nep-hea New Economics Papers
on Health Economics
Issue of 2023‒09‒18
27 papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. The Economics of Abortion Policy By Clarke, Damian
  2. Monitoring for Waste: Evidence from Medicare Audits By Maggie Shi
  3. Gender Identity, Race, and Ethnicity-Based Discrimination in Access to Mental Health Care: Evidence from an Audit Correspondence Field Experiment By Fumarco, Luca; Harrell, Benjamin; Button, Patrick; Schwegman, David J.; Dils, E
  4. The Effects of Social Insurance Benefits on Leaving Employment at Older Ages in the Netherlands By Adriaan Kalwij; Arie Kapteyn
  5. The Impact of Learning Disabilities on Children and Parental Outcomes: Evidence from the Panel Study of Income Dynamics By Rachel Cummings; Maria Jose Luengo-Prado
  6. The Effect of Medicaid Expansion on the Take-up of Disability Benefits by Race and Ethnicity By Becky Staiger; Madeline S. Helfer; Jessica Van Parys
  7. Productivity Variation and Input Misallocation: Evidence from Hospitals By Amitabh Chandra; Carrie H. Colla; Jonathan S. Skinner
  8. Personality and physician performance pay: Evidence from a behavioral experiment in health By Groß, Mona; Hennig-Schmidt, Heike; Wiesen, Daniel
  9. Disadvantaging Rivals: Vertical Integration in the Pharmaceutical Market By Charles Gray; Abby E. Alpert; Neeraj Sood
  10. ``Invisible Killer'': Seasonal Allergies and Accidents By Hitoshi Shigeoka; Mika Akesaka
  11. An Ounce of Prevention for a Pound of Cure: Efficiency of Community-Based Healthcare By Bancalari, Antonella; Bernal, Pedro; Celhay, Pablo; Martinez, Sebastian; Sánchez, Maria Deni
  12. Maternal Dengue and Health Outcomes of Children By Martin Foureaux Koppensteiner; Livia Menezes
  13. Immigration Enforcement and the Institutionalization of Elderly Americans By Almuhaisen, Abdulmohsen; Amuedo-Dorantes, Catalina; Furtado, Delia
  14. Light cannabis as a substitute for addictive substances: A cross-sectional analysis of survey data in France and Italy By Davide Fortin
  15. Fear or Knowledge The Impact of Graphic Cigarette Warnings on Tobacco Product Choices By Donald S. Kenkel; Alan D. Mathios; Grace N. Phillips; Revathy Suryanarayana; Hua Wang; Sen Zeng
  16. A Replication of "When a Doctor Falls from the Sky: The Impact of Easing Doctor Supply Constraints on Mortality", Okeke E.N. (2023) By McManus, Emma; Richardson, Joseph; Wattal, Vasudha; Woodard, Ritchie
  17. Healthcare Quality by Specialists under a Mixed Compensation System: an Empirical Analysis By Damien Ãchevin; Bernard Fortin; Aristide Houndetoungan
  18. Climate, weather, and child health in Burkina Faso By Dasgupta, Shouro; Robinson, Elizabeth
  19. Extreme temperatures: Gender differences in well-being By Ignacio Belloc; J. Ignacio Giménez-Nadal; José Alberto Molina
  20. The effects of women's bargaining power on contraceptive use: Evidence from Zambia By Tamara Pressman
  21. Temperature and Maltreatment of Young Children By Mary F. Evans; Ludovica Gazze; Jessamyn Schaller
  22. Victimisation and Birth Outcomes By Livia Menezes; Martin Foureaux Koppensteiner
  23. Difference in differences with unpoolable data By Sunny Karim; Matthew Webb; Nicole Austin; Erin Strumpf
  24. Impact of COVID-19 Lockdown Measures on Chinese Startups and Local Government Public Finance: Challenges and Policy Implications By Xin Sun
  25. The robustness of preferences during a crisis: The case of COVID-19 By Bokern, Paul; Linde, Jona; Riedl, Arno; Werner, Peter
  26. Conditional Persistence? Historical Disease Exposure and Government Response to COVID-19 By Lindskog, Annika; Olsson, Ola
  27. Understanding the relationship between remote-working employees’ well-being and job-effectiveness during the COVID-19 pandemic By Mandeep Saini; Thomas Roulet

  1. By: Clarke, Damian (University of Chile)
    Abstract: This article provides a review of the economics of abortion policy. In particular, it focuses on the determinants of abortion reform, as well as the effects of abortion reform on individual circumstances. The economic literature on abortion policy is broad, studying abortion reforms that have occurred over the past two centuries, although there is a concentration of studies examining policy reform over the 20th and 21st centuries. The literature has examined a range of policies: both those which restrict access and those which legalise elective abortion, but within these two broad classes, the precise nature of policy reform can vary greatly. Policy reforms studied range from particular types of limits or financial barriers restricting access for particular age groups, up to policies which entirely criminalise or legalise elective abortion. The economic literature on abortion reform has illuminated a number of clear links, showing that increased availability of abortion decreases rates of undesired births, and vice versa when access to abortion is limited. These effects have been shown to have downstream impacts in many domains such as family formation, educational attainment, labour market attachment, as well as impacts on health, empowerment and well-being. There is mixed evidence when examining the impact which abortion reform has on cohorts of children exposed to reform variation. Much of what is known in the economic literature on abortion is gleaned from country-level case studies and cohort variation in access, with this evidence generated from a relatively small number of countries in which reforms have occurred and data is available. In general, much of the literature available covers low fertility and industralised settings. Additional evidence from other settings would allow for a more broad understanding of how abortion reform affects well-being.
    Keywords: abortion, contraceptives, labour markets, fertility, child outcomes, crime, health, political economy
    JEL: A33 I18 J10 K36 O57
    Date: 2023–08
  2. By: Maggie Shi
    Abstract: This paper examines the tradeoffs of monitoring for wasteful public spending. By penalizing unnecessary spending, monitoring improves the quality of public expenditure and incentivizes firms to invest in compliance technology. I study a large Medicare program that monitored for unnecessary healthcare spending and consider its effect on government savings, provider behavior, and patient health. Every dollar Medicare spent on monitoring generated $24–29 in government savings. The majority of savings stem from the deterrence of future care, rather than reclaimed payments from prior care. I do not find evidence that the health of the marginal patient is harmed, indicating that monitoring primarily deters low-value care. Monitoring does increase provider administrative costs, but these costs are mostly incurred upfront and include investments in technology to assess the medical necessity of care.
    JEL: H0 H00 H5 H50 H51 H53 H57 I0 I00 I1 I10 I11 I13 I18
    Date: 2023–08
  3. By: Fumarco, Luca (Masaryk University); Harrell, Benjamin (Trinity University); Button, Patrick (Tulane University); Schwegman, David J. (American University); Dils, E (YouthForce NOLA)
    Abstract: Racial, ethnic, and gender minorities face mental health disparities. While mental health care can help, minoritized groups could face discriminatory barriers in accessing it. Discrimination may be particularly pronounced in mental health care because providers have more discretion over accepting patients. Research documents discrimination broadly, including in access to health care, but there is limited empirical research on discrimination in access to mental health care. We provide the first experimental evidence, from a correspondence audit field experiment ("simulated patients" study), of the extent to which transgender and non-binary people, African Americans, and Hispanics face discrimination in access to mental health care appointments. We find significant discrimination against transgender or non-binary African Americans and Hispanics. We do not find evidence of discrimination against White transgender and non-binary prospective patients. We are mostly inconclusive as to if cisgender African Americans or Hispanics face discrimination, except we find evidence of discrimination against cisgender African American women.
    Keywords: mental health care, transgender, racial discrimination, audit, therapy
    JEL: C93 I14 J16 I11 I18 J15
    Date: 2023–08
  4. By: Adriaan Kalwij; Arie Kapteyn
    Abstract: In the Netherlands, from 1989 to 2013, in the age group 55-63 the annual exit rate from employment to receiving social insurance benefits in the following year decreased from around 17 percent to 7 percent for men, and from 14 percent to 5 percent for women. We found that less generous social insurance benefits have had small but significant negative effects on these exit rates: The annual exit rate to social insurance benefit receipt next year (at ages 56-64) would have been about 14 percent higher for both men and women in 2013 should social insurance benefits schemes of 1989 still have been in place. This increase amounts to staying, on average, three months longer in employment from age 55 onwards in 2013 than in 1989. These findings are driven to some extent by the reduction in the maximum duration of unemployment insurance benefits in 2007, but predominantly by making (early) retirement schemes actuarially fair from 2006 onwards. The increase in disability insurance’s income replacement rate in 2006 has led to a slight increase in the exit rate from employment, conditional on eligibility. As the estimated effects of changes in the social insurance benefits from 1989 to 2013 on working beyond age 55 are relatively small, they suggest the importance of other factors such as changes in workers’ skills, improved health (on which we provide some evidence), and social insurance’s tighter eligibility criteria.
    JEL: H0 J26
    Date: 2023–08
  5. By: Rachel Cummings; Maria Jose Luengo-Prado
    Abstract: We document the characteristics of children and young adults identified in the Panel Study of Income Dynamics as having a learning disability and study whether legislative changes in diagnosis criteria have had a noticeable effect determining who receives a diagnosis. We further document that children and young adults identified as a having a learning disability experience less desirable outcomes early in life, including trouble with the police, drug use, violent behavior, incarceration, self-reported low levels of well-being, lower educational attainment, and less favorable labor market outcomes. We also find that the mothers of children diagnosed with learning disabilities are less likely than other mothers to participate in the labor market.
    Keywords: learning disabilities; young adult outcomes; labor market outcomes
    JEL: I24 J24
    Date: 2023–07–01
  6. By: Becky Staiger; Madeline S. Helfer; Jessica Van Parys
    Abstract: Public disability programs provide financial support to 12 million working-age individuals per year, though not all eligible individuals take up these programs. Mixed evidence exists regarding the impact of Medicaid eligibility expansion on program take-up, and even less is known about the relationship between Medicaid expansion and racial and ethnic disparities in take-up. Using 2009-2020 Current Population Survey (CPS) data, we compare changes in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) take-up among people with disabilities living in Medicaid expansion states, compared to people with disabilities living in non-expansion states, before and after Medicaid expansion. We further explore heterogeneity by race/ethnicity. We find that Medicaid expansion reduced SSI take-up among White and Hispanic respondents by 10% and 21%, respectively, and increased SSDI take-up among White and Black respondents by 9% and 11%, respectively. We further find that Medicaid expansion reduced the probability that disabled respondents had employer-sponsored health insurance by approximately 8%, an effect primarily observed among Black and other-race respondents, suggesting that expansion reduced job-lock among the SSDI-eligible, contributing to the observed increase in SSDI take-up.
    JEL: I13 I14 J15 J22
    Date: 2023–08
  7. By: Amitabh Chandra; Carrie H. Colla; Jonathan S. Skinner
    Abstract: There are widespread differences in total factor productivity across producers in the U.S. and around the world. To help explain these variations, we devise a general test for misallocation in input choices – the underuse of effective inputs and overuse of ineffective ones. Misallocation implies that conditional on total input use, the return to using a particular input is not zero (a positive return implies underuse, and a negative return implies overuse). We measure misallocation across hospitals, where inputs and outputs are better measured than in other industries. Applying our test to a sample of 1.6 million Medicare beneficiaries with heart attacks (of which 436 thousand were admitted by ambulance), we reject the hypothesis of productive efficiency; moving a patient from a 10th percentile to a 90th percentile hospital with respect to misallocation, holding spending constant, is predicted to increase survival by 3.1 percentage points. With misallocation accounting for as much as 25 percent of the variation in hospital productivity, our results suggest that how the money is spent, rather than how much money is spent, is central to understanding productivity differences both in health care, and in the rest of the economy.
    JEL: E23 I1 I10
    Date: 2023–08
  8. By: Groß, Mona (Department of Health Care Management, University of Cologne, Germany); Hennig-Schmidt, Heike (Department of Economics, University of Bonn, Germany Departement of Health Economics and Health Management, University of Oslo, Norway); Wiesen, Daniel (Department of Health Care Management, University of Cologne, Germany)
    Abstract: We study how the heterogeneity in responses to performance pay can be explained by personality traits. We utilize data from behavioral experiments and surveys on personality traits with physicians, medical students, and non-medical students. Performance pay is introduced at a within-subject level and complements either fee-for-service or capitation. We find that the payment system matters regarding the behavioral impact of personality traits. More conscientious and more agreeable individuals provide higher quality of care under capitation. Although performance pay further improves the quality, more conscientious and agreeable individuals respond less to capitation-based performance pay. Other personality traits are not behaviorally relevant. Under fee-for-service-based schemes, personality traits do not significantly related to individuals’ behavior. Our findings inform the incentive design for physicians and the potential sorting into incentive schemes based on personality traits.
    Keywords: Fee-for-service; capitation; blended pay for performance; personality traits; quality of care; heterogeneity
    JEL: C91 I11
    Date: 2023–09–07
  9. By: Charles Gray; Abby E. Alpert; Neeraj Sood
    Abstract: The pharmaceutical market has experienced a massive wave of vertical integration between pharmacy benefit managers (PBMs) and health insurers in recent years. Using a unique dataset on insurer-PBM contracts, we document increasing vertical integration in Medicare Part D–vertically integrated insurers' market share increased from about 30% to 80% between 2010 and 2018. Next, we evaluate a large insurer-PBM merger in 2015 to assess the trade-offs of vertical integration–harms to competition due to input and customer foreclosure on the one hand and improved efficiency on the other. We find premium increases after the merger for insurers who bought PBM services from rivals, which is consistent with vertically integrated PBMs raising costs through input foreclosure.
    JEL: I1 I11 I13
    Date: 2023–08
  10. By: Hitoshi Shigeoka; Mika Akesaka
    Abstract: Although at least 400 million people suffer from seasonal allergies worldwide, the adverse effects of pollen on ``non-health'' outcomes, such as cognition and productivity, are relatively understudied. Using ambulance archives from Japan, we demonstrate that high pollen days are associated with increased accidents and injuries--one of the most extreme consequences of cognitive impairment. We find some evidence of avoidance behavior in buying allergy products but limited evidence in curtailing outdoor activity, implying that the cognitive risk of pollen exposure is discounted. Our results call for governmental efforts to raise public awareness of the risks and promote widespread behavioral change.
    Date: 2023–08
  11. By: Bancalari, Antonella (Institute for Fiscal Studies, London); Bernal, Pedro (Inter-American Development Bank); Celhay, Pablo (Pontificia Universidad Catolica de Chile); Martinez, Sebastian (International Initiative for Impact Evaluation (3ie)); Sánchez, Maria Deni (Inter-American Development Bank)
    Abstract: We study the efficiency in health systems generated by community health teams, a common strategy in low- and middle-income countries for primary healthcare delivery. We exploit the rollout of a nation-wide expansion of coverage to this model in El Salvador. Using a panel dataset of municipalities spanning 2009-2018 from consultation and hospital records of almost 4 million episodes, we show that investing in community-based healthcare, which relied on less-specialized health workers, led to a more efficient allocation of care. Preventive care increased and curative care and hospitalizations from preventable conditions decreased, while coverage in curative care for previously unattended chronic diseases increased.
    Keywords: community-based healthcare, efficiency, access
    JEL: I15 I18 H21 H51
    Date: 2023–07
  12. By: Martin Foureaux Koppensteiner (University of Surrey); Livia Menezes (University of Birmingham)
    Abstract: We study the effect of maternal dengue infections on birth outcomes using linked administrative records from Brazil estimating maternal fixed-effect specifications. In contrast to previous studies, we find robust evidence for the negative effect of dengue infections on birth weight (BW). The effect is particularly pronounced at lower parts of the BW distribution, with an increase of 15%, 67%, and 133% for low, very low, and extremely low BW, respectively. We also document large increases in children's hospitalizations and medical expenditures for up to three years after birth.
    JEL: I15 I18 J13
    Date: 2023–06
  13. By: Almuhaisen, Abdulmohsen (University of Connecticut); Amuedo-Dorantes, Catalina (University of California, Merced); Furtado, Delia (University of Connecticut)
    Abstract: This paper examines the relationship between immigration enforcement and institutionalization rates of the elderly. Exploiting the staggered implementation of the Secure Communities (SC) immigration enforcement program across U.S. counties from 2008 through 2014, we show that SC led to a 0.26 percentage points (6.8 percent) increase in the likelihood that Americans aged 65 and above live in an institution. Supportive of supply shocks in the household services market as a central mechanism, we find that the elderly who are most likely to purchase domestic worker services are also the most likely to move into nursing homes following the implementation of SC. Additionally, we find suggestive evidence of significant reductions in the work hours of housekeepers, personal care aids, and home health workers hinting at the critical role of negative supply shocks in occupations that facilitate aging in community.
    Keywords: secure communities, elder care, immigration enforcement, aging, nursing homes
    JEL: J14 J61 J68
    Date: 2023–07
  14. By: Davide Fortin (Aix-Marseille Université)
    Abstract: Cannabidiol-based products are attractive to consumers because of their wide range of potential health effects. Despite the hype of this market, there is a substantial lack of information on consumers' attitudes and motivations toward light cannabis products. We conducted an ad-hoc online survey to investigate the characteristics of French and Italian users, focusing on smoking as the main mode of consumption. Logistic regressions are performed to explain the factors associated to light cannabis use as a substitution for any drug or for a specific substance. Our results indicate that one out of five current light cannabis users use it as a substitute (self-replacement therapy) for other substances. The reduction in substance use is more prevalent for regular cannabis, tobacco, and medications than for alcohol use. However, the use of light cannabis seems to facilitate alcohol consumption reduction, mostly among males with low income. Whereas sublingual oils are more likely to be used to substitute medications, smoking is the favorite means of substitution for tobacco and regular cannabis. Overall, the motivations behind consumption determine differential preferences across light cannabis users. This calls for a rethinking of the most adequate distribution channels for specific products based on the purpose of use. The goal should be to maximize the substitution with other addictive substances by providing a differential degree of quality and taxation across supply channels based on the expected harm.
    Date: 2023–08–11
  15. By: Donald S. Kenkel; Alan D. Mathios; Grace N. Phillips; Revathy Suryanarayana; Hua Wang; Sen Zeng
    Abstract: Requiring graphic warning labels (GWLs) on cigarette packaging has become a highly contentious unresolved legal battle. The constitutionality depends, in part, on the likely impact of GWLs on smoking decisions, and whether they generate knowledge as opposed to emotional reactions against smoking. Using an online discrete choice stated preference experiment we compare tobacco choices (cigarettes, e-cigarettes, quitting) for those presented with a GWL versus the currently existing label. We find the fraction of individuals choosing cigarettes to be lower and quitting higher for the GWL group. Our findings reveal that the differences between groups were primarily driven by the evocation of fear and disgust rather than an improvement in health knowledge related to the GWL. The discrete choice experiment also provides new evidence on how cigarette prices, e-cigarette prices, and policy-manipulable e-cigarette attributes such as e-cigarette warning labels, and flavor availability influence tobacco product choices.
    JEL: I12
    Date: 2023–08
  16. By: McManus, Emma; Richardson, Joseph; Wattal, Vasudha; Woodard, Ritchie
    Abstract: Okeke (2023) evaluates a policy experiment conducted in Nigeria, whereby communities were randomly allocated to receive a new doctor at the local public health center. The performance of these centers was compared to other sites which were allocated either a new midlevel health-care provider, or no additional staff. The study finds that communities assigned a new doctor were associated with a decrease in seven-day infant mortality, such a decrease was not observed in communities assigned a midlevel health-care provider. This suggests that it is the 'quality' of the additional doctor driving the effects rather than due to a quantity increase of an additional health worker. The size of the mortality reduction increased with increased exposure to the intervention. We first conduct a computational reproduction, rerunning the original code and data, finding that the results reported in the original study are reproducible. Second, we test the robustness of the results in several ways, by 1) adapting the existing controls to make the results robust to contamination bias, 2) altering and adding to the control variables included, 3) changing the specification or regression technique used, and 4) testing coding grouping and changing how service use was coded. These changes cause little change to the point estimates, although we find that the original paper's standard errors were overly conservative, and thus the statistical significance of some results was understated.
    Date: 2023
  17. By: Damien Ãchevin; Bernard Fortin; Aristide Houndetoungan
    Abstract: We analyze the effects of a mixed compensation (MC) scheme for specialists on the quality of their healthcare services. To do so, we exploit a major reform that was implemented in Quebec (Canada) in 1999. The government introduced a payment mechanism combining a fixed per diem with a reduced fee per clinical service. Using panel patient-doctor data covering the period 1996-2016 and including 320, 441 patients, we estimate a multi-state multi-spell hazard model with correlated heterogeneity, analogous to a difference-in-differences approach. We compute three output-based quality indicators from our model. Our results suggest that the reform reduced the quality of MC specialist services as measured by the risk of re-hospitalization within 30 days after discharge and the risk of mortality within one year after discharge. These effects vary depending upon the specialty of the treating doctor. Nous analysons les effets d'un mode de rémunération mixte pour les médecins sur la qualité de leurs services cliniques. Pour ce faire, nous exploitons une réforme majeure mise en œuvre au Québec en 1999. Le gouvernement du Québec a introduit un mode de rémunération mixte combinant un per diem fixe et des tarifs à l'acte réduits pour le médecins spécialistes travaillant en établissement. En utilisant des données administratives panel patient-médecin couvrant la période 1996-2016 et incluant 320 441 patients, nous estimons un modèle de risque multi-état multi-épisode avec hétérogénéité corrélée au niveau individuel, analogue à une approche de différence en différences. Nous calculons trois indicateurs de qualité de services cliniques à partir de notre modèle. Nos résultats suggèrent que la réforme a réduit la qualité des services des médecins spécialistes en rémunération mixte, telle que mesurée par le risque de ré-hospitalisation dans les 30 jours suivant la sortie de l'hôpital du patient et le risque de mortalité dans l'année suivant la sortie de l'hôpital du patient. Ces effets varient en fonction de la spécialité du médecin traitant.
    Keywords: Mixed compensation, Quality of medical services, Hospital length-ofstay, Risk of re-hospitalization, Risk of death, Hazard model, Natural experiment, Rémunération mixte, Qualité des services médicaux, Durée du séjour à l'hôpital, Risque de ré-hospitalisation, Risque de décès, Modèle des risques, Expérience naturelle
    JEL: I10 I12 I18 C41
    Date: 2023–08–31
  18. By: Dasgupta, Shouro; Robinson, Elizabeth
    Abstract: It is now clear that anthropogenic climate change is having a negative impact on human health. In this paper, we provide the first comprehensive assessment of the impact of climatic stressors on child health in Burkina Faso. We undertake a rigorous empirical analysis of the impact of climate and weather shocks on mortality, stunting (height-for-age Z-score) and wasting (weight-for-age Z-score), using Demographic and Health Surveys, combined with high-resolution meteorological data, controlling for household and individual covariates. We find robust evidence that both lifetime and short-term exposure to high temperatures and droughts have a negative impact on child health, as do increased temperature anomalies during crop seasons, suggesting a link between climate and health through domestic food production. Income and household wealth, access to electricity, sanitation and a health facility for childbirth negate some adverse impacts of climate change. Combining our econometric estimates with updated CMIP6 scenarios, we compute policy-relevant projections of future child health. Our results show that future warming is projected to significantly increase child mortality, and share of underweight and stunted children, in all but the Paris Agreement scenario. Given the links between health, a key element of human capital, and economic growth, our findings and projections provide yet more evidence of the importance of a rapid reduction in global emissions combined with adaptation funding, if lower-income countries are to achieve poverty reduction and increasing prosperity.
    Keywords: Burkina Faso; child health; climate change; extreme weather events; socio-economic modifiers; stunting; wasting; Grantham Research Institute on Climate Change and the Environment; London School of Economics and Political Science; (European Cooperation in Science and Technology; Grant/Award Number: CA19390; Wiley deal
    JEL: I10 O55 Q51 Q54
    Date: 2023–08–08
  19. By: Ignacio Belloc (University of Zaragoza); J. Ignacio Giménez-Nadal (University of Zaragoza); José Alberto Molina (Departamento de Análisis Económico, Universidad de Zaragoza)
    Abstract: Climate change and global warming have significant implications for people worldwide, necessitating an understanding of how extreme weather conditions affect individuals. This study investigates the relationship between individual affective well-being and extreme temperatures, using data from the American Time Use Survey's Well-Being Module for multiple years. The analysis focuses on daily variations in weather conditions at the county level in the United States. Findings reveal gender-specific outcomes, with males being more susceptible to extreme temperatures. On days with maximum temperatures exceeding 80oF, males experience higher levels of fatigue and stress, as well as reduced happiness and meaningfulness, compared to days with temperatures around 70oF. The study suggests that the negative impact on males' sleep quality may contribute to these gender disparities. Additionally, warmer states have witnessed a decline in the male population over the past four decades. These results offer valuable insights into the gender-specific, affective well-being consequences of climate change, emphasizing the need for gender-sensitive approaches in designing comprehensive strategies for climate mitigation and adaptation.
    Keywords: gender, weather conditions, extreme temperatures, well-being, time use, United States
    JEL: I31 J16 Q54
    Date: 2023–08–27
  20. By: Tamara Pressman (McGill University)
    Abstract: This presentation aims to examine the relationship between women's household bargaining power and their adoption of modern contraception in Zambia, using the 2018 DHS survey data. Relying on direct measures of women's bargaining power (as indicated by the preexisting literature), which include a woman's ability to make decisions about her own healthcare, large household purchases, small household purchases, visits to her family and friends, and contraceptive use, as well as measures of her autonomous financial capability. This measure of financial capability is then interacted with a woman's ability to make healthcare decisions solely or jointly with her husband to shed additional light on the influence that bargaining power has on the uptake of modern contraceptive methods. Having both financial capability and the sole ability to make healthcare decisions for herself increases a woman's probability of adopting modern contraceptive methods by 87%, and having sole responsibility over contraceptive decisions increases it by approximately 56%. Using lasso as a robustness check, it is determined that the model is relatively well specified and has quite a large amount of explanatory power. Finally, the presentation uses a comparative analysis of spousal discord to demonstrate how spouses' often conflicting reports of intrahousehold decision making can impact key outcomes for women and finds that both spousal accord and the scenario in which the woman takes power are most effective for the adoption of modern contraception (leading to a 16.7% and 14.6% increase in the probability of using modern contraception, respectively). Overall, the study finds that several aspects of a woman's household decision making and financial freedom, as well as the degree and directionality of spousal discord within her household impact her probability of adopting modern contraceptive methods.
    Date: 2023–08–20
  21. By: Mary F. Evans; Ludovica Gazze; Jessamyn Schaller
    Abstract: We estimate the impacts of temperature on alleged and substantiated child maltreatment among young children using administrative data from state child protective service agencies. Leveraging short-term weather variation, we find increases in maltreatment of young children during hot periods. We rule out that our results are solely due to changes in reporting. Additional analysis identifies neglect as the temperature-sensitive maltreatment type, and we do not find evidence that adaptation via air conditioning mitigates this relationship. Given that climate change will increase exposure to extreme temperatures, our findings speak to additional costs of climate change among the most vulnerable.
    JEL: I31 J12 J13 Q54
    Date: 2023–08
  22. By: Livia Menezes (University of Birmingham); Martin Foureaux Koppensteiner (University of Surrey)
    Abstract: We estimate the causal effect of individual criminal victimisation in robbery and theft on birth outcomes using a unique dataset from Brazil combining information on the universe of victims of crime with vital statistics data. We find that victimisation during pregnancy reduces birth- weight by about 16 grams - 3 percent of a standard deviation in birthweight - and increases the likelihood of low and extremely low birthweight by about 8.5 and 30 percent, respectively, compared to the baseline. The results are robust to the inclusion of place of residence, maternal and time fixed effects and to the inclusion of a very large array of mother and pregnancy characteristics. We also show that victimisation leads to behavioural adjustments of mothers as we observe a reduction in the number of prenatal visits. Effects are stronger for individuals of lower socio-economic background, indicating that victimisation might contribute to the intergenerational transmission of poverty.
    JEL: I12 J13 K42 O12
    Date: 2023–06
  23. By: Sunny Karim (Carleton University); Matthew Webb (Carleton University); Nicole Austin (Carleton University); Erin Strumpf (Carleton University)
    Abstract: In this presentation, we describe a new Stata package called unpooled-DID. This procedure is useful when data from different jurisdictions cannot be combined for analysis because of legal restrictions or confidentiality laws. Through Monte Carlo simulation studies, this procedure has been shown to be equivalent to a variation of the conventional DID model when data are poolable. The canonical DID implicitly assumes that the data for the treated group and the control group can be combined. The combined dataset is used to generate a post and treat dummy variables, which are then interacted to estimate the ATT. We also require “poolable” data to verify parallel trends, a key assumption of DID. As a result, conducting DID analysis is nearly impossible using traditional methods when datasets are not combinable. The problem is pronounced for health economists, for whom legal restrictions in sharing administrative data can constrain DID analysis to learn of health systems. This package will make it easier for researchers who work with “unpoolable” data to conduct DID analysis. Furthermore, the package will also provide researchers with a plausibility check for pretreatment trends.
    Date: 2023–08–20
  24. By: Xin Sun
    Abstract: This paper aims to assess the impact of COVID-19 on the public finance of Chinese local governments, with a particular focus on the effect of lockdown measures on startups during the pandemic. The outbreak has placed significant fiscal pressure on local governments, as containment measures have led to declines in revenue and increased expenses related to public health and social welfare. In tandem, startups have faced substantial challenges, including reduced funding and profitability, due to the negative impact of lockdown measures on entrepreneurship. Moreover, the pandemic has generated short- and long-term economic shocks, affecting both employment and economic recovery. To address these challenges, policymakers must balance health concerns with economic development. In this regard, the government should consider implementing more preferential policies that focus on startups to ensure their survival and growth. Such policies may include financial assistance, tax incentives, and regulatory flexibility to foster innovation and entrepreneurship. By and large, the COVID-19 pandemic has had a profound impact on both the public finance of Chinese local governments and the startup ecosystem. Addressing the challenges faced by local governments and startups will require a comprehensive approach that balances health and economic considerations and includes targeted policies to support entrepreneurship and innovation.
    Date: 2023–08
  25. By: Bokern, Paul (RS: GSBE UM-BIC, Microeconomics & Public Economics, RS: GSBE other - not theme-related research); Linde, Jona (RS: GSBE UM-BIC, Microeconomics & Public Economics); Riedl, Arno (RS: GSBE UM-BIC, Microeconomics & Public Economics); Werner, Peter (RS: GSBE UM-BIC, Microeconomics & Public Economics)
    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.
    JEL: C90 D01
    Date: 2023–08–31
  26. By: Lindskog, Annika (Department of Economics, School of Business, Economics and Law, Göteborg University); Olsson, Ola (Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: In this paper, we investigate differences in government responses to the COVID-19 pandemic. Drawing on the theory of the Behavioral Immune System and the Para-site Stress Theory, we hypothesize that a higher historical disease exposure leads to a stricter government response to the pandemic, in particular during the first year which was characterized by fundamental uncertainty. Our empirical analysis, using weekly panel data for almost every country in the world, show that a higher historical disease exposure is indeed related to a stronger response to disease dynamics, at least in the first year of the pandemic. The pattern is the same for state-level containment policies within the United States. Our results suggest that the persistence of historical legacies may not be deterministic, but rather time-varying and conditional on circumstances. Cultural norms may matter more in times of crisis and fundamental uncertainty.
    Keywords: COVID-19; cultural persistence; pathogen prevalence; containment policy; behavioral immune system
    JEL: H12 I18 Z18
    Date: 2023–08
  27. By: Mandeep Saini; Thomas Roulet (Cambridge Judge Business School, University of Cambridge)
    Abstract: While extensive research has been done to understand the relationship between employees’ wellbeing and job-effectiveness, the research is limited and inconclusive for a remote-working context. This mixed-methods study investigates the unique context of COVID-19-induced remote working to understand that relationship and its influencing factors, and help shape remote working in the future. The research was carried out at a medium-size, not-for-profit organization, using a subjective assessment for measuring employees’ job-effectiveness and four sub-variables to measure their well-being: job satisfaction, stress level, work-life balance, and general health. The study finds a positive correlation between employees’ well-being and job-effectiveness; however, the results indicate a stronger correlation for decline in well-being and job-effectiveness. It identifies three types of factors which have impacted the employees’ well-being and jobeffectiveness while working remotely during the COVID-19 pandemic: organizational (organisational support and preparedness, communication, and job type), external (caring responsibilities, lack of social interaction, closed activities, and travel restrictions) and individual (personality traits, lack of commute, healthy habits, career stage/skill level, home-working environment, and time-planning flexibility and control). The study proposes a set of recommendations for practitioners in relation to remote working, including adopting a flexible approach that allows for individual differences.
    Date: 2022–01

This nep-hea issue is ©2023 by Nicolas R. Ziebarth. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.