nep-hea New Economics Papers
on Health Economics
Issue of 2023‒09‒11
twelve papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. Seasonal patterns in newborns’ health: quantifying the roles of climate, communicable disease, economic and social factors By Doyle, Mary-Alice
  2. ‘Fear of the Light’? Transparency does not reduce the effectiveness of nudges. A data-driven review By Hendrik Bruns; Adrien Fillon,; Zacharias Maniadis; Yavor Paunov
  3. The gender composition of supervisor-worker dyads: Career blocks and gender pay gap By Paola Profeta; Giacomo Pasini; Valeria Maggian; Ludovica Spinola
  4. Parental Health Penalty on Adult Children's Employment: Gender Difference and Long-Term Consequence By Jiayi Wen; Haili Huang
  5. Risk Preferences Over Health: Empirical Estimates and Implications for Healthcare Decision-Making By Karen Mulligan; Drishti Baid; Jason N. Doctor; Charles E. Phelps; Darius N. Lakdawalla
  6. Effective community mobilization: Evidence from Mali By Maria Laura Alzua; Juan-Camilo Cardenas; Habiba Djebbari
  7. The Causal Factors Driving the Rise in U.S. Health-services Prices By Feldman, Maria; Pretnar, Nick
  8. The Impact of Vaccines and Behavior on U.S. Cumulative Deaths from COVID-19 By Andrew Atkeson
  9. Turning worries into performance: Results from an online experiment during COVID By Eva Raiber; Daniela Horta Saenz; Timothée Demont
  10. Higher Chronic Absenteeism Threatens Academic Recovery from the COVID-19 Pandemic By Dee, Thomas Sean
  11. COVID-19 Lockdowns, Women's Employment, and the Motherhood Penalty: Evidence from the Philippines By Geoffrey M. Ducanes; Vincent Jerald Ramos
  12. Delayed learning to read and write during the COVID-19 pandemic: longitudinal study of the heterogeneous effects on all first graders in France By Heidmann, Laure; Neirac, Lucie; Andreu, Sandra; Conceiçao, Pierre; Eteve, Yann; Fabre, Marianne; Vourc'h, Ronan

  1. By: Doyle, Mary-Alice
    Abstract: Poor health at birth can have long-term consequences for children’s development. This paper analyses an important factor associated with health at birth: the time of year that the baby is born, and hence seasonal risks they were exposed to in utero. There are multiple potential explanations for seasonality in newborns’ health. Most previous research has examined these in isolation. We therefore do not know which explanations are most important – and hence which policy interventions would most effectively reduce the resulting early-life inequalities. In this paper, I use administrative data to estimate and compare the magnitudes of several seasonal risks, seeking to identify the most important drivers of seasonality in the Northern Territory of Australia, a large territory spanning tropical and arid climates and where newborn health varies dramatically with the seasons. I find that the most important explanations are heat exposure and disease prevalence. Seasonality in food prices and road accessibility have smaller effects on some outcomes. Seasonal fertility patterns, rainfall and humidity do not have statistically significant effects. I conclude that interventions that protect pregnant women from seasonal disease and heat exposure would likely improve newborn health in the Northern Territory, with potential long-term benefits for child development. It is likely that similar impacts would apply in other locations with tropical and arid climates, and that, without action, climate change will accentuate these risks.
    Keywords: birth outcomes; season; heat exposure; influenza; STI; Elsevier deal
    JEL: J13 I12 Q54
    Date: 2023–12–01
  2. By: Hendrik Bruns; Adrien Fillon,; Zacharias Maniadis; Yavor Paunov
    Abstract: Does transparency reduce the effectiveness of nudges? The question is central in recent research about nudges, since it leads to ethical and practical implications regarding responsibility, agency, the design of nudges and policy-making. We meta-analysed results from 19 studies comparing transparent to opaque nudges and found no difference in the effectiveness of the nudge. We then tested several moderators such as the type of experiment (Online, Laboratory, Field), Category (structure, information, assistance) and domain (environment, food, health, pro-social and other) and found no meaningful moderator. We note that only two studies were conducted in the field and that there is an over-representation of default nudges in the studies included. We call for an improvement of research conducted on transparent nudges and the inclusion of more types of nudges, preferably in a field setting. It is also important to define what form of transparency societies require for respecting their citizen’s autonomy.
    Keywords: nudge, transparency, meta-analysis, review
    Date: 2023–08–21
  3. By: Paola Profeta (Bocconi University); Giacomo Pasini (Université de Venise Ca' Foscari); Valeria Maggian (Université de Venise Ca' Foscari); Ludovica Spinola (Université de Venise Ca' Foscari)
    Abstract: We present how the gender composition of supervisor–worker dyads affects workers' outcomes. We use fine-grained longitudinal personnel data on workers from an Italian insurance company over the period 2014–2021 and assign to each worker the gender of the direct supervisor. We implement an individual worker's fixed-effect model, together with a dichotomous variable that captures pre- and post- COVID-19 period and time-varying individual characteristics. Our findings show that, although both male and female managers evaluate similarly the performance of male and female workers, female supervisors grant-lower amount of one-off bonus than male managers to both male and female workers. Moreover, both male and female workers have a lower probability of receiving a promotion from an employee of level VI to middle-managers when the manager is a female.s When exploiting a heterogeneous analysis by gender, results confirm that the gender of the supervisors does not affect workers' performance assessments, while it negatively impacts the total amount of bonus of both male and female workers. We interpret these results as evidence either that female managers are more severe to conform to a masculine gender stereotype associated with a leadership position that female managers are at the head of marginal areas and offices and hence receive less funds to provide bonuses and promotions to workers they supervise.
    Date: 2023–08–11
  4. By: Jiayi Wen (Xiamen University); Haili Huang (Xiamen University)
    Abstract: This paper examines the long-term gender-specific impacts of parental health shocks on adult children's employment in China. We build up an inter-temporal cooperative framework to analyze household work decisions in response to parental health deterioration. Then employing an event-study approach, we establish a causal link between parental health shocks and a notable decline in female employment rates. Male employment, however, remains largely unaffected. This negative impact shows no abatement up to eight years that are observable by the sample. These findings indicate the consequence of ``growing old before getting rich'' for developing countries.
    Keywords: Gender Inequality; Female Labor Supply; Health Shock; Aging
    JEL: D13 I10 J22 O15
    Date: 2023–08–18
  5. By: Karen Mulligan; Drishti Baid; Jason N. Doctor; Charles E. Phelps; Darius N. Lakdawalla
    Abstract: Recent research has documented a link between consumer risk preferences over health and the willingness to pay (WTP) for medical technologies. However, the absence of empirical health risk preference estimates so far limits the implementation of this generalized risk-adjusted cost-effectiveness (GRACE) theory, which addresses several limitations of traditional cost-effectiveness analysis (CEA). To address this gap, we elicit from a nationally representative U.S. sample individual risk preference parameters over health-related quality of life (HRQoL) that shed light on health risk attitudes and enable GRACE valuation of medical technology. We find individuals exhibit risk-seeking preferences at low levels of health, switch to risk-averse preferences at health equal to 0.485 (measured on a zero to one scale), and become most risk-averse when their health is perfect (coefficient of relative risk aversion = 4.36). The risk preference estimates imply an empirical premium for disease severity: each unit of health is worth three times more to patients with serious health conditions (health equals 0.5) than those who are perfectly healthy. They also imply that traditional CEA overvalues treatments for the mildest diseases by more than a factor of two. Use of traditional CEA both overstimulates mild disease treatment innovation and underprovides severe disease treatment innovation.
    JEL: I11 I18
    Date: 2023–08
  6. By: Maria Laura Alzua (Universidad de La Plata); Juan-Camilo Cardenas (Universidad de los Andes); Habiba Djebbari (Aix Marseille Université Économiques)
    Abstract: Experts argue that adoption of healthy sanitation practices such as handwashing and latrine use requires focusing on the whole community rather than on individual behaviors. According to this view, one limiting factor for ending open defecation lies in the capacity of the community for collective action: Each member of a community bears the private cost of contributing by washing hands and using latrines, but benefits through better health outcomes depend on whether other community members also opt out from open defecation. We rely on a community-based intervention carried out in Mali as an illustrative example (Community Led Total Sanitation or CLTS). Using a series of experiments conducted in 121 villages and designed to measure the willingness of community members to contribute to a local public good, we investigate the process of participation in a collective action problem setting. Our focus is on two types of activities: gathering of community members to encourage public discussion of the collective-action problem and facilitating the adoption of individual actions to attain the socially preferred outcome. When the facilitator starts by introducing a topic and a group discussion follows, can the facilitator further improve outcomes? Will a group discussion that follows facilitation improve, reduce, or have no effect on collective action? We find evidence that cheap talk raises public good provision and that facilitation by a community member does not improve upon open discussion.
    Date: 2023–08–11
  7. By: Feldman, Maria; Pretnar, Nick
    Abstract: We explore several possible avenues which have driven the rise in aggregate U.S. health-services prices since the mid-twentieth century. Our multi-sector general equilibrium model is structural change meets health macro, featuring endogenous population aging, market concentration in the health sector, and differential rates of sectoral technological change. The rise in the relative price of health services is almost exclusively a result of increasing market concentration in the health services sector, as well as slow health-sector TFP growth. Rising health prices have had no impact on life expectancy. Further, our results partially challenge the idea that population aging is responsible for dampening GDP growth rates. While health-sector TFP grows slowly, this is offset by gains to the efficiency of converting health investment to healthy outcomes which leads to increases in expenditure and higher rates of GFP growth.
    Keywords: health services, market concentration, health prices, growth, structural change, aging
    JEL: I1 L1 O3 O4
    Date: 2023–07–06
  8. By: Andrew Atkeson
    Abstract: The CDC reports that 1.13 million Americans have died of COVID-19 through June of 2023. I use a model of the impact over the past three years of vaccines and private and public behavior to mitigate disease transmission during the COVID-19 pandemic in the United States to address two questions. First, holding the strength of the response of behavior to the level of daily deaths from COVID-19 fixed, what was the impact of vaccines on cumulative mortality from COVID-19 up through June 2023? And second, holding the pace of deployment of vaccinations fixed, what would have been the impact of stricter or looser behavioral responses to COVID-19 deaths on cumulative mortality from COVID-19 over this same time period? In answering the first question, I find that vaccines saved 748, 600 lives through June 2023. That is, without vaccines, cumulative mortality from COVID-19 would have been closer to 1.91 million over this time period. In answering the second question, I find that behavioral efforts to slow the transmission of the virus before vaccines became widely administered were critical to this positive impact of vaccines on cumulative mortality. For example, with a complete relaxation of these mitigation efforts, vaccines would have come too late to have saved a significant number of lives. Earlier deployment of vaccines would have saved many lives. I find that marginal changes in the strength of the behavioral response to COVID-19 deaths within the range of those responses estimated with the model have a significantly impact on cumulative COVID-19 mortality over this time period.
    JEL: I00 I12
    Date: 2023–08
  9. By: Eva Raiber (Aix-Marseille School of Economics and Center for Economic Policy Research); Daniela Horta Saenz (Aix-Marseille School of Economics); Timothée Demont (Aix Marseille Université Économiques)
    Abstract: Worrisome topics, such as climate change, economic crises, or the COVID-19 pandemic are increasingly present and pervasive because of digital media and social networks. Do worries triggered by such topics affect the cognitive capacities of the youth? In an online experiment during the COVID-19 pandemic (N=1503), we test how the cognitive performance of university students responds when exposed to topics discussing current mental health issues related to social restrictions or future labor market uncertainties linked to the economic contraction. Moreover, we study how such response is affected by a performance goal. We find that the labor market topic increases cognitive performance when the latter is motivated by a goal. The positive reaction is mainly concentrated among students with larger financial and social resources, which points to an inequality-widening mechanism. Conversely, we find no effect after the mental health topic. We even find a weak negative response among those mentally vulnerable when payout is not conditioned on reaching a goal.
    Date: 2023–08–11
  10. By: Dee, Thomas Sean (Stanford University)
    Abstract: The broad and substantial educational harm caused by the COVID-19 pandemic has motivated large federal, state, and local investments in academic recovery. However, the success of these efforts depends in part on students’ regular school attendance. Using newly collected data, I show that the rate of chronic absenteeism among U.S. public-school students grew substantially as students returned to in-person instruction. Specifically, between the 2018-19 and 2021-22 school years, the share of students chronically absent grew by 13.5 percentage points—a 91-percent increase that implies an additional 6.5 million students are now chronically absent. Enrollment loss, COVID-19 case rates, and school masking policies are not associated with the state-level growth in chronic absenteeism. This suggests the sharp rise in chronic absenteeism reflects other important barriers to learning (e.g., declining youth mental health, academic disengagement) that merit further scrutiny and policy responses.
    Date: 2023–08–10
  11. By: Geoffrey M. Ducanes (Department of Economics, Ateneo de Manila University); Vincent Jerald Ramos (Humboldt University Berlin, Hertie School of Governance)
    Abstract: Using labor force survey (LFS) data collected before and during the COVID-19 lockdowns in the Philippines, we show that hard lockdowns have a larger negative impact on the employment of women who have minor children compared to women who do not have minor children. Among Southeast Asian countries, the Philippines is among the hardest-hit by the pandemic, in terms of both the number of infected and its economic toll. A big reason for the relatively large negative economic toll of the pandemic on the country is the extreme and militarized lockdown imposed at the onset of the pandemic in the country's three most populous and economically-important regions, namely Metro Manila, CALABARZON, and Central Luzon. Using difference-in-differences on pooled LFS data, we show that female household heads or spouses with children were significanlty less likely to have work during the hard lockdown compared to female household heads or spouses without children, even after controlling for important covariates. Among women with children, the employment losses are larger the greater number of children a woman has, suggesting a lockdown-induced motherhood penalty in the labor market. A big part of the explanation is the increased care responsibilities disproportionately done by mothers during hard lockdowns, given that children are forced to be at home and to do distance learning. We contribute to the literature on the gendered effects of COVID-19 lockdowns in a developing country.
    Keywords: female employment, Covid-19, hard lockdown, motherhood penalty
    JEL: J16 J21 J23
    Date: 2023–06
  12. By: Heidmann, Laure; Neirac, Lucie; Andreu, Sandra; Conceiçao, Pierre; Eteve, Yann; Fabre, Marianne; Vourc'h, Ronan
    Abstract: In March 2020, schools in France closed for two months due to the COVID-19 pandemic. Using data from the national assessments, we measure the impact of this unprecedented crisis on the learning of 800, 000 students who were in first grade during the school closures. We show that students' learning progress dropped after the lockdown by 10% standard deviation from a normal year in mathematics, and even more dramatically in French with a decrease of 15% standard deviation. The crisis exacerbated pre-existing inequalities since students from disadvantaged schools were the most affected. We also find that the effects are particularly strong in domains where the school plays a fundamental role in reducing social inequalities in early learning, namely reading and writing.
    Date: 2023–04–06

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