nep-hea New Economics Papers
on Health Economics
Issue of 2023‒10‒02
thirteen papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. Graying and staying on the job: The welfare implications of employment protection for older workers By Todd Morris; Benoit Dostie
  2. Do Cops Know Who to Stop? Assessing Optimizing Models of Police Behavior with a Natural Experiment By David Abrams; Hanming Fang; Priyanka Goonetilleke
  3. “Invisible Killer”: Seasonal Allergies and Accidents By Mika Akesaka; Hitoshi Shigeoka
  4. Impacts of Certificate-of-need State Laws on Substance Abuse Treatment Facilities and Services By Shishir Shakya; Christine Bretschneider Fries
  5. Summertime and the drivin’ is easy? Daylight saving time and vehicle accidents By Laliotis, Ioannis; Moscelli, Giuseppe; Monastiriotis, Vassilis
  6. I've Got 99 Problems But a Bill Ain't One: Hospital Billing Caps and Financial Distress in California By Yaa Asoka Antwi; Marion Aouad; Nathan Blascak
  7. Higher education and mortality: legacies of an authoritarian college contraction By Felipe Gonzalez; Luis R. Martinez; Pablo Munoz; Mounu Prem
  8. Are You Okay? Effects of a National Peer-Support Campaign on Mental Health By Nicole Black; Lachlan Deer; David W. Johnston; Johannes S. Kunz
  9. The Value of Communication for Mental Health By Francis Annan; Belinda Archibong
  10. Everyday administrative burdens and inequality By Martin, Lucie; Delaney, Liam; Doyle, Orla
  11. Attitudes to long-term care in India By Alberts, Sweedal; Nadarajah, Abinaya; Cooper, Claudia; Brijnath, Bianca; Loganathan, Santosh; Varghese, Matthew; Antoniades, Josefine; Baruah, Upasana; Dow, Briony; Kent, Mike
  12. Decentralized Purchasing of Essential Medicines and Its Impact on Availability, Prices, and Quality: A Review of Current Evidence By Lyudmila Nepomnyashchiy; Prashant Yadav
  13. India’s Medical Devices Sector: A Window of Opportunity for South Korea By Singh, Ram

  1. By: Todd Morris; Benoit Dostie
    Abstract: We study the welfare implications of employment protection for older workers, exploiting recent bans on mandatory retirement across Canadian provinces. Using linked employer-employee tax data, we show that the bans cause large and similar reductions in job separation rates and retirement hazards at age 65, with further reductions at higher ages. The effects vary substantially across industries and firms, and around two-fifths of the adjustments occur between ban announcement and implementation dates. We find no evidence that the demand for older workers falls, but the welfare effects are mediated by spillovers on savings behavior, workplace injuries, and spousal retirement timing.
    Keywords: employment protection; retirement; welfare; active and passive savings responses; health effects; spousal spillovers
    JEL: J26 J78 H55
    Date: 2023
  2. By: David Abrams; Hanming Fang; Priyanka Goonetilleke
    Abstract: The standard economic model of police stops implies that the contraband hit rate should rise when the number of stops or searches per officer falls, ceteris paribus. We provide empirical corroboration of such optimizing models of police behavior by examining changes in stops and frisks around two extraordinary events of 2020: the COVID-19 pandemic onset and the nationwide protests following the killing of George Floyd. We find that hit rates from pedestrian and vehicle stops generally rose as stops and frisks fell dramatically. Using detailed data, we are able to rule out a number of alternative explanations, including changes in street population, crime, police allocation, and policing intensity. We find mixed evidence about the changes in racial disparities, and evidence that police stops do not decrease crime, at least in the short run. The results are robust to a number of different specifications. Our findings provide quantitative estimates that can contribute to the important goals of improving and reforming policing.
    JEL: J14 K0
    Date: 2023–08
  3. By: Mika Akesaka; Hitoshi Shigeoka
    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 suggest that policymakers may wish to consider programs to raise public awareness of the risk and promote behavioral change.
    JEL: I12 J24 Q51 Q53 Q54
    Date: 2023–08
  4. By: Shishir Shakya; Christine Bretschneider Fries
    Abstract: We investigate how the Certificate-of-need laws influence access to substance abuse treatment facilities in the United States. First, we use the National Directory of Drug and Alcohol Abuse Treatment Facilities dataset, which lists all federal, state, and local government facilities and private facilities that provide substance abuse treatment services in 2020. We also use Geocodio, a geocoding tool, to determine the precise locations of these facilities. Next, we develop a novel access index that accounts for both driving distance and travel time to measure the ease of reaching these facilities for individuals living at the population-weighted county centroids. Our findings indicate that counties located in states with Certificate-of-need laws have 10% lower access to substance abuse treatment services compared to their neighboring counties in states without such regulations. Key Words: Certificate-of-need laws, Substance abuse treatment services, Spatial accessibility
    Date: 2023
  5. By: Laliotis, Ioannis; Moscelli, Giuseppe; Monastiriotis, Vassilis
    Abstract: We investigate how exogenous variation in daylight caused by Daylight Saving Time affects road safety as measured by the count of vehicle crashes. We use administrative daily data from Greece covering the universe of all types of recorded vehicle accidents during the 2006–2016 period. Our regression discontinuity estimates support an ambient light mechanism that reduces the counts of serious vehicle accidents during the Spring transition and increases the count of minor ones during the Fall transition. The effects are driven from the hour intervals that are mostly affected from seasonal clock changes. We then discuss the potential cost implications of those seasonal transitions. In light of the talks about abolishing seasonal clock changes in the European Union (EU), our findings are policy relevant and can inform the public debate as empirical evidence for the block is scarce.
    Keywords: daylight saving time; regression discontinuity; vehicle accidents
    JEL: I12 I18 R41
    Date: 2023–10–01
  6. By: Yaa Asoka Antwi; Marion Aouad; Nathan Blascak
    Abstract: We examine the financial consequences of the 2007 California Fair Pricing Law (FPL), a law that places a price ceiling on hospital bills for uninsured and financially vulnerable individuals. Using difference-in difference-in-differences models, we exploit cross-sectional variation in exposure to the law to estimate the causal effects of the FPL on different measures of financial distress. We find that the law reduces the medical and non-medical debt burden of individuals targeted by the law, with the likelihood of incurring non-medical debt in collections declining by 14.5 percent and the number of non-medical collections declining by 31 percent. The law also reduces the probability of having medical and non-medical debt balances between $1 and $1, 000 in collections by 16.5 percent and 40 percent, respectively. Our results suggest that hospital billing regulations have direct and indirect effects on the personal financial outcomes of uninsured and financially vulnerable individuals.
    Keywords: inancial distress; consumer credit; hospitals; health care
    JEL: G51 I18 H75
    Date: 2023–09–19
  7. By: Felipe Gonzalez (Queen Mary University); Luis R. Martinez (University of Chicago); Pablo Munoz (University of Chile); Mounu Prem (Einaudi Institute)
    Abstract: We provide new evidence on the causal effect of higher education on mortality. Our empirical strategy exploits the reduction in college openings introduced by the Pinochet regime after the 1973 coup in Chile, which led to a sharp downward kink in college enrollment among those cohorts reaching college age in the following years. Using administrative data from the vital statistics, we document an upward kink in the age-specific yearly mortality rate of individuals in the affected cohorts. We estimate a negative effect of college on mortality between ages 34-74, which is larger for men, but also sizable for women. Individuals in the affected cohorts experience worse labor market outcomes, are more likely to be enrolled in the public health system, and report lower consumption of health services. This suggests that economic disad-vantage and limited access to care play an important mediating role in the link between higher education and mortality.
    Date: 2023–09–18
  8. By: Nicole Black (Monash University); Lachlan Deer (Tilburg University); David W. Johnston (Monash University); Johannes S. Kunz (Monash University)
    Abstract: Peer-to-peer support is often a critical component of mental health programs, but evidence on the effect of peer-based support programs at scale is limited. Using quasi-experimental methods, we examine whether a prominent peer-based support campaign, “R U OK? Day”, affects short-term mental health outcomes in Australia. Using variation in daily records and differences in the campaign’s intensity over nine years, we find no evidence that “R U OK? Day” reduces suicides and suicidal behaviours in the month after the campaign. However, we find positive effects on mental wellbeing, particularly among middle-aged males, with improved social support the likely mechanism. Our results provide evidence that peer support campaigns may be a practical, low-cost approach to improve population mental wellbeing.
    Keywords: Peer-to-Peer, Mental Health, Program Evaluation, Suicide Prevention
    JEL: I10 I30
    Date: 2023–09
  9. By: Francis Annan; Belinda Archibong
    Abstract: Mental health disorders account for a significant share of the overall global disease burden. The economic losses from such disorders are staggeringly large, particularly in low-income countries, where people are faced with several unexpected shocks. We test whether improved communication can mitigate such mental health disorders. Partnering with a major telecommunications company, we implement low-cost communication interventions that provide mobile calling credits to a nationally representative set of low-income adults in Ghana during the COVID-19 pandemic. Individuals’ inability to make unexpected calls, need to borrow SOS airtime, and to seek digital loans decreased significantly relative to a control group. As a result, the programs led to a significant decrease in mental distress (-9.8%), the likelihood of severe mental distress by -2.3 percentage points (a quarter of the mean prevalence), and domestic violence, with null impact on consumption expenditure. The effects are stronger for monthly mobile credits than a lump-sum. We present evidence that improvements in both business-related services and social inclusion and/or protection are relevant explanations. Simple cost-benefit analysis shows that providing communication credit to low-income adults is a cost-effective policy for improving mental health. Communication – the ability to stay connected – meaningfully improves mental well-being and interventions about communication are particularly valuable when implemented as many installments.
    JEL: I12 I15 I38 L63 O12
    Date: 2023–08
  10. By: Martin, Lucie; Delaney, Liam; Doyle, Orla
    Abstract: Administrative burdens create costly experiences for citizens, especially disadvantaged groups. Research to date focuses on how burdens affect outcomes in specific policy contexts, thus little is known about cumulative experiences of burdens in everyday life and their distribution in society. This is the first study to document everyday administrative experiences, accounting for time and well-being costs across 10 domains: tax, retirement, government benefits, bills, goods and services, savings, debt, health, child care, and adult care. Survey results from 2243 UK adults show that administrative tasks are a significant part of everyday life, with time and well-being costs that vary by domain. Benefits-related tasks are particularly costly. There is evidence of distributive effects. Those in poor health and financial insecurity are more likely to engage in salient tasks, such as benefits, but less likely to engage with longer-term tasks including savings and retirement. They experience higher well-being costs, especially during salient tasks.
    JEL: J50
    Date: 2023–08–24
  11. By: Alberts, Sweedal; Nadarajah, Abinaya; Cooper, Claudia; Brijnath, Bianca; Loganathan, Santosh; Varghese, Matthew; Antoniades, Josefine; Baruah, Upasana; Dow, Briony; Kent, Mike
    Abstract: Objectives: In India, globalisation is purported to have contributed to shifting family structures and changing attitudes to long-term care (LTC) facility use. We investigated the usage frequency and attitudes to LTC in India. Methods: We conducted secondary analyses of: (a) The LASI (Longitudinal Ageing Study in India) 2017-18 cross-sectional survey of a randomised probability sample of Indian adults aged 45+ living in private households; and (b) Moving Pictures India Project qualitative interviews with 19 carers for people with dementia and 25 professionals, collected in 2022, exploring attitudes to LTC. Results: Of 73, 396 LASI participants, 40 were considering moving to LTC; 18, 281 had a parent alive, of whom 9 reported that their father, and 16 that their mother, was living in LTC. Whilst rare overall, LTC use and consideration of use were more likely to be in urban areas, in middle-richest income quintiles with higher levels of education, and for those who were more likely to rate their health as good or very good. We identified three themes from qualitative data: 1. LTC as a last resort, describes how LTC could be acceptable if care at home was “impossible” due to the person’s medical condition or unavailability of the family carer, for example if they lived abroad. 2. Social expectations of care at home from family members and paid carers and; 3. Limited availability of LTC facilities in India, especially in rural localities, and the financial barriers to their use. Conclusions: Preference for intergenerational community care, limited availability and societal stigma contribute to low rates of LTC use among Indian families. Future social policies should consider how to plan for greater equity in strengthening care at home, supporting care in the community, and bolstering respite and LTC services when other options are not available.
    Date: 2023–08–06
  12. By: Lyudmila Nepomnyashchiy (Independent consultant); Prashant Yadav (Center for Global Development)
    Abstract: Providing patients with high-quality essential medicines requires a well-functioning procurement, distribution, and regulatory system. However, in many low- and lower-middle-income countries (LMICs), public sector supply chain performance is far from optimal, resulting in frequent stockouts at health clinics. Decentralized purchasing of essential medicines by health facilities themselves provides greater autonomy to health facilities in managing their medicine stock, and has the potential to reduce essential medicine stockouts. This paper attempts to synthesize available evidence on the impact of greater facility autonomy in purchasing medicines on medicine availability, price, and quality. We find that literature is sparse on the impact of different roles played by lower-level health facilities in product selection, price negotiations, purchasing, and contract performance management. Our review suggests that decentralized purchasing with regional or central price contracting and supplier selection has the potential to improve the availability of medicines at health facilities, but depends on many prerequisite conditions to be met. These include, at a minimum, requisite capacity at government and health facility levels to support demand forecasting financing and data sharing, and a healthy distributor network that operates under government stewardship. Currently available evidence suggests that institutionalizing an enabling environment under which health facilities can place orders of essential medicines to preselected suppliers who have been vetted for quality and price terms have been negotiated, can provide them a much-needed recourse to secure essential medicines when the public sector supply system is not working.
    Keywords: medicines; procurement; supply chain; decentralization; direct financing
    Date: 2022–01–28
  13. By: Singh, Ram (Indian Institute of Foreign Trade, New Delhi)
    Abstract: The medical devices sector in India has been rapidly growing and evolving, driven by factors such as increasing healthcare expenditure, rising awareness of advanced medical technologies, government initiatives, and a growing population with a rising demand for healthcare services. The Indian medical devices market was valued at approximately $12 billion in 2021 and is expected to reach $50 billion by 2025, indicating significant growth potential. The sector covers a wide range of products, such as diagnostic imaging equipment, surgical instruments, patient monitoring devices, implants, consumables, and healthcare IT solutions. The market is primarily driven by imports, with domestic manufacturing accounting for a smaller share (Dang and Sharma 2019). However, the government has been promoting domestic manufacturing with an aim to reduce import dependency, the Medical Devices Policy-2023 of India should be seen in the same context.
    Keywords: India’s Medical Devices Sector; A Window of Opportunity for South Korea
    Date: 2023–07–27

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