nep-hea New Economics Papers
on Health Economics
Issue of 2023‒09‒04
thirteen papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. Cognitive Decline and Dynamic Selection By Darden, M.E.;
  2. When death was postponed: the effect of hiv medication on work, savings and marriage By Mette Ejrnæs; Esteban García-Miralles; Mette Gørtz; Petter Lundborg
  3. The Impact of a Disease-Specific Health Insurance Reform on Mortality By Menares, F.;; Muñoz, P.;
  4. Parenthood and Labor Market Outcomes: Evidence from Chile By Misty Heggeness; Ana Sofía León
  5. Drug Shortages: Empirical Evidence from France By Dubois, P.;; Majewska, G.;; Reig, V.;
  6. Welfare Losses from Wildfire Smoke: Evidence from Daily Outdoor Recreation Data By Gellman, Jacob; Walls, Margaret A.; Wibbenmeyer, Matthew
  7. A Guide to Impact Evaluation under Sample Selection and Missing Data: Teacher's Aides and Adolescent Mental Health By Simon Calmar Andersen; Louise Beuchert; Phillip Heiler; Helena Skyt Nielsen
  8. What predicts willingness to participate in a follow-up panel study among respondents to a national web/mail survey? By Saw, Htay-Wah; West, Brady; Couper, Mick P.; Axinn, William G.
  9. Deep spectral Q-learning with application to mobile health By Gao, Yuhe; Shi, Chengchun; Song, Rui
  10. Economic Impact of European Liver and Intestine Transplantation Association (ELITA) Recommendations for Hepatitis B Prophylaxis After Liver Transplantation By Paolo Angelo Cortesi; Raffaella Viganò; Sara Conti; Ilaria Lenci; Riccardo Volpes; Silvia Martini; Mario Angelico; James Fung; Maria Buti; Audrey Coilly; Francois Durand; Constantino Fondevila; Pascal Lebray; Frederik Nevens; Wojciech G Polak; Mario Rizzetto; Fabien Zoulim; Giovanni Perricone; Marina Berenguer; Lorenzo Giovanni Mantovani; Christophe Duvoux; Luca Saverio Belli
  11. 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
  12. Scarring through the German hyperinflation By Gregori Galofre-Vila
  13. The Robustness of Preferences during a Crisis: The Case of Covid-19 By Paul Bokern; Jona Linde; Arno Riedl; Peter Werner

  1. By: Darden, M.E.;
    Abstract: The age profile of cognitive skill decline, and the investments that shape it, are potentially confounded by non-random mortality. I frame this dynamic selection problem in the context of health capital (Grossman, 1972), and I estimate a general model of health investment, health, and mortality. Consistent with theory, I find substantially wider gaps in cognitive health by education, race, and smoking behavior relative to cross-sectional comparisons, in some cases by 100%. Furthermore, these gaps grow in age, which suggests that theories of cognitive decline need to accommodate differential rates of change in cognitive health.
    Keywords: health production; dynamic selection; cognitive skills; dementia; tobacco; disparities;
    JEL: I10 I12 J24
    Date: 2023–08
  2. By: Mette Ejrnæs (University of Copenhagen and CEBI); Esteban García-Miralles (Banco de España); Mette Gørtz (University of Copenhagen, CEBI and IZA); Petter Lundborg (IZA and Department of Economics, Lund University)
    Abstract: Longer life expectancy can affect individuals’ incentives to work, save and marry, net of any changes in their underlying health. We test this hypothesis by using the sudden arrival of a new treatment in 1995 that dramatically increased life expectancy for HIV-infected individuals. We compare the behavioural responses of HIV-infected individuals who were still in good health but who differed in their access to the new treatment. Those with access to treatment work substantially more, marry later, but do not save more. Our results highlight the importance of accounting for such incentive effects when valuing increases in life expectancy.
    Keywords: esperanza de vida, empleo, matrimonio, VIH
    JEL: D84 I12 J12 J21
    Date: 2023–06
  3. By: Menares, F.;; Muñoz, P.;
    Abstract: We study the impact of a healthcare reform that standardized procedures across health providers to guarantee the timely coverage of a set of diseases. Using the universe of death records from Chile and a difference-in-differences research design, we show that mortality from the diseases covered by this reform decreased by 4.4%. The impact was larger on deaths from diseases more amenable to health care, which decreased by 7.1%. Among inpatients with covered diseases, the reform led to a 6.9% decrease in deaths and a 15% increase in surgeries. Our results suggest that this reform increased life expectancy by 0.39 years, creating benefits that largely outweighed its costs.
    Keywords: health insurance; mortality; health reform;
    JEL: I13 I14 I15 I18
    Date: 2023–08
  4. By: Misty Heggeness; Ana Sofía León
    Abstract: Throughout the pandemic Chile implemented a series of public health mandates restricting mobility and high social-contact activities with a goal of reducing disease spread. In this paper, we study the impact of one of these policies - central planner variation in school re-openings on labor market outcomes. We examine how access to supervised care for children in school affected mothers’ labor supply and show that mothers increased labor force participation anywhere from 2.6 to 21.0 percentage points (ppts) as schools re-opened. As mothers came back to the labor force, however, unplanned disruptions decreased their ability to stay actively engaged in work and increased their take up of leave from work, an artifact of unanticipated sick children and quarantine policies that particularly affected mothers who were secondary earners in the household. Conditional on being in the labor force, having a teenager buffered both mothers and fathers from work disruptions; parents were more likely to be actively working and less likely to be on leave. Our findings support a theory that parental labor supply is sensitivity to disruptions in the care of children but also depends on household composition and each parent’s role beyond gender. Policies that encourage consistent formalized systems of care and learning for children will not only benefit children, but also a second-earner’s ability to re-enter the labor force and advance at work.
    Keywords: Gender; Cost of caregiving; Labor force participation; NPI policies
    JEL: J22 J16 J13
    Date: 2023–06–26
  5. By: Dubois, P.;; Majewska, G.;; Reig, V.;
    Abstract: Drug shortages are a problem widely documented around the world. We develop a simple method allowing to identify shortage events and their intensity using sales data at a national level. In the case of prescription drugs, shortages occur when the quantities supplied do not meet demand at regulated prices. Using sales data only, shortages that are driven by supply shocks affect only the lower distribution of sales quantities and can be identified using a demand prediction model estimated on sales observed above a given quantile threshold. We can then measure the likelihood and the magnitude of shortage events. We provide evidence that lower French prices increase the likelihood and magnitude of shortages in France. However, higher prices in the UK seem to have positive spillover effects on reducing the likelihood of shortages, while a negative one when shortages happen and there is competition for scarce resources internationally. Finally, we provide evidence on the heterogeneous effects of shortage reductions achievable through higher regulated prices in France.
    Keywords: drug shortages; prices; regulation; econometrics;
    JEL: L5 L65 I18
    Date: 2023–08
  6. By: Gellman, Jacob; Walls, Margaret A. (Resources for the Future); Wibbenmeyer, Matthew (Resources for the Future)
    Abstract: Wildfire smoke pollution is growing in the western United States. Estimates of its health impacts are numerous, but few revealed preference estimates of its damages exist. We study a setting where individuals are directly exposed to smoke, and avoidance behavior is measured with high frequency: outdoor recreation. We combine millions of administrative campground reservation records with satellite data on wildfire, smoke, and air pollution. These data are rich among most studies of recreation, with nearly 1, 000 campgrounds and detailed individual-level observations. The data allow us to model sequential recreation decisions under evolving information using a novel control function approach. We estimate that wildfire smoke reduces welfare by $107 per person per trip. Damages are larger when campgrounds are affected by consecutive days of smoke and attenuated when smoke events are sufficiently far from active fires. In total, 21.5 million outdoor recreation visits in the western United States are affected by wildfire smoke every year, with annual welfare losses of approximately $2.3 billion. These findings contribute to a growing body of evidence on the costs of wildfire smoke.
    Date: 2023–08–14
  7. By: Simon Calmar Andersen; Louise Beuchert; Phillip Heiler; Helena Skyt Nielsen
    Abstract: This paper is concerned with identification, estimation, and specification testing in causal evaluation problems when data is selective and/or missing. We leverage recent advances in the literature on graphical methods to provide a unifying framework for guiding empirical practice. The approach integrates and connects to prominent identification and testing strategies in the literature on missing data, causal machine learning, panel data analysis, and more. We demonstrate its utility in the context of identification and specification testing in sample selection models and field experiments with attrition. We provide a novel analysis of a large-scale cluster-randomized controlled teacher's aide trial in Danish schools at grade 6. Even with detailed administrative data, the handling of missing data crucially affects broader conclusions about effects on mental health. Results suggest that teaching assistants provide an effective way of improving internalizing behavior for large parts of the student population.
    Date: 2023–08
  8. By: Saw, Htay-Wah; West, Brady; Couper, Mick P.; Axinn, William G.
    Abstract: The American Family Health Study (AFHS) collected family health and fertility data from a national probability sample of persons aged 18–49 between September 2021 and May 2022, using web and mail exclusively. In July 2022, we surveyed AFHS respondents and gauged their willingness to become part of a national web panel that would create novel longitudinal data on these topics. We focus on predictors of willingness to participate, identifying the potential selection bias that this type of approach may introduce. We found that efforts of this type to create a national web panel may introduce potential selection bias in estimates based on the panel respondents, with individuals having higher socioeconomic status being more cooperative. Thus, alternative recruitment strategies and re-weighting of the subsample may be needed to further reduce selection bias. We present methodological implications of our results, limitations of our approach, and suggestions for further research on this topic.
    Date: 2023–07–27
  9. By: Gao, Yuhe; Shi, Chengchun; Song, Rui
    Abstract: Dynamic treatment regimes assign personalized treatments to patients sequentially over time based on their baseline information and time-varying covariates. In mobile health applications, these covariates are typically collected at different frequencies over a long time horizon. In this paper, we propose a deep spectral Q-learning algorithm, which integrates principal component analysis (PCA) with deep Q-learning to handle the mixed frequency data. In theory, we prove that the mean return under the estimated optimal policy converges to that under the optimal one and establish its rate of convergence. The usefulness of our proposal is further illustrated via simulations and an application to a diabetes dataset.
    Keywords: dynamic treatment regimes; mixed frequency data; principal component analysis; reinforcement learning
    JEL: C1
    Date: 2023–12–01
  10. By: Paolo Angelo Cortesi (UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca); Raffaella Viganò; Sara Conti (UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca); Ilaria Lenci; Riccardo Volpes; Silvia Martini; Mario Angelico; James Fung; Maria Buti; Audrey Coilly; Francois Durand; Constantino Fondevila; Pascal Lebray; Frederik Nevens; Wojciech G Polak; Mario Rizzetto; Fabien Zoulim (UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon - Centre Léon Bérard [Lyon] - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique, HCL - Hospices Civils de Lyon); Giovanni Perricone; Marina Berenguer; Lorenzo Giovanni Mantovani (UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca); Christophe Duvoux; Luca Saverio Belli
    Abstract: The European Liver and Intestine Transplant Association, ELITA, promoted a Consensus Conference involving 20 experts across the world which generated updated guidelines on HBV prophylaxis in liver transplant candidates and recipients. This study explores the economic impact associated with the implementation of the new ELITA guidelines. To this aim, a condition-specific cohort simulation model has been developed to compare new and historical prophylaxis, including only pharmaceutical cost and using the European perspective. The target population simulated in the model included both prevalent and incident cases, and consisted of 6, 133 patients after the first year, that increased to 7, 442 and 8, 743 patents after 5 and 10 years from its implementation. The ELITA protocols allowed a cost saving of around € 235.65 million after 5 years and € 540.73 million after 10 years; which was mainly due to early HIBG withdrawal either after the first 4 weeks or after the first year post Liver Transplantation (LT) depending on the virological risk at transplantation. Results were confirmed by sensitivity analyses. The money saved by the implementation of the ELITA guidelines would allow healthcare decision makers and budget holders to understand where costs could be reduced and resources re-allocated to different needs.
    Keywords: prophylaxis, hepatitis B, immunoglobulin (IgG), liver transplant, economics
    Date: 2023
  11. By: Mitrou, Francis; Nguyen, Ha Trong; Le, Huong Thu; Zubrick, Stephen
    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: 2023–08
  12. By: Gregori Galofre-Vila (Universitat de Valencia)
    Abstract: I study the link between the 1923 German hyperinflation and health by linking monthly data on the cost-of-living index with monthly infant and cause-specific adult mortality rates in 280 cities. By exploring panel data with a range of fixed effects, I find that hyperinflation boosted mortality rates. The largest increases in mortality came from rises in amenable mortality, which are cause-specific deaths plausibly linked to deteriorating social conditions over the short-term, such as deaths from influenza, meningitis, scarlet fever, tuberculosis, and whooping cough. I also rely on children's heights and weights to show that worsening health was related to impaired nutrition. The results are robust to a range of specifications, placebo tests, and Conley standard errors.
    Keywords: Hyperinflation, monetary policy, mortality, anthropometry, weimar
    JEL: N14 N34 N44 D7 D72
    Date: 2023–08
  13. By: Paul Bokern; Jona Linde; Arno Riedl; Peter Werner
    Abstract: We investigate how preferences have been affected by exposure to the COVID-19 crisis. Our main contributions are: first, our participant pool consists of a large general population sample; second, we elicited a wide range of preferences (risk, time, ambiguity, and social preferences) using different incentivized experimental tasks; third, we elicited preferences before the onset of the crises and in three additional waves during the crises over a time period of more than a year, allowing us to investigate both short-term and medium-term preference responses; fourth, besides the measurement of causal effects of the crisis, we also analyze within each wave during the crisis, how differential exposure to the crisis in the health and financial domain affects preferences. We find that preferences remain remarkably stable during the crisis. Comparing them before the start and during the crisis, we do not observe robust differences in any of the elicited preferences. Moreover, individual differences in the exposure to the crisis at best show only weak effects in the financial domain.
    Keywords: preference robustness, crisis, risk-, time-, ambiguity- and social preferences, Covid-19
    JEL: C90 D01
    Date: 2023

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