nep-hea New Economics Papers
on Health Economics
Issue of 2023‒08‒14
35 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Disability Insurance Screening and Worker Outcomes By Ahammer, Alexander; Packham, Analisa
  2. The Labor Market Effects of Disability Benefit Loss By Anikó Bíró; Cecília Hornok; Judit Krekó; Dániel Prinz; Ágota Scharle
  3. Working conditions and disabilities in French workers: a career-long retrospective study By Thomas Barnay; Éric Defebvre
  4. Accident-Induced Absence from Work and Wage Ladders By Anikó Bíró; Márta Bisztray; João G. da Fonseca; Tímea Molnár
  5. The Incentive Effects of Sickness Benefit for the Unemployed – Analysis of a Reduction in Potential Benefit Duration By Márton Csilalg; Lili Márk
  6. The Incidence of Adverse Selection: Theory and Evidence from Health Insurance Choices By Michael Geruso; Timothy Layton; Adam Leive
  7. The Largest Insurance Expansion in History: Saving One Million Lives Per Year in China By Jonathan Gruber; Mengyun Lin; Junjian Yi
  8. Getting the Right Tail Right: Modeling Tails of Health Expenditure Distributions By Martin Karlsson; Yulong Wang; Nicolas R. Ziebarth
  9. Later-Life Mortality and the Repeal of Federal Prohibition By Jacks, David S.; Pendakur, Krishna; Shigeoka, Hitoshi; Wray, Anthony
  10. (Breaking) Intergenerational Transmission of Mental Health By Bütikofer, Aline; Ginja, Rita; Karbownik, Krzysztof; Landaud, Fanny
  11. Impact of tariff refinement on the choice between scheduled C‐section and normal delivery: Evidence from France By Alex Proshin; Alexandre Cazenave-Lacroutz; Lise Rochaix
  12. The Oral Contraceptive Pill and Adolescents' Mental Health By Costa-Ramón, Ana; Daysal, N. Meltem; Rodríguez-González, Ana
  13. Universal Cash Transfer Impacts on Maternal and Infant Health By Mary Kopriva
  14. In utero shocks and health at birth: the distorting effect of fetal losses By Tamás Hajdu
  15. Fatherless: The Long-Term Effects of Losing a Father in the U.S. Civil War By Yannick Dupraz; Andreas Ferrara
  16. Geographic and Socioeconomic Variation in Healthcare: Evidence from Migration By Péter Elek; Anita Győrfi; Nóra Kungl; Dániel Prinz
  17. The Effects of Cash for Clunkers on Local Air Quality By Ines Helm; Nicolas Koch; Alexander Rohlf
  18. Sick as a Dog? The Prevalence, Politicization, and Health Policy Consequences of Canine Vaccine Hesitancy (CVH) By Motta, Matt; Motta, Gabriella; Stecula, Dominik
  19. Unintended Consequences of Sanitation Investment: Negative Externalities on Water Quality and Health in India By Kazuki Motohashi
  20. What does job applicants' body art signal to employers? By Stijn Baert; Jolien Herregods; Philippe Sterkens
  21. Optimizing the Ethiopian health extension programme: strategies to address workforce challenges By Haile Mariam, Damon; Estifanos, Abiy; Wondimagegn, Dawit; Simmons, Bryony; Conteh, Lesong
  22. Why and How Patients Complain: Decoding Patterns of Patient Complaint Behaviour in Private and Public Hospitals By Omari, Firas; , Abu Bakar Abdul Hamid; Ya’akub, Noor Inayah
  23. Into the Far West? Investigating Health Policy-Makers' Willingness to Adopt Decrementally Cost-Effective Innovations Using a DCE Approach By Ivan Tzintzun; Jonathan Sicsic; Lise Rochaix
  24. Multistate analysis and decomposition of disability-free life expectancy trends in Italy 2004-2019 By Margherita Moretti; Timothy Riffe; Angelo Lorenti
  25. Revisiting the Environmental Protection Agency's Value of Statistical Life By Cropper, Maureen L.; Joiner, Emily; Krupnick, Alan
  26. The Impact of Maternal Education on Early Childhood Development: The Case of Turkey By Deniz Karaoglan; Serap Sagir; Meltem Dayioglu; Durdane Sirin Saracoglu
  27. Successful Replication of "The Long-Run Effects of Sports Club Vouchers for Primary School Children (2022)" By Bacon, Felix; Bello, Abdel-Hamid; Brown, Myriam; Morris, Todd; Renée, Laëtitia
  28. Time Use, College Attainment, and The Working-from-Home Revolution By Benjamin W. Cowan
  29. 2022-2023 Campus Travel Survey Telecommuting Trends: Before and After COVID 19 Pandemic By Jain, Aakansha
  30. Trends in depression risk before and during the COVID-19 pandemic. By Villas-Boas, Sofia B; White, Justin S; Kaplan, Scott; Hsia, Renee Y
  31. The Political Effects of the 1918 Influenza Pandemic in Weimar Germany By Stefan Bauernschuster; Matthias Blum; Erik Hornung; Christoph Koenig
  32. Mobility Restrictions and Alcohol Use during Lockdown: “A Still and Dry Pandemic for the Many"? By Martina Celidoni; Joan Costa-i-Font; Luca Salmasi
  33. Inequalities in regional excess mortality and life expectancy during the COVID-19 pandemic in Europe By Tamás Hajdu; Judit Krekó; Csaba G. Tóth
  34. COVID-19 Lockdown and Neonatal Mortality: Evidence from India By Abu S. Shonchoy; Shatakshee Dhongde; Erdal Asker
  35. "Covid-19 and Income Inequality in OECD Countries:" A Methodological Comment By Stark, Oded

  1. By: Ahammer, Alexander (University of Linz); Packham, Analisa (Vanderbilt University)
    Abstract: We estimate the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze workers after a workplace injury that experience differential levels of application screening. We find that when workers face stricter screening requirements, they are less likely to receive DI benefits and are more likely to remain in the labor force. We observe no differences in any physical or mental health outcomes. Our findings imply that imposing stricter DI screening has large fiscal benefits but does not yield any detectable health costs, on the margin.
    Keywords: disability insurance, retirement, health
    JEL: I38 I18 J18 J16
    Date: 2023–06
  2. By: Anikó Bíró (Centre for Economic and Regional Studies); Cecília Hornok (KIEL Institute for the World Economy); Judit Krekó (Centre for Economic and Regional Studies, Budapest Institute for Policy Analysis); Dániel Prinz (World Bank); Ágota Scharle (Budapest Institute for Policy Analysis)
    Abstract: Disability benefits are costly and tend to reduce labor supply. While costs can be reduced by careful targeting, correcting past eligibility rules or assessment procedures may entail welfare costs. We study a major reform in Hungary that reassessed the health and working capacity of a large share of beneficiaries. Leveraging age and health cutoffs in the reassessment, we estimate employment responses to loss or reduction of benefits. We find that among those who left disability insurance due to the reform, 57% were employed in the primary labor market and 38% had neither employment nor benefit income. The consequences of leaving disability insurance sharply differed by pre-reform employment status. 62% of those without pre-reform employment did not work after exiting disability insurance, whereas this ratio was only 14% for those who had some employment in the pre-reform year. The gains of the reform in activating beneficiaries were small and strongly driven by pre-reform employment status. This points to the importance of combining financial incentives with broader labor market programs that increase employability.
    Keywords: Keywords: disability benefit, reactivation, employment policy
    JEL: H53 H55 J08 J14
    Date: 2023–06
  3. 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
  4. By: Anikó Bíró (Centre for Economic and Regional Studies); Márta Bisztray (Centre for Economic and Regional Studies); João G. da Fonseca (Université de Montréal); Tímea Molnár (Central European University and IZA)
    Abstract: How do temporary spells of absence from work affect individuals’ labor trajectory? To answer this question, we augment a `wage ladder' model, in which individuals receive alternative takeit-or-leave-it wage offers from firms and potentially suffer accidents which may push them into temporary absence. In such an environment, during absence, individuals do not have the opportunity to receive alternative wage offers that they would have received had they remained present. To test our model's predictions and to quantify the importance of foregone opportunities to climb the wage ladder, we use linked employer-employee administrative data from Hungary, that is linked to rich individual-level administrative health records. We use unexpected and mild accidents with arguably no permanent labor productivity losses, as exogenous drivers of short periods of absence. Difference-in-Differences results show that, relative to counterfactual outcomes in the case of no accidents, (i) even short (3-12-months long) periods of absence due to accidents decrease individuals' wages for up to two years, by around 2.5 percent; and that (ii) individuals reallocate to lower-paying employers. The share of wage loss due to missed opportunities to switch employers is between 7-20 percent over a two-year period after returning to work, whereas at most 2 percent is due to occupation switches. Our results are robust to (a) instrumenting absence with having suffered an accident, (b) exploiting the random nature of the time of the accident, and (c) within-firm matching of individuals with and without an accident and subsequent absence spell.
    Keywords: Keywords: wage ladder; accidents; health shocks; temporary absence from work
    JEL: J22 J23 I10
    Date: 2023–07
  5. By: Márton Csilalg (Centre for Economic and Regional Studies, Budapest Institute for Policy Analysis); Lili Márk (Central European University)
    Abstract: In Hungary, employees could claim sickness insurance benefit within 3 days of job-loss, which would enable them to extend their benefit duration by up to 90 days. The maximum number of days of this ‘passive sickness benefit’ was halved in 2007. We first investigate whether claiming passive sickness benefit was related to the monetary advantage relative to claiming unemployment insurance benefits. Then, we explore the effect of potential benefit duration on the transitions to stable employment relying on the variation induced by the policy change. Relying on high quality longitudinal matched administrative data we can estimate these relationships while using controls for employment histories and healthcare spending. On the one hand, we find that passive sickness benefit claiming behavior was indeed correlated with the financial gains. On the other hand, we find only a very small and insignificant immediate effect on transitions to employment when maximum benefit duration was cut by 45 days. However, we find that job finding hazard on the week after benefit exhaustion increased more for individuals who were not on sick leave just prior to job-loss. Our finding is suggestive that a non-negligible proportion of this group were subject to moral hazard.
    Keywords: sickness absence; statutory long-term sick pay; difference-in-difference methods
    JEL: I18 J22 J32
    Date: 2023–06
  6. By: Michael Geruso; Timothy Layton; Adam Leive
    Abstract: Existing research on selection in insurance markets focuses on how adverse selection distorts prices and misallocates products across people. This ignores the distributional consequences of who pays the higher prices. In this paper, we show that the distributional incidence depends on the correlations between income, expected costs, and insurance demand. We discuss the general implications for the design of subsidies and mandates when policymakers value both equity and efficiency. Then, in an empirical case study of a large employer, we show that the incidence of selection falls on higher-income employees, who are more likely to choose generous health insurance plans.
    JEL: D31 D8 D82 H22 I13
    Date: 2023–07
  7. By: Jonathan Gruber; Mengyun Lin; Junjian Yi
    Abstract: The New Cooperative Medical Scheme (NCMS) rolled out in China from 2003-2008 provided insurance to 800 million rural Chinese. We combine aggregate mortality data with individual survey data, and identify the impact of the NCMS from program rollout and heterogeneity across areas in their rural share. We find that there was a significant decline in aggregate mortality, with the program saving more than one million lives per year at its peak, and explaining 78% of the entire increase in life expectancy in China over this period. We confirm these mortality effects using micro-data on mortality, other health outcomes, and utilization.
    JEL: H4 I13
    Date: 2023–07
  8. By: Martin Karlsson; Yulong Wang; Nicolas R. Ziebarth
    Abstract: Health expenditure data almost always include extreme values. Such heavy tails can be a threat to the commonly adopted least squares methods. To accommodate extreme values, we propose the use of an estimation method that recovers the often ignored right tail of health expenditure distributions. We apply the proposed method to a claims dataset from one of the biggest German private health insurers and find that the age gradient in health care spending differs substantially from the standard least squares method. Finally, we extend the popular two-part model and develop a novel three-part model.
    JEL: C10 C13 I10 I13
    Date: 2023–07
  9. By: Jacks, David S. (National University of Singapore); Pendakur, Krishna (Simon Fraser University); Shigeoka, Hitoshi (Simon Fraser University); Wray, Anthony (University of Southern Denmark)
    Abstract: Despite a recent and dramatic re-evaluation of the health consequences of alcohol consumption, very little is known about the effects of in utero exposure to alcohol on long-run outcomes such as later-life mortality. Here, we investigate how state by year variation in alcohol control arising from the repeal of federal prohibition affects mortality for cohorts born in the 1930s. We find that individuals born in wet states experienced higher later-life mortality than individuals born in dry states, translating into a 3.3% increase in mortality rates between 1990 and 2004 for affected cohorts.
    Keywords: alcohol, federal prohibition, in utero exposure, later-life mortality
    JEL: H73 I18 J18 N32
    Date: 2023–07
  10. By: Bütikofer, Aline (Norwegian School of Economics); Ginja, Rita (University of Bergen); Karbownik, Krzysztof (Emory University); Landaud, Fanny (INSEAD)
    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
  11. By: Alex Proshin (Canadian Center for Health Economics, Hospinomics - 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, 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); Alexandre Cazenave-Lacroutz (CREST - Centre de Recherche en Économie et Statistique - ENSAI - Ecole Nationale de la Statistique et de l'Analyse de l'Information [Bruz] - X - École polytechnique - ENSAE Paris - École Nationale de la Statistique et de l'Administration Économique - CNRS - Centre National de la Recherche Scientifique); Lise Rochaix (Hospinomics - 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, 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)
    Abstract: Studying quasi-experimental data from French hospitals from 2010 to 2013, we test the effects of a substantial diagnosis-related group (DRG) tariff refinement that occurred in 2012, designed to reduce financial risks of French maternity wards. To estimate the resulting DRG incentives with regard to the choice between scheduled C-sections and other modes of child delivery, we predict, based on pre-admission patient characteristics, the probability of each possible child delivery outcome and calculate expected differences in associated tariffs. Using patient-level administrative data, we find that introducing additional severity levels and clinical factors into the reimbursement algorithm had no significant effect on the probability of a scheduled C-section being performed. The results are robust to multiple formulations of DRG financial incentives. Our paper is the first study that focuses on the consequences of a DRG refinement in obstetrics and develops a probabilistic approach suitable for measuring the expected effects of DRG fee incentives in the presence of multiple tariff groups.
    Keywords: C-section, Delivery, Diagnosis-related groups, Financial incentives, Midwives, Obstetricians, Refinement, Vaginal labor
    Date: 2023–07
  12. By: Costa-Ramón, Ana (University of Zurich); Daysal, N. Meltem (University of Copenhagen); Rodríguez-González, Ana (Lund University)
    Abstract: What is the impact of the oral contraceptive pill on the mental health of adolescent girls? Using administrative data from Denmark and exploiting the variation in the timing of pill initiation in an event study design, we find that the likelihood of a depression diagnosis and antidepressant use increases shortly after pill initiation. We then uncover substantial variation in primary care providers' tendency to prescribe the pill to adolescents, unrelated to patient characteristics. Being assigned to a high prescribing physician strongly predicts pill use by age 16 and leads to worse mental health outcomes between ages 16-18.
    Keywords: contraceptive pill, mental health, adolescents, prescribing practices
    JEL: I12 J13
    Date: 2023–07
  13. By: Mary Kopriva (Institute of Social and Economics Research, University of Alaska Anchorage)
    Abstract: In this paper, I examine how the receipt of an unconditional cash transfer during pregnancy impacts maternal and infant health outcomes. Using linked birth certificate data, I apply a within-mother estimator to analyze how receipt of the Alaska permanent fund dividend (PFD), an annual cash transfer for all Alaska residents, affects the likelihood of being born preterm or low birth weight and the likelihood of experiencing complications at the time of labor and delivery. I find that receiving an additional $1, 000 in PFD payment during the 12 months prior to birth decreases the likelihood of having a labor/delivery complication by approximately 12% and reduces the likelihood of being born very preterm by approximately 22%. The results are strongest for mothers with less than a high school education.
    Keywords: cash transfers, maternal health, infant health, prenatal period
    JEL: I12 I38 J13
    Date: 2023–07
  14. By: Tamás Hajdu (Centre for Economic and Regional Studies)
    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: Keywords: in utero selection, health at birth, birth weight, temperature, climate change
    JEL: I12 J13 Q54
    Date: 2023–06
  15. By: Yannick Dupraz (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Andreas Ferrara
    Abstract: We estimate the causal effect of losing a father in the U.S. Civil War on children's long-run socioeconomic outcomes. Linking military records from the 2.2 million Union Army soldiers with the 1860 U.S. population census, we track soldiers' sons into the 1880 and 1900 census. Sons of soldiers who died had lower occupational income scores and were less likely to work in a high-or semiskilled job as opposed to being low-skilled or farmers. These effects persisted at least until the 1900 census. Our results are robust to instrumenting paternal death with the mortality rate of the father's regiment, which we argue was driven by military strategy that did not take into account the social origins of soldiers. Prewar family wealth is a strong mitigating factor: there is no effect of losing a father in the top quartile of the wealth distribution.
    Keywords: U.S. civil war, Orphans, Intergenerational Mobility
    Date: 2023–02–07
  16. By: Péter Elek (Centre for Economic and Regional Studies, Corvinus University of Budapest); Anita Győrfi (Vienna Graduate School of Economics); Nóra Kungl (Vienna Graduate School of Economics); Dániel Prinz (World Bank)
    Abstract: We study variation in healthcare utilization across geographies and socioeconomic groups in Hungary. Exploiting migration across geographic regions and relying on high-quality administrative data on healthcare use and income we show that the role of place-specific supply factors is heterogeneous across types of care and across socioeconomic groups. Overall, place-specific factors account for 68% of the variation in outpatient spending and 35% of the variation in drug spending, but almost none of the variation in inpatient spending. Place effects explain four-fifth of outpatient spending variation for non-employed working-age individuals, but less than two-fifth for individuals with above-median wage incomes. There is a positive association between place effects and outpatient capacity, especially for low-income individuals. These results suggest that access to healthcare varies especially for low-income people even in a context with universal coverage.
    Keywords: healthcare utilization, healthcare supply, regional variation, socioeconomic status
    JEL: I11 I14 C23
    Date: 2023–06
  17. By: Ines Helm; Nicolas Koch; Alexander Rohlf
    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
  18. By: Motta, Matt (Boston University School of Public Health); Motta, Gabriella; Stecula, Dominik (University of Pennsylvania)
    Abstract: Canine vaccine hesitancy (CVH) can be thought about as dog owners’ skepticism about the safety and efficacy of administering routine vaccinations to their pets. CVH is potentially problematic not only because it may inspire vaccine refusal – which may in turn facilitate infectious disease spread in both canine and human populations – but because it may contribute to veterinary care provider burnout. While anecdotal reports suggest that CVH may be widespread, few have made an effort to assess its prevalence, socio-political correlates, or animal/human health consequences. In a nationally representative survey of the US adult population (N = 2, 200), we introduce a novel survey-based instrument for measuring CVH. We document pervasive CVH in dog owner subpopulations, with 53% expressing concerns about the safety (37%), efficacy (22%), and/or necessity (30%) of canine vaccination. We further provide evidence of vaccine “spillover” effects; such that dog owners who hold negative attitudes about human vaccines – views which tend to be over-represented on the ideological right – are significantly more likely to express CVH. Troublingly, we find that CVH is associated with rabies non-vaccination, as well as opposition to evidence-based vaccine policies. We conclude by discussing the human and animal health consequences of CVH, and outline a research agenda for future opinion-based research on this important topic.
    Date: 2023–07–07
  19. By: Kazuki Motohashi
    Abstract: Developing countries have increased sanitation investment to reduce diarrheal diseases. However, the direct health benefits of latrine construction can be offset by water pollution externalities due to poor treatment of fecal sludge. I estimate these negative externalities of a sanitation policy in India that subsidized the construction of over 100 million latrines. Exploiting geographical variation in soil characteristics and the differential increase in latrine coverage across districts, I find that the policy increases river pollution by 72%. While it reduces diarrheal mortality overall, this positive health effect is two-thirds smaller in areas with lower capacities for treatment of fecal sludge where water pollution externalities are consequently larger.
    Date: 2023–07
  20. By: Stijn Baert; Jolien Herregods; Philippe Sterkens (-)
    Abstract: In this study, we present a state-of-the-art scenario experiment which, for the first time in the literature, directly measures the stigma surrounding job candidates with tattoos and piercings using real recruiters. We find that job candidates with body art are perceived as less pleasant to work with, less honest, less emotionally stable, less agreeable, less conscientious and less manageable. This goes hand in hand with lower hireability for men with body art but not for women. Compared to candidates who reveal obesity, a characteristic we also randomise, those with body art score better overall in terms of hireability and rated personality, similar in terms of rated taste to collaborate but worse in terms of rated direct productivity drivers.
    Keywords: body art, obesity, stigma, personality, hiring, taste discrimination, statistical discrimination
    JEL: C91 J24 J71
    Date: 2023–07
  21. By: Haile Mariam, Damon; Estifanos, Abiy; Wondimagegn, Dawit; Simmons, Bryony; Conteh, Lesong
    Abstract: The Health Extension Programme (HEP) serves as a flagship programme in the delivery of primary health care (PHC) in Ethiopia. However, its implementation has faced various health system barriers. By laying out transformative strategies, the HEP Optimization Roadmap (2020–2035) presents an opportunity to restructure and standardize the programme’s service delivery approach to ensure long-term sustainability and impact.
    JEL: R14 J01
    Date: 2023–06–20
  22. By: Omari, Firas; , Abu Bakar Abdul Hamid; Ya’akub, Noor Inayah
    Abstract: The spread of diseases underscores the significance of understanding the patient complaint behaviour in order to deliver a quick responsiveness in a very empathetic, reliable, and courteous manner that helps patient recovering from illness as soon as possible. Our study mainly examines patient complaint behaviour, including the propensity to complain, engage in negative word of mouth, switch healthcare providers, and seek third-party assistance, within private and public hospitals in Damascus, Syria. Convenience sampling method was used to select 446 patients from four hospitals (two private and two public) in the Syrian capital Damascus. Structural equation modelling (SEM) implemented to empirically test the proposed hypotheses and to examine the significance relationship between the constructs. our findings indicate that complaint behaviour among Syrian patients in public hospitals differs significantly from that observed in private hospitals. Besides, in the private healthcare sector, our empirical findings provide substantial evidence of a significant association between price consciousness and the propensity to voice complaints (β= 0.36, P<0.00). However, in the public healthcare sector, the relationship between price consciousness and the propensity to complain is not statistically significant (β= 0.33, P >0.05). The findings of this study will provide valuable insights for policymakers and hospital administrators in mitigating the effects of complaints, minimizing their adverse impact on the quality of care, and improving patients' capacity to express their discontent. To the authors' knowledge, this study represents a distinctive and unique contribution as it explores and compares patient complaint behaviour in public and private hospitals, specifically within the context of developing countries. It provides a valuable contribution by addressing an area that has not been extensively explored.
    Date: 2023–06–24
  23. By: Ivan Tzintzun (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); Jonathan Sicsic (LIRAES (URP_ 4470) - Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé - UPCité - Université Paris Cité); Lise Rochaix (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, UP1 - Université Paris 1 Panthéon-Sorbonne)
    Abstract: In a context of increasingly limited resources, a number of strategies, such as the adoption of decrementally cost-effective interventions (d-CEIs), which are both less clinically effective and less costly, could offer potential levers at enhancing both efficiency and equity in healthcare systems. These interventions are located in the SouthWest (S-W) quadrant of the cost-effectiveness plane, and have yet received little attention from researchers or HTA agencies as they are often perceived as per se "unethical" or "unacceptable", hence the reference sometimes made to the S-W quadrant as the 'Far West'. The purpose of our paper is to investigate policy-makers' willingness to adopt d-CEIs using a choice experiment. We use a two-stage pairwise DCE survey to elicit (i) preferences for d-CEIs' attributes in forced choices and (ii) adoption preferences, i.e. the determinants of d-CEIs' adoption (unforced choices). We investigate the effect (and trade-offs) between three attributes: health loss (very small to significant), reversibility defined as the possibility to switch back to usual care (from possible to hardly possible) and cost-savings (from 5% to 15% of a fixed budget). Such trade-offs are contextualized by using two sensitivity attributes: disease severity (low and moderate) and savings uncertainty (low and high). Our final sample consists of 180 respondents with 46.7% originating from France and the remaining respondents from other EU countries. All attributes' levels have a significant effect in the two decision stages. The "health loss" attribute dominates in the first stage followed by "reversibility": we calculate that decision-makers would require 28.3% increase of budget savings to be indifferent between a scenario of small versus significant health losses and 14.5% budget savings to be indifferent between a scenario of possible and hardly possible reversibility. In contrast, the "reversibility" attribute dominates in the second stage suggesting that anticipated regret may play a role in adoption decisions.
    Keywords: health policy-makers choices, Discrete Choice Experiment, Decrementally Cost-Effective Interventions, Disinvestment
    Date: 2023–07
  24. By: Margherita Moretti (Max Planck Institute for Demographic Research, Rostock, Germany); Timothy Riffe (Max Planck Institute for Demographic Research, Rostock, Germany); Angelo Lorenti (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Italy has witnessed increases in life expectancy and severe population ageing, raising concerns about their impact on population health. Disability status greatly affects the participation of older adults in various aspects of life. This study examines the long-term trend of disability-free life expectancy (DFLE) in Italy and explores the drivers in terms of disability onset and recovery dynamics, as well as changes in disability-specific mortality. By using IT-SILC longitudinal data (2004-2019), transition probabilities and DFLE between ages 50 and 79 are calculated, and the drivers of DFLE evolution are analysed through decomposition. DFLE among mid-to-older Italians has progressed overall over the last decades, albeit not as favourably as life expectancy. The trends indicate compression of disability in recent years. Changes in disability transitions have the greatest influence on DFLE patterns, while less the changes in disability-specific mortality. The greatest contributions come from increases in the probability of recovery from disability.
    Keywords: Italy, ageing, demographic models, disability
    JEL: J1 Z0
    Date: 2023
  25. By: Cropper, Maureen L. (Resources for the Future); Joiner, Emily (Resources for the Future); Krupnick, Alan (Resources for the Future)
    Abstract: The US Environmental Protection Agency (EPA) bases its estimate of the value of statistical life (VSL) on 17 hedonic wage studies and five contingent valuation studies conducted between 1974 and 1991. We summarize advances in the mortality risk valuation literature since these papers were published, focusing on studies that value risks to adults and were conducted in the United States. We review hedonic wage, other revealed preference, and stated preference studies, identifying papers that satisfy appropriate validity criteria. We conclude that the recent literature is sufficiently rich to permit a revision of EPA’s baseline estimate. Importantly, VSL estimates from both the averting behavior and stated preference studies we review reflect the preferences of a wider range of demographic groups than the current VSL, and newer studies better target causes of death relevant to EPA regulations.
    Date: 2023–07–19
  26. By: Deniz Karaoglan (Department of Economics, Gebze Technical University); Serap Sagir (Department of Economics, Middle East Technical University); Meltem Dayioglu (Department of Economics, Middle East Technical University); Durdane Sirin Saracoglu (Department of Economics, Middle East Technical University)
    Abstract: In this paper we investigate the relationship between mother’s education level and the development of young children in Turkey using representative microdata from the 2018 Turkey Demographic and Health Survey (TDHS). The data include detailed information about the developmental status of young children of 36-to-59 months old. We find that only when the mother has at least a high school level education, there is a positive impact on the child’s developmental status as summarized the Early Childhood Development (ECD) index, which is an index constructed based on the child’s four developmental domains. We also show that the household’s wealth is also positively associated with the child’s developmental status, particularly in the socio-emotional and the learning readiness domains.
    Keywords: Early Childhood Development, Mother’s Education, Socioeconomic Status, Turkey
    JEL: C5 I00 O15
    Date: 2023–07–27
  27. By: Bacon, Felix; Bello, Abdel-Hamid; Brown, Myriam; Morris, Todd; Renée, Laëtitia
    Abstract: Marcus, Siedler and Ziebarth (2022 American Economic Journal: Economic Policy) examine the long-run health effects of a universal sports-club voucher program that was introduced in Saxony for primary school children in 2009. In 2018, the authors designed a survey that targeted the affected cohorts and nearby cohorts in Saxony and two neighboring states, and use a differences-in-differences identification strategy that exploits variation across states and cohorts in policy exposure. The authors document that treated individuals have knowledge of the program and recall receiving and redeeming the vouchers at higher rates, but find no effects on any health outcomes or behaviors. We successfully reproduce the main results of the paper exactly using data available in the paper's replication package and new Stata and R code. We also verify the robustness of the results using different outcomes, different control variables, different sample restrictions and different inference methods.
    Date: 2023
  28. By: Benjamin W. Cowan
    Abstract: I demonstrate that the profound change in working from home (WFH) in the wake of the COVID-19 pandemic is concentrated among individuals with college degrees. Relative to 2015-19, the number of minutes worked from home on fall 2021 weekdays increased by over 90 minutes for college graduates; for non-graduates, it was 17 minutes. The share of work done at home (for those who worked at all) increased by 21% for graduates and 6% for non-graduates. Average minutes worked changed little for either group. Daily time spent traveling (e.g., commuting) fell by 24 minutes for college graduates but did not change for non-graduates. I examine how time-use patterns change for college graduates relative to non-graduates over the same period. Preliminary evidence suggests that time spent with children has risen for college graduates relative to non-graduates, potentially a sign that gaps in children’s outcomes by college attainment will be exacerbated by the WFH revolution.
    JEL: I12 I24 J22 J24 J32
    Date: 2023–07
  29. By: Jain, Aakansha
    Abstract: Every year the UC Davis Campus Travel Survey includes questions related to travel to campus during different days in the reference week. Respondents from all role groups indicate how often they travel to the campus during the reference week for school or work. They also indicate the reasons for not coming to work in-person during the same time period. Travel to campus was highly impacted by the COVID-19 pandemic in the 2020-2021 school year as campus switched to remote instruction. In 2021-22, the campus returned to in-person working and instruction which led to increased physical travel. Travel to campus further increased in 2022-23 as more students and staff returned to campus for in-person learning and working. This report discusses some of the key results from the survey on questions related to physical travel to campus and reasons for no travel to campus before and after COVID-19 pandemic. It presents a comparative analysis of physical travel to campus during the reference week across three years, 2019-20, 2021-22, and 2022-23. The report also provides details on how telecommuting patterns changed before and after the pandemic among both students and employees.
    Keywords: Social and Behavioral Sciences, College students, Mode choice, Travel behavior, Travel surveys, Universities and colleges
    Date: 2023–06–01
  30. By: Villas-Boas, Sofia B; White, Justin S; Kaplan, Scott; Hsia, Renee Y
    Abstract: Using 11 years of the U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System survey data set for 2011 to 2021, we track the evolution of depression risk for U.S. states and territories before and during the COVID-19 pandemic. We use these data in conjunction with unemployment and COVID case data by state and by year to describe changes in the prevalence of self-reported diagnosis with a depressive disorder over time and especially after the onset of COVID in 2020 and 2021. We further investigate heterogeneous associations of depression risk by demographic characteristics. Regression analyses of these associations adjust for state-specific and period-specific factors using state and year-fixed effects. First, we find that depression risk had been increasing in the US in years preceding the pandemic. Second, we find no significant average changes in depression risk at the onset of COVID in 2020 relative to previous trends, but estimate a 3% increase in average depression risk in 2021. Importantly, we find meaningful variation in terms of changes in depression risk during the pandemic across demographic subgroups.
    Keywords: Humans, Behavioral Risk Factor Surveillance System, Prevalence, Depression, Pandemics, COVID-19, Behavioral and Social Science, Mental Health, Brain Disorders, Prevention, 2.4 Surveillance and distribution, Aetiology, Good Health and Well Being, General Science & Technology
    Date: 2023–01–01
  31. By: Stefan Bauernschuster; Matthias Blum; Erik Hornung; Christoph Koenig
    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
  32. By: Martina Celidoni; Joan Costa-i-Font; Luca Salmasi
    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
  33. By: Tamás Hajdu (Centre for Economic and Regional Studies); Judit Krekó (Centre for Economic and Regional Studies, Budapest Institute for Policy Analysis); Csaba G. Tóth (Centre for Economic and Regional Studies, Corvinus University of Budapest)
    Abstract: Using data for 201 regions (NUTS 2) in Europe, we examine the mortality burden of the COVID-19 pandemic and how the mortality inequalities between regions changed between 2020 and 2022. We show that over the three years of the pandemic, not only did the level of excess mortality rate change considerably, but also its geographical distribution. Focusing on life expectancy as a summary measure of mortality conditions, we find that the variance of regional life expectancy increased sharply in 2021. This was due to a much higher-than-average excess mortality in regions with lower pre-pandemic life expectancy. While the life expectancy inequality has returned to its pre-pandemic level in 2022, the observed life expectancy in almost all regions is far below that expected without the pandemic.
    Keywords: COVID-19, excess mortality, life expectancy, inequality
    JEL: I10 I14 I18
    Date: 2023–06
  34. By: Abu S. Shonchoy (Department of Economics, Florida International University); Shatakshee Dhongde (Department of Economics, Georgia Institute of Technology); Erdal Asker (Department of Economics, Georgia Institute of Technology)
    Abstract: Using nationally representative data from India, we document the first survey-based evidence of the unintended consequences of lockdown on neonatal mortality in a developing country. Event-study shows neonatal mortality significantly increased during the first nationwide lockdown and became insignificant one-month later. The difference-in-difference estimates show neonatal mortality increased to 47 from 30 per 1, 000 births during the lockdown. Negative in-utero exposure, forgone healthcare (through service interruption and avoidance), and delaying vaccinations are crucial impact mechanisms. Our findings stimulate the debate on the efficacy of strict lockdown, its duration, and missing policy directives in resource-poor countries, particularly for the care-dependent population.
    Keywords: COVID-19, India, Neonatal and nfant mortality, Lockdown, In-utero exposure, Child vaccinations, Antenatal care visits
    JEL: I18 J13
    Date: 2023–07
  35. By: Stark, Oded (University of Bonn)
    Abstract: Wildman (2021), who identifies "a clear association between income inequality [measured by the Gini coefficient] and COVID-19 cases and deaths, " concludes that "a goal of government should be to reduce [income] inequalities and [thereby] improve [the COVID-19 outcomes /] underlying health of their populations." In this Comment, we argue that reducing the Gini coefficient of the income distribution of a population need not weaken the population's social stress. It is this stress which is a source of adverse health outcomes of the population. Because a measure of this stress is a component of the Gini coefficient, reducing the coefficient can leave the measure as is, or even increase the measure.
    Keywords: social stress, Gini coefficient, income inequality, forming public health policy
    JEL: D01 D63 D91 I10 I14 I31 Z18
    Date: 2023–06

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