nep-hea New Economics Papers
on Health Economics
Issue of 2023‒08‒28
nineteen papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. To What Extent are Trends in Teen Mental Health Driven by Changes in Reporting? The Example of Suicide-Related Hospital Visits By Adriana Corredor-Waldron; Janet Currie
  2. The Expansionary and Contractionary Supply-Side Effects of Health Insurance By Eilidh Geddes; Molly Schnell
  3. Trajectories of Early Childhood Skill Development and Maternal Mental Health By Sevim, Dilek; Baranov, Victoria; Bhalotra, Sonia; Maselko, Joanna; Biroli, Pietro
  4. The Education-Health Gradient: Revisiting the Role of Socio-Emotional Skills By Gørtz, Mette; Gensowski, Miriam
  5. Under the Same Umbrella: Public Health Insurance Expansions and the Uniformity of Insurance for Families By Sarah Hamersma; Daniel S. Grossman; Sebastian Tello-Trillo
  6. Consequences of a Shortage and Rationing: Evidence from a Pediatric Vaccine By Eli B. Liebman; Emily C. Lawler; Abe Dunn; David B. Ridley
  7. Debt Relief for the Financially Vulnerable: Impact on Employment, Welfare Receipt, and Mental Health By de Bruijn, Ernst-Jan; Vethaak, Heike; Koning, Pierre; Knoef, Marike
  8. Do hospital mergers reduce waiting times? Theory and evidence from the english NHS By Vanessa Cirulli; Giorgia Marini; Marco A. Marini; Odd Rune Straume
  9. The causal impact of mental health on tobacco and alcohol consumption: An instrumental variables approach By Mitrou, Francis; Nguyen, Ha Trong; Le, Huong Thu; Zubrick, Stephen R.
  10. Open and inclusive: fair processes for financing universal health coverage By Kurowski, Christoph
  11. Forest Protection and Human Health: The Case of Malaria in the Brazilian Amazon By Karpavicius, Luiza; Chimeli, Ariaster
  12. Effects of social media addiction on daily work performance of government employees By Sulasula, Josephine
  13. What Does Job Applicants' Body Art Signal to Employers? By Baert, Stijn; Herregods, Jolien; Sterkens, Philippe
  14. Social exclusion in the lab By Mariana Blanco; Darwin Cortés; Amalia Rodríguez-Valencia
  15. The Wage Effect of Workplace Sexual Harassment: Evidence for Women in Europe By Giulia Zacchia; Izaskun Zuazu
  16. Why Are Unemployment Insurance Claims So Low? By Christopher J. O'Leary; Kenneth J. Kline; Thomas A. Stengle; Stephen A. Wandner
  17. Dynamic Regression Discontinuity: A Within-Design Approach By Francesco Ruggieri
  18. Is This Time Different? The Safety Net Response to the Pandemic Recession By Erik A. Hembre; Robert A. Moffitt; James P. Ziliak
  19. Social Connections and COVID-19 Vaccination By Basu, Arnab K.; Chau, Nancy H.; Firsin, Oleg

  1. By: Adriana Corredor-Waldron; Janet Currie
    Abstract: Rising reports of suicidal behaviors in children and adolescents have led to the recognition of a youth mental health crisis. However, reported rates can be influenced by access to screening and changes in reporting conventions, as well as by changes in social stigma. Using data on all hospital visits in New Jersey from 2008-2019, we investigate two inflection points in adolescent suicide-related visits and show that a rise in 2012 followed changes in screening recommendations, while a sharp rise in 2016-2017 followed changes in the coding of suicidal ideation. Rates of other suicidal behaviors including self-harm, attempted suicides, and completed suicides were essentially flat over this period. These results suggest that underlying suicide-related behaviors among children, while alarmingly high, may not have risen as sharply as reported rates suggest. Hence, researchers should approach reported trends cautiously.
    JEL: I12
    Date: 2023–07
  2. By: Eilidh Geddes; Molly Schnell
    Abstract: We examine how health insurance expansions affect the entry and location decisions of health care clinics. Exploiting county-level changes in insurance coverage following the Affordable Care Act and 1, 721 retail clinic entries and exits, we find that local increases in insurance coverage do not lead to growth in the concentration of clinics on average using two-way fixed effects and instrumental variable designs. However, this null effect masks important heterogeneity by insurance type: growth in private insurance leads to large growth in clinic entry, whereas clinic penetration is dampened by increases in Medicaid coverage. Consistent with a model in which firms face demand from markets with both administered and market-based pricing, we find that the positive (negative) supply-side effects of private insurance (Medicaid) coverage are concentrated in states with low provider reimbursements under Medicaid. We further show that similar location patterns are observed among other types of health care clinics, including urgent care centers. While it has long been accepted that reductions in the prices paid by consumers following insurance expansions should lead the supply side to expand to meet increased demand (Arrow, 1963), our results demonstrate that whether health insurance expansions cause the supply side to expand or contract further depends on how the prices received by providers are affected.
    JEL: H44 I11 I13 I14 L11
    Date: 2023–07
  3. By: Sevim, Dilek (University of Basel); Baranov, Victoria (University of Melbourne); Bhalotra, Sonia (University of Warwick); Maselko, Joanna (University of North Carolina); Biroli, Pietro (University of Bologna)
    Abstract: We investigate the impacts of a perinatal psychosocial intervention on trajectories of maternal mental health and child skills, from birth to age 3. We find improved maternal mental health and functioning (0.17 – 0.29 SD), modest but imprecisely estimated improvements in parental investments (0.07 to 0.11 SD), and transitory improvements in child socioemotional development (0.06 to 0.39 SD). We also find negligible influence of the intervention on physical health and cognitive development. Estimates of a skill production function reveal that the intervention is associated with reduced productivity of maternal mental health and narrowed depression gaps in mother and child outcomes.
    Keywords: Mental health ; stress ; socioemotional ; RCT; child development ; technology of skill formation ; gender
    Date: 2023
  4. By: Gørtz, Mette (University of Copenhagen); Gensowski, Miriam (Rockwool Foundation Research Unit)
    Abstract: Is the education-health gradient inflated because both education and health are associated with unobserved socio-emotional skills? Revisiting the literature, we find that the gradient is reduced by 30-45% by fine-grained personality facets and Locus of Control. Traditional aggregated Big-Five scales, in contrast, have a much smaller and mostly insignificant contribution to the gradient. We decompose the gradient into its components with an order-invariant method, and use sibling-fixed effects to address that much of the observed education-health gradient reflects associations rather than causal relationships. There are education-health gradients even within sibling pairs; personality facets reduce these gradients by 30% or more. Our analyses use an extraordinarily large survey (N=28, 261) linked to high-quality administrative registers with information on SES background and objective health outcomes.
    Keywords: inequality, Health-Education Gradient, personality, Big Five-2 Inventory, sibling fixed effects
    JEL: I14 I12 I24 I31
    Date: 2023–07
  5. By: Sarah Hamersma; Daniel S. Grossman; Sebastian Tello-Trillo
    Abstract: Evaluating insurance coverage at the individual level abstracts away from the family-level decision making behind healthcare utilization. While traditional private insurance tends to be offered to either adult individuals or whole families, public insurance eligibility is determined person-by-person. Income eligibility thresholds for public coverage can differ for parents and children, and even among children in different age groups. Having different insurance sources, or a mix of insured and uninsured members of a family, may be disruptive to consistent medical care. In this paper we investigate how changes in eligibility thresholds for adults and children are associated with mismatched patterns of insurance coverage. Using the Current Population Survey and the Survey of Income and Program Participation, we document the patterns of insurance mismatch over time and their relationship to Medicaid and State Children’s Health Insurance Program income eligibility thresholds. We find that expansions of parent thresholds can promote uniform insurance coverage for families. These results are driven by families led by single mothers, who are more likely to be affected by Medicaid expansions for parents. Treating a family as the main unit of observation provides important insights and details potential unintended consequences of individual-level public insurance policy.
    JEL: I0 I13 I18 I38
    Date: 2023–07
  6. By: Eli B. Liebman; Emily C. Lawler; Abe Dunn; David B. Ridley
    Abstract: Shortages and rationing are common in health care, yet we know little about the consequences. We examine an 18-month shortage of the pediatric Haemophilus Influenzae Type B (Hib) vaccine. Using insurance claims data and variation in shortage exposure across birth cohorts, we find that the shortage reduced uptake of high-value primary doses by 4 percentage points and low-value booster doses by 26 percentage points. This suggests providers largely complied with rationing recommendations. In the long-run, catch-up vaccination occurred but was incomplete: shortage-exposed cohorts were 4 percentage points less likely to have received their booster dose years later. We also find that the shortage and rationing caused provider switches, extra provider visits, and negative spillovers to other care.
    JEL: I12 I18 L65
    Date: 2023–07
  7. By: de Bruijn, Ernst-Jan (Leiden University); Vethaak, Heike (University of Leiden); Koning, Pierre (Vrije Universiteit Amsterdam); Knoef, Marike (Tilburg University)
    Abstract: We study the labor market and mental health impacts of debt relief among financially vulnerable individuals. We exploit a cutoff rule used by a Dutch welfare office to determine eligibility to debt relief of welfare debts. We use this cutoff as an instrument in both a fuzzy regression discontinuity and instrumented difference-in-difference design. With administrative data, we estimate economically small and insignificant effects of debt relief on employment, earnings, welfare receipt, and medication use for mental health problems. Subgroup analyses suggest that debt relief increases employment among debtors with larger welfare debts. The larger amount of debt relief for this group has probably a stronger potential to improve their overall debt position.
    Keywords: debt relief, welfare debts, welfare recipients, fuzzy regression discontinuity design, instrumented difference-in-difference
    JEL: G51 I38 J22 J64 J68
    Date: 2023–07
  8. By: Vanessa Cirulli (Italian Agency for Development Cooperation, Italy); Giorgia Marini (Department of Juridical and Economic Studies (DSGE), Sapienza University of Rome); Marco A. Marini (Department of Social Sciences and Economics, Sapienza University of Rome); Odd Rune Straume (NIPE/Center for Research in Economics and Management, University of Minho, Portugal; and Department of Economics, University of Bergen, Norway)
    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-in-differences methodology applied to a long panel of data on hospital merger in the English NHS, where we find that the effects of a merger on waiting times crucially rely on a legal status that can reasonably be linked to the degree of profit-orientation. Whereas hospital mergers involving Foundation Trusts tend to reduce waiting times, the corresponding effect of mergers involving hospitals without this legal status tends to go in the opposite direction.
    Keywords: Hospital merger; waiting times; profit-orientation
    JEL: I11 I18 L21 L41
    Date: 2023
  9. By: Mitrou, Francis; Nguyen, Ha Trong; Le, Huong Thu; Zubrick, Stephen R.
    Abstract: The reciprocal relationship between psychiatric and substance use disorders is well-known, yet it remains largely unknown whether mental health morbidity causally leads to addictive behaviours. This paper utilises a fixed effects instrumental variables model, which is identified by time-varying sources of plausibly exogenous variations in mental health, and a nationally representative panel dataset from Australia to present robust evidence on the causal impact of mental distress on cigarette smoking and alcohol drinking behaviours. We find that mental distress significantly increases the prevalence and intensity of either cigarette or alcohol consumption. Further analysis reveals that mental distress also substantially increases household monetary expenditures on either tobacco or alcohol. The impact is greater for lower educated individuals or children of smokers, and is slightly higher for males. Our findings highlight the importance of mental health screening and treatment programs, especially among lower educated individuals or children of smokers, to assist in the prevention of addictive activities.
    Keywords: Mental Health, Depression, Smoking, Drinking, Alcohol Addiction, Instrumental Variables
    JEL: C26 I10 I12 I14
    Date: 2023
  10. By: Kurowski, Christoph
    Abstract: Does fairness matter? This report argues that, in key areas of public policy making, it does. And that, in policy decisions related to health financing, there are reliable ways for countries to bring fairness about. The report offers decision support on fair processes for policy choices relating to health financing for universal health coverage (UHC). It opens by making the case for why fair processes matter for health financing. It argues that procedural fairness contributes to fairer outcomes, strengthens the legitimacy of decision processes, builds trust in authorities, and promotes the sustainability of reforms on the path to UHC. The report then describes key health financing decisions with an impact on equity in service coverage and financial protection, where issues of procedural fairness are particularly important. Next, it offers principles and criteria for designing and assessing the processes around these health financing decisions and provides suggestions for how to make them fairer. Finally, the report examines country experiences with diverse instruments that can be used to operationalize principles and criteria for fair processes in health financing decision-making.
    JEL: E6
    Date: 2023
  11. By: Karpavicius, Luiza (Department of Environmental Science, Aarhus University (ENVS/AU)); Chimeli, Ariaster (Departamento de Economia, Universidade de São Paulo)
    Abstract: Ecosystem degradation and contact with wildlife is often linked to infectious diseases such as COVID-19 and malaria, a major cause of death and incapacitation worldwide. This paper investigates a quasi-experiment involving two forest protection policies for the Brazilian Amazon region and their consequences to malaria incidence. The first inadvertently increased forest degradation in part of the Amazon, whereas the second curbed deforestation in the entire region. Using actual malaria case data distributed across space and over 17 years, we estimate the causal link between deforestation and malaria. The results imply that effective forest protection reduced malaria incidence by over 50%.
    Keywords: Malaria; deforestation; forest protection policies
    JEL: D04 I18 Q23 Q56 Q57 Q58
    Date: 2023–08–05
  12. By: Sulasula, Josephine
    Abstract: This research study examines the effects of social media addiction on the daily work performance of government employees in the Zamboanga Peninsula Region of the Philippines. Drawing upon the sampled government employees, data were collected through surveys and analyzed using statistical techniques. The study investigates the relationship between social media addiction and work performance. Results indicate a significant negative correlation between social media addiction and work performance among government employees in the region (r = -0.45, p
    Keywords: social media addiction, work performance, government employees, Zamboanga Peninsula Region
    JEL: I0 I1 I10 I18 I19 I2 I23 I3 I30 I31 M0 M00 M1 M10 M12 M54
    Date: 2023–07–17
  13. By: Baert, Stijn (Ghent University); Herregods, Jolien (Ghent University); Sterkens, Philippe (Ghent University)
    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
  14. By: Mariana Blanco; Darwin Cortés; Amalia Rodríguez-Valencia
    Abstract: We propose a laboratory experiment to understand how social exclusion affects the participants of this antisocial interaction in terms of performance and reported emotions. We adopt a widely used ostracism manipulation from psychology and take it to an experimental economics laboratory. We find that social exclusion events only affect lightly excluded participants and that this effect is explained by the emotions generated after exclusion. In addition, the victims of exclusion report reductions in the valence dimension of emotions, as do those who have the option to exclude but decide not to. The possibility of bystanders punishing potential offenders, the generalized disapproval of exclusion, and an extended approval of inclusion reduce the incidence of exclusion. This reduction comes at the cost of negative changes in the reported emotions of most participant types, but it does not translate into changes in performance in a task. Last, we find that previous exclusion increases the decision of former victims to ostracize
    Date: 2023–07–27
  15. By: Giulia Zacchia (Sapienza University of Rome); Izaskun Zuazu (Duisburg-Essen University)
    Abstract: This article contributes to the literature on wage discrimination by examining the consequences of sexual harassment in the workplace on wages for women in Europe. We model the empirical relationship between sexual harassment risk and wages for European women employees using individual-level data provided by the European Working Conditions Survey (EWCS, Eurostat). We find that sexual harassment risk has a negative and statistically significant effect on wages of -0.03% on average for women in Europe. However, our empirical analysis uncovers the importance of considering the dynamics of workplace power relations: analyzing individual-level data, we find evidence of a higher negative impact of sexual harassment risk on wages for women working in counter-stereotypical occupations. We conclude that the wage effect of hostile working conditions, mainly in terms of sexual harassment risk in the workplace, should be considered and monitored as a first critical step in making women be less vulnerable at work and increasing their bargaining power, thereby reducing inequalities in working conditions and pay in Europe.
    Keywords: Sexual harassment, wages, working conditions, Europe.
    JEL: J71 J31 J16 M52
    Date: 2023–05–08
  16. By: Christopher J. O'Leary (W.E. Upjohn Institute for Employment Research); Kenneth J. Kline (W.E. Upjohn Institute for Employment Research); Thomas A. Stengle (Retired); Stephen A. Wandner (National Academy of Social Insurance)
    Abstract: In this paper, we examine the reasons why unemployment insurance (UI) claims have declined so dramatically over the past three decades. The fall in the UI claims rate is concerning because it suggests a reduced countercyclical effectiveness of the UI program. Additionally, weekly initial UI claims are regarded as an important leading indicator of aggregate economic activity, so their meaning has changed. We use a Oaxaca (1973) decomposition approach to identify the main factors for the decline in claims. The procedure suggests what the level of claims would have been later in the period, had values of variables or parameters of the system been at levels observed earlier in the period. Our analysis of state-year data over the past three decades suggests that the decline in UI claims stems from changes in the industrial and occupational mix of employment interacting with changes in UI program features set by individual states. Employment declines in manufacturing and increases in the health-care and education workforce, along with lower potential UI duration and lower wage replacement rates, contribute to the decline in claims. This decline could be offset by federal rules for states to improve benefit access, replacement rates, and durations. Such changes could improve the relevance of UI to the labor market and help restore UI as meaningful social insurance against job loss and as an automatic stabilizer of the macroeconomy.
    Keywords: unemployment insurance (UI), applications for benefits, first claims, wage replacement rate, potential duration of benefits, industrial mix of employment, occupational mix of employment
    JEL: J65 J68 H76
    Date: 2023–04
  17. By: Francesco Ruggieri
    Abstract: I propose a novel argument to point identify economically interpretable intertemporal treatment effects in dynamic regression discontinuity designs (RDDs). Specifically, I develop a dynamic potential outcomes model and specialize two assumptions of the difference-in-differences literature, the no anticipation and common trends restrictions, to point identify cutoff-specific impulse responses. The estimand associated with each target parameter can be expressed as the sum of two static RDD outcome contrasts, thereby allowing for estimation via standard local polynomial tools. I leverage a limited path independence assumption to reduce the dimensionality of the problem.
    Date: 2023–07
  18. By: Erik A. Hembre; Robert A. Moffitt; James P. Ziliak
    Abstract: The federal government enacted massive spending in the Pandemic Recession. But was this spending scaled to the magnitude of the economic downturn? We examine the responsiveness of the safety net to the Pandemic Recession and compare it to that in the Great Recession. Using monthly state-level administrative caseload data from five large transfer programs–SNAP, TANF, Medicaid, SSI, and UI–and measuring responsiveness in the conventional way as the state-level caseload response to cross-state variation in measures of the business cycle–we find that the safety net response during the Pandemic Recession was greater than occurred during the Great Recession for the most important recessionary-relief programs–UI and SNAP. But we find that the two smaller programs, TANF and SSI, were less responsive during the Pandemic, and we find that Medicaid caseloads are generally unresponsive to the business cycle. We also consider the role of Pandemic state-level policies, such as school and business closures, on caseloads, finding that states with more strict government Pandemic policies had greater caseload increases.
    JEL: H75 I38
    Date: 2023–07
  19. By: Basu, Arnab K. (Cornell University); Chau, Nancy H. (Cornell University); Firsin, Oleg (Cornell University)
    Abstract: This paper unpacks the effects of social networks on monthly county-level COVID19 vaccinations in the US. To parse out short-term community-level externalities where people help each other overcome immediate access barriers, from learning spillovers regarding vaccine efficacy that naturally take time, we distinguish between the contemporaneous and dynamic network effects of vaccination exposure. Leveraging an extensive list of controls and network proxies including Facebook county-to-county links, we find evidence showing positive, stage-of-pandemic dependent contemporaneous friendship network effects. We also consistently find null dynamic network effect, suggesting that social exposure to vaccination has had limited effect on alleviating COVID vaccine hesitancy.
    Keywords: friendship network, COVID-19, vaccine uptake
    JEL: I12 D83 H12
    Date: 2023–07

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