nep-hea New Economics Papers
on Health Economics
Issue of 2023‒11‒06
thirty-six papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. The Hidden Cost of Firearm Violence on Pregnant Women and Their Infants By Janet Currie; Bahadir Dursun; Michael Hatch; Erdal Tekin
  2. Intergenerational Transmission of Inequality: Maternal Endowments, Investments, and Birth Outcomes By Sadegh Eshaghnia; James J. Heckman
  3. Estimating Intergenerational Health Transmission in Taiwan with Administrative Health Records By Harrison Chang; Timothy J. Halliday; Ming-Jen Lin; Bhashkar Mazumder
  4. Structural Empirical Analysis of Vacancy Referrals with Imperfect Monitoring and the Strategic Use of Sickness Absence By van den Berg, Bernard; Foerster, Hanno; Uhlendorff, Arne
  5. Workplace health and safety and the future of work: Evidence from linked-unit record data By Juliane Hennecke; Lisa Meehan; Gail Pacheco
  6. Geographic Variation in Healthcare Utilization: The Role of Physicians By Ivan Badinski; Amy Finkelstein; Matthew Gentzkow; Peter Hull
  7. The Effect of Organizations on Physician Prescribing: The Case of Opioids By M. Kate Bundorf; Daniel Kessler; Sahil Lalwani
  8. Dynamic, incentive-compatible contracting for health services By Rosella Levaggi; Michele Moretto; Paolo Pertile
  9. The Effects of Prescription Drug Monitoring Programs on Labor Market Activity and Credit Outcomes By Bhashkar Mazumder
  10. The Parenthood Penalty in Mental Health: Evidence from Austria and Denmark By Alexander Ahammer; Ulrich Glogowsky; Martin Halla; Timo Hener
  11. Do Wind Turbines Have Adverse Health Impacts? By Krekel, Christian; Rode, Johannes; Roth, Alexander
  12. The impact of high temperatures on performance in work-related activities By Matteo Picchio; Jan van Ours
  13. The Effect of Reducing Welfare Access on Employment, Health, and Children's Long-Run Outcomes By Hicks, Jeffrey; Simard-Duplain, Gaëlle; Green, David A.; Warburton, William P.
  14. Racial Discrimination in Child Protective Services By E. Jason Baron; Joseph J. Doyle; Natalia Emanuel; Peter Hull
  15. Mindfulness Training, Cognitive Performance and Stress Reduction By Charness, Gary; Le Bihan, Yves; Villeval, Marie Claire
  16. The Long Shadow of the Past: Early-Life Disease Environment and Later-Life Mortality By Noghanibehambari, Hamid; Fletcher, Jason M.
  17. Health shocks, recovery and the first thousand days: the effect of the Second World War on height growth in Japanese children By Schneider, Eric B.; Ogasawara, Kota; Cole, Tim
  18. Exposure or Income? The Unequal Effects of Pollution on Daily Labor Supply By Hoffmann, Bridget; Rud, Juan Pablo
  19. Life Expectancy, Income and Long-Term Care: The Preston Curve Reexamined By Ponthiere, Gregory; Thibault, Emmanuel
  20. Medicaid expansion and the mental health of spousal caregivers By Raut, Nilesh; Costa-Font, Joan; van-Houtven, Courtney
  21. Canadian long-term residential care staff recommendations for pandemic preparedness and workforce mental health By Boettcher, Nick; Celis, Sofia; Lashewicz, Bonnie
  22. Improving Performance Through Allocation and Competition: Evidence from a Patient Choice Reform By Kortelainen, Mika; Laine, Liisa T.; Lavaste, Konsta; Saxell, Tanja; Siciliani, Luigi
  23. Power to choose? Examining the link between contraceptive use and domestic violence By Ojha, Manini; Babbar, Karan
  24. Mandatory membership of community-based mutual health insurance in Senegal: A national survey By Valéry Ridde; Ibrahima Gaye; Bruno Ventelou; Elisabeth Paul; Adama Faye
  25. Measuring the Structural Capacity of Philippine Hospitals to Provide High-Quality Health Care By Ulep, Valerie Gilbert T.; Nuevo, Christian Edward L.; Uy, Jhanna; Casas, Lyle Daryll D.
  26. An open database on inequality and polarization in length of life (1950-2021) By Vanesa Jorda; Miguel Niño-Zarazúa; Mercedes Tejería
  27. Who Wins and Who Loses from PhilHealth? Cost and Benefit Incidence of Social Health Insurance in a Lifecycle Perspective By Abrigo, Michael R.M.
  28. Forced Labor and Health-Related Outcomes. The Case of Beggar Children By Drydakis, Nick
  29. Harmonizing the Yin and Yang: Gender Disparities in Subjective Well-Being after Retirement in China By Erkmen G. Aslim; Shin-Yi Chou; Han Yu
  30. The Political Economy of a “Miracle Cure”: The Case of Nebulized Ibuprofen and its Diffusion in Argentina By Sebastian Calónico; Rafael Di Tella; Juan Cruz Lopez del Valle
  31. Hunting Militias at All Cost: Urban Military Operation and Birth Outcomes By Cortes, Darwin; Gómez, Catalina; Posso, Christian; Suarez, Gabriel
  32. Estimating Impact with Surveys versus Digital Traces: Evidence from Randomized Cash Transfers in Togo By Emily Aiken; Suzanne Bellue; Joshua Blumenstock; Dean Karlan; Christopher R. Udry
  33. Stringent COVID-19 government restrictions were associated with a marked increase in Twitter activity in Europe By Millard, Joe; Akimova, Evelina Tamerlanov; Ding, Xuejie; Leasure, Douglas; Zhao, Bo; Mills, Melinda
  34. Credit Card Spending and Borrowing since the Start of the COVID-19 Pandemic By Joanna Stavins
  35. Racial Differences in Parent Response to COVID Schooling Policies By Micah Y. Baum; Brian Jacob
  36. Vaccination Spillovers in Economic Interactions By Fabian Siuda; Thomas O. Zörner

  1. By: Janet Currie; Bahadir Dursun; Michael Hatch; Erdal Tekin
    Abstract: Firearm violence is a pervasive public health crisis in the United States, with significant numbers of homicides involving firearms, including indiscriminate shootings in public spaces. This paper investigates the largely unexplored consequences of stress induced by these attacks on newborn health. We use two approaches to examine this question. First, we consider the "beltway sniper" attacks of 2002 as a natural experiment, using administrative birth records with maternal residential addresses in Virginia. The beltway sniper attacks, a series of random shootings in the Washington DC metropolitan area, led to significant terror and disruptions in daily life over a three-week period. We compare birth outcomes of children exposed to the attacks in utero due to timing or having a residential address near a shooting location to those who were not exposed. Second, we investigate the impact of in-utero exposure to mass shootings on infant health outcomes using restricted-access U.S. Vital Statistics Natality records from 2006 to 2019 and leveraging variation in the timing of mass shootings in counties where at least one shooting occurred. Our findings reveal that mass shootings impose substantial, previously unconsidered costs on pregnant women and their infants. Exposure to the beltway sniper attacks during pregnancy increased the likelihood of very low birthweight and very premature birth by 25 percent. The analysis based on national data from mass shootings confirms these findings, albeit with smaller effect sizes. These results underscore the need to recognize the broader impact of violence on vulnerable populations when assessing the true costs of firearm violence. Calculations based on our estimates suggest significant economic burdens, with the additional costs of the beltway sniper attacks reaching $15.5 billion in 2023 dollars and mass shootings imposing annual costs of seven billion dollars. These findings suggest that pregnant women and their infants may require additional support in the aftermath of mass gun violence.
    JEL: I12 I18 J13 K40
    Date: 2023–10
  2. By: Sadegh Eshaghnia; James J. Heckman
    Abstract: Newborn health is an important component in the chain of intergenerational transmission of disadvantage. This paper contributes to the literature on the determinants of health at birth in two ways. First, we analyze the role of maternal endowments and investments (education and smoking in pregnancy) on the probability of having a baby who is small for gestational age (SGA). We estimate both the total impact of maternal endowments on birth outcomes, and we also decompose it into a direct, “biological” effect and a “choice” effect, mediated by maternal behaviors. Second, we estimate the causal effects of maternal education and smoking in pregnancy, and investigate whether women endowed with different traits have different returns. We find that maternal cognition affects birth outcomes primarily through maternal education, that personality traits mainly operate by changing maternal smoking, and that the physical fitness of the mother has a direct, “biological” effect on SGA. We find significant heterogeneity in the effects of education and smoking along the distribution of maternal physical traits, suggesting that women with less healthy physical constitutions should be the primary target of prenatal interventions.
    JEL: I12 I14 J24
    Date: 2023–10
  3. By: Harrison Chang (University of Toronto); Timothy J. Halliday (University of HawaiÔi); Ming-Jen Lin (National University of Taiwan); Bhashkar Mazumder (Federal Reserve Bank of Chicago)
    Abstract: We use population-wide administrative health records from Taiwan to estimate intergenerational persistence in health, providing the first estimates for a middle income country. We measure latent health by applying principal components analysis to a set of indicators for 13 broad ICD categories and quintiles of visits to a general practitioner. We find that the rank-rank slope in health between adult children and their parents is 0.22 which is broadly in line with results from other countries. Maternal transmission is stronger than paternal transmission and sons have higher persistence than daughters. Persistence is also higher at the upper tail of the parent health distribution. Persistence is lower when using inpatient data or when using total medical expenses and may overstate mobility. Health transmission is almost entirely unrelated to household income levels in Taiwan. We also find that that there are small geographic differences in health persistence across townships and that these are modestly correlated with area level income and doctor availability. Finally, by looking at persistence within health conditions that vary in their genetic component, we find little evidence that health persistence is driven by genetic factors.
    Keywords: intergenerational health mobility, mental health, physical health, United Kingdom
    JEL: J62 I14
    Date: 2023–10
  4. By: van den Berg, Bernard (University of York); Foerster, Hanno (Boston College); Uhlendorff, Arne (CREST)
    Abstract: This paper provides a structural analysis of the role of job vacancy referrals (VRs) by public employment agencies in the job search behavior of unemployed individuals, incorporating institutional features of the monitoring of search behavior by the agencies. Notably, rejections of VRs may lead to sanctions (temporary benefits reductions) while workers may report sick to avoid those. We estimate models using German administrative data from social security records linked with caseworker recorded data on VRs, sick reporting and sanctions. The analysis highlights the influence of aspects of the health care system on unemployment durations. We estimate that for around 25% of unemployed workers, removing the channel that enables strategic sick reporting reduces the mean unemployment duration by 4 days.
    Keywords: unemployment, wage, sanctions, moral hazard, sickness absence, physician, structural estimation, counterfactual policy evaluation, unemployment duration
    JEL: J64 J65 C51 C54
    Date: 2023–10
  5. By: Juliane Hennecke (Otto-von-Guericke University Magdeburg and IZA); Lisa Meehan (NZ Work Research Institute, Auckland University of Technology); Gail Pacheco (NZ Work Research Institute, Auckland University of Technology)
    Abstract: Despite presenting potentially significant challenges and opportunities, the possible implications for workplace health and safety (WHS) of future-of-work trends have so far received scant attention. This paper, therefore, empirically examines the relationship between future-of-work trends and workplace injuries. It undertakes multivariate regression analysis using population-level accident compensation data for New Zealand linked to other data sources within Stats NZ’s Integrated Data Infrastructure (IDI) and Longitudinal Business Database (LBD), including information on business practices related to the future-of-work. It finds that work-related injury claim rates tend to increase with age, which presents a potential challenge for WHS given the ageing workforce. The injury claim rate decreases as job tenure increases, suggesting that future-of-work trends that increase the rate of job switching, such as nonstandard work and technological change, also present a challenge. Workers in industries such as agriculture and manufacturing have relatively high injury claim rates, suggesting that the ongoing shift away from these higher-risk industries and towards lower-risk service industries is positive for WHS outcomes. In addition, the finding that workers in firms with high levels of automation have lower injury claim rates highlights the potential of automation to remove workers from potentially hazardous situations. While workers in firms that offer flexible working arrangements, such as working from home, have lower injury claim rates, this is likely to be largely due to the nature of the jobs that are amenable to flexible work arrangements.
    Date: 2023–04
  6. By: Ivan Badinski; Amy Finkelstein; Matthew Gentzkow; Peter Hull
    Abstract: We study the role of physicians in driving geographic variation of US healthcare utilization. We estimate a model that separates variation in average utilization of Medicare beneficiaries due to physicians, non-physician supply side factors, and patient demand. The model is identified by migration of patients and physicians across areas, as well as by variation in within-area matching. We find that physicians vary greatly in the intensity with which they treat otherwise similar patients, and that at least a third of geographic differences in healthcare utilization can be explained by differences in average physician treatment intensity. Conservatively, physicians are three times as important as non-physician supply-side factors in explaining geographic variation. Around three-fifths of physicians’ role comes from differences across areas in physician practice styles within the same specialty, while the other two-fifths reflects differences across areas in physician specialty mix.
    JEL: H51 I1 I11
    Date: 2023–10
  7. By: M. Kate Bundorf; Daniel Kessler; Sahil Lalwani
    Abstract: In theory, there are several reasons why physician organizational form might affect the price, quantity, and quality of physician services. In this paper, we examine the effect of three aspects of physician organizational form on opioid prescribing: the number of physicians in the physician’s group (if any); the physician’s integration with or employment by a hospital or hospital system; and the average age of the other physicians in the physician’s group. We present three key findings. First, all else held constant, group physicians prescribe far fewer opioids, and prescribe them more appropriately, than do solo physicians. Second, although physicians who are employed by a hospital or practice in a hospital-owned group prescribe fewer opioids than do independent physicians, there is evidence that this difference may be due to differences in the other characteristics of physicians who are hospital-integrated rather than a causal effect. Third, we find substantial peer effects on opioid prescribing. Physicians in groups with a higher average age (excluding the physician him- or herself) prescribe more intensively and are more likely to write inappropriate opioid prescriptions than physicians in younger groups – holding constant the physician’s own age and other characteristics of his or her group.
    JEL: I11 L2
    Date: 2023–10
  8. By: Rosella Levaggi (Department of Economics and Management, University of Brescia); Michele Moretto (Department of Economics and Management, University of Padua); Paolo Pertile (Department of Economics, University of Verona)
    Abstract: This paper aims to characterise a dynamic, incentive-compatible contract for the provision of health services, allowing for both moral hazard and adverse selection. Patients’ severity changes over time following a stochastic process and is private information of the provider. We characterise the optimal dynamic contract and show that it is made up of two components: a time-invariant payment, which depends on the structural characteristics of the provider, and a time-varying component, which is affected by both patient and hospital characteristics. To illustrate the characteristics of the dynamic contract and compare it with a more standard static contract, we provide a numerical exercise calibrated with data from hip replacement hospitalisations in Italy.
    Keywords: hospital payments, dynamic mechanism design, DRG, two-part tariffs, adverse selection, moral hazard
    JEL: H42 I18 D82
    Date: 2023–09
  9. By: Bhashkar Mazumder
    Abstract: We examine how the availability of prescription opioids affects labor market activity and household economic well-being. While greater access to opioids may lead people to substance use disorders and negative economic consequences, appropriate pain medication may allow some individuals to effectively participate in the labor market. We study prescription drug monitoring programs (PDMPs), which were designed to curb inappropriate opioid prescribing and assess how these policies affected labor force attachment and credit outcomes. We use variation across states in the timing of implementation of PDMPs and recent methods developed for difference-in-difference event study designs with multiple time periods. In line with previous work, we find that PDMPs lead to a decline in opioid prescribing rates. Although we find that these reductions in opioid supply have no clear effect on measures of labor force activity in our pooled sample, we see some suggestive evidence of negative effects on labor force attachment in states where there is less scope for substitution to illicit drugs. We also show that PDMPs lead to a decline in credit scores and increases in the number and amount of third-party debt collections, and that these effects are more pronounced in states lacking an illicit market. These findings suggest that some individuals are likely negatively affected by the lack of access to pain medication due to the PDMP laws.
    Keywords: opioids; prescription drugs; Labor force participation; Disability insurance
    Date: 2023–03
  10. By: Alexander Ahammer; Ulrich Glogowsky; Martin Halla; Timo Hener
    Abstract: Using Austrian and Danish administrative data, we examine the impacts of parenthood on mental health. Parenthood imposes a greater mental health burden on mothers than on fathers. It creates a long-run gender gap in antidepressant prescriptions of about 93.2% (Austria) and 64.8% (Denmark). These parenthood penalties in mental health are unlikely to reflect differential help-seeking behavior across the sexes or postpartum depression. Instead, they are related to mothers’ higher investments in childcare: Mothers who take extended maternity leave in quasi-experimental settings are more likely to face mental health problems.
    Keywords: gender equality, fertility, parenthood, motherhood, mental health, parental leave
    JEL: D63 J13 I10 J16 J22
    Date: 2023
  11. By: Krekel, Christian (London School of Economics); Rode, Johannes (Darmstadt University of Technology); Roth, Alexander (DIW Berlin)
    Abstract: While wind power is considered key in the transition towards net zero, there are concerns about adverse health impacts on nearby residents. Based on precise geographical coordinates, we link a representative longitudinal household panel to all wind turbines in Germany and exploit their staggered rollout over two decades for identification. We do not find evidence of negative effects on general, mental, or physical health in the 12-Item Short Form Survey (SF- 12), nor on self-assessed health or doctor visits. We also do not find evidence for effects on suicides, an extreme measure of negative mental health outcomes, at the county level.
    Keywords: wind turbines, externalities, health, renewable energy, difference-in-differences, event study
    JEL: D62 I10 Q20 Q42 R10
    Date: 2023–10
  12. By: Matteo Picchio (Marche Polytechnic University); Jan van Ours (Erasmus University Rotterdam)
    Abstract: High temperatures can have a negative effect on work-related activities. Labor productivity may go down because mental health or physical health is worse when it is too warm. Workers may experience difficulties concentrating or they have to reduce effort in order to cope with heat. We investigate how temperature affects performance of male professional tennis players. We use data about outdoor singles matches from 2003 until 2021. Our identification strategy relies on the plausible exogeneity of short-term daily temperature variations in a given tournament from the average temperature over the same tournament. We find that performance significantly decreases with ambient temperature. The magnitude of the temperature effect is age-specific and skill specific. Older and less-skilled players suffer more from high temperatures than younger and more skilled players do. The effect of temperature on performance is smaller when there is more at stake. Our findings also suggest that there is adaptation to high temperatures: the effects are smaller if the heat lasts for several days.
    Keywords: Climate change, temperatures, tennis, performance, productivity
    JEL: J24 J81 Q51 Q54
    Date: 2023–10–12
  13. By: Hicks, Jeffrey (University of Toronto); Simard-Duplain, Gaëlle (Carleton University); Green, David A. (University of British Columbia, Vancouver); Warburton, William P. (Enterprise Economic Consulting)
    Abstract: Welfare caseloads in North America halved following reforms in the 1990s and 2000s. We study how this shift affected families by linking Canadian welfare records to tax returns, medical spending, educational attainment, and crime data. We find substantial and heterogeneous employment responses that increased average income despite reduced transfers. We find zero effects on aggregate health expenditures, but mothers saw reduced preventative care and increased mental health treatment, consistent with the transition to employment elevating time pressure and stress. We find no effect on teenagers' education and criminal charges as young adults but do find evidence of intergenerational welfare transmission.
    Keywords: welfare, income, health
    JEL: H23 H31 I14 I24 I38 J62
    Date: 2023–10
  14. By: E. Jason Baron; Joseph J. Doyle; Natalia Emanuel; Peter Hull
    Abstract: Childhood experiences have an enormous impact on children’s long-term societal contributions. Experiencing childhood maltreatment is associated with compromised physical and mental health, decreased educational attainment and future earnings, and increased criminal activity. Child protective services is the government’s way of endeavoring to protect children. Foster care consequently has large potential effects on a child’s future education, earnings, and criminal activity. In this post, we draw on a recent study to document disparities in the likelihood that children of different races will be placed into foster care.
    Keywords: child protective services (CPS); human capital; Racial discrimination
    JEL: D63 E24
    Date: 2023–10–16
  15. By: Charness, Gary (University of California, Santa Barbara); Le Bihan, Yves (Institut Français du Leadership Positif); Villeval, Marie Claire (CNRS, GATE)
    Abstract: Improving cognitive function and reducing stress may yield important benefits to individuals' health and to society. We conduct an experiment involving a three-month within-firm training program based on the principles of mindfulness and positive psychology at three large companies. We find an improvement in the difference-in-differences across the training and control groups in all five non-incentivized measures and in seven of the eight incentivized tasks but only the non-incentivized measures and one of the incentivized measures reached a standard level of significance (above 5%), showing strong evidence of its impact on both reducing perceived stress and increasing self-reported cognitive flexibility and mindfulness. At the aggregate level, we identify an average treatment effect on the treated for the non-incentivized measures and some effect for the incentivized measures. Remarkably, the treatment effects persisted three months after the training sessions ended. Overall, mindfulness training seems to provide benefits for psychological and cognitive health in adults.
    Keywords: mindfulness, attention, cognition, stress, lab-in-the-field experiment
    JEL: C91 I12
    Date: 2023–09
  16. By: Noghanibehambari, Hamid (University of Wisconsin-Madison); Fletcher, Jason M. (University of Wisconsin-Madison)
    Abstract: A recently growing literature evaluates the influence of early-life conditions on life-cycle health and mortality. This paper extends this literature by estimating the associations between birth-state infant mortality rates experienced during early-life (as a proxy for general disease environment, health-care access, and nutrition) and life-cycle mortality rates. Using the universe of death records in the US over the years 1979-2020 and implementing two-way fixed effect models, we find that a 10 percent rise in birth-state infant mortality rate is associated with about 0.23 percent higher age-specific mortality rate. These correlations are more concentrated in ages past 50, suggesting delayed effects of early-life exposures. Moreover, we find substantially larger correlations among nonwhites, suggesting that the observed racial disparities in mortality can partly be explained by disparities in early-life conditions. Further, we provide empirical evidence to argue that reductions in education, income, and socioeconomic scores are likely mechanism channels.
    Keywords: mortality, infant mortality, early-life exposures
    JEL: I18 J13 N31 N32
    Date: 2023–10
  17. By: Schneider, Eric B.; Ogasawara, Kota; Cole, Tim
    Abstract: This article uses the health shock on Japanese civilians of the Second World War to understand the effects of health shocks at different developmental stages on children's long-run growth pattern and to test whether recovery is possible after an early-life health shock. We construct a prefecture-level dataset of mean heights of boys and girls aged 6–19 from 1929 to 2015. Linking the heights recorded at different ages for the same birth cohort, we measure a counterfactual causal effect of the health shocks during the Second World War on the cohort growth pattern of children. We find that the war effect was greatest for cohorts exposed to the war in late childhood and adolescence: these cohorts were 1.7–3.0 cm shorter at adulthood and had delayed pubertal growth and slower maturation than they would have had if the war had never occurred. However, there were no persistent health penalties for children exposed to the war in early life, suggesting that catch-up growth was possible as health conditions improved after the war. These findings challenge the thousand-days consensus that children cannot recover from nutritional shocks in early life and indicate that adolescence is a sensitive period for health shocks.
    Keywords: child growth; health shocks; catch-up growth; nutrition; Japan; Second World War
    JEL: N35
    Date: 2021–12–01
  18. By: Hoffmann, Bridget; Rud, Juan Pablo
    Abstract: We use high-frequency data on fine particulate matter air pollution (PM 2.5) at the locality level to study the effects of high pollution on labor supply decisions and hospitalizations for respiratory disease in the metropolitan area of Mexico City. We document a negative, non-linear relationship between PM 2.5 and same-day labor supply, with strong effects on days with extremely high pollution levels. On these days, the average worker experiences a reduction of around 7.5% of working hours. Workers partially compensate for lost hours by increasing their labor supply on days that follow high-pollution days. Informal workers reduce their labor supply less than formal workers on high-pollution days and also compensate less on the following days. This suggests that informal workers may experience greater exposure to high pollution and greater reductions in labor supply and income. We provide evidence that reductions in labor supply due to high pollution are consistent with avoidance behavior and that income constraints may play an important role in workers' labor supply decisions.
    Keywords: Air pollution;Informal workers;Mexico
    JEL: Q52 Q53 J22 J46 I14
    Date: 2022–02
  19. By: Ponthiere, Gregory; Thibault, Emmanuel
    Abstract: The Preston Curve - the increasing relation between income per capita and life expectancy - cannot be observed in countries where old-age dependency is widespread (that is, where long-term care (LTC) spending per capita is high). The absence of the Preston Curve in countries with high old-age dependency can be related to two other stylized facts: (1) the inverted-U relation between LTC spending and life expectancy; (2) the inverted-U relation between LTC spending and preventive health investments. This paper develops a two-period OLG model where survival to the old age depends on preventive health spending chosen by individuals while anticipating (fixed) old-age LTC costs. In that model, anticipated LTC costs are shown to have a non-monotonic effect on preventive health investment, thus rationalizing stylized facts (1) and (2). This framework is shown to provide an explanation for the absence of the Preston Curve in countries where old-age dependency is more acute.
    Keywords: Preston Curve, life expectancy, OLG models, long-term care
    JEL: E13 E21 I15 J14
    Date: 2023
  20. By: Raut, Nilesh; Costa-Font, Joan; van-Houtven, Courtney
    Abstract: Health insurance expansions can exert wellbeing effects on individuals who provide informal care to their loved ones, reducing their experience of depression. This study exploits evidence from the Affordable Care Act’s Medicaid expansion (ACA Medicaid) to examine the effects on the mental wellbeing of informal caregivers. Drawing on an event study and a Difference-in-Differences (DID) design we investigate the policy impact of ACA Medicaid using longitudinal evidence (from the Health and Retirement Study, HRS) for low-income individuals aged 64 or below. We find that ACA’s Medicaid reduced depressive symptoms among spousal caregivers, and specifically we estimate that exposure to ACA Medicaid gives rise to 8.2% points (on average, equivalent to 30% decrease) reduction in the feeling of depression and 8.7% points increase in the feeling of happiness (on average, 11% increase). The estimates are robust to various specifications, and we identify several potential driving mechanisms for the findings: reductions in out of -pocket expenses and labor supply and, as expected, increased after Medicaid uptake. The evidence from falsification tests confirms that the estimated effects are likely due to ACA’s Medicaid.
    Keywords: Springer deal
    JEL: I10
    Date: 2023–09–13
  21. By: Boettcher, Nick; Celis, Sofia; Lashewicz, Bonnie
    Abstract: Context: The impacts of Covid-19 pandemic conditions in Canada’s long-term residential care (LTRC) sector have demonstrated that future pandemic preparedness necessitates not only recovery but deeper sectoral transformation of longstanding vulnerabilities. Improving workforce mental health and resilience is central to these transformative efforts. Objective: This study presents a content analysis of staff recommendations for pandemic preparedness and employee mental health in LTRC. Methods: Qualitative data were gathered through semi-structured interviews conducted with 50 LTRC staff members from 12 organizations. The interviews aimed to gain insights into supporting worker mental health in the first wave of the Covid-19 pandemic. Participant responses to a question seeking recommendations for future pandemic preparedness were extracted and analyzed using qualitative content analysis. Findings: Our findings encompass staff recommendations organized into seven categories: 1) Risk reduction and compensation, 2) Staffing reappraisal, 3) Opportunities for relief, 4) Spaces to be heard, 5) Improved communication, 6) Cultivating responsive leadership, and 7) Redefining public accountability. Limitations: The data primarily relied on interviews with LTRC workers from western Canada. Implications: Recommendations are situated within existing policy and research for worker mental health and staffing. We discuss how supporting and listening to LTRC workers can strengthen pandemic preparedness, workforce mental health, and delivery of quality person-centered care. We position the increased presence of worker voices in knowledge generation and policymaking as vital for realizing the sectoral transformations needed in LTRC.
    Keywords: long-term residential care; pandemic preparedness; mental health; staffing; workforce; Canada
    JEL: R14 J01
    Date: 2023–09–14
  22. By: Kortelainen, Mika; Laine, Liisa T.; Lavaste, Konsta; Saxell, Tanja; Siciliani, Luigi
    Abstract: We study the allocative effects of enhancing consumer choice and non-price competition in markets with heterogeneous producers. We use comprehensive administrative data and a difference-in-differences design based on the introduction of a regional patient choice reform for planned surgeries in Finland. We find that large teaching hospitals attracted more patients and concentration increased in their markets. Waiting times decreased in hospitals exposed to the reform and more patients were treated, with little effect on clinical quality or average surgical expenditure after the reform. Our results suggest that increased choice can reallocate patients towards large producers and improve public hospital performance.
    Keywords: Reallocation, Heterogeneous Producers, Performance, Competition, Concentration, Patient Choice, Market Structure, Local public finance and provision of public services, I11, L11, I18, L32, L38, fi=Elinkeinopolitiikka|sv=Näringspolitik|en=Industrial and economic policy|, fi=Kunnat ja hyvinvointialueet|sv=Kommuner och välfärdsområden|en=Municipalities and wellbeing services counties|, fi=Terveyspalvelut|sv=Hälsovårdstjänster|en=Healthcare services|,
    Date: 2023
  23. By: Ojha, Manini; Babbar, Karan
    Abstract: Contraception is a crucial tool that empowers women to control their bodily autonomy. Concurrently, violence against women remains a pressing public-health issue depleting women's autonomy. We establish a causal link between the decision to use contraception and the occurrence of intimate partner violence. Utilizing newly available nationally representative data for India, we use an instrumental variable approach to estimate our causal effects. Using exogenous variation in the cluster average of women's exposure to family planning messages via radio, we find that if the decision to use contraceptives is solely taken by the woman, she is at a significantly higher risk of physical, sexual and emotional domestic violence. We estimate bounds of our effects by assuming the IV to be plausibly exogenous where we relax the exogeneity condition. Our findings underscore the importance of reproductive health in initiatives that reduce domestic violence and targeted policies towards men's understanding of family planning.
    Keywords: contraception, intimate partner violence, mass-media, family planning, NFHS-5, India
    JEL: I15 J12 J13 J16 C26
    Date: 2023
  24. By: Valéry Ridde (CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPCité - Université Paris Cité); Ibrahima Gaye (ISED - ISED - UCAD - Université Cheikh Anta Diop [Dakar, Sénégal] - AGRISAN - Centre d’Excellence Africain en Agriculture pour la Sécurité Alimentaire et Nutritionnelle); Bruno Ventelou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Elisabeth Paul (ULB - Université libre de Bruxelles); Adama Faye (ISED - ISED - UCAD - Université Cheikh Anta Diop [Dakar, Sénégal] - AGRISAN - Centre d’Excellence Africain en Agriculture pour la Sécurité Alimentaire et Nutritionnelle)
    Abstract: With the low adherence to voluntary mutual health insurance, Senegal's policymakers have sought to understand the feasibility of compulsory health insurance membership. This study aims to measure the acceptability of mandatory membership in community-based mutual health insurance (CBHI) and to understand its possible administrative modalities. The study consists of a national survey among a representative population sample selected by marginal quotas. The survey was conducted in 2022 over the phone, with a random composition method involving 914 people. The questionnaire measured the socio-economic characteristics of households, their level of acceptability concerning voluntary and compulsory membership, and their level of confidence in CBHIs and the health system. Respondents preferred voluntary (86%) over mandatory (70%) membership of a CBHI. The gap between voluntary and compulsory membership scores was smaller among women (p = 0.040), people under 35 (p = 0.033), and people with no health coverage (p = 0.011). Voluntary or compulsory membership was correlated (p = 0.000) to trust in current CBHIs and health systems. Lack of trust in the CBHI management has been more disadvantageous for acceptance of the mandatory than the voluntary membership. No particular preference emerged as the preferred administrative channel (e.g. death certificate, identity card, etc.) to enforce the mandatory option. The results confirmed the well-known challenges of building universal health coverage based on CBHIs—a poorly appreciated model whose low performance reduces the acceptability of populations to adhere to it, whether voluntary or mandatory. Suppose Senegal persists in its health insurance approach. In that case, it will be essential to strengthen the performance and funding of CBHIs, and to gain population trust to enable a mandatory or more systemic membership.
    Date: 2023
  25. By: Ulep, Valerie Gilbert T.; Nuevo, Christian Edward L.; Uy, Jhanna; Casas, Lyle Daryll D.
    Abstract: This paper measures Philippine hospitals’ management practices and service capability based on their structural inputs. The authors collected a wide range of data on hospital management and service delivery of selected public and private health facilities using a validated online profiling questionnaire. They identified the challenges and limitations that hospitals commonly encounter, particularly in governance and administration and service capacity. The authors recommend systematically collecting healthcare quality indicators and providing incentives and grants to enable the collection, measurement, and submission of data from health facilities.
    Keywords: health care;healthcare quality;service capability;universal health care;health service delivery;UHC
    Date: 2023
  26. By: Vanesa Jorda; Miguel Niño-Zarazúa; Mercedes Tejería
    Abstract: Monitoring health is key for identifying priorities in public health planning and improving healthcare services. Life expectancy has conventionally been regarded as a valuable indicator to compare the health status of different populations. However, this measure is simply the mean of the distribution of the length of life and, as such, neglects individual disparities in health outcomes. Tracking the evolution of lifespan inequality is essential to promoting social justice and equity by identifying and addressing the root causes of these disparities.
    Keywords: Inequality, Polarization, Lifespan, Life expectancy
    Date: 2023
  27. By: Abrigo, Michael R.M.
    Abstract: This paper used incidence analysis to examine the financial costs and benefits of the National Health Insurance Program (NHIP) through the Philippine Health Insurance Corporation (PhilHealth), which accrue to different ages and socioeconomic classes. Based on the study’s findings, premium contributions to and benefit payments by PhilHealth are pro-poor, which means that poor individuals receive more benefits while contributing less to PhilHealth. Throughout an average Filipino’s lifetime, the NHIP is estimated to subsidize about 40 centavos worth of health care for every peso an individual contributes directly or indirectly as a premium to PhilHealth.
    Keywords: social health insurance;benefit incidence analysis;cost incidence analysis;national transfer account;Philhealth;Philippine Health Insurance Corporation
    Date: 2023
  28. By: Drydakis, Nick (Anglia Ruskin University)
    Abstract: The study aims to examine whether beggar children are victims of forced labor, as well as to identify the manifestations of forced labor in beggar children, and assess whether forced child begging relates to deteriorated health-related quality of life and mental health. The study focused on the capital city of Greece, Athens, where beggar children are not a hard-to-reach group. Cross-sectional data were collected in 2011, 2014, 2018 and 2022, with 127 beggar children taking part in the study. The study adopted the Anti-Slavery International research toolkit, which sets methodological guidelines on researching child begging. A scale was developed to quantify forced child begging based on the International Labour Organization's definition of forced labor. The study found that most beggar children were forced by others to beg, experienced threats of violence, physical and verbal harassment aimed at forcing them to beg, and difficulty in terms of being allowed by others to stop begging. It was found that forced child begging was positively associated with living with unknown people, hunger due to food unavailability the previous week, and negatively associated with native beggar children. It was discovered that forced child begging was negatively associated with health-related quality of life and mental health for beggar children. Child begging encompasses elements of coercion and the deprivation of human freedom. These factors collectively amount to instances of forced labor and/or modern slavery. Policies should ensure that beggar children are removed from harm's way, and that those forcing children to beg are brought to justice.
    Keywords: beggar children, forced labor, coercion, modern slavery, health-related quality of life, mental health
    JEL: J10 J13 J46 J70 I14
    Date: 2023–10
  29. By: Erkmen G. Aslim; Shin-Yi Chou; Han Yu
    Abstract: China’s distinctive demographic landscape, early retirement policies, and deeply ingrained gender norms provide a unique backdrop for investigating gender disparities in retirement and subjective well-being. Drawing upon data from the China Family Panel Studies and leveraging the variation around the pensionable age cutoff, we find substantial increases in retirement rates, surging by 19 percentage points for males and 13 percentage points for females in proximity to this age threshold. Notably, retirement manifests significant gender heterogeneity in its influence on life satisfaction, leading to an enhancement among males while not yielding statistically significant improvements among females. Furthermore, this study probes multiple dimensions of subjective well-being and objective health behaviors, laying bare gender disparities in health, behaviors, perceptions of income and social status, and confidence about the future. Males showcase improvements in healthy behaviors, report enhanced self-perceived health, perceive higher relative income and social status, and exude greater confidence about their future. In stark contrast, females show no statistically significant changes along these dimensions. In fact, they tend to engage in health-compromising behaviors, such as increased smoking, and exhibit higher rates of obesity. These findings underscore the imperative of recognizing gender disparities in the consequences of retirement on subjective well-being. They highlight the need for targeted policies aimed at enhancing social and economic opportunities for women, ultimately striving for greater gender equality in the post-retirement phase.
    JEL: I10 I12 I31 J16 J26
    Date: 2023–10
  30. By: Sebastian Calónico; Rafael Di Tella; Juan Cruz Lopez del Valle
    Abstract: We document the diffusion of nebulized ibuprofen in Argentina as a treatment for COVID-19. As the pandemic spread, this clinically unsupported drug reached thousands of patients, even some seriously ill, despite warnings by the regulator and medical societies. Detailed daily data on deliveries for all towns in one of the largest provinces suggests a role for “rational” forces in the adoption of a miracle cure: towns adopt it when neighbors that adopt it are successful in containing deaths (a learning effect), even after controlling for the average adoption of peers. Results from a survey are consistent with learning. They also reveal a large role of beliefs: subjects that are classified as “Right” are more likely adopt and to learn, while those that are “Skeptical” report an increase in their demand when primed with the regulator’s ban.
    JEL: I18 O33 P46
    Date: 2023–10
  31. By: Cortes, Darwin (Universidad del Rosario); Gómez, Catalina (Universidad Eafit); Posso, Christian (Banco de la República); Suarez, Gabriel (World Bank)
    Abstract: This study examines the impact of the Orion Operation on newborn health outcomes. Previous research has explored the negative effects of conflict on child health, but the specific consequences of state military operations on newborns, especially in urban settings, remain poorly understood. Employing a Difference-in-Differences design and using administrative data from the Colombian Vital Statistics Reports, we assess the effects of the Orion Operation on birth weight, height, and the probability of a high Apgar score. Our analysis reveals a significant reduction in birth weight among infants born in intervention-affected neighborhoods, with concentrated effects observed among married and less educated mothers. We find a decrease in height at birth and a reduction in the probability of having an Apgar score higher than 7, which indicates good health at birth. While direct testing of stress as the primary underlying mechanism was unfeasible, our findings suggest that stress might influence birth outcomes. These findings enhance our understanding of the complex impacts of state military operations and underscore the importance of considering the context when assessing their consequences on local communities.
    Keywords: Birth Outcomes; Conflict; Colombia; Urban Military Operation
    JEL: D74 I12 J13
    Date: 2023–10–17
  32. By: Emily Aiken; Suzanne Bellue; Joshua Blumenstock; Dean Karlan; Christopher R. Udry
    Abstract: Do non-traditional digital trace data and traditional survey data yield similar estimates of the impact of a cash transfer program? In a randomized controlled trial of Togo’s COVID-19 Novissi program, endline survey data indicate positive treatment effects on beneficiary food security, mental health, and self-perceived economic status. However, impact estimates based on mobile phone data – processed with machine learning to predict beneficiary welfare – do not yield similar results, even though related data and methods do accurately predict wealth and consumption in prior cross-sectional analysis in Togo. This limitation likely arises from the underlying difficulty of using mobile phone data to predict short-term changes in wellbeing within a rural population with fairly homogeneous baseline levels of poverty. We discuss the implications of these results for using new digital data sources in impact evaluation.
    JEL: C55 I32 I38
    Date: 2023–10
  33. By: Millard, Joe; Akimova, Evelina Tamerlanov; Ding, Xuejie; Leasure, Douglas; Zhao, Bo; Mills, Melinda
    Abstract: The COVID-19 pandemic has had an unprecedented effect on health, well-being, and socioeconomic conditions worldwide. One consequence was changes in social media activity, disruption of schedules, and potentially sleep. We use Twitter data to explore changes in daily and nightly online activity at the onset of the COVID-19 pandemic in 2020. Using a pseudo-random sample of 2, 489 users across 6 cities in the UK (Aberdeen, Belfast, Bristol, Cardiff, London, and Manchester), 4 cities in Italy (Milan, Naples, Rome, and Turin), and 4 cities in Sweden (Göteborg, Malmo, Stockholm, Uppsala), we test the extent to which the COVID-19 pandemic changed online activity in Europe. Using a dataset of ~24 million tweets, we show that tweet activity increased by ~20% in 2020 relative to the previous non-pandemic year of 2019. We further show that tweet activity is associated with the degree of government response to COVID-19, particularly during the day, and that the stringency of restrictions was the strongest predictive component of change in tweet count.
    Date: 2023–10–03
  34. By: Joanna Stavins
    Abstract: Consumers improved their financial health early during the COVID-19 pandemic, but credit card revolving and delinquencies have been rising since 2021, in terms of both the share of accounts and average balances. Financial stress is especially high among lower-income cardholders, whose credit card revolving and delinquencies have risen faster than those of other income cohorts. This is consistent with excess savings being depleted faster among lower-income cohorts. The rising financial stress suggests a weakening in consumption as utilization rates, revolving amounts, and delinquencies all continue to rise. Balances on delinquent accounts held by lower-income consumers are approaching their credit limits. With utilization rates of 80 to 90 percent on average, these cardholders might have to cut their spending. An unemployment spell might cause further distress for these individuals and potentially others who are not currently delinquent.
    Keywords: credit card utilization; delinquencies; COVID-19
    JEL: D31 E21 G51
    Date: 2023–10–19
  35. By: Micah Y. Baum; Brian Jacob
    Abstract: This paper examines whether school COVID-19 policies influenced enrollment differently by student age and race/ethnicity. Unlike much prior research, we (i) analyze enrollments for virtually the entire U.S. public school population for both the 2020-21 and 2021-22 school years, (ii) compare enrollment trends within districts in order to isolate subgroup heterogeneity from district characteristics, and (iii) account for district selection into preferred learning modes. Analyzing data on over 9, 000 districts that serve more than 90% of public school students in the U.S., we find enrollment responses to COVID policies differed notably. We find that White enrollments declined more than Black, Hispanic, and Asian enrollments in districts that started the 2020-21 school year virtually, but in districts that started in-person the reverse was true: non-White enrollments declined more than White enrollments. Moreover, Black, Hispanic, and Asian families responded more than White families to higher COVID-19 death rates in the months preceding the start of the 2021 school year. In 2021-22, enrollment differences by the previous year’s learning mode persisted. Racial/ethnic differences did not vary by whether the district required masking in classrooms. These findings are consistent with the greater risk faced by communities of color during the pandemic and demonstrate an additional source of disparate impact from COVID policies.
    JEL: I1 I20 I21
    Date: 2023–10
  36. By: Fabian Siuda (Department of Economics, Vienna University of Economics and Business); Thomas O. Zörner (Oesterreichische Nationalbank)
    Abstract: Vaccinations are very effective in reducing the risk of infection on an individual level and thereby also reduce the risk of subsequently infecting others. This vaccination spillover effect reduces health related transaction costs in economic interactions and increases both consumer and producer surplus. In this paper, we quantify the valuation for vaccination spillovers for close contact services in an experimental setting. To generate a comprehensible scenario, we exploit the substitutability of testing for the disease and vaccination spillovers for infection risk reduction. We elicit individuals' willingness to pay (WTP) for testing and randomize the vaccination status of the service provider. The spillover effect of the service provider's vaccination is equivalent to 69% of the full infection risk reduction via testing. We demonstrate that higher levels of disease specific risk aversion increase both the WTP for testing and the vaccination spillover effect in levels, resulting in a constant relative vaccination spillover effect.
    Keywords: vaccinations, vaccination spillover, transaction costs, infection risk, randomized experiment
    JEL: I10 I12 D10 J20
    Date: 2023–09

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