nep-hea New Economics Papers
on Health Economics
Issue of 2023‒07‒31
sixteen papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. How Costs Limit Contraceptive Use among Low-Income Women in the U.S.: A Randomized Control Trial By Martha J. Bailey; Vanessa Wanner Lang; Alexa Prettyman; Iris Vrioni; Lea J. Bart; Daniel Eisenberg; Paula Fomby; Jennifer Barber; Vanessa Dalton
  2. In-Kind Welfare Benefits and Reincarceration Risk: Evidence from Medicaid By Marguerite Burns; Laura Dague
  3. The Impact of Lead Exposure on Fertility, Infant Mortality, and Infant Birth Outcomes By Clay, Karen; Hollingsworth, Alex; Severnini, Edson R.
  4. Air Pollution and Mortality Impacts of Coal Mining: Evidence from Coalmine Accidents in China By Chu, Yin; Holladay, J. Scott; Qiu, Yun; Tian, Xian-Liang; Zhou, Maigeng
  5. The Effects of an Unconditional Cash Transfer on Mental Health in the United States By Pignatti, Clemente; Parolin, Zachary
  6. Behavioral Health Treatment and Police Officer Safety By Monica Deza; Thanh Lu; Johanna Catherine Maclean; Alberto Ortega
  7. In utero shocks and health at birth: The distorting effect of fetal losses By Hajdu, Tamás
  8. Response toward Public Health Policy Ambiguity and Insurance Decisions By Qiang Li
  9. Heterogeneity in health insurance choice: An experimental investigation of consumer choice and feature preferences By Hermanns, Benedicta; Kairies-Schwarz, Nadja; Kokot, Johanna; Vomhof, Markus
  10. Maternal mortality, race, and the abortion laws of the 1960s and 1970s By McDonald, Tia M.
  11. Abdominal Elephantiasis: An Obstructive Disease Due to Extreme Obesity By Mohajan, Devajit; Mohajan, Haradhan
  12. Mobile money innovations and health performance in sub-Saharan Africa By Simplice A. Asongu; Yolande E. Ngoungou; Joseph Nnanna
  13. The economic impacts of malaria: past, present, and future By Kuschnig, Nikolas; Vashold, Lukas
  14. The Effects of Cash for Clunkers on Local Air Quality By Helm, Ines; Koch, Nicolas; Rohlf, Alexander
  15. Market Power and Regulation in Pharmaceutical Markets By Gugler, Klaus; Szücs, Florian
  16. Peer and social decision-making predictors of adherence to COVID-19 social distancing rules in adolescents in England By Bignardi, Giacomo; Ahmed, Saz; Bennett, Marc Patrick; Dunning, Darren Lee; Griffiths, Kirsty; Sakhardande, Ashok; Leung, Jovita Tung; Piera Pi-Sunyer, Blanca; Kuyken, Willem; Dalgleish, Tim

  1. By: Martha J. Bailey; Vanessa Wanner Lang; Alexa Prettyman; Iris Vrioni; Lea J. Bart; Daniel Eisenberg; Paula Fomby; Jennifer Barber; Vanessa Dalton
    Abstract: The Affordable Care Act eliminated cost-sharing for contraception for Americans with health insurance, but substantial cost sharing remains for uninsured individuals who seek care through Title X—a national family planning program that provides patient-centered, subsidized contraception and reproductive health services in the U.S. This paper uses a randomized control trial (RCT) to examine how cost-sharing at Title X providers affects the choice of contraceptive method. The study randomizes vouchers that cover any contraceptive method up to the cost of 50% or 100% of a name-brand intra-uterine device (IUD). The results show that Title X clients are highly constrained by the out-of-pocket costs of contraception. The offer of free contraception is associated with a 40% increase in the use of any birth control method (ITT effect), a 94% increase in the value of birth control purchased, a 328-day (226%) increase in the period covered by contraceptives purchased, and a 324% increase in the likelihood of choosing a long-acting, reversible method (an IUD or implant). The results imply that eliminating the costs of contraception for Title X clients nationwide would reduce undesired pregnancies by 5.3%, birth rates by 3.9%, and abortions by 8.3%, and save $1.43 billion in the first year of the program.
    JEL: I18 J13 J18
    Date: 2023–06
  2. By: Marguerite Burns; Laura Dague
    Abstract: Most of the 600, 000 adults returning to the community from state and federal prisons annually in the U.S. carry substantial debt, have low income and low education, and limited formal employment prior to entering prison. Upon reentry, they face financial hardship, high rates of morbidity and mortality, and high incidence of re-offense. Medicaid coverage, as a means-tested transfer program providing subsidized health insurance, may influence reincarceration through both financial and health channels. In this paper, we provide a comprehensive look at the effects of public health insurance coverage on post-release behavior of formerly incarcerated adults. We study a natural experiment in which two separate state policy changes resulted in a 60 percentage point increase in Medicaid enrollment at release. Using a series of linked individual level administrative datasets, we estimate the effects of this change in Medicaid enrollment, finding declines in reincarceration, increased employment, and higher health care use. Leveraging data on financial concerns and need for mental health and substance use treatment to examine mechanisms, we find support for a financial channel and mixed support for health channels. Policies that enhance access to healthcare and provide financial security for this population may have significant benefits for individuals and society.
    JEL: H75 I13 J22 K42
    Date: 2023–06
  3. By: Clay, Karen (Carnegie Mellon University); Hollingsworth, Alex (Indiana University); Severnini, Edson R. (Carnegie Mellon University)
    Abstract: Lead exposure has detrimental effects on fertility, infants, children, and adults. Despite the success in removing lead from on-road gasoline, industrial and aviation emissions continue to pose a substantial global challenge. Other major sources of exposure include dust, soil resuspension, and consumption of contaminated water or food. Both animal studies and evidence from humans support claims of an adverse relationship between lead pollution and human health. Since lead exposure is not randomly assigned, quasi-experimental studies play a crucial role in this knowledge base. Among these studies, extensive research links elevated blood lead levels in children to academic and behavioral outcomes, but more limited attention has been given to lead's impact on fertility, infant mortality, and infant health. This paper examines the existing quasi-experimental literature on lead and fertility, infant mortality, and infant birth outcomes, highlighting key results, methods, and implications for policymakers.
    Keywords: lead exposure, fertility, mortality, infant health
    JEL: I12 Q53 Q58
    Date: 2023–06
  4. By: Chu, Yin; Holladay, J. Scott; Qiu, Yun; Tian, Xian-Liang; Zhou, Maigeng
    Abstract: We leverage the timing of coalmine accidents to examine the effect of coal mining on air pollution. Safety regulations mandate that coal mining be suspended if a mine experiences an accident with 10 or more fatalities. We use a stacked difference-in-differences approach to compare counties with an accident to those experiencing an accident more than two years earlier or later. We provide evidence that the timing of accidents cannot be predicted. Next, we combine satellite-based air pollution data at the county-day level with the dates of accidents to show that on average, suspending coal mining reduces local air pollution by 8%. Changes in the level of coal consumption do not drive this reduction. We also find significant decreases in respiratory mortality after suspending coal mining with particularly large effects on vulnerable populations.
    Keywords: air pollution, coal mining, coalmine accidents, health impacts
    JEL: I10 Q40 Q53 R11
    Date: 2023
  5. By: Pignatti, Clemente (ILO International Labour Organization); Parolin, Zachary (Bocconi University)
    Abstract: Mental health conditions have worsened in many countries in recent decades. The provision of unconditional cash transfers may be one effective policy strategy for improving mental health, but causal evidence on their efficacy is rare in high-income countries. This study investigates the mental health consequences of the 2021 Child Tax Credit (CTC) expansion, which temporarily provided unconditional and monthly cash support to most families with children in the United States (US). Using data from the Behavioral Risk Factor Surveillance System, the largest health-related survey in the US, we exploit differences in CTC benefit levels for households with younger versus older children. More generous CTC transfers are associated with a decrease in the number of reported bad mental health days. The effect materializes after the third monthly payment and disappears when the benefits are withdrawn. The CTC's improvement of mental health is larger for more credit-constrained individuals, including low-income households, women, and younger respondents.
    Keywords: child tax credit, mental health, public policy
    JEL: H51 I18 J18
    Date: 2023–06
  6. By: Monica Deza; Thanh Lu; Johanna Catherine Maclean; Alberto Ortega
    Abstract: We study the effect of community access to behavioral health (mental health and substance use disorders) treatment on police officer safety, which we proxy with on-duty assaults on officers. Combining agency-level data on police officer on-duty assaults and county-level data on the number of treatment centers within the community that offer behavioral health treatment, we estimate two-way fixed-effects regressions and find that that an additional four centers per county (average increase) leads to a 1.3% reduction per police agency in on-duty assaults against police officers. Previously established benefits of access to treatment on behavioral health extend to the work environment of police officers.
    JEL: I10 I12
    Date: 2023–06
  7. By: Hajdu, Tamás
    Abstract: Research on the effect of in utero shocks on health at birth may be influenced by in utero selection. This study outlines a conceptual framework and shows that the results of the standard empirical approach are biased if (i) the exposure changes the probability of fetal death and (ii) health differences exist between deceased and surviving fetuses. Furthermore, an empirical example is provided to illustrate, the potential importance of fetal selection. Examining the impact of heat on birth weight, I find that accounting for fetal selection substantially increases the heat effect compared to the standard approach. These results suggest that incorporating the distorting effect of fetal losses into the estimations may be critical in some cases to provide more informed guidance for public policy.
    Keywords: in utero selection, health at birth, birth weight, temperature, climate change
    JEL: I12 J13 Q54
    Date: 2023
  8. By: Qiang Li
    Abstract: Adjustments to public health policy are common. This paper investigates the impact of COVID-19 policy ambiguity on specific groups' insurance consumption. The results show that sensitive groups' willingness to pay (WTP) for insurance is 12.2% above the benchmark. Groups that have experienced income disruptions are more likely to suffer this. This paper offers fresh perspectives on the effects of pandemic control shifts.
    Date: 2023–06
  9. By: Hermanns, Benedicta; Kairies-Schwarz, Nadja; Kokot, Johanna; Vomhof, Markus
    Abstract: We investigate heterogeneity in patterns of preferences for health insurance features using health insurance choice data from a controlled laboratory experiment. Within the experiment, participants make consecutive insurance choices based on choice sets that vary in composition and size. We keep the health risk constant and equal for everyone. In addition, we implement a treatment that entails a feature-based insurance filter, allowing us to validate feature preferences. We also account for individually elicited risk preferences. On aggregate, we find that there is considerable heterogeneity in consumer choice. Participants differ particularly (a) in their willingness to pay to insure themselves against illnesses that differ in terms of their probability of occurrence and the size of the losses to be covered and (b) in their preference to forgo deductibles. However, if we measure the quality of individuals' decisions based on risk preferences, the heterogeneity among participants disappears. Our results suggest that heterogeneity in health insurance choices is not reflected in decision quality when we assume a rank-dependent expected utility model of risk preferences.
    Keywords: health insurance, consumer preferences, heterogeneity, laboratory experiment, risk preferences
    JEL: C91 I13 D81 D83 G22
    Date: 2023
  10. By: McDonald, Tia M.
    Keywords: Health Economics and Policy, Community/Rural/Urban Development, Labor and Human Capital
    Date: 2023
  11. By: Mohajan, Devajit; Mohajan, Haradhan
    Abstract: This study deals with abdominal elephantiasis disease due to extensive lymph node destruction by erysipelas. The disease is rare, and only seen in developed countries among unfortunate morbid obese (e.g., BMI is in the range 60 to 80 or above) individuals. Abdominal elephantiasis is viewed as by chronic inflammation and obstruction of the lymphatic channels, and by hypertrophy of the skin and subcutaneous tissues. This mini review tries to make conscious about the negative effects of extreme obesity.
    Keywords: Abdominal elephantiasis, lymphedema, lymph fluid
    JEL: A14 I1 I12 I15 I3 I31 P2
    Date: 2023–05–03
  12. By: Simplice A. Asongu (Yaounde, Cameroon); Yolande E. Ngoungou (Yaoundé, Cameroon); Joseph Nnanna (The Development Bank of Nigeria, Abuja, Nigeria)
    Abstract: This study assesses nexuses between mobile money innovations and health performance in terms of total life expectancy in 43 countries in Sub-Saharan Africa employing data for the period 2004-2018. Four mobile money innovation dynamics are proxied with registered mobile money agents and active mobile money agents. The empirical evidence is based on quantile regressions. The findings overwhelmingly show that mobile money innovations are relevant in improving health performance or total life expectancy exclusively in bottom quantiles of the conditional distribution of total life expectancy. In other words, countries with below-median levels of total life expectancy are more susceptible to benefit from mobile money innovations compared to countries with above-median levels of total life expectancy. It follows that common or general policy measures on the linkage between mobile money innovations and health performance are unlikely to succeed unless attendant policies are contingent on initial levels of health performance and hence, tailored differently across countries with various initial levels of health performance. More policy implications are discussed.
    Keywords: Mobile phones; financial inclusion; health; sub-Saharan Africa
    JEL: O40 G20 I10 I32 I20
    Date: 2023–01
  13. By: Kuschnig, Nikolas; Vashold, Lukas
    Abstract: Malaria places a great burden on the health and prosperity of many and occupies a great number of scientists and policymakers. The dynamics of the disease are tightly interwoven with economics - incidence is both tied to economic circumstances and impacts them. Economic research plays an important role in understanding and supporting the fight against malaria. The economic literature, however, features a number of peculiarities that can hamper accessibility and has been slow to approach interdisciplinary issues. Here, we explain the economic perspective and summarise the literature on the economic impacts of malaria. Malaria has severe impacts on individual and aggregate economic outcomes, including mortality and morbidity, but also indirect burdens that materialise with a delay. The fight against malaria is not an economic policy per se, but may provide beneficial economic spillovers and can be vital in establishing an environment that allows for prosperity. Economic insights can make a difference in the design and implementation of effective and efficient eradication and control strategies. This is critical in the light of increasing disease (re-)exposure due to climate change and the emergence of resistant vectors and pathogens.
    Keywords: malaria; development; economic growth; education; health
    Date: 2023–07
  14. By: Helm, Ines (Ludwig-Maximilians-Universität München); Koch, Nicolas (Mercator Research Institute on Global Commons and Climate Change (MCC)); Rohlf, Alexander (Mercator Research Institute on Global Commons and Climate Change (MCC))
    Abstract: We study the effects of a large car scrappage scheme in Germany on new car purchases and local air quality by combining vehicle registration data with data on local air pollutant emissions. For identification we exploit cross-sectional variation across districts in the number of cars eligible for scrappage. The scheme had substantial effects on car purchases and did not simply reallocate demand across time in the short-term. Nevertheless, about half of all subsidized buyers benefited from windfall gains. The renewal of the car stock improved local air quality suggesting substantial mortality benefits that likely exceed the cost of the policy. While policy take-up is somewhat smaller in urban districts, improvements in air quality and health tend to be larger due to a higher car density.
    Keywords: cash for clunkers, local air quality, car scrappage schemes, emissions, car rebate
    JEL: H20 H23 Q53 Q58
    Date: 2023–06
  15. By: Gugler, Klaus; Szücs, Florian
    Abstract: We exploit the regulatory environment in the Austrian pharmaceutical market to study the effects of price regulation on market outcomes and consumer welfare. We evaluate all mergers of drug producers in the 2009-2017 period and find that the coexisting regulated and unregulated markets were unequally affected. While M&A have substantially increased prices without regulation, particularly for price-inelastic products, prices did not increase under regulation. Instead, variety increased in regulated markets. Therefore, regulation can successfully mitigate the effects of market power: whereas M&A decrease consumer welfare absent regulation, the additional product variety increases consumer welfare in the regulated market.
    Keywords: pharmaceuticals; regulation; market power; consumer welfare; pharma mergers; product variety
    Date: 2023–07
  16. By: Bignardi, Giacomo; Ahmed, Saz; Bennett, Marc Patrick (University of Cambridge); Dunning, Darren Lee; Griffiths, Kirsty; Sakhardande, Ashok; Leung, Jovita Tung (University College London); Piera Pi-Sunyer, Blanca (University College London); Kuyken, Willem; Dalgleish, Tim
    Abstract: The COVID-19 pandemic prompted governments worldwide to introduce social distancing measures, including school closures and restrictions on in-person socialising. However, adherence to social distancing was challenging for many, and particularly for adolescents, for whom social interaction is crucial for development. The current study aimed to identify individual-level predictors of adherence to social distancing in a longitudinal sample of 460 adolescents aged 11-20 years. Participants completed detailed pre-pandemic assessments, including mental health and well-being, altruism, delayed reward discounting, rejection sensitivity, prosociality and susceptibility to prosocial and anti-social influence. Bayesian ordinal regression models were used to predict adherence to social distancing from predictors. The results indicated that higher levels of prosociality, altruism and lower susceptibility to anti-social influence were associated with higher adherence to social distancing. These findings have implications for understanding how adolescents comply with public health guidelines, highlighting the role of social influence and peer norms.
    Date: 2023–06–20

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