; Christoph Koenig
  24. Mobility Restrictions and Alcohol Use during Lockdown: "A Still and Dry Pandemic for the Many"? By Celidoni, Martina; Costa-Font, Joan; Salmasi, Luca
  25. The Macroeconomics of the Covid-19 Epidemic: The Case of China By Peng, Tao; Chan , Ying Tung; Minetti, Raoul
  26. How large are the costs of local pollution emitted by freight vehicles? Insights from the COVID-19 lockdown in Paris By Lucie Letrouit; Martin Koning
  27. Lives and livelihoods: estimates of the global mortality and poverty effects of the Covid-19 pandemic By Decerf, Benoit; Ferreira, Francisco H.G.; Mahler, Daniel G.; Sterck, Olivier
  28. Dynamical analysis of healthcare policy effects in an integrated economic-epidemiological model By Fausto Cavalli; Ahmad Naimzada; Daniela Visetti
  29. The political economy of lockdown: does free media matter? By Besley, Timothy; Dray, Sacha
  30. COVID-19 Impact on Artistic Income By Alexander Cuntz; Matthias Sahli
  31. Pathways to Better Health? Assessing the Impact of Ethiopian Community-Based Health Insurance on Children Health Outcomes By Anteneh, Zecharias; Celidoni, Martina; Rocco, Lorenzo

  1. By: Hernaes, Erik (Ragnar Frisch Centre for Economic Research); Markussen, Simen (Ragnar Frisch Centre for Economic Research); Piggott, John (University of New South Wales); Røed, Knut (Ragnar Frisch Centre for Economic Research)
    Abstract: We evaluate a comprehensive reform of Norwegian early retirement institutions in 2011 through the lens of a parsimonious random utility choice model. The reform radically changed work incentives and/or pension access-age for some (but not all) workers. We find that improved work incentives caused employment to rise considerably, at the expense of both early retirement and exits through disability insurance. Lower access-age to own pension funds caused a small increase in employment and a large drop in disability program participation. Properly designed pension reforms thus need to take the interplay between old age pension and disability insurance programs into account.
    Keywords: pension reform, disability insurance, program substitution
    JEL: H55 J22
    Date: 2023–06
  2. By: Thomas Barnay (ERUDITE - Equipe de Recherche sur l’Utilisation des Données Individuelles en lien avec la Théorie Economique - UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12 - Université Gustave Eiffel); Éric Defebvre (CES - Centre d'économie de la Sorbonne - UP1 - Université Paris 1 Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: This study aims to estimate the causal impact of detrimental working conditions on disabilities in France. Using a rebuilt retrospective lifelong panel and defining indicators for physical and psychosocial strains, we implement a mixed econometric strategy relying on difference-in-differences and matching methods to take into account for selection biases as well as unobserved heterogeneity. For men and women, deleterious effects of both types of working conditions on disability after exposure are found, with varying patterns of impacts according to the nature and magnitude of the strains. These results provide insights into the debate on legal retirement age postponement and justify not only policies being enacted early in individuals' careers in order to prevent subsequent mid-career health repercussions, but also schemes that are more focused on psychosocial risk factors.
    Keywords: Working conditions, Disability, Matching, Difference in differences, France
    Date: 2023–07–04
  3. By: Lisa Faessler; Rafael Lalive; Charles Efferson
    Abstract: Results from cultural evolutionary theory often suggest that social learning can lead cultural groups to differ markedly in the same environment. Put differently, cultural evolutionary processes can in principle stabilise behavioural differences between groups, which in turn could lead selection pressures to vary across cultural groups. Separating the effects of culture from other confounds, however, is often a daunting, sometimes intractable challenge for the working empiricist. To meet this challenge, we exploit a cultural border dividing Switzerland in ways that are independent of institutional, environmental, and genetic variation. Using a regression discontinuity design, we estimate discontinuities at the border in terms of preferences related to fertility and mortality, the two basic components of genetic fitness. We specifically select six referenda related to health and fertility and analyse differences in the proportion of yes votes across municipalities on the two sides of the border. Our results show multiple discontinuities and thus indicate a potential role of culture to shape preferences and choices related to individual health and fertility. These findings further suggest that at least one of the two groups, in order to uphold its cultural values, has supported policies that could impose fitness costs on individuals in the group.
    Keywords: gene-culture coevolution, cultural evolution, social learning, cultural variation, fitness, cultural border, regression discontinuity design
    JEL: Z10 Z13 D72 I18
    Date: 2023
  4. By: Cirulli, Vanessa; Marini, Giorgia; Marini, Marco A.; Straume, Odd Rune
    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: Health Economics and Policy, Productivity Analysis, Public Economics
    Date: 2023–07–04
  5. By: Luca Bertuzzi; Paul J. Eliason; Benjamin Heebsh; Riley J. League; Ryan C. McDevitt; James W. Roberts
    Abstract: Health insurers often tie payments to providers’ quality of care. Although payers do this to elicit more effort from providers, some providers may game the system by avoiding patients who would cause their quality scores to fall. We use annual variation in the criteria for Medicare’s Quality Incentive Program in dialysis to distinguish strategic patient dropping from higher-quality care. Patients who would reduce their facilities’ scores are 14.3–71.5% more likely to switch facilities, often to ones that suggest the move was involuntary, while under certain conditions facilities exert more effort to improve their scores by providing better care.
    JEL: I11 I13 L10 L15 L2 L50
    Date: 2023–06
  6. By: Bütikofer, Aline (Dept. of Economics, Norwegian School of Economics and Business Administration); Ginja, Rita (University of Bergen); Karbownik, Krzysztof (Emory University); Landaud, Fanny (CNRS and CY Cergy Paris University)
    Abstract: We estimate health associations across generations and dynasties using information on healthcare visits from administrative data for the entire Norwegian population. A parental mental health diagnosis is associated with a 9.3 percentage point (40%) higher probability of a mental health diagnosis of their adolescent child. Intensive margin physical and mental health associations are similar, and dynastic estimates account for about 40% of the intergenerational persistence. We also show that a policy targeting additional health resources for the young children of adults diagnosed with mental health conditions reduced the parent-child mental health association by about 40%.
    Keywords: Mental Health; Intergenerational Persistence; Dynastic Effects; Public Policy
    JEL: I14 I18 J12 J62
    Date: 2023–06–30
  7. 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
  8. By: Baker, Jennifer L.; Bjerregaard, Lise G.; Dahl, Christian M. (University of Southern Denmark); Johansen, Torben S. D. (University of Southern Denmark); Sørensen, Emil N. (University of Bristol); Wüst, Miriam (University of Copenhagen)
    Abstract: Exploiting a 1960s government trial in Copenhagen, we study the long-run and inter-generational effects of preventive care for toddlers. We combine administrative data with handwritten nurse records to document universal treatment take-up and positive health effects for treated children over the life course. Beneficial health impacts are largest for disadvantaged children and may even extend to their offspring. While initial trial cohorts experienced positive health and socioeconomic impacts, those are absent for the final cohorts. This heterogeneity across individuals' background and cohorts documents that universal toddler care can alleviate inequalities at low costs, and that the counterfactual policy environment matters.
    Keywords: early-life investments, health, public policy, government trial, Denmark, digitization, automated transcription
    JEL: I1 J1
    Date: 2023–06
  9. By: Guilherme Amorim; Diogo Britto; Alexandre Fonseca; Breno Sampaio
    Abstract: We study the causal effects of job loss and unemployment insurance (UI) on hospitalization and mortality for Brazilian workers. We construct a novel dataset that merges millions of individual-level administrative records on employment, hospital discharges, and mortality for a period of 17 years. Using a difference-in-differences research design that compares laid-off workers from firms that experienced mass layoffs to similar workers in firms that did not, we find that job loss causes a 30% increase in the probability of male in-patient admission to public hospitals, and a 34% increase in the risk of male mortality. Our estimates are driven primarily by external causes and apply to both older and younger male workers. We find no effects on female outcomes, but children of both male and female workers are subjected to higher risks of hospitalization following their parent's job dismissal. Using a regression-discontinuity design that exploits variation in UI eligibility following job loss, we show that UI largely offsets the risk of hospitalization for older male workers. Our results indicate that governmental labor market policies can effectively mitigate a substantial portion of the adverse health impacts of job loss.
    Keywords: job loss, unemployment insurance, hospitalization, mortality
    JEL: I12 J63 J65
    Date: 2022
  10. By: Jay Bhattacharya; Paul Bollyky; Jeremy D. Goldhaber-Fiebert; Geir H. Holom; Mikko Packalen; David M. Studdert
    Abstract: The Nobel Prize in Physiology or Medicine is the most prestigious and coveted award in medical research. Anecdotal evidence and related research suggest that receiving it may adversely affect research productivity. We compared the post-Nobel research output of laureates (prize years: 1950-2010) with their pre-Nobel output and with the output of a matched control group consisting of winners of the Lasker Award, another highly prestigious medical research prize. Pre-Nobel, laureates’ publications were more voluminous, highly cited, and novel than those of (future) Lasker winners. Post-Nobel, laureates’ productivity decreased sharply, eventually falling below that of Lasker winners on all three measures. These declines may reflect diversionary effects of the Prize, changed incentives, or intrinsically different career arcs for medical researchers who win the Nobel Prize.
    JEL: I1 I23 O3
    Date: 2023–06
  11. By: Kettlewell, Nathan (University of Technology, Sydney); Zhang, Yuting (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: 2023–06
  12. By: Tafti, Elena Ashtari
    Abstract: This paper investigates the potential of new technologies to reduce disparities in the provision of healthcare services. Differences in providers’ skills may cause variation in patient outcomes. The adoption of innovations, like robots, can attenuate this problem if technological gains are decreasing in users’ skills or may exacerbate existing variation in performance otherwise. I show that, in England, the diffusion of surgical robots coincided with an improvement in average surgical performance and a convergence in outcomes between high and lower-skilled surgeons for prostate cancer patients. I study whether this pattern can be attributed to the adoption of robots using the universe of inpatient admissions to the National Health Service (NHS). To identify the effects of robotic surgery on patient outcomes, I exploit quasi-random variation in the geographic allocation of robots, allowing for selection and heterogeneity in treatment effects. I find that robots shorten patients’ length of stay in hospital and decrease the incidence of adverse events from surgery, but their effects significantly depend on surgeons’ skills. The robot has little impact on the performance of highly skilled surgeons, while lower skilled surgeons gain the most from it. I also uncover a strong pattern of negative selection on both observable and unobservable characteristics. Although the attainable gains are higher for lower-skilled surgeons, they use the robot the least. My results suggest that the potential benefit of a new technology largely depends on how it combines with the skills of the individual users.
    Keywords: Health innovation, Surgical robots, Surgical performance, Skill heterogeneity
    Date: 2023–07–11
  13. By: Jouko Verho; Jarkko Harju
    Abstract: We study the moral hazard effects of the drug copayment threshold in Finland using detailed prescription drug purchase data. The analysis reveals that the average drug costs increase discontinuously by 17% at the threshold above which out-of-pocket drug costs decrease substantially. Our results suggest an average price elasticity of -0.17, which indicates evident moral hazard costs. Approximately 80% of the overall effect is due to individuals buying drugs in larger quantities rather than purchasing higher-priced drugs. The heterogeneity analysis suggests that the responses are largest for drug categories taken on an as-needed rather than a regular basis.
    Keywords: prescription drugs, moral hazard, health insurance
    JEL: I10 H51 D12
    Date: 2023
  14. By: Arthur E. Attema (Erasmus University Rotterdam); Olivier L'Haridon (CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR - Université de Rennes - CNRS - Centre National de la Recherche Scientifique, UGENT - Universiteit Gent = Ghent University); Gijs van de Kuilen (Tilburg University [Netherlands])
    Abstract: This study reports the results of the first artefactual field experiment designed to measure the prevalence of aversion toward different components of social risks in a large and demographically representative sample. We identify social risk preferences for health and wealth for losses and gains, and decompose these attitudes into four different dimensions: individual risk, collective risk, ex-post inequality, and ex-ante inequality. The results of a non-parametric analysis suggest that aversion to risk and inequality is the mean preference for outcomes in health and wealth in the domain of gains and losses. A parametric decomposition of aversion to risk and inequality shows that respondents are averse to ex-post and ex-ante inequality in health and wealth for gains and losses. Likewise, respondents are averse to collective risk, but neutral to individual risk, which highlights the importance of considering different components of social risk preferences when managing social health and wealth risks.
    Keywords: Inequality, Risk aversion, Social risk
    Date: 2023
  15. By: Arthur E. Attema (Erasmus University Rotterdam); Olivier L'Haridon (IUF - Institut Universitaire de France - M.E.N.E.S.R. - Ministère de l'Education nationale, de l’Enseignement supérieur et de la Recherche, CREM - Centre de recherche en économie et management - UNICAEN - Université de Caen Normandie - NU - Normandie Université - UR - Université de Rennes - CNRS - Centre National de la Recherche Scientifique); Gijs van de Kuilen (Tilburg University [Netherlands])
    Abstract: In this paper, we use the risk apportionment technique of Eeckhoudt, Rey and Schlesinger (2007) to study higher order risk preferences for others' health as well as ex-ante and ex-post inequality preferences for social risky distributions, and their interaction. In an experiment on a sample of university students acting as impartial spectators, we observe risk aversion towards social health losses and a dislike of ex-ante inequality. In addition, evidence for ex-post inequality seeking is much weaker than evidence for ex-ante inequality aversion. Because ex-ante inequality aversion is unrelated to risk aversion, we conclude that simple forms of utilitarianism are not relevant for individual judgment of social risk over health. Last, our investigation of precautionary distribution, which would occur when one particular group in the society suffers from background health risk, shows substantial polarization of preferences.
    Keywords: Social risk, Ex-ante social welfare, Ex-post social welfare, Risk apportionment
    Date: 2023
  16. By: Shrader, Jeffrey G. (Columbia University); Bakkensen, Laura (University of Arizona); Lemoine, Derek (University of Arizona)
    Abstract: We provide the first revealed preference estimates of the benefits of routine weather forecasts. The benefits come from how people use advance information to reduce mortality from heat and cold. Theoretically, more accurate forecasts reduce mortality if and only if mortality risk is convex in forecast errors. We test for such convexity using data on the universe of mortality events and weather forecasts for a twelve-year period in the U.S. Results show that erroneously mild forecasts increase mortality whereas erroneously extreme forecasts do not reduce mortality. Making forecasts 50% more accurate would save 2, 200 lives per year. The public would be willing to pay $112 billion to make forecasts 50% more accurate over the remainder of the century, of which $22 billion reflects how forecasts facilitate adaptation to climate change.
    Keywords: weather forecasts, information provision, mortality, climate change
    JEL: D83 I12 Q51
    Date: 2023–06
  17. By: Angelini, Viola (University of Groningen); Costa-Font, Joan (London School of Economics)
    Abstract: Major health shocks can have far-reaching consequences on the welfare of an individual's support and emotional network. This paper investigates both long-term and short-term spillovers of a major non-communicable health shock, namely a cancer diagnosis (CD), on the health and well- being of an individual's partner. We rely on data from a longitudinal sample of individuals over fifty from 19 European countries. Our estimates provide economically relevant evidence of the spillovers of a CD on the partner's mental health and well-being. We document a negative association between a partner's CD and several measures of well-being, which is not driven by changes in health behaviors and persists over time for some dimensions. These findings suggest that focusing on the individual economic impact of a CD is likely to underestimate its long-term welfare effects unless spillovers on the emotional support network are considered.
    Keywords: cancer, family spillovers, health behaviors, household well-being, employment, loneliness, welfare effects
    JEL: I18 J14
    Date: 2023–06
  18. By: Clay, Karen (Carnegie Mellon University); Lewis, Joshua (University of Montreal); Severnini, Edson R. (Carnegie Mellon University)
    Abstract: Historically coal has offered both benefits and costs to urban areas. Benefits include coal's role in fueling industry and thus employment. The primary costs are air pollution and its impact on human health. This paper starts by using a Rosen-Roback style model to examine how differences in local coal availability affect equilibrium city employment. Drawing on the model, the paper surveys papers that examine the net effects of coal on the growth in city population and air pollution on health. The paper then turns to papers that explicitly consider the trade-offs between production benefits and pollution disamenities across space and over time. The paper ends with a discussion of opportunities for future work on coal and cities in historical settings.
    Keywords: coal availability, local development, air pollution, trade-offs of coal consumption
    JEL: N52 N72 O13 Q53 Q56
    Date: 2023–06
  19. By: Lazuka, Volha (Lund University)
    Abstract: This study provides new evidence regarding the extent to which medical care mitigates the economic consequences of various health shocks for the individual and a wider family. To obtain causal effects, I focus on the role of medical scientific discoveries and leverage the longitudinal dimension of unique administrative data for Sweden. The results indicate that medical innovations strongly mitigate the negative economic consequences of a health shock for the individual and create spillovers to relatives. Such mitigating effects are highly heterogeneous across diagnoses that cause health shocks. These results suggest that medical innovations substantially reduce the burden of welfare costs yet produce income inequalities.
    Keywords: medical innovation, health shock, family disposable income, income inequality, difference-in-differences-in-differences approach, machine learning
    JEL: I14 I18 J22 J24 J38 O31
    Date: 2023–06
  20. By: Stefano Castriota; Paolo Frumento; Francesco Suppressa
    Abstract: Until a few years ago, moderate alcohol consumption was thought to have (mild) beneficial effects on health. However, some recent studies have suggested that "there is no safe level" of alcohol intake. Consequently, public health institutions have responded by advising against any level of alcohol use and suggesting governments a number of policies to reduce the overall alcohol consumption. Nonetheless, medical studies suffer from a variety of methodological issues that could undermine the reliability of the findings, especially when focusing on low-intake levels. We apply a search algorithm to extract 19, 981 Confidence Intervals (CIs) from 6, 763 medical abstracts, and show the existence of a clear publication bias which appears to have even increased and not decreased, in recent years. Further, we assess the quality of a sample of articles, showing the presence of several limitations such as omitted variable bias, miscalculation of alcohol intake, use of linear in place of non-linear models, and lack of validation of Mendelian Randomization (MR) assumptions. We conclude that the methodological limitations of the literature preclude us from claiming that "there is no safe level" of alcohol intake.
    Keywords: Alcohol, health, safe level, publication bias, statistical bias
    JEL: I12 I18
    Date: 2023–06–01
  21. By: Nicole Black (Monash University); Danusha Jayawardana (Monash University); Gawain Heckley (Lund University)
    Abstract: Children’s time investments in various activities may be important for reducing socioeconomic status (SES) gaps in educational and mental health outcomes. Using time use diaries of Australian children aged 4-14, we find children from low SES backgrounds spend more time on digital media and less time on cognitively stimulating out-of-school activities, organised or for leisure. This difference contributes about 4% to the observed SES gap in numeracy skills. The contribution is larger for males, older age groups, and when the cumulative effect on learning is considered. No clear results are found for literacy skills and mental health outcomes.
    Keywords: Time use, mental health, cognitive skills, socioeconomic gap, human capital
    JEL: I14 I24 J22 J24
    Date: 2023–07
  22. By: Laura Grigolon; Laura Lasio
    Abstract: Lung cancer is associated with smoking and is characterized by low treatment rates and research funds. We estimate a model of treatment choice where patients internalize societally biased beliefs on the effectiveness of treatment and stigma, basing their treatment decision on the treatment decisions of their reference group. Identification rests on the exogenous variation in the treatment propensity of physicians. Placing all patients in a neighborhood characterized by low social discrimination increases treatment rates by 4% and the use of innovative therapies by 3%. Social effects account for around 2% of the gap in research funding for lung cancer.
    Date: 2023–02
  23. By: Stefan Bauernschuster (University of Passau); Matthias Blum (German Medical Association); Erik Hornung (University of Cologne); Christoph Koenig (University of Rome Tor Vergata)
    Abstract: How do health crises affect election results? We combine a panel of election results from 1893-1933 with spatial heterogeneity in excess mortality due to the 1918 Influenza to assess the pandemic's effect on voting behavior across German constituencies. Applying a dynamic differences-in-differences approach, we find that areas with higher influenza mortality saw a lasting shift towards left-wing parties. We argue that pandemic intensity increased the salience of public health policy, prompting voters to reward parties signaling competence in health issues. Alternative explanations such as pandemic-induced economic hardship, punishment of incumbents for inadequate policy responses, or polarization of the electorate towards more extremist parties are not supported by our findings.
    Keywords: Pandemics, Elections, Health, Voting behavior, Issue salience, Issue ownership, Weimar Republic
    JEL: D72 I18 N34 H51
    Date: 2023–06
  24. By: Celidoni, Martina (University of Padova); Costa-Font, Joan (London School of Economics); Salmasi, Luca (Catholic University - Rome)
    Abstract: Unexpected mobility disruptions during lockdown during the first wave of COVID-19 became 'tipping points' with the potential to alter pre-pandemic routines sensitive to socialisation. This paper investigates the impact of lockdown exposure on alcohol consumption. We document two findings using information from the Google Mobility Report and longitudinal data from the Understanding Society in the United Kingdom. First, we find a sharp reduction in both actual mobility and alcohol use (consistent with a "still and dry pandemic for the many" hypothesis). However, we document an increase in alcohol use among heavy drinkers, implying a split behavioural response to COVID-19 mobility restrictions based on alcohol use prior to the pandemic. Second, using the predictions of the prevalence-response elasticity theory, we find that the pandemic's reduction in social contacts is responsible for a 2.8 percentage point reduction in drinking among men.
    Keywords: health behaviours, lockdown, mobility restrictions, alcohol use, routines, mobility, difference in differences, COVID-19
    JEL: I13 I18
    Date: 2023–06
  25. By: Peng, Tao (Southwestern University of Finance and Economics); Chan , Ying Tung (Beijing Normal University); Minetti, Raoul (Michigan State University, Department of Economics)
    Abstract: This paper studies the impacts of the Covid-19 epidemic on economic and health outcomes in China from January 20 to September 28, 2020. We first document the outbreak and the decline of the epidemic and the containment policies implemented in China during this period. We then use a SIR-Macro model to study the macroeconomic and health outcomes of the epidemic. Our model can generate the infection and death dynamics broadly consistent with the data and the U-shaped recovery of the Chinese economy at the weekly frequency. Our paper demonstrates that both the containment policies and the resilience of the society play important roles in fighting the epidemic.
    Keywords: Covid-19; containment policies; digital economy; resilience of the society
    JEL: E00 E65 H12 I10
    Date: 2023–06–22
  26. By: Lucie Letrouit (AME-SPLOTT - Systèmes Productifs, Logistique, Organisation des Transports et Travail - Université Gustave Eiffel); Martin Koning (AME-SPLOTT - Systèmes Productifs, Logistique, Organisation des Transports et Travail - Université Gustave Eiffel)
    Abstract: Building on the exogenous shock linked with the first COVID-19 lockdown in France (March-May 2020), we propose an original approach relying on econometric modelling to estimate the impacts of road freight transport on the concentration of NO2, NOx and PM10 in Paris. We argue that this shock led to a significant change in the composition of road traffic, with an increase in the relative share of freight vehicles with respect to passenger cars, due to the combined exodus of numerous inhabitants, the prohibition of non-mandatory trips and the promotion of home-deliveries. As light-duty vehicles and trucks pollute more than passenger cars, we hypothesize that it led to a rise in the average emissions of pollutants per kilometer traveled in Paris. We confirm this assumption by applying a simple econometric analysis to a rich dataset containing hourly pollutant concentrations and hourly traffic flows recorded in various locations of the French capital city. Relying on the econometric results and on additional back-of-theenvelope computations, we propose tentative estimates of the health impacts of road freight transport. As compared to a counterfactual in which freight traffic in Paris would have declined in the same proportion as cars during the sanitary crisis, hence resulting in a larger decrease in pollutants concentrations, we conclude that around 7 lives have been lost. Crossing this estimate with the official value of statistical life in France, our central scenario approximates at 0.20 euro/km the excess external cost of the local pollution emitted by freight vehicles as compared to cars.
    Keywords: Road freight traffic, Air pollution, Covid-19 lockdown, Health, External cost
    Date: 2023–05–25
  27. By: Decerf, Benoit; Ferreira, Francisco H.G.; Mahler, Daniel G.; Sterck, Olivier
    Abstract: We evaluate the global welfare consequences of increases in mortality and poverty generated by the Covid-19 pandemic. Increases in mortality are measured in terms of the number of years of life lost (LY) to the pandemic. Additional years spent in poverty (PY) are conservatively estimated using growth estimates for 2020 and two different scenarios for its distributional characteristics. Using years of life as a welfare metric yields a single parameter that captures the underlying trade-off between lives and livelihoods: how many PYs have the same welfare cost as one LY. Taking an agnostic view of this parameter, we compare estimates of LYs and PYs across countries for different scenarios. Three main findings arise. First, we estimate that, as of early June 2020, the pandemic (and the observed private and policy responses) had generated at least 68 million additional poverty years and 4.3 million years of life lost across 150 countries. The ratio of PYs to LYs is very large in most countries, suggesting that the poverty consequences of the crisis are of paramount importance. Second, this ratio declines systematically with GDP per capita: poverty accounts for a much greater share of the welfare costs in poorer countries. Finally, a comparison of these baseline results with mortality estimates in a counterfactual “herd immunity” scenario suggests that welfare losses would be greater in the latter in most countries.
    Keywords: Covid-19; mortality; poverty; welfare; coronavirus
    JEL: D63 I32 O15
    Date: 2021–10–01
  28. By: Fausto Cavalli; Ahmad Naimzada; Daniela Visetti
    Abstract: We study the static and dynamical properties of a model that describes the interaction between the economic and epidemiological domains. The epidemiological sphere is represented by a susceptible-infected-susceptible model, while the economic domain consists of an overlapping generations model in which the workers correspond to the non infected population of adults. The productivity of the firms and the propensity to save for retirement of the households are negatively affected by the disease spread. A capital tax is levied and the collected resources are used to curb the spread of the outbreak. We show that multiple endemic steady states can arise from the interaction between the two domains, and different stable endemic attractors can coexist with the stable disease free steady state. We study analytically and numerically the complex dynamics and the evolution of the basins of attraction in the case of multistability. We show that the effect of taxation can be beneficial both from the epidemiological and the economic points of view, as it can give rise to new steady states characterized by reduced shares of infected people and increased capital level, it can simplify the dynamical behaviors and reduce the size of the basins of attraction of those outcomes in which large shares of infected people and low capital levels are observed.
    Date: 2023–06
  29. By: Besley, Timothy; Dray, Sacha
    Abstract: This paper studies the role of free media in how governments and the public responded to the COVID-19 pandemic. We first document the presence of policy and behavioral responsiveness during the early phase of the pandemic. Using a panel data of daily COVID-19 deaths, lockdown policies, and mobility changes in 155 countries, we find that governments were more likely to impose a lockdown, and citizens to reduce their mobility, as the initial number of deaths increased. To measure the role of media freedom on responsiveness given endogeneity in death reporting, we simulate deaths from a calibrated SEIR model as an instrument for reported deaths. Using this approach, we find evidence that the presence of free media mattered for the timing of early responses to COVID-19. Responsiveness to deaths was limited to citizens in free-media countries, and accounted for 40% of the difference in lockdown decision and mobility changes between free-media and censored-media countries. In support of the role of free media, we show that differences in responsiveness are not explained by a range of other country characteristics such as the level of income, education or democracy. We also find evidence that citizens with access to free media were better informed about the pandemic and had more responsive levels of online searches about COVID-19, supporting the view that free media served to inform the public on the risks of COVID-19.
    Keywords: COVID-19; lockdown; media freedom; responsiveness; Coronavirus; PERISCOPE project which has received funding from the European Union’s Horizon 2020 Research and Innovation programme under the Grant Agreement number 101016233; Elsevier deal
    JEL: D72 D78 L82
    Date: 2023–01–31
  30. By: Alexander Cuntz; Matthias Sahli
    Abstract: This paper assesses the impact of the pandemic crisis on self-employed income among artists resident in Germany. Using unique data from the latest available public insurance records, we show that musicians and performing artists are among the most vulnerable groups, and that writers, on average, are relatively less impacted. Moreover, the paper looks at the impact of the 2020 crisis on income differences by gender, career stages and regions, and it investigates the effect of specific non-pharmaceutical, public intervention implemented in German states.
    Keywords: COVID-19, Creative Industries, Artists, Labor Market
    JEL: J00 J08 E24 Z11
    Date: 2021–09
  31. By: Anteneh, Zecharias; Celidoni, Martina; Rocco, Lorenzo
    Abstract: Publicly financed Community Based-Health Insurance (CBHI) schemes are typically implemented in developing countries to foster healthcare utilization and improve health outcomes among low-income households. Using the Demographic and Health Survey from 2005 to 2016, we estimate the effects of the Ethiopian CBHI on children's health. Difference-in-differences estimates show that CBHI reduced mortality and the probability of being underweight among children under five. We also find that CBHI significantly reduces wasting, a measure of short-term nutritional deficiency or health conditions, but not stunting, known to be an indicator of long-term chronic malnutrition. Potential mechanisms underlying our results are improved maternal health, access to health care, nutrition and a reduced risk of poverty.
    Keywords: community-based health insurance, children health, infant feeding, Difference in Differences approach
    JEL: G52 I13 J13
    Date: 2023

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